Disparities in the Diagnosis and Treatment of Osteoporosis in Persons with Cognitive Impairment and Dementia.

Shrestha P, Basida B, Elam RE, Hajj JE, Le B, Fink HA, Bethel M, Tharrington SG, Carbone LD. Disparities in the Diagnosis and Treatment of Osteoporosis in Persons with Cognitive Impairment and Dementia. Current osteoporosis reports. 2025 Jul 9; 23(1):31, DOI: 10.1007/s11914-025-00924-3.

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Abstract:

PURPOSE OF REVIEW: The purpose of this review is to summarize recently published scientific evidence (from January 1, 2020-January 1, 2025), on disparities in the diagnosis and treatment of osteoporosis and the treatment of fragility fractures in persons with cognitive impairment and dementia. RECENT FINDINGS: Worldwide, the population is aging, and coincident with this, the number of individuals with osteoporosis and dementia is rapidly increasing. Several reports have suggested a link between these two chronic conditions. Persons with dementia who sustain an osteoporotic fracture have excess morbidity and mortality compared to similarly aged populations without cognitive impairment. However, the extent to which these differences are a function of disparities in the diagnosis and treatment of osteoporosis and treatment and rehabilitation for osteoporotic fractures is not clear. In this summary, we review the evidence that health and health care disparities exist for older adults with cognitive impairment or dementia with respect to osteoporosis diagnosis and treatment and management of fragility fractures. We highlight unique considerations for persons with cognitive impairment or dementia relative to diagnosis of osteoporosis, choice and frequency of use of osteoporosis pharmacotherapies, and consideration for rehabilitation services post hip fracture. More research is necessary to determine how best to reduce health care disparities with respect to diagnosis and treatment of osteoporosis and fragility fractures in older adults with cognitive impairment or dementia. Considerations should include early identification of persons at risk for fracture, use of osteoporosis drug therapies that require less frequent dosing and are administered by clinicians to enhance adherence, and access to patient and family-centered rehabilitation post hip fracture.