Age discrimination in osteoporosis screening-Data from the Aalborg University Hospital Record for Osteoporosis Risk Assessment (AURORA)

BACKGROUND: Old age carries a markedly increased risk of osteoporotic fractures with subsequent disability, dependency and premature death. Timely detection and treatment reduces fracture risk and particular attention should be drawn to age.

OBJECTIVE: To assess the impact of age on referral for osteoporosis screening.

SETTING AND METHODS: Dual energy X-ray Absorptiometry (DXA) at the Osteoporosis Clinic in North Denmark was reorganised from 2010. Risk factors, anthropometry and bone mineral density were recorded and considered in the reply and recommendations to the referring doctor. We report data from the 8,131 consecutive evaluations in 7914 individuals at the Osteoporosis Clinic from January 1st 2010 through December 31st 2012.

RESULTS: Risk factor data were available in >96% and DXA in 98%. Population DXA frequency decreased markedly after the 7th decade and was performed yearly in 1.2% of the population aged >80 years in North Denmark. The >80 years group had more fragility fractures and lower T-scores (p<0.001) compared to those below 80 years of age, and age >80 years was a dominant risk factor for fragility fracture (OR 2.4, 95% CI 2.0-2.9; p<0.001) and for having diagnosed osteoporosis by DXA (OR 2.1, 95% CI 1.7, 2.5; p<0.001).

CONCLUSION: Referral for osteoporosis screening decreased after the 7th decade despite the finding that high age carried the highest risk of osteoporosis by DXA and by fragility fracture. Osteoporosis is a disease of aging, but it is apparently not recognised as such. This is likely to cause undertreatment among the old.