Undertreatment of osteoporosis in the oldest old? A nationwide study of over 700,000 older people

SUMMARY: We analysed data from elderly people registered in the Swedish Prescribed Drug Register to investigate whether age is associated with use of osteoporosis drugs in a nationwide population. Our results indicate an undertreatment of osteoporosis, particularly with bisphosphonates, in the oldest old in Sweden. INTRODUCTION: The aim of this study was to investigate whether age is associated with use of osteoporosis drugs in a large population of older people. METHODS: We analysed data on age, sex, type of residential area (urban/rural) and dispensed drugs for people aged ≥75 years registered in the Swedish Prescribed Drug Register from October to December 2005 (n = 731,105). Multivariate logistic regression was used to analyse whether age was associated with use of osteoporosis drugs, after adjustment for type of residential area and number of other drugs (a proxy for comorbidity). RESULTS: Osteoporosis drugs were used by 16.1% of the women and 3.4% of the men. The probability of use of bisphosphonates declined with increasing age [ORwomen = 0.36 (95% CI 0.34–0.38) and ORmen = 0.46 (95% CI 0.37–0.56) for age ≥90 years vs. 75–79 years]. Raloxifene was also negatively associated with age. Calcium + vitamin D supplements, however, showed a divergent pattern regarding age. In women, the lowest likelihood of use of calcium + vitamin D supplements occurred in the oldest old (≥90 years). CONCLUSIONS: Our results indicate an undertreatment of osteoporosis, particularly with bisphosphonates, in the oldest old in Sweden. Future research is needed for understanding the mechanisms behind this age effect.