Osteoporosis treatment gap and prescribing patterns in Ireland: a cross-sectional analysis of the DXA HIP project

TL;DR

This study finds that most people in Ireland at risk of osteoporosis aren't getting proper treatment, with significant inappropriate prescribing.

Contribution

The study reveals a larger treatment gap in Ireland than previously estimated, highlighting widespread inappropriate prescribing.

Findings

Only 58.3% of eligible patients received calcium and vitamin D, and 39.1% received osteoporosis medication.

Inappropriate prescribing was high, with 50.6% of patients without treatment indications receiving calcium and vitamin D.

The true treatment gap is much larger than aggregate estimates suggest.

Abstract

Previous studies suggest Ireland has the smallest osteoporosis treatment in Europe and very little inappropriate prescribing, in contrast to our experience. In this study, we examine the osteoporosis treatment gap in Ireland by assessing the prevalence of appropriate and inappropriate prescribing in 2 subgroups of the Irish dual-energy X-ray absorptiometry (DXA) Health Informatics Prediction (HIP) Project. Treatment eligibility was defined using established intervention thresholds, including prior fracture, femoral-neck T-score ≤−2.5, glucocorticoid use, or Fracture Risk Assessment Tool (FRAX) major osteoporotic fracture risk ≥20% or hip fracture risk ≥3%.

Secondary cross-sectional analysis of a subgroup of the DXA HIP Project Cohort.

3 hospitals in the West of Ireland. DXA referrals come from primary care providers, hospital consultants and the osteoporosis service.

5564 participants of a previously described convenience cohort including: (i) 3474 subjects referred for a DXA scan, and (ii) 2090 patients who completed a DXA scan.

82.4% were female with a mean age of 66.6 years, 59.6% of whom had a prior fracture. Prescribing data of calcium and vitamin D were available for 3738 (67.2%) subjects, and osteoporosis medication for 4157 (74.7%) subjects. Prescribing information was available for more than 99% of the DXA group, but just over 50% of the referral group. When examined in aggregate, the treatment gap is 6% for calcium and vitamin D and 38% for osteoporosis medication, in line with prior publications. However, among those with prescribing information and at least one indication for treatment, only 58.3% were prescribed calcium and vitamin D and 39.1% an osteoporosis medication. Furthermore, among patients without a clear indication for treatment, 50.6% were prescribed calcium and vitamin D, and 32.5% an osteoporosis medication.

These data suggest the majority of patients with osteoporosis or at high risk of fracture in Ireland today do not receive appropriate osteoporosis treatment, while inappropriate prescribing is substantial. These findings suggest that the true treatment gap in Ireland is substantially larger than aggregate estimates imply.