Osteoporosis Among Older Adults
Osteoporosis is a condition that weakens the skeleton and increases the risk of fractures. The disease primarily affects older adults and is underdiagnosed and undertreated in Sweden, as well as globally. We have previously shown that the prescribing of osteoporosis medication is low and that there are regional differences in Sweden. The project now continues by investigating why this is the case and what opportunities exist for primary prevention.
Secondary Prevention After a Fracture
The Swedish National Board of Health and Welfare (Socialstyrelsen) publishes national guidelines for the assessment and treatment of osteoporosis. These guidelines focus on identifying individuals who have sustained fractures for further assessment and treatment, referred to as secondary prevention. Socialstyrelsen recommends a structured approach through so-called fracture liaison services (FLS), in which patients are identified directly after a fracture and referred for further assessment and treatment. Fracture liaison services should also link different healthcare providers to one another to prevent patients from falling through the gaps between services.
There are different types of fracture liaison services (A, B, C and D), and the model used depends largely on how healthcare is organized at the regional and, in some cases, local level. However, fracture liaison services have not been implemented in all regions, and the low rates of pharmacological treatment suggest that they are not always being fully implemented or followed.
We want to understand why this is the case and, based on our findings, develop concrete proposals for how the fracture liaison pathway can be simplified. Since orthopedic clinics often refer patients to primary care for further assessment and/or treatment, we want to investigate how primary care staff perceive their role in the fracture liaison pathway and in the management of suspected osteoporosis. We also aim to identify organizational and practical barriers and facilitators, as well as to explore experiences of current referral processes and suggestions for improvement in order to strengthen the management of patients with fractures or suspected osteoporosis.
How?
The project uses both qualitative and quantitative methods. We will engage with and visit the regions, map healthcare pathways, and conduct interviews with healthcare professionals. We will also use registry data (Research group Karin Modig: Ageing and Health Cohort | Karolinska Institutet (ki.se)). The registry data will primarily be used to describe fracture patterns across different regions and to examine how these patterns relate to the way each region works with secondary prevention for people with osteoporosis.
Primary Prevention Through Opportunistic Screening
Since the first symptom of osteoporosis is often a fracture resulting from a fall, current healthcare efforts primarily focus on secondary prevention. Ideally, however, osteoporosis would be detected before the first fracture occurs, thereby reducing individual suffering and the number of fractures.
At present, there is no evidence that population-based screening for osteoporosis is cost-effective, and in Sweden the focus is therefore on secondary prevention. An interesting alternative is opportunistic screening, in which osteoporosis is detected in connection with imaging performed for other reasons.
In 2010, the STOP project was initiated by Professor Torkel Brismar, a radiologist, with the aim of investigating whether wrist radiography performed in conjunction with mammography could be a cost-effective way of detecting osteoporosis. Using the STOP cohort, we will investigate whether low bone density identified during mammographic screening is associated with future fracture risk, and how hereditary factors, medical history, lifestyle and protective factors influence this risk.
We hope that our projects will contribute to increased knowledge and awareness of osteoporosis and its treatment options.
Who?
Karin Modig, Senior Lecturer, Associate Professor of Epidemiology
Stina Ek, Assistant Professor, Associate Professor of Epidemiology
Margareta Hedström, Orthopaedic Surgeon and Adjunct Professor
Maria Sääf, Endocrinologist and Affiliated Researcher at Karolinska Institutet
Nathalie Frisendahl, Postdoctoral Researcher, Physiotherapist
Miriam Leung, Postdoctoral Researcher
Funding
Too low osteoporosis treatment rates – what can we do better? An assessment across the regions and a search for bad and good practice (2024–2025). Private donation to Karolinska Institutet from the Krook family.
Fewer fractures through more effective prescribing of osteoporosis medication? (2020–2023). Private donation to Karolinska Institutet from the Krook family.
Mammographic screening as an opportunity for primary prevention of osteoporosis – Next step: Who should we target? (2026–2027). Private donation to Karolinska Institutet from the Krook family.
The role of primary care in the management of osteoporosis and fragility fractures (2026–2027). Private donation to Karolinska Institutet from the Krook family.
Mammographic screening as an opportunity for primary prevention of osteoporosis – Next step: Who should we target interventions towards? (2026–2027). Loo and Hans Österman Foundation.
Publications
Låg förskrivning av läkemedel för osteoporos inom Sverige
Secondary fracture prevention with osteoporosis medication after a fragility fracture in Sweden remains low despite new guidelines.
Ek S, Meyer AC, Sääf M, Hedström M, Modig K
Arch Osteoporos 2023 Jul;18(1):107
[Few are treated in primary care after a fragility fracture].
Fricke J, Ek S, Modig K
Lakartidningen 2025 Oct;122():
[From fragility fracture to secondary prevention - no standardized care pathways].
Ek S, Hedström M, Sääf M, Wolf O, Modig K
Lakartidningen 2026 Apr;123():
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