Treatment of osteoporosis among older adults discharged from hospital in Italy

Objective: Osteoporosis and its complications represent one of the most imp ortant causes of morbidity and mortality among the elderly. Despite the ava ilability of several drugs deemed effective at reducing the incidence of fr actures, only a minority of patients receive pharmacological treatment. We studied patients with a diagnosis of osteoporosis at discharge from hospita l in Italy to identify predictors of receiving specific pharmacological tre atment and to analyse how the pattern of drug prescription has changed in t he last decade. Methods: We analysed data from a multicentre pharmacoepidemiology study tha t collected data on hospitalised patients throughout Italy. Patients with a diagnosis of osteoporosis admitted during five different surveys in 1988, 1991, 1993, 1995 and 1997 were considered for the present study. Results: Of 863 patients with a diagnosis of osteoporosis, 461 (53.4%) rece ived treatment. Age [odds ratio (OR) 0.86 for each decade of increment, 95% confidence interval (CI) 0.73, 0.99], male gender (OR 0.67, 95% CI 0.44, 0 .99), number of comorbid conditions (4-5 vs 0-3 conditions: OR 0.66, 95% Cl 0.47, 0.91; 6 or more vs 0-3 conditions: OR 0.47, 95% Cl 0.31, 0.72) and n umber of medications (OR 0.92 for each drug increase, 95% Cl 0.85, 0.99) we re all associated with a reduced likelihood of receiving pharmacological tr eatment for osteoporosis. In contrast, concomitant corticosteroid use (OR 2 .00, 95% CI 1.05, 3.80), admission for hip or vertebral fracture (OR 2.10, 95% Cl 1.12, 3.93) and year of survey (OR 1.11, 95% Cl 1.01, 1.24) were ind ependent predictors of a higher treatment rate. Among individual drugs, cal citonin use remarkably declined from 42.1% in 1988 to 0.8% in 1997 (P for t rend <0.001), while bisphosphonate prescriptions increased from 1.3% in 198 8 to 34.9% in 1997 (P for trend <0.001). Prescription of calcium did not ch ancre significantly throughout the decade examined, while vitamin D had a t wofold increase (14.2% in 1988 to 26.2% in 1997, P for trend <0.001). Conclusions: Among patients discharged from hospital in Italy, osteoporosis is an uncommon diagnosis. Even when the diagnosis is made, osteoporosis is often undertreated, and treatment is reserved for younger and less medical ly complex patients.