Background: Osteoporosis is a common cause of disability and death in elderlymen and women. Until 2007, Australian Government-subsidized use of oralbisphosphonates, raloxifene and calcitriol (1a,25-dihydroxycholecalciferol) was limited to secondary prevention (requiring x-ray evidence of previouslow-trauma fracture). The cost to the Pharmaceutical Benefits Scheme wassubstantial (164 million Australian dollars in 2005/6).Objective: To examine the dispensed prescriptions for oral bisphosphonates,raloxifene, calcitriol and two calcium products for the secondary prevention ofosteoporosis (after previous low-trauma fracture) in the Australian population.Methods: We analysed government data on prescriptions for oral bisphosphonates,raloxifene, calcitriol and two calcium products from 1995 to 2006,and by sex and age from 2002 to 2006. Prescription counts were converted todefined daily doses (DDD)/1000 population/day. This standardized drugutilization method used census population data, and adjusts for the effects ofaging in the Australian population.Results: Total bisphosphonate use increased 460% from 2.19 to 12.26 DDD/1000 population/day between June 2000 and June 2006. The proportion of totalbisphosphonate use in June 2006 was 75.1%alendronate, 24.6%risedronate and0.3% etidronate. Raloxifene use in June 2006 was 1.32 DDD/1000 population/day. The weekly forms of alendronate and risedronate, introduced in 2001and 2003, respectively, were quickly adopted. Bisphosphonate use peaked at age80-89 years in females and 85-94 years in males, with 3-fold higher use infemales than in males.Conclusions: Pharmaceutical intervention for osteoporosis in Australia is increasingwith most use in the elderly, the population at greatest risk of fracture.However, fracture prevalence in this population is considerably higherthan prescribing of effective anti-osteoporosis medications, representing amissed opportunity for the quality use of medicines.