Pharmacological treatment of osteoporosis in the oldest old

A Vandenbroucke,1 FP Luyten,2,3 J Flamaing,4 E Gielen3,4 1Clinical Department of Internal Medicine, UZ Leuven, 2Skeletal Biology and Engineering, Department of Development and Regeneration, KU Leuven, 3Center for Metabolic Bone Disease, UZ Leuven, 4Gerontology and Geriatrics, Department of Clinical...

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Autores principales:	Vandenbroucke A, Luyten FP, Flamaing J, Gielen E
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2017
Materias:	Osteoporosis fractures frailty ageing Geriatrics RC952-954.6
Acceso en línea:	https://doaj.org/article/654745218587429693748c49e93493bb
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spelling	oai:doaj.org-article:654745218587429693748c49e93493bb2021-12-02T00:22:49ZPharmacological treatment of osteoporosis in the oldest old1178-1998https://doaj.org/article/654745218587429693748c49e93493bb2017-07-01T00:00:00Zhttps://www.dovepress.com/pharmacological-treatment-of-osteoporosis-in-the-oldest-old-peer-reviewed-article-CIAhttps://doaj.org/toc/1178-1998A Vandenbroucke,1 FP Luyten,2,3 J Flamaing,4 E Gielen3,4 1Clinical Department of Internal Medicine, UZ Leuven, 2Skeletal Biology and Engineering, Department of Development and Regeneration, KU Leuven, 3Center for Metabolic Bone Disease, UZ Leuven, 4Gerontology and Geriatrics, Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium Abstract: The incidence of osteoporotic fractures increases with age. Consequently, the global prevalence of osteoporotic fractures will increase with the aging of the population. In old age, osteoporosis is associated with a substantial burden in terms of morbidity and mortality. Nevertheless, osteoporosis in old age continues to be underdiagnosed and undertreated. This may, at least partly, be explained by the fact that evidence of the antifracture efficacy of osteoporosis treatments comes mainly from randomized controlled trials in postmenopausal women with a mean age of 70–75 years. However, in the last years, subgroup analyses of these landmark trials have been published investigating the efficacy and safety of osteoporosis treatment in the very elderly. Based on this evidence, this narrative review discusses the pharmacological management of osteoporosis in the oldest old (≥80 years). Because of the high prevalence of calcium and/or vitamin D deficiency in old age, these supplements are essential in the management of osteoporosis in the elderly people. Adding antiresorptive or anabolic treatments or combinations, thereof, reduces the risk of vertebral fractures even more, at least in the elderly with documented osteoporosis. The reduction of hip fracture risk by antiresorptive treatments is less convincing, which may be explained by insufficient statistical power in some subanalyses and/or a higher impact of nonskeletal risk factors in the occurrence of hip fractures. Compared with younger individuals, a larger absolute risk reduction is observed in the elderly because of the higher baseline fracture risk. Therefore, the elderly will benefit more of treatment. In addition, current osteoporosis therapies also appear to be safe in the elderly. Although more research is required to further clarify the effect of osteoporosis drugs in the elderly, especially with respect to hip fractures, there is currently sufficient evidence to initiate appropriate treatment in the elderly with osteoporosis and osteoporotic fractures. Keywords: oldest old, vulnerability, antiresorptives, anabolics, efficacy, safetyVandenbroucke ALuyten FPFlamaing JGielen EDove Medical PressarticleOsteoporosisfracturesfrailtyageingGeriatricsRC952-954.6ENClinical Interventions in Aging, Vol Volume 12, Pp 1065-1077 (2017)
institution	DOAJ
collection	DOAJ
language	EN
topic	Osteoporosis fractures frailty ageing Geriatrics RC952-954.6
spellingShingle	Osteoporosis fractures frailty ageing Geriatrics RC952-954.6 Vandenbroucke A Luyten FP Flamaing J Gielen E Pharmacological treatment of osteoporosis in the oldest old
description	A Vandenbroucke,1 FP Luyten,2,3 J Flamaing,4 E Gielen3,4 1Clinical Department of Internal Medicine, UZ Leuven, 2Skeletal Biology and Engineering, Department of Development and Regeneration, KU Leuven, 3Center for Metabolic Bone Disease, UZ Leuven, 4Gerontology and Geriatrics, Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium Abstract: The incidence of osteoporotic fractures increases with age. Consequently, the global prevalence of osteoporotic fractures will increase with the aging of the population. In old age, osteoporosis is associated with a substantial burden in terms of morbidity and mortality. Nevertheless, osteoporosis in old age continues to be underdiagnosed and undertreated. This may, at least partly, be explained by the fact that evidence of the antifracture efficacy of osteoporosis treatments comes mainly from randomized controlled trials in postmenopausal women with a mean age of 70–75 years. However, in the last years, subgroup analyses of these landmark trials have been published investigating the efficacy and safety of osteoporosis treatment in the very elderly. Based on this evidence, this narrative review discusses the pharmacological management of osteoporosis in the oldest old (≥80 years). Because of the high prevalence of calcium and/or vitamin D deficiency in old age, these supplements are essential in the management of osteoporosis in the elderly people. Adding antiresorptive or anabolic treatments or combinations, thereof, reduces the risk of vertebral fractures even more, at least in the elderly with documented osteoporosis. The reduction of hip fracture risk by antiresorptive treatments is less convincing, which may be explained by insufficient statistical power in some subanalyses and/or a higher impact of nonskeletal risk factors in the occurrence of hip fractures. Compared with younger individuals, a larger absolute risk reduction is observed in the elderly because of the higher baseline fracture risk. Therefore, the elderly will benefit more of treatment. In addition, current osteoporosis therapies also appear to be safe in the elderly. Although more research is required to further clarify the effect of osteoporosis drugs in the elderly, especially with respect to hip fractures, there is currently sufficient evidence to initiate appropriate treatment in the elderly with osteoporosis and osteoporotic fractures. Keywords: oldest old, vulnerability, antiresorptives, anabolics, efficacy, safety
format	article
author	Vandenbroucke A Luyten FP Flamaing J Gielen E
author_facet	Vandenbroucke A Luyten FP Flamaing J Gielen E
author_sort	Vandenbroucke A
title	Pharmacological treatment of osteoporosis in the oldest old
title_short	Pharmacological treatment of osteoporosis in the oldest old
title_full	Pharmacological treatment of osteoporosis in the oldest old
title_fullStr	Pharmacological treatment of osteoporosis in the oldest old
title_full_unstemmed	Pharmacological treatment of osteoporosis in the oldest old
title_sort	pharmacological treatment of osteoporosis in the oldest old
publisher	Dove Medical Press
publishDate	2017
url	https://doaj.org/article/654745218587429693748c49e93493bb
work_keys_str_mv	AT vandenbrouckea pharmacologicaltreatmentofosteoporosisintheoldestold AT luytenfp pharmacologicaltreatmentofosteoporosisintheoldestold AT flamaingj pharmacologicaltreatmentofosteoporosisintheoldestold AT gielene pharmacologicaltreatmentofosteoporosisintheoldestold
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Pharmacological treatment of osteoporosis in the oldest old

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