Pharmacological treatment of osteoporosis for people over 70.
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.
Moro Alvarez
M Jesús
MJ
Internal Medicine, Metabolic Bone Disease Unit, Hospital Central Cruz Roja, 28003 Madrid, Spain. mjmoro.hccruzr@salud.madrid.org
Díaz-Curiel
Manuel
M
D000368:Aged; D019386:Alendronate / Q000627:therapeutic use; D015519:Bone Density / Q000187:drug effects; D002116:Calcitonin / Q000627:therapeutic use; D002118:Calcium / Q000008:administration & dosage; D004164:Diphosphonates / Q000627:therapeutic use; D012968:Etidronic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D005260:Female; D050723:Fractures, Bone / Q000209:etiology; D006801:Humans; D000077557:Ibandronic Acid; D009942:Organometallic Compounds / Q000627:therapeutic use; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy*; D010281:Parathyroid Hormone / Q000627:therapeutic use; D000068296:Risedronic Acid; D013876:Thiophenes / Q000627:therapeutic use; D014807:Vitamin D / Q000008:administration & dosage
D004164:Diphosphonates; D009942:Organometallic Compounds; D010281:Parathyroid Hormone; D013876:Thiophenes; C081587:strontium ranelate; D014807:Vitamin D; D002116:Calcitonin; D000068296:Risedronic Acid; D012968:Etidronic Acid; D002118:Calcium; D000077557:Ibandronic Acid; D019386:Alendronate