An update of the prevalence of osteoporosis, fracture risk factors, and medication use among community-dwelling older adults: results from the Canadian Longitudinal Study on Aging (CLSA)

Abstract

Summary The prevalence of self-reported and DXA-confirmed osteoporosis was 7.8% (males 2.2%; females 12.7%), and 3.6% (males 1.2%; females 5.9%), respectively. We found that most community-dwelling older adults at high fracture risk are not taking osteoporosis medication, particularly males. There is a major opportunity for improved primary fracture prevention in the community. Purpose To provide an up-to-date prevalence estimate of osteoporosis, fracture risk factors, fracture risk, and the proportion of older Canadians at high fracture risk who are not taking an osteoporosis medication. Methods We included Canadian Longitudinal Study on Aging (CLSA) participants: a community-dwelling cohort aged 45 to 85 years who completed the baseline (2015) comprehensive interview and had dual-energy X-ray absorptiometry (DXA) scans (N = 30,097). We describe the age- and sex-stratified prevalence of (1) self-reported osteoporosis; (2) DXA-confirmed osteoporosis; (3) fracture risk factors and people who are at high risk (FRAX® major osteoporotic fracture probability ≥ 20%); and (4) people who are at high fracture risk not taking osteoporosis medications. Sampling weights, as defined by the CLSA, were applied. Results The mean age of participants was 70.0 (SD 10.3). Overall, 7.8% had self-reported osteoporosis (males 2.2%; females 12.7%) while 3.6% had DXA-confirmed osteoporosis (males 1.2%; females 5.9%), and 2.8% were at high fracture risk (males 0.3%; females 5.1%). Of people who had osteoporosis and were at high risk, 77.3% were not taking an osteoporosis medication (males 92.3%; females 76.8%). Conclusions Our study provides an up-to-date prevalence estimate of osteoporosis for community-dwelling older Canadians. We found that most community-dwelling older adults at high fracture risk are not taking an osteoporosis medication, particularly males. There is a major opportunity for improved primary fracture prevention in the community.

Associations between Social Isolation Index and changes in grip strength, gait speed, bone mineral density (BMD), and self-reported incident fractures among older adults: Results from the Canadian Longitudinal Study on Aging (CLSA)

“…This may be because females are more likely to take an osteoporosis medication, which could affect their BMD. Males are often undertreated for osteoporosis and are less likely to be taking medication [ 49 ]. Our study did not adjust for osteoporosis medication use because we could not access data on these medications.…”

The prevalence and treatment rate trends of osteoporosis in postmenopausal women

“…Xiao et al conducted a systematic review and meta-analysis, which found that the global prevalence of osteoporosis was 19.7% according to the World Health Organization diagnostic criteria and the prevalence varied greatly in different countries (from 4.1% in Netherlands to 52.0% in Turkey) and continents (from Oceania 8.0% to 26.9% in Africa) [ 16 ]. The prevalence of physician diagnosed and DXA-confirmed osteoporosis was 12.7% and 5.9% in females, respectively based on data from community-dwelling older adults from the Canadian Longitudinal Study on Aging [ 17 ]. Buttros and cols conducted a cross-sectional study and found a prevalence of 24.6% of osteoporosis in postmenopausal women (aged 40–75 years) using BMD for diagnosis [ 18 ].…”

“…In our study, the treatment rate of osteoporosis patients was decreased during 2005–2018. Previously, McArthur et al observed that for community-dwelling older adults who have already diagnosed with osteoporosis, 76.8% females were not taking an osteoporosis medication [ 17 ]. A systematic review and meta-analysis identified that the treatment rate of osteoporosis in patients undergoing total knee and hip arthroplasty patients was 32.9% [ 15 ].…”