Review of osteoporosis pharmacotherapy for geriatric patients.
BACKGROUND
Fractures are a significant problem in geriatric patients, and understanding the evidence for benefit and possible harm of osteoporosis treatments is critical to appropriate management of this patient population.


OBJECTIVE
The purpose of this article was to review the evidence and treatment considerations related to use of the approved osteoporosis treatments in the United States across the continuum of ages in the geriatric population.


METHODS
MEDLINE and the Web of Science were searched to find English-language articles published from 2000 through July 2009. Search terms included: practice guideline, osteoporosis, calcium, vitamin D, pharmacoeconomics, ethnicity, and treatment. The generic names of each of the osteoporosis treatments approved in the United States were searched to find relevant clinical trials and randomized controlled trials (RCTs). Pivotal trials that included fracture data or focused specifically on elderly patients (> or = 60 years of age) were selected. Bibliographies in the identified articles were searched for additional articles, and the prescribing information for each of the approved treatments was reviewed.


RESULTS
Many osteoporosis studies have a mean patient age >60 years, but data for older patients are limited. Subanalyses of older patient groups have found risedronate to be beneficial for vertebral fractures in patients aged 70 to 79 years (absolute risk reduction [ARR], 8.4%; P < 0.001) and teriparatide to be beneficial for both vertebral (ARR, 6.4%; P < 0.05) and new nonvertebral fragility fractures (ARR, 9.9%; P < 0.05) in women aged > or = 75 years. However, no RCTs of geriatric patients who were either nonambulatory or had multiple comorbidities were identified in the literature.


CONCLUSIONS
Evidence indicates that the osteoporosis treatments currently available in the United States are beneficial for treating osteoporosis in geriatric patients. However, data are limited for the oldest patients (> or = 80 years) and those with significant comorbidities. Because of the limited availability of data for geriatric patients with significant comorbidities, the properties of the various agents, including efficacy, tolerability, and potential contraindications, should be considered carefully for each geriatric patient.
Department of Pharmacotherapy, Washington State University College of Pharmacy, Spokane, Washington 99202-3989, USA. brian_gates@wsu.edu
Brian J
BJ
Gates
Travis E
TE
Sonnett
Cristina A K
CA
Duvall
Erin K
EK
Dobbins
D000368:Aged; D019386:Alendronate / Q000009:adverse effects / Q000627:therapeutic use; D015519:Bone Density / Q000187:drug effects; D002116:Calcitonin / Q000009:adverse effects / Q000627:therapeutic use; D002136:Calcium, Dietary / Q000008:administration & dosage; D004164:Diphosphonates / Q000009:adverse effects / Q000627:therapeutic use; D017850:Economics, Pharmaceutical; D012968:Etidronic Acid / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D015444:Exercise; D005260:Female; D006801:Humans; D000077557:Ibandronic Acid; D008019:Life Style; D008297:Male; D010020:Osteonecrosis / Q000139:chemically induced; D010024:Osteoporosis / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics; D016032:Randomized Controlled Trials as Topic; D000068296:Risedronic Acid; D012307:Risk Factors; D014807:Vitamin D / Q000008:administration & dosage
D002136:Calcium, Dietary; D004164:Diphosphonates; D014807:Vitamin D; D002116:Calcitonin; D000068296:Risedronic Acid; D012968:Etidronic Acid; D000077557:Ibandronic Acid; D019386:Alendronate