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KMID : 1024720210110020053
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Geriatric Rehabilitation
2021 Volume.11 No. 2 p.53 ~ p.58
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Pharmacological Treatment of Osteoporosis in the Very Elderly People
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Kim Sang-Wan
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Abstract
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The incidences of osteoporosis and osteoporotic fracture unquestionably increase with age. 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. Only a few randomized controlled trials investigating anti-osteoporotic agents with fracture endpoints have included participants over the age of 80 years. However, in the last years, subgroup analyses of these pivotal 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 treatment of osteoporosis in the very elderly (≥80 years). As the prevalence of calcium and/or vitamin D deficiency is very high in old age, these supplements are essential in the management of osteoporosis in the elderly people. Both antiresorptive agents such as alendronate, risedronate, zoledronate and denosumab, and anabolic agents such as teriparatide and abaloparatide 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. Nevertheless, denosumab is effective to prevent hip fractures in the elderly. In addition, current osteoporosis therapies also appear to be safe in the elderly. However, comorbidity, which may influence the choice of therapy, should be taken into account in the very elderly. Although more emphasis is required on researching the benefits of these pharmacological agents in very elderly people, especially with respect to hip fractures, there is currently sufficient evidence supporting the initiation of appropriate treatments for fracture prevention in the elderly.
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KEYWORD
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Very elderly, Antiresorptives, Anabolics, Efficacy, Safety
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