# Osteoporosis diagnosis and ingredients of prescription medications: a population-based study

## TL;DR

This study explores how prescription medications and their ingredients are linked to osteoporosis diagnosis in older adults, aiming to improve treatment guidelines.

## Contribution

The study identifies 34 medication ingredients associated with osteoporosis diagnosis, offering insights into their potential roles and gaps in clinical data.

## Key findings

- Osteoporosis diagnosis prevalence increased from 9.00% to 13.23% between 1999 and 2020.
- Thirty-four medication ingredients were found to be correlated with osteoporosis diagnosis, with varying clinical implications.
- Some medications may contribute to or alleviate osteoporosis, highlighting the need for updated guidelines.

## Abstract

Osteoporosis (OP) is common in the elderly, who typically have multiple comorbidities. Current guidelines for managing drug-induced OP are limited due to the complexity of multi-agent medications and the lack of sufficient clinical data.

Information of demographics, health status, prescription medication use, OP diagnoses, and bone fracture history in US adults aged ≥50 years was from NHANES. Administration of individual medication ingredients was extracted and association between medication component use and OP diagnosis was determined. National trends in OP diagnosis, prescription medication use, and medication ingredient administrations were examined.

OP diagnosis prevalence rose from 9.00% to 13.23% during 1999–March 2020 (p-trend = 0.00). Increased medication prescription was noted in OP patients (p-trendNo. prescription medications=4–7 <0.0001, p-trendNo. prescription medications≥8 < 0.0001, and p-trendDays taking medications≥500 < 0.0001). Thirty-four medication ingredients were correlated with OP diagnosis, including three OP-specific medications, three avoided in OP patients in current practice, seven contribute to OP but commonly prescribed, four relieved OP when treating diseases causing secondary OP, two bone health-friendly agents, and 15 lack of prior statistical records to support their clinical use in OP. Amongst 10 ingredients associated with OP diagnosis may be underlying their roles in regulating bone remodeling, sympathetic activity, and gastric acidity, whereas the remaining five were not clear.

The findings of this study contribute to updating and improving the existing guidelines. Efforts are recommended to examine how the use of medications contribute to OP and to identify alternative treatments for comorbidities.

Most medicines contain multiple active substances to increase their effectiveness, to target different aspects of the disease, and or to simultaneously relieve several symptoms, which make it complex and difficult to manage drug-induced OP. However, drug holiday or switching to bone health-friendly medications is recommended but not always feasible, attributing to the limited clinical data and unclear mechanisms. The aim of this study is to determine the association between the active pharmaceutical ingredient use and OP diagnosis, and the finding of this study will contribute to develop rational drug use strategies for OP management.