A study at University of Galway has found that the majority of people at high risk of bone fracture are not on any treatment.
Researchers found that osteoporotic fractures are one of the main reasons for acute public hospital admissions.
Overall, researchers found there's over-treatment of people at low risk of osteoporosis - and under treatment of those most in need of medication.
This, they say, has led to a false impression that the treatment gap in Ireland is quite small.
But after analysing more than 5 thousand patients referred to UHG, they found that 70% of men, and 54% of women, at very high risk of fracture are not on treatment.
And when it comes to patients considered at immediate risk, that figure jumps to 80% for men and 70% for women.
The research team says these issues could be tackled through the introduction of a national osteoporosis programme.
This, they say, would reduce waste in the health service, prevent harm from overdiagnosis and overprescription, and improve treatment for those who need it most.
