Pharmacological treatment of osteoporosis for people over 70

Abstract

Osteoporosis has been defined as "a systemic disease characterized by low bone mass and microarchitectural deterioration of bone tissue, with consequent increase in bone fragility and susceptibility to fracture". The impact of osteoporosis is most pronounced in elderly populations who run the greatest risk of fractures. The probability of developing mainly hip, vertebral and other non-vertebral fractures (for example, a Colles fracture) not only depends on bone mineral density (BMD) but also on age. Older patients are more susceptible to fracture than younger patients with the same BMD T-score. As the older population increases, the incidence of osteoporotic fractures is expected to rise dramatically over the next few decades. Although hip fractures are considered to be the most severe and economically important osteoporotic fracture, vertebral fractures also lead to adverse health outcomes, including back pain, height loss and kyphosis. These changes may result in significant declines in physical performance, function and, ultimately, loss of independence. The challenge for physicians is to prevent bone loss, to diagnose and treat osteoporosis before fractures occur, and to treat patients who have already experienced a fracture to prevent recurrent fractures. The objective of this review is to analyze the capacity to reduce fractures as the key element to evaluate the effectiveness of available medications: calcium and Vitamin D, bone formation drugs, antiresortive drugs, and dual-effect drugs. In view of the paucity of information about treatment of osteoporosis in the elderly population, available studies were not designed with this objective, so that this article reviews data mostly deriving from post-hoc analysis or sub-analysis of the main phase III clinical trials of each of the tested medications.

Effect of alendronate in elderly patients after low trauma hip fracture repair

“…In addition, there is a paucity of information about the efficacy of osteoporosis therapies in elderly population [15]. Only in a recent publication, the anti-fracture efficacy of intravenous zoledronic acid in patients with recent low trauma hip fractures has been established [16], nevertheless, the effects of alendronate-an oral bisphosphonate that has become one of the pivotal osteoporosis therapies-has not been previously studied in this high-risk elderly population.…”

Citrus nobiletin suppresses bone loss in ovariectomized ddY mice and collagen‐induced arthritis in DBA/1J mice: Possible involvement of receptor activator of NF‐kappaB ligand (RANKL)‐induced osteoclastogenesis regulation

“…Osteoporosis is now recognized as a social concern and the impact of its pathology is most pronounced in elderly individuals, who run the greatest risk of fractures [28]. In the present study, we attempted to identify food ingredients that have notable potential to regulate bone destruction-associated diseases using an animal model of postmenopausal OP.…”

Evidence for the Treatment of Osteoporosis with Vitamin D in Residential Care and in the Community Dwelling Elderly

“…The associated burden of minimal trauma fracture is expected to increase as populations age [1, 2]. Both age more than 70 years and living in residential care are associated with osteoporosis and increased fracture risk [3, 4]. The prevalence of osteoporosis in individuals aged more than 70 years has been shown to be 40% at the lumbar spine and 24% at the hip [4].…”

“…Both age more than 70 years and living in residential care are associated with osteoporosis and increased fracture risk [3, 4]. The prevalence of osteoporosis in individuals aged more than 70 years has been shown to be 40% at the lumbar spine and 24% at the hip [4]. Age more than 70 years is associated with fractures in high-risk individuals [3].…”