MANAGEMENT OF OSTEOPOROSIS IN ELDERLY WOMEN

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Citation:

Pages 35 - 39

Author(s):

Lina E. Aguirre, MD, MS, and E. Michael Lewiecki, MD, FACP, FACE

Osteoporosis is characterized by low bone mineral density (BMD) and poor bone quality, resulting in reduced bone strength and increased risk of fracture. Osteoporotic fractures are associated with increased morbidity and mortality, particularly in the elderly, as well as high healthcare costs. The risk of fragility fractures increases with aging, independently of BMD. Many therapeutic agents are available for the treatment of osteoporosis, yet there are limited data on their efficacy and safety in the elderly. Post-hoc analyses of data from prospective, randomized, placebo-controlled clinical trials evaluating drugs for the treatment of postmenopausal osteoporosis have shown a similar response in elderly postmenopausal women as compared with younger postmenopausal women. This article reviews the evidence regarding the treatment of osteoporosis in elderly women and provides suggestions for long-term management in clinical practice. (Annals of Long-Term Care: Clinical Care and Aging 2009;17[10]:35-39)

Introduction

Osteoporosis is a systemic skeletal disease that affects millions of people worldwide. Approximately 30% of all postmenopausal women have osteoporosis in the United States, and at least 40% of these women will sustain one or more fragility fractures in their remaining lifetime,1,2 with the incidence of fractures increasing with advancing age.2 Osteoporosis is diagnosed by measuring a patient’s bone mineral density (BMD) by dual-energy x-ray absorptiometry (DXA) and applying criteria established by the World Health Organization (WHO).3 A patient with a BMD value at least 2.5 standard deviations below the mean BMD of a young-adult reference population (T-score ≤ -2.5) at the femoral neck, total hip, lumbar spine, or 33% (one-third) radius, if measured, is classified as having osteoporosis. A diagnosis of osteoporosis may also be made in a patient with a fragility fracture independently of BMD, assuming that other causes of fracture have been considered and found to not be present.

Risk factors for fracture that are independent of BMD include age, previous fracture, parent with hip fracture, current smoking, glucocorticoid therapy, rheumatoid arthritis, and excess alcohol ingestion.3 The incidence of osteoporotic fractures increases with advancing age and is associated with healthcare expenditures over $17 billion per year in the United States.4 Unfortunately, few studies of drug therapy for osteoporosis have included data in postmenopausal females age 75 years or older to guide the management of these high-risk patients.

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