Missed Opportunities In The Diagnosis And Treatment Of Osteoporosis In Older People In Ireland, A Population-Based Study

Abstract Background In Ireland, approximately 30,000 non-hip fragility fractures occur annually among older people, resulting from low-impact falls. These fractures are primarily associated with osteoporosis. While appropriate treatment for osteoporosis can reduce fracture risk by > 50%, it has been suggested that many cases of osteoporosis are undiagnosed or untreated. This aim of this study was to use population-representative data from a large longitudinal study on older people in Ireland to clarify the burden of undiagnosed/untreated osteoporosis amongst older people in Ireland. Methods This study analysed weighted population-representative data on 3,332 participants aged ≥65 years. Osteoporosis was by self-report. Medication lists were examined for osteoporosis treatment and Falls-Risk Increasing Drgs (FRID). Heel ultrasounds were performed on a subset of participants to objectively profile osteoporosis risk (n=1,399). Results Over one fifth of participants (mean age 74 years, 53% female) reported a diagnosis of osteoporosis. One quarter of those reporting an osteoporosis diagnosis were prescribed appropriate pharmacological treatment (Bisphosphonate, Denosumab or other anti-resorptive therapy), while 58% were prescribed Calcium/Vitamin D. Less than 43% of participants with a heel ultrasound in the osteoporotic range reported a doctor’s diagnosis of osteoporosis. Almost 3% of participants sustained a fracture (hip, wrist, vertebra) in the last 2 years. Less than 10% of participants with a recent fracture were prescribed treatment for Osteoporosis, and less than 40% were prescribed Calcium/Vitamin D. Over 40% of participants reporting a recent fracture were prescribed at least one FRID. Conclusion Despite the availability of effective treatments for osteoporosis, a significant proportion of cases are undiagnosed and untreated. Given future projected increased longevity, with increasing prevalence of osteoporosis, it is anticipated that the number of fragility fractures will rise significantly in coming decades, highlighting the need for a national strategy to identify and treat osteoporosis.