Undertreatment of osteoporosis in persons with dementia? A population-based study
In this population-based study of more than 2,600 elderly, people with dementia received less preventive treatment for osteoporosis compared to people without dementia, although osteoporotic fractures were more common in patients with dementia. Thus, our results indicate an undertreatment of osteoporosis in dementia.
This study compares the use of osteoporosis drugs in elderly with and without dementia, taking into account osteoporotic fractures and type of housing.
We analyzed data from the baseline examination (2001–2004) of The Swedish National Study on Aging and Care- Kungsholmen (SNAC-K), Stockholm, Sweden. Participants were aged ≥66 years (n = 2610). We analysed the use of bisphosphonates, raloxifene, and calcium/vitamin D combinations in relation to clinically based dementia diagnosis. Information about osteoporotic fractures during the previous 4 years was obtained from the Swedish National Patient Register. We used logistic regression to analyze the association between dementia status and use of osteoporosis drugs.
Osteoporosis drugs (mainly calcium/vitamin D combinations) were used by 5% of the persons with dementia and 12% of the persons without dementia. Furthermore, 25% of the persons with dementia and 7% of the persons without dementia had had at least one osteoporotic fracture during the past 4 years. After controlling for age, sex, osteoporotic fractures, and type of housing (own home or institution), persons with dementia were less likely to use osteoporosis drugs than persons without dementia (OR = 0.34; 95% CI, 0.19–0.59).
Our results indicate an undertreatment of osteoporosis in persons with dementia, although osteoporotic fractures are common among these patients.
KeywordsCommunity dwelling Dementia Institution Osteoporosis The Swedish National Study on Aging and Care-Kungsholmen
The Swedish National study on Aging and Care, SNAC, (http://www.snac.org) is financially supported by the Ministry of Health and Social Affairs, Sweden and the participating county councils, municipalities, and university departments. We are grateful to the participants, the participating counties, and municipalities. We want to thank the members of the SNAC-K Project Study Group for data collection and collaboration. We also wish to thank Associate Professor Ingemar Kåreholt for statistical advice. This study was supported by grants from the Swedish Research Council, the Swedish Council for Working Life and Social Research, and Karolinska Institutet KID-grant.
Conflicts of interest
- 2.SBU—The Swedish Council on Technology Assasment in Health Care (2003) Osteoporosis—prevention, diagnosis and treatment. A systematic reviewGoogle Scholar
- 12.Cranney A, Wells G, Willan A, Griffith L, Zytaruk N, Robinson V, Black D, Adachi J, Shea B, Tugwell P, Guyatt G (2002) Meta-analyses of therapies for postmenopausal osteoporosis. II. Meta-analysis of alendronate for the treatment of postmenopausal women. Endocr Rev 23:508–516PubMedCrossRefGoogle Scholar
- 13.Cranney A, Tugwell P, Adachi J, Weaver B, Zytaruk N, Papaioannou A, Robinson V, Shea B, Wells G, Guyatt G (2002) Meta-analyses of therapies for postmenopausal osteoporosis. III. Meta-analysis of risedronate for the treatment of postmenopausal osteoporosis. Endocr Rev 23:517–523PubMedCrossRefGoogle Scholar
- 23.The Swedish National Board of Health and Welfare (2007) The societal costs and prevalence of dementia in Sweden 2005 (in Swedish)Google Scholar
- 24.Lagergren M, Fratiglioni L, Hallberg IR, Berglund J, Elmstahl S, Hagberg B, Holst G, Rennemark M, Sjolund BM, Thorslund M, Wiberg I, Winblad B, Wimo A (2004) A longitudinal study integrating population, care and social services data. The Swedish National study on Aging and Care (SNAC). Aging Clin Exp Res 16:158–168PubMedGoogle Scholar
- 25.WHO Collaboration Centre for Drug Statistics Methodology, Oslo, Norway: About the ATC/DDD System. Available at http://www.whocc.no/atcddd/. Accessed 26 Oct 2009
- 26.National Board of Health and Welfare. The National Inpatient register. Available at http://www.socialstyrelsen.se/register/halsodataregister/patientregistret/inenglish. Accessed 22 Nov 2010
- 29.American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders, 4th ed. American Psychiatric Association, WashingtonGoogle Scholar
- 32.Klarin I, Fastbom J, Wimo A (2006) The use of angiotensin-converting enzyme inhibitors and other drugs with cardiovascular effects by non-demented and demented elderly with a clinical diagnosis of heart failure. A population-based study of the very old. Eur J Clin Pharmacol 62:555–562PubMedCrossRefGoogle Scholar
- 39.van Geel TA, Nguyen ND, Geusens PP, Center JR, Nguyen TV, Dinant GJ, Eisman JA (2011) Development of a simple prognostic nomogram for individualising 5-year and 10-year absolute risks of fracture: a population-based prospective study among postmenopausal women. Ann Rheum Dis 70:92–97PubMedCrossRefGoogle Scholar
- 46.Devold HM, Doung GM, Tverdal A, Furu K, Meyer HE, Falch JA, Sogaard AJ (2010) Prescription of anti-osteoporosis drugs during 2004–2007—a nationwide register study in Norway. Eur J Clin Pharmacol 66:299–306Google Scholar