Author
RIZZOLI, RENE - Geneva University Hospital | |
BRANCO, J - New University Of Lisbon | |
BRANDI, MARIA LUISA - University Of Florence | |
BOONEN, STEVEN - Catholic University Of Leuven | |
BRUYERE, OLIVIER - University Of Liege | |
CACOUB, P - University Of Paris | |
COOPER, CYRUS - University Of Southampton | |
DIEZ-PEREZ, A - Hospital Del Mar Medical Research Institute | |
DUDER, J - Atlantis Healthcare | |
FIELDING, ROGER - Jean Mayer Human Nutrition Research Center On Aging At Tufts University | |
HARVEY, NICK - University Of Southampton | |
HILIGSMANN, MICKAEL - Maastricht University | |
KANIS, JOHN - University Of Sheffield | |
PETERMANS, JEAN - Universite De Liege | |
RINGE, JOHANN - University Of Cologne | |
TSOURDEROS, Y - Internationales Servier Research Institute (IRIS) | |
WEINMAN, J - King'S College | |
REGINSTER, J-Y - Universite De Liege |
Submitted to: Osteoporosis International
Publication Type: Review Article Publication Acceptance Date: 4/16/2014 Publication Date: 11/1/2014 Citation: Rizzoli, R., Branco, J., Brandi, M., Boonen, S., Bruyere, O., Cacoub, P., Cooper, C., Diez-Perez, A., Duder, J., Fielding, R.A., Harvey, N.C., Hiligsmann, M., Kanis, J.A., Petermans, J., Ringe, J.D., Tsourderos, Y., Weinman, J., Reginster, J. 2014. Management of osteoporosis of the oldest old. Osteoporosis International. 25(11):2507-2529. Interpretive Summary: Technical Abstract: This consensus article reviews the diagnosis and treatment of osteoporosis in geriatric populations. Specifically, it reviews the risk assessment and intervention thresholds, the impact of nutritional deficiencies, fall prevention strategies, pharmacological treatments and their safety considerations, the risks of sub-optimal treatment adherence and strategies for its improvement. INTRODUCTION: This consensus article reviews the therapeutic strategies and management options for the treatment of osteoporosis of the oldest old. This vulnerable segment (persons over 80 years of age) stands to gain substantially from effective anti-osteoporosis treatment, but the under-prescription of these treatments is frequent. METHODS: This report is the result of an ESCEO (European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis) expert working group, which explores some of the reasons for this and presents the arguments to counter these beliefs. The risk assessment of older individuals is briefly reviewed along with the differences between some intervention guidelines. The current evidence on the impact of nutritional deficiencies (i.e. calcium, protein and vitamin D) is presented, as are strategies to prevent falls. One possible reason for the under-prescription of pharmacological treatments for osteoporosis in the oldest old is the perception that anti-fracture efficacy requires long-term treatment. However, a review of the data shows convincing anti-fracture efficacy already by 12 months. RESULTS: The safety profiles of these pharmacological agents are generally satisfactory in this patient segment provided a few precautions are followed. CONCLUSION: These patients should be considered for particular consultation/follow-up procedures in the effort to convince on the benefits of treatment and to allay fears of adverse drug reactions, since poor adherence is a major problem for the success of a strategy for osteoporosis and limits cost-effectiveness. |