Authors
Elahe Hesari, Noushin Fahimfar, Kazem Khalagi, Hossein Yarmohammadi, Shokouh Shahrousvand, Pardis Zarepour, Safoora Gharibzadeh, Mohammad Javad Mansourzadeh, Gita Sahafiee, Akram Farhadi, Bagher Larijani, Afshin Ostovar, Mahnaz Sanjari
Published in
Archives of osteoporosis. Volume 21. Issue 1. Oct 31, 2026. Epub Oct 31, 2026.
Abstract
This study examined why many older adults in Iran with osteoporosis are not diagnosed or treated. It found very high rates of missed diagnosis and lack of treatment, especially influenced by age, gender, and education. Addressing these gaps is essential to improve awareness, care access, and prevent serious bone-related health problems.
Despite the availability of diagnostic and therapeutic facilities for osteoporosis, a significant proportion of older adults remain undiagnosed and untreated. This care gap may stem from various barriers and understanding the underlying reasons for these disparities is crucial for developing targeted interventions. This study aimed to investigate the gaps in osteoporosis diagnosis and treatment among older adults in Iran and to identify the key factors contributing to these gaps.
This cross-sectional study analyzed data from two phases of the Bushehr Elderly Health (BEH) Program. Participants were selected using multistage cluster random sampling. The first phase, conducted between 2015 and 2017, included 2424 residents aged 60 and above. The second phase, from 2018 to 2021, involved 1721 residents aged 50 and above. Bone mineral density (BMD) was measured using the Dual-energy X-ray absorptiometry method and T-score ≤ -2.5 in either of the femoral neck, total hip, or spinal sites was defined as osteoporosis. Participants reported whether a doctor had diagnosed them with osteoporosis and if they received treatment. Those diagnosed via bone densitometry but unaware of their condition were considered underdiagnosed. Those diagnosed through BMD tests but not on osteoporosis medication were considered undertreated. Multiple logistic regression was used to identify determinant factors of the underdiagnosis and undertreatment of osteoporosis.
A total of 4145 elder adults with a mean age of 65.5 (54.40% female) participated in this study. Underdiagnosis and undertreatment in the participants who underwent DXA were estimated at 1050 (73.06% (and 1328 (92.41), respectively. The undertreatment rate was 666 (91.98%), 836(90.96%) and 868 (92.53%) based on the intervention thresholds of FRAX without BMD, MOF-FRAX with BMD and FRAX with TBS for MOF, respectively. A statistically significant association was found between osteoporosis underdiagnosis and variables including male (OR = 0.57, P < 0.001), age (OR:1.05, P < 0.001), asset in quintiles 4 (OR = 0.79, P = 0.028), and years of education (OR:0.96, P < 0.001). Male sex (OR:0.37, P < 0.001), age (OR:1.07, P < 0.001), years of education (OR:0.95, P < 0.001), marital status (OR:0.78, P:0.013), and being disable in IADL (OR:1.28, P:0.003) were significantly associated with undertreatment.
This study highlights significant gaps in the diagnosis and treatment of osteoporosis among participants, with significant disparities linked to demographic and socioeconomic factors. Further research is needed to investigate the causes and extensive interventions at the population level should be taken to fill the gap and raise awareness on osteoporosis as a growing public health concern and provide access to the treatment of the disease.
PMID:
42966781
Bibliographic data and abstract were imported from PubMed on 01 Nov 2026.
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