title: Management of osteoporosis of the oldest old.
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.
  
  
  BACKGROUND
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Service of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland, Rene.Rizzoli@unige.ch.
authors.forename: R
authors.initials: R
authors.lastname: Rizzoli
authors.forename: J
authors.initials: J
authors.lastname: Branco
authors.forename: M-L
authors.initials: ML
authors.lastname: Brandi
authors.forename: S
authors.initials: S
authors.lastname: Boonen
authors.forename: O
authors.initials: O
authors.lastname: Bruyère
authors.forename: P
authors.initials: P
authors.lastname: Cacoub
authors.forename: C
authors.initials: C
authors.lastname: Cooper
authors.forename: A
authors.initials: A
authors.lastname: Diez-Perez
authors.forename: J
authors.initials: J
authors.lastname: Duder
authors.forename: R A
authors.initials: RA
authors.lastname: Fielding
authors.forename: N C
authors.initials: NC
authors.lastname: Harvey
authors.forename: M
authors.initials: M
authors.lastname: Hiligsmann
authors.forename: J A
authors.initials: JA
authors.lastname: Kanis
authors.forename: J
authors.initials: J
authors.lastname: Petermans
authors.forename: J D
authors.initials: JD
authors.lastname: Ringe
authors.forename: Y
authors.initials: Y
authors.lastname: Tsouderos
authors.forename: J
authors.initials: J
authors.lastname: Weinman
authors.forename: J-Y
authors.initials: JY
authors.lastname: Reginster
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology; D015519:Bone Density / Q000502:physiology; D050071:Bone Density Conservation Agents / Q000009:adverse effects / Q000627:therapeutic use; D019587:Dietary Supplements; D019468:Disease Management; D006801:Humans; D055118:Medication Adherence; D010024:Osteoporosis / Q000175:diagnosis* / Q000188:drug therapy*; D058866:Osteoporotic Fractures / Q000517:prevention & control; D014807:Vitamin D / Q000627:therapeutic use
chemical_list: D050071:Bone Density Conservation Agents; D014807:Vitamin D