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Management of osteoporosis of the oldest old

Rizzoli, R. ; Branco, J. ; Brandi, M.-L ; Boonen, S. ; Bruyère, O. ; Cacoub, P. ; Cooper, C. ; Diez-Perez, A. ; Duder, J. ; Fielding, R. ; Harvey, N. ; Hiligsmann, M. ; Kanis, J. ; Petermans, J. ; Ringe, J. ; Tsouderos, Y. ; Weinman, J. ; Reginster, J.-Y

In: Osteoporosis International, 2014, vol. 25, no. 11, p. 2507-2529

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    Titre
    • Management of osteoporosis of the oldest old
    Auteur
    • Rizzoli, R.. Service of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
    • Branco, J.. CEDOC, Department of Rheumatology, Faculdade de Ciências Médicas, Universidade Nova de Lisboa/CHLO, EPE-Hospital Egas Moniz, Lisbon, Portugal
    • Brandi, M.-L. Department of Internal Medicine, University of Florence, Florence, Italy
    • Boonen, S.. Katholieke Universiteit Leuven, Liege, Belgium
    • Bruyère, O.. Department of Public Health, Epidemiology and Health Economics, University of Liege, Liege, Belgium
    • Cacoub, P.. Department Hospitalo-Universitaire I2B, UPMC University of Paris 06; INSERM, UMR S 959; CNRS, UMR 7211; and AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine, Paris, France
    • Cooper, C.. MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
    • Diez-Perez, A.. Servicio de Medicina Interna y Enfermedades Infecciosas, Hospital del Mar-IMIM and RETICEF, Barcelona, Spain
    • Duder, J.. Atlantis Healthcare, 5 Chiswick Park, 566 Chiswick High Road, London, UK
    • Fielding, R.. Nutrition, Exercise Physiology and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging & Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
    • Harvey, N.. MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
    • Hiligsmann, M.. Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, Netherlands
    • Kanis, J.. WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
    • Petermans, J.. Service of Geriatrics, CHU of Liege, Liege, Belgium
    • Ringe, J.. Department of General Internal Medicine, Klinikum Leverkusen University of Cologne, Cologne, Germany
    • Tsouderos, Y.. Institut de Recherches Internationales Servier, Suresnes, France
    • Weinman, J.. Institute of Pharmaceutical Sciences, Institute of Psychiatry, Kings College London & Atlantis Healthcare, London, UK
    • Reginster, J.-Y. Department of Public Health, Epidemiology and Health Economics, University of Liege, Liege, Belgium
    Type de document
    • Postprint
    Langue
    • Inglese
    Publié dans
    • Osteoporosis International, 2014, vol. 25, no. 11, p. 2507-2529. Springer London
    Autre version électronique
    Identifiant OAI-PMH
    • oai:doc.rero.ch:326197
    Summary
    Summary: 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 80years 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 12months. 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.