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Anti-osteoporosis drug use: too little, too much, or just right? The HUNT study, Norway

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Abstract

Summary

Use of anti-osteoporotic drugs (AODs) was examined in a Norwegian population 50–85 years. Among them with Fracture Risk Assessment Tool (FRAX) score for major osteoporotic fracture ≥ 20, 25% of the women and 17% of the men received AODs. The strongest predictors for AODs were high age in women and use of glucocorticoids among men.

Introduction

To examine the use of anti-osteoporotic drugs (AODs) and to identify predictors for prescriptions.

Methods

Data were obtained from the Nord-Trøndelag Health Study (HUNT3) performed in 2006–2008 and the Norwegian Prescription Database, including 15,075 women and 13,386 men aged 50–85 years. Bone mineral density (BMD) in the femoral neck was measured in a subgroup of 4538 women and 2322 men. High fracture risk was defined as a FRAX score for major osteoporotic fracture (MOF) ≥ 20%; in the subgroup with BMD, high risk was in addition defined as FRAXMOF ≥ 20% or T-score ≤ − 2.5. Hazard ratios (HRs) for predictors of incident use of AODs within 2 years after HUNT3 were estimated by Cox’ proportional hazards model.

Results

Among individuals with FRAX MOF ≥ 20%, 25% of the women and 17% of the men were treated with AODs. Among those with FRAX MOF < 20%, 3% and 1% were treated, respectively. In the subgroup with BMD measurement, 24% of the women and 16% of the men at high risk of fractures were treated, compared to 3 and 1% in women and men not fulfilling the criteria. In women, high age was the strongest predictor for treatment (HR 3.84: 95% confidence interval 2.81–5.24), followed by use of glucocorticoids (GCs) (2.68:1.84–3.89). In men, predictors were use of GCs (5.28: 2.70–10.35) followed by multimorbidity (3.16:1.31–7.63). In the subgroup with BMD, T-score ≤ − 2.5 was the strongest predictor (women 3.98:2.67–5.89; men 13.31:6.17–28.74).

Conclusions

This study suggests an undertreatment of AODs in individuals at high risk of fracture.

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Acknowledgements

The Nord-Trøndelag Health Study (The HUNT Study) is in collaboration between HUNT Research Centre (Faculty of Medicine, Norwegian University of Science and Technology NTNU), Nord-Trøndelag County Council, Central Norway Health Authority, and the Norwegian Institute of Public Health.

Funding

MH received a postdoctoral fellowship grant from the Liaison Committee between the Central Norway Regional Health Authority (RHA) and the Norwegian University of Science and Technology (NTNU).

Author information

Authors and Affiliations

  1. Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway

    M. Hoff, A. Langhammer, E. Skovlund, S. Forsmo & B. Schei

  2. Department of Rheumatology, St. Olavs Hospital, Trondheim, Norway

    M. Hoff

  3. Norwegian Institute of Public Health, Oslo, Norway

    S. Skurtveit, H.E. Meyer, A.J. Søgaard & E. Skovlund

  4. Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway

    S. Skurtveit

  5. Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway

    H.E. Meyer

  6. Department of Endocrinology, St. Olavs Hospital, Trondheim, Norway

    U. Syversen

  7. Institute of Cancer Research and Molecular Medicine, NTNU, Trondheim, Norway

    U. Syversen

  8. Department of Medicine, Holbæk Hospital, Holbæk, Denmark

    B. Abrahamsen

  9. Odense Patient Data Explorative Network, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark

    B. Abrahamsen

  10. Department of Gynecology, St. Olavs Hospital, Trondheim, Norway

    B. Schei

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  1. M. Hoff
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Corresponding author

Correspondence to M. Hoff.

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Conflicts of interests

BA has institutional research contracts with UCB and Novartis with funds paid to the institutions.

US has received research grants from or served as a Principal Investigator in studies conducted by Amgen, Eli Lilly, Novartis, Merck and Wyeth pharmaceuticals.

MH, SS, HM, AD, AJS, AL, ES and BS have no disclosures.

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Hoff, M., Skurtveit, S., Meyer, H. et al. Anti-osteoporosis drug use: too little, too much, or just right? The HUNT study, Norway. Osteoporos Int 29, 1875–1885 (2018). https://doi.org/10.1007/s00198-018-4560-3

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