Dementia patients undertreated for osteoporosis
MedWire News: Elderly people with dementia are less likely to take medication for osteoporosis than those without dementia, despite having a higher fracture prevalence, Swedish research shows.
Ylva Haasum (Karolinska Institute, Stockholm) and colleagues explain that osteoporosis often co-occurs with dementia, as both disorders are strongly related to old age.
In addition, "dementia has been associated with an increased risk of falls and hip fractures, suggesting that people with dementia are a population [at risk] for osteoporotic fractures," they say.
In their study of 2610 men and women aged 66 years and older, Haasum and team compared the use of osteoporosis drugs in people with and without dementia.
Among the study participants, 305 (11.7%) had dementia diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders (4th Edition) criteria.
The researchers report that 5.4% of people with dementia were taking osteoporosis drugs (mainly calcium/vitamin D combinations) compared with 12.0% of people without dementia.
However, a quarter of the people with dementia had at least one osteoporotic fracture documented in their medical records during the 4 years prior to the study, compared with only 6.9% of those without dementia.
Multivariate analysis adjusted for age, gender, osteoporotic fractures, and type of housing (own home or institution) showed that people with dementia were a significant 66% less likely to be taking osteoporosis drugs than those without dementia.
Furthermore, the results changed only marginally when people with severe dementia were excluded from the analysis, indicating that the finding was not explained by low use among patients with severe dementia.
"Our results indicate an undertreatment of osteoporosis in persons with dementia," conclude Haasum and co-authors in the journal Osteoporosis International.
They speculate that the reasons for the low use of osteoporosis drugs in people with dementia may be underdiagnosis of osteoporosis and fear of polypharmacy in these frail elderly patients.
In addition, "dementia may dominate the practitioner's attention, leading to undertreatment of other conditions," say the authors.
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By Laura Dean