Management of Osteoporosis among the Elderly with Other Chronic Medical Conditions
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Osteoporosis is a highly prevalent chronic disease in the US and worldwide. The most serious consequence of this disorder is fractures, which have a serious negative impact on quality of life and are often the trigger for accelerated deterioration, ultimately ending in death. Despite the availability of effective preventive treatments, osteoporosis is frequently underdiagnosed and/or undertreated, particularly among the elderly, who are also at greatest risk. In addition, the presence of co-morbid medical conditions may be both a barrier to osteoporosis care and a risk factor for falls; thus individuals with multiple co-morbid conditions may be a particularly high-risk group.
The management of osteoporosis involves improving bone health via adequate nutrition, calcium and vitamin D supplements, and fall prevention strategies. Although these measures are important in the management of all patients, most elderly patients are likely to need additional pharmacological therapy to adequately reduce their fracture risk. Several pharmacological treatments have been shown to significantly reduce the risk of fracture, including bisphosphonates (e.g. alendronate, risedronate, ibandronate, zoledronic acid), denosumab, raloxifene, calcitonin and teriparatide.
Despite recent advances in osteoporosis care, additional action is urgently needed to improve the quality of life of osteoporotic patients in general and of elderly patients in particular, since fracture outcomes are typically poorer in older than in younger patients. This article reviews the current status of osteoporosis management, emphasizing the need to improve osteoporosis care, with a particular focus on the US, by the use of quality-improvement measures and incentives, which might result in an increased awareness and improved treatment for this debilitating disease.
KeywordsBone Mineral Density Osteoporosis Vertebral Fracture Alendronate Zoledronic Acid
Funding: Editorial and writing support in the preparation of this manuscript was funded by Warner Chilcott (US) LLC, and Sanofi. Dr Curtis and Dr Safford were supported by AHRQ 1U18HS016956-01. Dr Curtis received support from the National Institutes of Health (NIH).[AR053351].
Tam Vo, PhD, and a team from Excerpta Medica provided editorial and writing assistance. The authors were fully responsible for all content and editorial decisions, and received no other financial support or other form of compensation related to the development of the paper.
Conflicts of interest: Dr Curtis has received research grants from Merck, Procter & Gamble, Eli Lilly and Novartis and has acted as a consultant for and received honoraria from Merck, Novartis, Roche, Amgen and Eli Lilly. Dr Safford has received research grants from the NIH, American College of Rheumatology and Peers for Progress (a collaboration between the American Academy of Family Physicians and the Eli Lilly Foundation).
Authorship: Both Dr Curtis and Dr Safford contributed to the conceptualization, drafting, interpretation, critical revisions and final approval of the manuscript, and the decision to submit the manuscript.
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