[Prevention of hip fractures in the elderly: where are we in 2003?]

Osteoporosis in very elderly subjects is now considered, in most developed and several developing countries as a major social, clinical and financial burden. While many compounds have been investigated in the prevention or treatment of spinal fractures, few of them have unequivocally demonstrated their ability to reduce the risk of non vertebral and more specifically hip fractures in the very elderly. This situation may seem highly paradoxical since hip fractures are unanimously considered to be the most dramatic and disabling consequence of osteoporosis. The present article reviews the current evidence available to justify anti-osteoporotic medications to be recommended to very elderly subjects, in the perspective of reducing their risk of appendicular fractures.