Screening for Osteoporosis in Nonagenarians: A Scoping Review

As the United States population continues to age and advancements contribute to enhanced life expectancy, care for nonagenarians (adults aged 90 years and older) is as important as ever. A prominent concern within healthcare for the oldest old remains the occurrence of fragility fractures, and subsequent 1-year mortality, making prevention key. As it stands, current guidelines recommend initial screening for all patients aged 65 years or older without further guidance regarding age-related surveillance. The purpose of this scoping review is to better understand the current literature surrounding the benefits and shortcomings of osteoporosis screening and intervention among nonagenarians.

A comprehensive literature search following PRISMA guidelines was conducted using Cochrane, CINAHL, Embase, SCOPUS, Web of Science, and PubMed-MEDLINE from 2018 to present. The search yielded 3346 studies.

Twenty-one articles met inclusion criteria. Common themes were identified among included studies: evaluation of the effectiveness of existing screening guidelines, utility of new osteoporotic screening tools including fracture risk calculators, the role of frailty and multimorbidity in osteoporosis, and reporting of treatment rates and disparities in the management of osteoporosis.

Osteoporosis screening and management has been poorly studied within the population of nonagenarians. When caring for the oldest old, there is an apparent discrepancy between current guidelines and clinical decision making. We highlight the need for future research centering on nonagenarians as the primary study group in order to establish factors which should be incorporated into future predictive models and screening recommendations.