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.
Literature
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Gates BJ, Sonnett TE, Duvall CA, et al.
Review of osteoporosis pharmacotherapy for geriatric patients. Am J Geriatr Pharmacother. 2009 Dec;7(6):293–323.
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Curtis JR, Arora T, Matthews RS, et al.
Is withholding osteoporosis medication after fracture sometimes rational? A comparison of the risk for second fracture versus death. J Am Med Dir Assoc. 2010 Oct;11(8):584–591.
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.
Literature
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Validation of a combined comorbidity index.
J Clin Epidemiol. 1994 Nov;47(11):1245–1251.
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Mahoney FI, Barthel DW.
Functional evaluation: the Barthel Index.
Md State Med J. 1965 Feb;14:61–65.
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Parker MJ, Palmer CR.
A new mobility score for predicting mortality after hip fracture.
J Bone Joint Surg Br. 1993 Sep;75(5):797–798.
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Kammerlander C, Gosch M, Kammerlander-Knauer U, et al.
Long-term functional outcome in geriatric hip fracture patients.
Arch Orthop Trauma Surg. 2011 Oct;131(10):1435–1444.
- http://www.shef.ac.uk/FRAX.