Evidence for specific osteoporosis treatment

Evidence indicates that specific osteoporosis treatments are beneficial in older adults. However, data in studies have been limited to the oldest patients (> 80 years of age) and those with significant comorbidities. In some cases, withholding medication for osteoporosis after a fracture could be reasonable. In a large population-based study of older Americans with a hip, clinical vertebral, or wrist/forearm fracture the risk of death was substantial and often exceeded the risk of a second fracture after a first hip, clinical vertebral, or wrist/forearm fracture.

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The life expectancy of the patient should be at least 6 months. Age, comorbities, and functional status may help to estimate the life expectancy of an older adult. To assess comorbidities, the Charlson Comorbidity Index can be used. To assess the functional status, the Barthel Index and the Parker Mobility Score are useful tools. Both show a significant correlation with mortality. Fracture risk can be estimated by the FRAX Score.

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