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Osteoporosis prescribing trends in primary care: a population-based retrospective cohort study

  • Li Wang (a1), C. Shawn Tracy (a1), Rahim Moineddin (a1) (a2) (a3) and Ross E.G. Upshur (a1) (a2) (a3)

Osteoporosis is a highly prevalent and costly disease associated with aging. Previous studies have indicated low intervention rates in primary care; however, there is little research investigating the prescribing patterns of osteoporosis medications by primary-care physicians.


We conducted a population-based retrospective cohort study to examine trends in osteoporosis medication utilization in primary care between 1 January 2000 and 31 December 2009 in Ontario, Canada. All Ontario residents aged 65 years or older and eligible for public health coverage were included in the analysis (∼1.46 million residents in 2000, ∼1.75 million residents in 2009).


Analysis of 10-year data indicates a trend toward higher utilization of osteoporosis medications among elderly primary-care patients. In 2000, 100 038 unique patients were prescribed an osteoporosis medication by a family physician; by 2009, this number increased to 301 679. Age-group analyses suggest an inverted U-shaped pattern, whereby utilization rates increase with advancing age and then decline for the oldest age groups. Utilization rates were the lowest for the 100+ age group.


This study indicates increased utilization of osteoporosis-related medications among elderly primary-care patients over a recent 10-year time period. It is unclear whether the observed increase in utilization is due to higher rates of osteoporosis. Further research is needed to determine the appropriateness of this higher utilization.

Corresponding author
Correspondence to: C. Shawn Tracy, Research Associate, Primary Care Research Unit, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room E3-49, Toronto, ON, Canada M4N 3M5. Email:
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Black D.M., Delmas P.D., Eastell R., Reid I.R., Boonen S., Cauley J.A., Cosman F., Lakatos P., Leung P.C., Man Z., Mautalen C., Mesenbrink P., Hu H., Caminis J., Tong K., Rosario-Jansen T., Krasnow J., Hue T.F., Sellmeyer D., Eriksen E.F. Cummings S.R. 2007: Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis. New England Journal of Medicine 356, 18091822.
Brown J.P. Josse R.G. 2002: Clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. Canadian Medical Association Journal 167 (Suppl 10), S1S34.
Burgener M., Arnold M., Katz J.N., Polinski J.M., Cabral D., Avorn J. Solomon D.H. 2005: Older adults’ knowledge and beliefs about osteoporosis: results of semistructured interviews used for the development of educational materials. Journal of Rheumatology 32, 673677.
Cadarette S.M., Katz J.N., Brookhart M.A. Stürmer T. 2008: Relative effectiveness of osteoporosis drugs for preventing nonvertebral fracture. Annals of Internal Medicine 148, 637646.
Canadian Institute for Health Information. 2009: Bisphosphonates in osteoporosis: an analysis focusing on drug claims by seniors. Retrieved 21 February 2012 from
Chen J.S., Hogan C., Lyubomirsky G. Sambrook P.N. 2009: Management of osteoporosis in primary care in Australia. Osteoporosis International 20, 491496.
Chesnut C.H., Skag A., Christiansen C., Recker R., Stakkestad J.A., Hoiseth A., Felsenberg D., Huss H., Gilbride J., Schimmer R.C. Delmas P.D. 2004: Effects of oral ibandronate administered daily or intermittently on fracture risk in postmenopausal osteoporosis. Journal of Bone and Mineral Research 19, 12411249.
European Foundation For Osteoporosis (EFFO) and National Osteoporosis Foundation (NOF). 1997: Who are candidates for prevention and treatment for osteoporosis? Osteoporosis International 7, 16.
Guggenbuhl P. 2009: Osteoporosis in males and females: is there really a difference? Joint, Bone, Spine 76, 595601.
Harris S.T. 2001: Bisphosphonates for the treatment of postmenopausal osteoporosis: clinical studies of etidronate and alendronate. Osteoporosis International 12 (Suppl 3), 311316.
Harris S.T., Watts N.B., Genant H.K., McKeever C.D., Hangartner T., Keller M., Chesnut C.H., Brown J., Eriksen E.F., Hoseyni M.S., Axelrod D.W. Miller P.D. 1999: Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. Journal of the American Medical Association 282, 13441352.
Hodsman A., Hanley D. Josse R. 2002: Do bisphosphonates reduce the risk of osteoporotic fractures? An evaluation of the evidence to date. Canadian Medical Association Journal 166, 14261430.
Hollingworth S.A., Gunanti I., Nissen L.M. Duncan E.L. 2010: Secondary prevention of osteoporosis in Australia: analysis of government-dispensed prescription data. Drugs & Aging 27, 255264.
Huot L., Couris C.M., Tainturier V., Jaglal S., Colin C. Schott A.M. 2008: Trends in HRT and anti-osteoporosis medication prescribing in a European population after the WHI study. Osteoporosis International 19, 10471054.
Jaglal S.B., Carroll J., Hawker G., McIsaac W.J., Jaakkimainen L., Cadarette S.M. et al. 2003: How are family physicians managing osteoporosis? Qualitative study of their experiences and educational needs. Canadian Family Physician 49, 462468.
Jaglal S.B., Carroll J., Hawker G., McIsaac W.J., Jaakkimainen L., Cadarette S.M., Cameron C. Davis D. 2005: Population trends in BMD testing, treatment, and hip and wrist fracture rates: are the hip fracture projections wrong? Journal of Bone and Mineral Research 20, 898905.
Lenart B.A., Neviaser A.S., Lyman S., Chang C.C., Edobor-Osula F., Steele B., van der Meulen M.C., Lorich D.G., Lane J.M. 2009: Association of low-energy femoral fractures with prolonged bisphosphonate use: a case control study. Osteoporosis International 20, 13531362.
Leslie W.D., Giangregorio L.M., Yogendran M., Azimaee M., Morin S., Metge C., Caetano P., Lix L.M. 2011: A population-based analysis of the post-fracture care gap 1996–2008: the situation is not improving. Osteoporosis International April 8 [Epub ahead of print].
Manek N. 2010: Missed opportunities for osteoporosis management in older patients: a literature review. Primary Health Care Research & Development 11, 155165.
McClung M.R., Geusens P., Miller P.D., Zippel H., Bensen W.G., Roux C., Adami S., Diamond T., Eastell R., Meunier P.J. Reginster J.Y. 2001: Effect of risedronate on hip fracture risk in elderly women. New England Journal of Medicine 344, 333340.
Olszynski W.P., Davison K.P., Adachi J.D., Brown J.P., Cummings S.R., Hanley D.A., Harris S.P., Hodsman A.B., Kendler D., McClung M.R., Miller P.D. Yuen C.K. 2004: Osteoporosis in men: epidemiology, diagnosis, prevention, and treatment. Clinical Therapeutics 26, 1528.
Osteoporosis Canada. 2012: Osteoporosis at a glance. Retrieved 21 February 2012 from
Papaioannou A., Kennedy C.C., Ioannidis G., Gao Y., Sawka A.M., Goltzman D., Tenenhouse A., Pickard L., Olszynski W.P., Davison K.S., Kaiser S., Josse R.G., Kreiger S., Josse R.G., Goltzman D., Kreiger N., Hanley D.A., Prior J.C., Brown J.P., Anastassiades T. Adachi J.D. 2008: The osteoporosis care gap in men with fragility fractures: the Canadian multicentre osteoporosis study. Osteoporosis International 19, 581587.
Papaioannou A., Morin S., Cheung A.M., Atkinson S., Brown J.P., Feldman S. et al. 2010: Canadian 2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. Canadian Medical Association Journal 82, 18641873.
Park-Wyllie L.Y., Mamdani M.M., Juurlink D.N., Hawker G.A., Gunraj N., Austin P.C., Whelan D.B., Weiler P.J. Laupacis A. 2011: Bisphosphonate use and the risk of subtrochanteric or femoral shaft fractures in older women. Journal of the American Medical Association 305, 783789.
Sawka A.M., Adachi J.D., Papaioannou A., Thabane L., Ioannidis G., Davison K.S., Olszynski W.P., Brown J.P., Hanley D.A., Murray T.M., Josse R.G., Sebaldt R.J., Petrie A., Tenenhouse A. Goldsmith C.H. 2004: Are there differences between men and women prescribed bisphosphonate therapy in Canadian subspecialty osteoporosis practices? Journal of Rheumatology 31, 19931995.
Seeman E. 2009: To stop or not to stop, that is the question. Osteoporosis International 20, 187195.
Shaffer T., Simoni-Wastila L., Toler W., Stuart B. Doshi J.A. 2010: Changing patterns in medication use with increasing probability of death for older Medicare beneficiaries. Journal of the American Geriatrics Society 58, 15491555.
Siris E.S., Pasquale M.K., Wang Y. Watts N.B. 2011: Estimating bisphosphonate use and fracture reduction among U.S. women age 45 and older, 2001–2008. Journal of Bone and Mineral Research 26, 311.
Siris E.S., Selby P.L., Saag K.G., Borgström F., Herings R.M.C. Silverman S.L. 2009: Impact of osteoporosis treatment adherence on fracture rates in North America and Europe. American Journal of Medicine 122(Suppl 2), S3S13.
Solimeo S.L. 2011: Living with a ‘women's disease: risk appraisal and management among men with osteoporosis. Journal of Men's Health 8, 185191.
Taylor J.C., Sterkel B., Utley M., Shipley M., Newman S., Horton M. Fitz-Clarence H. 2001: Opinions and experiences in general practice on osteoporosis prevention, diagnosis and management. Osteoporosis International 12, 844848.
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Primary Health Care Research & Development
  • ISSN: 1463-4236
  • EISSN: 1477-1128
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