The evidence for antiresorptive osteoporosis treatment in the elderly and old |
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| Authors: | M.V. Maraldo P. Vestergaard M.E.T. McMurdo P. Schwarz |
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| Affiliation: | 1. Cleveland Clinic, Cleveland, OH, USA;2. University of Rochester, Rochester, NY, USA;3. University of Washington, Seattle, WA, USA;4. University of Ottawa, Ottawa, ON, Canada;5. Thrombosis and Hemostasis Center, Division of Hematology, Duke University Medical Center, Durham, NC, USA;6. University of California, Sacramento, CA, USA;7. Roswell Park Cancer Institute, Buffalo, NY, USA;8. Division of Medical Oncology/Department of Medicine, University of Washington, Seattle, WA, USA;1. Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada;2. Department of Radiation Oncology, University of Texas Southwestern, Dallas, Texas;3. Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri;4. Department of Radiation Oncology, The Icahn School of Medicine at Mount Sinai, New York, New York;5. Department of Radiation Oncology, State University of New York Upstate Medical University, Syracuse, New York;6. Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia;7. Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin;8. Department of Medical Oncology, University of Pennsylvania, Philadelphia, Pennsylvania;9. Department of Radiation Oncology, Blanchard Valley Health System, Findlay, Ohio;10. Department of Radiation Oncology, UH Case Medical Center, Cleveland, Ohio;11. Department of Surgery, Washington University School of Medicine, St Louis, Missouri;12. Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania;13. Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio;1. Department of Endocrinology, The Netherlands;2. Department of Endocrinology, University of Groningen, The Netherlands;3. Department of Gastroenterology and Hepatology, University of Groningen and University Medical Center Groningen, The Netherlands |
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| Abstract: | PurposeThe mean age at diagnosis of osteoporosis is in the late 1960s, and fracture risk and need for fracture prevention rises sharply with increasing age. However, what is the evidence that supports the use of antiresorptive osteoporosis treatments in elderly people?MethodsThis study was a meta-analysis and meta-regression of the published literature on the clinical efficacy of antiresorptive therapy in the reduction of fracture risk in elderly (age > 70 years) and old (age > 80 years). A systematic literature search was performed. Studies included were randomised placebo controlled trials of post-menopausal women or men where the primary endpoint was vertebral, non-vertebral or hip fracture risk reduction. No papers on fractures in males were published, so BMD as primary endpoint was accepted.ResultsThirteen studies in women were included. We found increasing vertebral fracture risk reduction with increasing age, increasing BMI, and longer duration of treatment. A high baseline BMD was associated with a lesser effect. For non-vertebral fracture risk reduction, we found no effect of follow-up, age or BMD. For hip fracture risk reduction, we found no effect of treatment with increasing age or BMD, and no certain effect of duration of treatment. For men, three BMD studies were included, in these, we found a non-significant trend toward fracture reduction.ConclusionsFor women, pooled analyses showed increasing effect of antiresorptive drugs with increasing age, increasing BMI, and longer duration of treatment on vertebral fractures. The data on non-vertebral or hip fractures showed no effect on follow-up, age, or BMD. The data in men are scant at all sites and inconclusive. |
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