[Treatment of osteoporosis in octogenarians]

Osteoporosis is a major public health problem of older people. Most types of osteoporotic fractures increase in incidence with age, and the number of elderly individuals affected with osteoporosis is expected to increase dramatically in the coming years. Beside non pharmacological intervention and calcium and vitamin D administration, available pharmacological therapies for the treatment of osteoporosis include antiresorptive drugs (such as bisphosphonates, calcitonin, and raloxifene) and the bone forming drug teriparatide and drug which can have both anti resorptive effect and bone forming effect (strontium ranelate). Age does not affect the efficacy and the safety of most anti osteoporotic agents. Despite the debilitating effects of osteoporosis fractures and the availability of therapies to reduce fracture incidence, many elderly patients do not receive treatment and the proportion of treated subjects decreases with increasing age. One explanation for this decrease is the perception that it is too late to alter the course of the disease in its late stage. Given the known antifracture efficacy of available drugs, lack of appropriate and needed therapy in patients with osteoporosis may result in costly and debilitating fractures. Comprehensive geriatric assessment can help the practitioner to prioritize the problems and to adapt the treatment to the profile of frailty of the patient.