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ARS Home » Northeast Area » Boston, Massachusetts » Jean Mayer Human Nutrition Research Center On Aging » Research » Publications at this Location » Publication #357298

Research Project: Sarcopenia, Nutrition, and Physical Activity

Location: Jean Mayer Human Nutrition Research Center On Aging

Title: Management of osteoporosis of the oldest old

Author
item Rizzoli, Rene - Geneva University Hospital
item Branco, J - New University Of Lisbon
item Brandi, Maria Luisa - University Of Florence
item Boonen, Steven - Catholic University Of Leuven
item Bruyere, Olivier - University Of Liege
item Cacoub, P - University Of Paris
item Cooper, Cyrus - University Of Southampton
item Diez-perez, A - Hospital Del Mar Medical Research Institute
item Duder, J - Atlantis Healthcare
item Fielding, Roger - Jean Mayer Human Nutrition Research Center On Aging At Tufts University
item Harvey, Nick - University Of Southampton
item Hiligsmann, Mickael - Maastricht University
item Kanis, John - University Of Sheffield
item Petermans, Jean - Universite De Liege
item Ringe, Johann - University Of Cologne
item Tsourderos, Y - Internationales Servier Research Institute (IRIS)
item Weinman, J - King'S College
item Reginster, J-y - Universite De Liege

Submitted to: Osteoporosis International
Publication Type: Review Article
Publication Acceptance Date: 4/16/2014
Publication Date: 11/1/2014
Citation: Rizzoli, R., Branco, J., Brandi, M., Boonen, S., Bruyere, O., Cacoub, P., Cooper, C., Diez-Perez, A., Duder, J., Fielding, R.A., Harvey, N.C., Hiligsmann, M., Kanis, J.A., Petermans, J., Ringe, J.D., Tsourderos, Y., Weinman, J., Reginster, J. 2014. Management of osteoporosis of the oldest old. Osteoporosis International. 25(11):2507-2529.

Interpretive Summary:

Technical 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. INTRODUCTION: 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. CONCLUSION: 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.