European Journal of Clinical Pharmacology

, Volume 66, Issue 3, pp 299–306 | Cite as

Prescription of anti-osteoporosis drugs during 2004–2007—a nationwide register study in Norway

  • Helene M. DevoldEmail author
  • Gia Man Doung
  • Aage Tverdal
  • Kari Furu
  • Haakon E. Meyer
  • Jan A. Falch
  • Anne Johanne Sogaard
Pharmacoepidemiology and Prescription



To assess 1-year prevalence, incidence rates and minimum refill of anti-osteoporosis drug use in Norway by age, gender and place of residence during 2004–2007.


Data from patients aged ≥ 40 years receiving anti-osteoporosis drugs (AOD) were retrieved from the Norwegian Prescription Database (NorPD). AOD were defined as bisphosphonates (alendronate with or without cholecalciferol, risedronate, ibandronate and etidronate with or without calcium), raloxifene, teriparatide and nasal calcitonin. The NorPD covers the total Norwegian population in ambulatory care. Key measurements were 1-year prevalence, incidence rate and minimum refill.


Among Norwegian women and men ≥ 40 years, 4.3 and 0.45% respectively used AOD in 2004. In 2007, the prevalence of AOD use had slightly increased to 4.6% in women and to 0.52% in men. In 2007, 90% of users were women. The use of alendronate, representing 88% of all AOD use in 2007, increased from 2004 to 2007 while the use of other bisphosphonates decreased. The counties with highest overall bisphosphonate use were the counties with the historically lowest incidence of osteoporotic fractures. The incidence rate of overall bisphosphonate use decreased from 2005 to 2007. Among those patients who were dispensed a bisphosphonate in 2005, 72% refilled at least one prescription both in 2006 and 2007.


There was an increasing prevalence and a decreasing incidence of AOD use over this limited time period. There was substantial geographical variation in the prevalence of anti-osteoporosis drugs. We also observed a high minimum refill rate.


Osteoporosis Bisphosphonates Prescription drug use Norway Minimum refill Anti-osteoporosis drugs 


  1. 1.
    Falch JA, Meyer HE (1998) Osteoporosis and fractures in Norway. Occurrence and risk factors. Tidsskr Nor Laegeforen 118:568–572PubMedGoogle Scholar
  2. 2.
    Lofthus CM, Osnes EK, Falch JA, Kaastad TS, Kristiansen IS, Nordsletten L, Stensvold I, Meyer HE (2001) Epidemiology of hip fractures in Oslo, Norway. Bone 29:413–418CrossRefPubMedGoogle Scholar
  3. 3.
    Lunt M, Felsenberg D, Adams J, Benevolenskaya L, Cannata J, Dequeker J, Dodenhof C, Falch JA, Johnell O, Khaw KT, Masaryk P, Pols H, Poor G, Reid D, Scheidt-Nave C, Weber K, Silman AJ, Reeve J (1997) Population-based geographic variations in DXA bone density in Europe: the EVOS Study. European Vertebral Osteoporosis. Osteoporos Int 7:175–189CrossRefPubMedGoogle Scholar
  4. 4.
    O'Neill TW, Felsenberg D, Varlow J, Cooper C, Kanis JA, Silman AJ (1996) The prevalence of vertebral deformity in European men and women: the European Vertebral Osteoporosis Study. J Bone Miner Res 11:1010–1018CrossRefPubMedGoogle Scholar
  5. 5.
    Bulajic-Kopjar M, Wiik J, Nordhagen R (1998) Regional differences in the incidence of femoral neck fractures in Norway. Tidsskr Nor Laegeforen 118:30–33PubMedGoogle Scholar
  6. 6.
    Falch JA, Ilebekk A, Slungaard U (1985) Epidemiology of hip fractures in Norway. Acta Orthop Scand 56:12–16PubMedCrossRefGoogle Scholar
  7. 7.
    Falch JA, Kaastad TS, Bohler G, Espeland J, Sundsvold OJ (1993) Secular increase and geographical differences in hip fracture incidence in Norway. Bone 14:643–645CrossRefPubMedGoogle Scholar
  8. 8.
    Omsland TK, Gjesdal CG, Emaus N, Tell GS, Meyer HE (2008) Regional differences in hip bone mineral density levels in Norway: the NOREPOS study. Osteoporos Int 20:631–638CrossRefPubMedGoogle Scholar
  9. 9.
    Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, Kooperberg C, Stefanick ML, Jackson RD, Beresford SA, Howard BV, Johnson KC, Kotchen JM, Ockene J (2002) Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women's Health Initiative randomized controlled trial. JAMA 288:321–333CrossRefPubMedGoogle Scholar
  10. 10.
    Furu K (2008) Establishment of the nationwide Norwegian Prescription Database (NorPD)—new opportunities for research in pharmacoepidemiology in Norway. Norsk Epidemiologi 18:129–136Google Scholar
  11. 11.
    Rønning M (2008) WHO Collaborating Centre for Drug Statistics methodology. Guidelines for ATC classification and DDD assignment 2008, 11 ed. WHO, GenevaGoogle Scholar
  12. 12.
    Rønning M (2008) Drug Consumption in Norway 2003-2007.Norwegian Institute of Public Health. Available via Accessed 15 Jul 2008
  13. 13.
    Norwegian Institute of Public Health (2008) The Norwegian Prescription Database. Accessed 1 Nov 2008
  14. 14.
    Caetano PA, Lam JM, Morgan SG (2006) Toward a standard definition and measurement of persistence with drug therapy: examples from research on statin and antihypertensive utilization. Clin Ther 28:1411–1424CrossRefPubMedGoogle Scholar
  15. 15.
    Gabrielsen B, Lillegård M, Otnes B, Abrahamsen D, Strand P (2008) Individual based statistics of care and nursing services in the community] (in Norwegian). Accessed 15 Jan 2009
  16. 16.
    Beardon PH, McGilchrist MM, McKendrick AD, McDevitt DG, MacDonald TM (1993) Primary non-compliance with prescribed medication in primary care. BMJ 307:846–848CrossRefPubMedGoogle Scholar
  17. 17.
    Kanis JA, Johnell O, De Laet C, Jonsson B, Oden A, Ogelsby AK (2002) International variations in hip fracture probabilities: implications for risk assessment. J Bone Miner Res 17:1237–1244CrossRefPubMedGoogle Scholar
  18. 18.
    Kanis JA, Delmas P, Burckhardt P, Cooper C, Torgerson D (1997) Guidelines for diagnosis and management of osteoporosis. The European Foundation for Osteoporosis and Bone Disease. Osteoporos Int 7:390–406CrossRefPubMedGoogle Scholar
  19. 19.
    Kanis JA, Borgstrom F, De LC, Johansson H, Johnell O, Jonsson B, Oden A, Zethraeus N, Pfleger B, Khaltaev N (2005) Assessment of fracture risk. Osteoporos Int 16:581–589CrossRefPubMedGoogle Scholar
  20. 20.
    The National Board of Health and Welfare, Sweden (2008) [Pharmaceuticals—statistics for 2007]. Accessed 16 Feb 2009
  21. 21.
    Vestergaard P, Rejnmark L, Mosekilde L (2005) Osteoporosis is markedly underdiagnosed: a nationwide study from Denmark. Osteoporos Int 16:134–141CrossRefPubMedGoogle Scholar
  22. 22.
    The Danish Medicines Agency (2009) [Annual statistics on medicinal products]. Accessed 15 Feb 2009
  23. 23.
    Cadarette SM, Gignac MA, Jaglal SB, Beaton DE, Hawker GA (2007) Access to osteoporosis treatment is critically linked to access to dual-energy x-ray absorptiometry testing. Med Care 45:896–901CrossRefPubMedGoogle Scholar
  24. 24.
    Dolan AL, Koshy E, Waker M, Goble CM (2004) Access to bone densitometry increases general practitioners' prescribing for osteoporosis in steroid treated patients. Ann Rheum Dis 63:183–186CrossRefPubMedGoogle Scholar
  25. 25.
    Norwegian Medicines Agency (2007) The stepped price model.økonomi/ Accessed 2 Jul 2008
  26. 26.
    Norwegian Medicines Agency (undated) [Osteoporosis and reimbursement]. Accessed 2 Jul 2008
  27. 27.
    The Norwegian Labour and Welfare administration (2006) [Control of reimbursed drugs. Report on physicians prescribing in reimbursement code 42 (established osteoporosis)]. Accessed 21 Jul 2008
  28. 28.
    The Norwegian Labour and Welfare administration (2008) [Controll of reimbursed drugs. Report on physicians prescribing in reimbursement code 42 (established osteoporosis)]. Accessed 21 Jul 2008
  29. 29.
    Gallagher AM, Rietbrock S, Olson M, van Staa TP (2008) Fracture outcomes related to persistence and compliance with oral bisphosphonates. J Bone Miner Res 23:1569–1575CrossRefPubMedGoogle Scholar
  30. 30.
    Weycker D, Macarios D, Edelsberg J, Oster G (2006) Compliance with drug therapy for postmenopausal osteoporosis. Osteoporos Int 17:1645–1652CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Helene M. Devold
    • 1
    Email author
  • Gia Man Doung
    • 1
  • Aage Tverdal
    • 2
  • Kari Furu
    • 2
  • Haakon E. Meyer
    • 1
    • 3
  • Jan A. Falch
    • 1
  • Anne Johanne Sogaard
    • 1
    • 3
  1. 1.Department of Chronic DiseasesNorwegian Institute of Public HealthOsloNorway
  2. 2.Department of PharmacoepidemiologyNorwegian Institute of Public HealthOsloNorway
  3. 3.Institute of General Practice and Community MedicineUniversity of OsloOsloNorway

Personalised recommendations