A Review of Osteoporosis in the Older Adult

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Key points

  • Fractures and osteoporosis are common, especially in the elderly population. Hip fractures may be devastating.

  • Osteoporosis in men is greatly unrecognized and untreated.

  • Treatment of osteoporosis is generally recommended in postmenopausal women and men 50 years old or older who have a bone mineral density T score of −2.5 or less, a history of previous spine or hip fracture, or a Fracture Risk Assessment Tool score indicating increased fracture risk.

  • Bisphosphonates, teriparatide and denosumab have

Summary

Current approaches to the treatment of osteoporosis are based on BMD and fracture risk assessment. Bisphosphonates are typically the first-line agents. A treatment failure is considered when significant loss in BMD is seen or the patient sustains a fracture despite ongoing treatment. A drug holiday is considered after 3 to 5 years of bisphosphonate treatment. Goal-directed treatment has been recently proposed based on BMD or fracture risk assessment using the FRAX tool in order to aim for a

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References (70)

  • D.H. Solomon et al.

    Osteoporosis medication use after hip fracture in U.S. Patients between 2002 and 2011

    J Bone Miner Res

    (2014)
  • S. Khosla

    Minireview: the OPG/RANKL/RANK system

    Endocrinology

    (2001)
  • S. Khosla et al.

    The unitary model for estrogen deficiency and the pathogenesis of osteoporosis: is a revision needed?

    J Bone Miner Res

    (2010)
  • S.Y. Lim et al.

    Current approaches to osteoporosis treatment

    Curr Opin Rheumatol

    (2015)
  • G. Duque et al.

    Understanding the mechanisms of senile osteoporosis: new facts for a major geriatric syndrome

    J Am Geriatr Soc

    (2008)
  • G.M. Kiebzak et al.

    Undertreatment of osteoporosis in men with hip fractures

    Arch Intern Med

    (2002)
  • A.C. Feldstein et al.

    The near absence of osteoporosis treatment in older men with fractures

    Osteoporos Int

    (2005)
  • A.A. Abbasi et al.

    Observations on nursing home patient with history of hip fracture

    Am J Med Sci

    (1995)
  • P.R. Ebeling

    Osteoporosis in men

    N Engl J Med

    (2008)
  • H. Behre et al.

    Long-term effect of testosterone therapy on bone mineral density in hypogonadal men

    J Clin Endocrinol Metab

    (1997)
  • F. Cosman et al.

    Clinician’s guide to prevention and treatment of osteoporosis

    Osteoporos Int

    (2014)
  • Screening for osteoporosis: U.S. Preventive Services Task Force recommendation statement

    Ann Intern Med

    (2011)
  • N.O.F.a.I.S.f.C. Recommendations to DXA Manufacturers for FRAX® Implementation. Available at:...
  • N.B. Watts et al.

    Osteoporosis in men: an Endocrine Society clinical practice guideline

    J Clin Endocrinol Metab

    (2012)
  • L.M. Giangregorio et al.

    FRAX underestimates fracture risk in patients with diabetes

    J Bone Miner Res

    (2011)
  • D.M. Black et al.

    Continuing bisphosphonate treatment for osteoporosis–for whom and for how long?

    N Engl J Med

    (2012)
  • D.M. Black et al.

    Postmenopausal osteoporosis

    N Engl J Med

    (2016)
  • P. Ebeling et al.

    Effects of calcitriol or calcium on bone mineral density, bone turnover, and fractures in men with primary osteoporosis: a two-year randomized, double blind, double placebo study

    J Clin Endocrinol Metab

    (2001)
  • M.H. Murad et al.

    Comparative effectiveness of drug treatments to prevent fragility fractures: a systemic review and network meta-analysis

    J Clin Endocrinol Metab

    (2012)
  • R.D. Jackson et al.

    Calcium plus vitamin D supplementation and the risk of fractures

    N Engl J Med

    (2006)
  • J.K. Amory et al.

    Exogenous testosterone or testosterone with finasteride increases bone mineral density in older men with low serum testosterone

    J Clin Endocrinol Metab

    (2004)
  • B. Ettinger et al.

    Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial

    JAMA

    (1999)
  • S.R. Cummings et al.

    Prevention of breast cancer in postmenopausal women: approaches to estimating and reducing risk

    J Natl Cancer Inst

    (2009)
  • S.R. Cummings et al.

    Effect of alendronate on risk of fracture in women with low bone density but without vertebral fractures: results from the Fracture Intervention Trial

    JAMA

    (1998)
  • S.T. Harris et al.

    Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial

    JAMA

    (1999)
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    Disclosure Statement: The authors have nothing to disclose.

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