Osteoporosis in the community: Sensitivity of self-reported estimates and medication use of those diagnosed with the condition

Objectives

To assess the sensitivity and specificity of self-reported osteoporosis compared with dual energy X-ray absorptiometry (DXA) defined osteoporosis, and to describe medication use among participants with the condition.

Methods

Data were obtained from a population-based longitudinal study and assessed for the prevalence of osteoporosis, falls, fractures and medication use. DXA scans were also undertaken.

Results

Overall 3.8% (95% confidence interval (CI) 3.2 to 4.5) of respondents and 8.8% (95% CI 7.5 to 10.3) of those aged ≥ 50 years reported that they had been diagnosed with osteoporosis by a doctor. The sensitivity (those self-reporting osteoporosis and having low bone mineral density (BMD) on DXA) was low (22.7%), although the specificity was high (94.4%). Only 16.1% of those aged ≥ 50 years and with DXA-defined osteoporosis were taking bisphosphonates.

Conclusions

The sensitivity of self-reporting to identify osteoporosis is low. Anti-osteoporotic medications are an important part of osteoporosis treatment but opportunities to use appropriate medications were missed and inappropriate medications were used.

An analysis of the interactions between individual comorbidities and their treatments--implications for guidelines and polypharmacy

BACKGROUND

With aging there is an increase in frailty and chronic disease leading to a potential increase in medication use. Most clinical trials have excluded old, frail individuals and have failed to take into account the effects of outcome interaction.

METHODS AND RESULTS

In this article we provide a mathematical model demonstrating that comorbidities, including old age, interact with therapies, reducing their effectiveness.

CONCLUSION

These findings question the validity of single disease guidelines in old persons or in persons with multiple chronic diseases.