Medical treatment of osteoporosis in the elderly

Fractures, mostly of the hip and pelvis, wrist, and sometimes of the vertebra, account for nearly half of emergency department treatments for elderly individuals seen because of a fall. Bone density measurements show that more than half of these patients have osteoporosis. The notion that it is too late to start treatment in a late stage of the disease forms a barrier to treatment. The aim of this article is to evaluate the effectiveness of therapeutic options for osteoporosis in the elderly, with a view to reducing the incidence of fractures. Although most studies of fracture reduction with medical treatment were not designed for the "geriatric" population, the average age of participants in most clinical trials was about 70 years. Nowadays, clinicians can choose from several effective treatments for the prevention of osteoporotic fractures in high-risk postmenopausal women. Data on the antifracture potential of calcium/vitamin D, raloxifene, bisphosphonates, strontium ralenate, and parathyroid hormone are now available. In all major studies patients also received calcium and vitamin D supplements. Bisphosphonates and strontium ranelate are good choices for first- or second-line treatment, while for the time being parathyroid hormone should only be used for the second-line treatment of osteoporosis in the elderly. The ease of use of bisphosphonates, with once weekly, once monthly, or intravenous administration, may be advantageous for elderly patients already taking multiple medications.