Skip to main content

Pharmacological Treatment of Osteoporosis in Older Patients

  • Chapter
  • First Online:
Optimizing Pharmacotherapy in Older Patients

Part of the book series: Practical Issues in Geriatrics ((PIG))

  • 590 Accesses

Abstract

Osteoporotic fractures become increasingly prevalent with aging. Additionally, osteoporosis in old age is associated with a substantial burden in terms of morbidity, loss of mobility, and mortality. Nevertheless, this condition continues to be underdiagnosed and undertreated in older persons. In this chapter, the epidemiology and diagnosis of osteoporosis in older patients are discussed, followed by a summary of the evidence about the efficacy and safety of the pharmacological management of osteoporosis in older patients.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Cosman F, de Beur SJ, LeBoff MS, Lewiecki EM, Tanner B, Randall S, et al. Clinician’s guide to prevention and treatment of osteoporosis. Osteoporos Int. 2014;25(10):2359–81.

    CAS  PubMed  PubMed Central  Google Scholar 

  2. Cooper C, Campion G, Melton LJ 3rd. Hip fractures in the elderly: a world-wide projection. Osteoporos Int. 1992;2(6):285–9.

    CAS  PubMed  Google Scholar 

  3. Grados F, Marcelli C, Dargent-Molina P, Roux C, Vergnol JF, Meunier PJ, et al. Prevalence of vertebral fractures in French women older than 75 years from the EPIDOS study. Bone. 2004;34(2):362–7.

    CAS  PubMed  Google Scholar 

  4. Seeman E, Boonen S, Borgstrom F, Vellas B, Aquino JP, Semler J, et al. Five years treatment with strontium ranelate reduces vertebral and nonvertebral fractures and increases the number and quality of remaining life-years in women over 80 years of age. Bone. 2010;46(4):1038–42.

    CAS  PubMed  Google Scholar 

  5. Sambrook P, Cooper C. Osteoporosis. Lancet. 2006;367(9527):2010–8.

    CAS  PubMed  Google Scholar 

  6. Boonen S, Autier P, Barette M, Vanderschueren D, Lips P, Haentjens P. Functional outcome and quality of life following hip fracture in elderly women: a prospective controlled study. Osteoporos Int. 2004;15(2):87–94.

    PubMed  Google Scholar 

  7. Gielen E, Verschueren S, O'Neill TW, Pye SR, O'Connell MD, Lee DM, et al. Musculoskeletal frailty: a geriatric syndrome at the core of fracture occurrence in older age. Calcif Tissue Int. 2012;91(3):161–77.

    CAS  PubMed  Google Scholar 

  8. Leibson CL, Tosteson AN, Gabriel SE, Ransom JE, Melton LJ. Mortality, disability, and nursing home use for persons with and without hip fracture: a population-based study. J Am Geriatr Soc. 2002;50(10):1644–50.

    PubMed  Google Scholar 

  9. Schnell S, Friedman SM, Mendelson DA, Bingham KW, Kates SL. The 1-year mortality of patients treated in a hip fracture program for elders. Geriatr Orthop Surg Rehabil. 2010;1(1):6–14.

    PubMed  PubMed Central  Google Scholar 

  10. Gielen E, Vanderschueren D, Callewaert F, Boonen S. Osteoporosis in men. Best Pract Res Clin Endocrinol Metab. 2011;25(2):321–35.

    CAS  PubMed  Google Scholar 

  11. Haentjens P, Magaziner J, Colon-Emeric CS, Vanderschueren D, Milisen K, Velkeniers B, et al. Meta-analysis: excess mortality after hip fracture among older women and men. Ann Intern Med. 2010;152(6):380–90.

    PubMed  PubMed Central  Google Scholar 

  12. Tran T, Bliuc D, Hansen L, Abrahamsen B, van den Bergh J, Eisman JA, et al. Persistence of excess mortality following individual nonhip fractures: a relative survival analysis. J Clin Endocrinol Metab. 2018;103(9):3205–14.

    PubMed  Google Scholar 

  13. Feldstein A, Elmer PJ, Orwoll E, Herson M, Hillier T. Bone mineral density measurement and treatment for osteoporosis in older individuals with fractures: a gap in evidence-based practice guideline implementation. Arch Intern Med. 2003;163(18):2165–72.

    PubMed  Google Scholar 

  14. Johnell K, Fastbom J. Undertreatment of osteoporosis in the oldest old? A nationwide study of over 700,000 older people. Arch Osteoporos. 2009;4(1–2):17–23.

    PubMed  PubMed Central  Google Scholar 

  15. Kanis JA, Melton LJ 3rd, Christiansen C, Johnston CC, Khaltaev N. The diagnosis of osteoporosis. J Bone Miner Res. 1994;9(8):1137–41.

    CAS  PubMed  Google Scholar 

  16. Thomas-John M, Codd MB, Manne S, Watts NB, Mongey AB. Risk factors for the development of osteoporosis and osteoporotic fractures among older men. J Rheumatol. 2009;36(9):1947–52.

    PubMed  Google Scholar 

  17. Melton LJ 3rd, Atkinson EJ, Cooper C, O'Fallon WM, Riggs BL. Vertebral fractures predict subsequent fractures. Osteoporos Int. 1999;10(3):214–21.

    PubMed  Google Scholar 

  18. Kanis JA, Johnell O, Oden A, Dawson A, De Laet C, Jonsson B. Ten year probabilities of osteoporotic fractures according to BMD and diagnostic thresholds. Osteoporos Int. 2001;12(12):989–95.

    CAS  PubMed  Google Scholar 

  19. FRAX®. Fracture Risk Assessment Tool. http://www.shef.ac.uk/FRAX/.

  20. Kanis JA, McCloskey EV, Johansson H, Cooper C, Rizzoli R, Reginster JY, et al. European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int. 2013;24(1):23–57.

    CAS  PubMed  Google Scholar 

  21. Tosteson AN, Melton LJ 3rd, Dawson-Hughes B, Baim S, Favus MJ, Khosla S, et al. Cost-effective osteoporosis treatment thresholds: the United States perspective. Osteoporos Int. 2008;19(4):437–47.

    CAS  PubMed  PubMed Central  Google Scholar 

  22. Compston J, Bowring C, Cooper A, Cooper C, Davies C, Francis R, et al. Diagnosis and management of osteoporosis in postmenopausal women and older men in the UK: National Osteoporosis Guideline Group (NOGG) update 2013. Maturitas. 2013;75(4):392–6.

    CAS  PubMed  Google Scholar 

  23. McCloskey E, Kanis JA, Johansson H, Harvey N, Oden A, Cooper A, et al. FRAX-based assessment and intervention thresholds—an exploration of thresholds in women aged 50 years and older in the UK. Osteoporos Int. 2015;26(8):2091–9.

    CAS  PubMed  Google Scholar 

  24. Kanis JA, Harvey NC, Cooper C, Johansson H, Oden A, McCloskey EV, et al. A systematic review of intervention thresholds based on FRAX : a report prepared for the National Osteoporosis Guideline Group and the international osteoporosis foundation. Arch Osteoporos. 2016;11(1):25.

    PubMed  PubMed Central  Google Scholar 

  25. Lips P. Vitamin D deficiency and secondary hyperparathyroidism in the elderly: consequences for bone loss and fractures and therapeutic implications. Endocr Rev. 2001;22(4):477–501.

    CAS  PubMed  Google Scholar 

  26. MacLaughlin J, Holick MF. Aging decreases the capacity of human skin to produce vitamin D3. J Clin Invest. 1985;76(4):1536–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  27. Bolland MJ, Grey A, Gamble GD, Reid IR. The effect of vitamin D supplementation on skeletal, vascular, or cancer outcomes: a trial sequential meta-analysis. Lancet Diabetes Endocrinol. 2014;2(4):307–20.

    CAS  PubMed  Google Scholar 

  28. Jackson RD, LaCroix AZ, Gass M, Wallace RB, Robbins J, Lewis CE, et al. Calcium plus vitamin D supplementation and the risk of fractures. N Engl J Med. 2006;354(7):669–83.

    CAS  PubMed  Google Scholar 

  29. Grant AM, Avenell A, Campbell MK, McDonald AM, MacLennan GS, McPherson GC, et al. Oral vitamin D3 and calcium for secondary prevention of low-trauma fractures in elderly people (Randomised Evaluation of Calcium Or vitamin D, RECORD): a randomised placebo-controlled trial. Lancet. 2005;365(9471):1621–8.

    CAS  PubMed  Google Scholar 

  30. Boonen S, Vanderschueren D, Haentjens P, Lips P. Calcium and vitamin D in the prevention and treatment of osteoporosis - a clinical update. J Intern Med. 2006;259(6):539–52.

    CAS  PubMed  Google Scholar 

  31. Bouillon R, Van Schoor NM, Gielen E, Boonen S, Mathieu C, Vanderschueren D, et al. Optimal vitamin D status: a critical analysis on the basis of evidence-based medicine. J Clin Endocrinol Metab. 2013;98(8):E1283–304.

    CAS  PubMed  Google Scholar 

  32. Eleni A, Panagiotis P. A systematic review and meta-analysis of vitamin D and calcium in preventing osteoporotic fractures. Clin Rheumatol. 2020;39(12):3571–9.

    PubMed  Google Scholar 

  33. Dawson-Hughes B, Mithal A, Bonjour JP, Boonen S, Burckhardt P, Fuleihan GE, et al. IOF position statement: vitamin D recommendations for older adults. Osteoporos Int. 2010;21(7):1151–4.

    CAS  PubMed  Google Scholar 

  34. Sanders K. ACP journal Club: a single, annual, high dose of oral vitamin D increased falls and fractures in older women. Ann Intern Med. 2010;153(6):JC3.

    CAS  PubMed  Google Scholar 

  35. Bischoff-Ferrari HA, Dawson-Hughes B, Orav EJ, Staehelin HB, Meyer OW, Theiler R, et al. Monthly high-dose vitamin D treatment for the prevention of functional decline: a randomized clinical trial. JAMA Intern Med. 2016;176(2):175–83.

    PubMed  Google Scholar 

  36. American Geriatrics Society Workgroup on Vitamin DSfOA. Recommendations abstracted from the American Geriatrics Society consensus statement on vitamin D for prevention of falls and their consequences. J Am Geriatr Soc. 2014;62(1):147–52.

    Google Scholar 

  37. Rizzoli R, Branco J, Brandi ML, Boonen S, Bruyere O, Cacoub P, et al. Management of osteoporosis of the oldest old. Osteoporos Int. 2014;25(11):2507–29.

    CAS  PubMed  Google Scholar 

  38. Vondracek SF, Linnebur SA. Diagnosis and management of osteoporosis in the older senior. Clin Interv Aging. 2009;4:121–36.

    CAS  PubMed  PubMed Central  Google Scholar 

  39. Black DM, Cummings SR, Karpf DB, Cauley JA, Thompson DE, Nevitt MC, et al. Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Fracture Intervention Trial Research Group. Lancet. 1996;348(9041):1535–41.

    CAS  PubMed  Google Scholar 

  40. Cummings SR, Black DM, Thompson DE, Applegate WB, Barrett-Connor E, Musliner TA, et al. Effect of alendronate on risk of fracture in women with low bone density but without vertebral fractures: results from the Fracture Intervention Trial. JAMA. 1998;280(24):2077–82.

    CAS  PubMed  Google Scholar 

  41. Ensrud KE, Black DM, Palermo L, Bauer DC, Barrett-Connor E, Quandt SA, et al. Treatment with alendronate prevents fractures in women at highest risk: results from the fracture intervention trial. Arch Intern Med. 1997;157(22):2617–24.

    CAS  PubMed  Google Scholar 

  42. Hochberg MC, Thompson DE, Black DM, Quandt SA, Cauley J, Geusens P, et al. Effect of alendronate on the age-specific incidence of symptomatic osteoporotic fractures. J Bone Miner Res. 2005;20(6):971–6.

    CAS  PubMed  Google Scholar 

  43. Axelsson KF, Wallander M, Johansson H, Lundh D, Lorentzon M. Hip fracture risk and safety with alendronate treatment in the oldest-old. J Intern Med. 2017;282(6):546–59.

    CAS  PubMed  Google Scholar 

  44. Harris ST, Watts NB, Genant HK, McKeever CD, Hangartner T, Keller M, et al. Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. Vertebral Efficacy with Risedronate Therapy (VERT) Study Group. JAMA. 1999;282(14):1344–52.

    CAS  PubMed  Google Scholar 

  45. Reginster J, Minne HW, Sorensen OH, Hooper M, Roux C, Brandi ML, et al. Randomized trial of the effects of risedronate on vertebral fractures in women with established postmenopausal osteoporosis. Vertebral Efficacy with Risedronate Therapy (VERT) Study Group. Osteoporos Int. 2000;11(1):83–91.

    CAS  PubMed  Google Scholar 

  46. McClung MR, Geusens P, Miller PD, Zippel H, Bensen WG, Roux C, et al. Effect of risedronate on the risk of hip fracture in elderly women. Hip Intervention Program Study Group. N Engl J Med. 2001;344(5):333–40.

    CAS  PubMed  Google Scholar 

  47. Boonen S, McClung MR, Eastell R, El-Hajj Fuleihan G, Barton IP, Delmas P. Safety and efficacy of risedronate in reducing fracture risk in osteoporotic women aged 80 and older: implications for the use of antiresorptive agents in the old and oldest old. J Am Geriatr Soc. 2004;52(11):1832–9.

    PubMed  Google Scholar 

  48. Tom SE, Adachi JD, Anderson FA Jr, Boonen S, Chapurlat RD, Compston JE, et al. Frailty and fracture, disability, and falls: a multiple country study from the global longitudinal study of osteoporosis in women. J Am Geriatr Soc. 2013;61(3):327–34.

    PubMed  PubMed Central  Google Scholar 

  49. Cryer B, Bauer DC. Oral bisphosphonates and upper gastrointestinal tract problems: what is the evidence? Mayo Clin Proc. 2002;77(10):1031–43.

    PubMed  Google Scholar 

  50. Porras AG, Holland SD, Gertz BJ. Pharmacokinetics of alendronate. Clin Pharmacokinet. 1999;36(5):315–28.

    CAS  PubMed  Google Scholar 

  51. Lo JC, Pressman AR, Omar MA, Ettinger B. Persistence with weekly alendronate therapy among postmenopausal women. Osteoporos Int. 2006;17(6):922–8.

    CAS  PubMed  Google Scholar 

  52. Boonen S, Black DM, Colon-Emeric CS, Eastell R, Magaziner JS, Eriksen EF, et al. Efficacy and safety of a once-yearly intravenous zoledronic acid 5 mg for fracture prevention in elderly postmenopausal women with osteoporosis aged 75 and older. J Am Geriatr Soc. 2010;58(2):292–9.

    PubMed  PubMed Central  Google Scholar 

  53. Black DM, Delmas PD, Eastell R, Reid IR, Boonen S, Cauley JA, et al. Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis. N Engl J Med. 2007;356(18):1809–22.

    CAS  PubMed  Google Scholar 

  54. Lyles KW, Colon-Emeric CS, Magaziner JS, Adachi JD, Pieper CF, Mautalen C, et al. Zoledronic acid in reducing clinical fracture and mortality after hip fracture. N Engl J Med. 2007;357:nihpa40967.

    PubMed Central  Google Scholar 

  55. Cummings SR, San Martin J, McClung MR, Siris ES, Eastell R, Reid IR, et al. Denosumab for prevention of fractures in postmenopausal women with osteoporosis. N Engl J Med. 2009;361(8):756–65.

    CAS  PubMed  Google Scholar 

  56. Boonen S, Adachi JD, Man Z, Cummings SR, Lippuner K, Torring O, et al. Treatment with denosumab reduces the incidence of new vertebral and hip fractures in postmenopausal women at high risk. J Clin Endocrinol Metab. 2011;96(6):1727–36.

    CAS  PubMed  Google Scholar 

  57. McClung MR, Boonen S, Torring O, Roux C, Rizzoli R, Bone HG, et al. Effect of denosumab treatment on the risk of fractures in subgroups of women with postmenopausal osteoporosis. J Bone Miner Res. 2012;27(1):211–8.

    CAS  PubMed  Google Scholar 

  58. Papapoulos S, McClung M, Franchimont N, Adachi J, Bone H, Benhamou C, et al. Low fracture incidence is maintained in postmenopausal women ≥75 years with osteoporosis with long-term denosumab treatment. J Bone Miner Res. 2012;27(Suppl 1)

    Google Scholar 

  59. Genant HK, Libanati C, Engelke K, Zanchetta JR, Hoiseth A, Yuen CK, et al. Improvements in hip trabecular, subcortical, and cortical density and mass in postmenopausal women with osteoporosis treated with denosumab. Bone. 2013;56(2):482–8.

    CAS  PubMed  Google Scholar 

  60. Jamal SA, Ljunggren O, Stehman-Breen C, Cummings SR, McClung MR, Goemaere S, et al. Effects of denosumab on fracture and bone mineral density by level of kidney function. J Bone Miner Res. 2011;26(8):1829–35.

    CAS  PubMed  Google Scholar 

  61. Tsourdi E, Zillikens MC. Certainties and uncertainties about denosumab discontinuation. Calcif Tissue Int. 2018;103(1):1–4.

    CAS  PubMed  Google Scholar 

  62. Bone HG, Bolognese MA, Yuen CK, Kendler DL, Miller PD, Yang YC, et al. Effects of denosumab treatment and discontinuation on bone mineral density and bone turnover markers in postmenopausal women with low bone mass. J Clin Endocrinol Metab. 2011;96(4):972–80.

    CAS  PubMed  Google Scholar 

  63. Cummings SR, Ferrari S, Eastell R, Gilchrist N, Jensen JB, McClung M, et al. Vertebral fractures after discontinuation of denosumab: a post hoc analysis of the randomized placebo-controlled FREEDOM trial and its extension. J Bone Miner Res. 2018;33(2):190–8.

    CAS  PubMed  Google Scholar 

  64. Anastasilakis AD, Polyzos SA, Makras P, Aubry-Rozier B, Kaouri S, Lamy O. Clinical features of 24 patients with rebound-associated vertebral fractures after denosumab discontinuation: systematic review and additional cases. J Bone Miner Res. 2017;32(6):1291–6.

    CAS  PubMed  Google Scholar 

  65. Dupont J, Laurent MR, Dedeyne L, Luyten FP, Gielen E, Dejaeger M. Rebound-associated vertebral fractures after stopping denosumab: report of four cases. Joint Bone Spine. 2020;87(2):171–3.

    PubMed  Google Scholar 

  66. Dupont J, Laurent MR, Dedeyne L, Luyten FP, Gielen E, Dejaeger M. Vertebral fractures after denosumab cessation. Cleve Clin J Med. 2020;87(6):337–8.

    PubMed  Google Scholar 

  67. Grassi G, Chiodini I, Palmieri S, Cairoli E, Arosio M, Eller-Vainicher C. Bisphosphonates after denosumab withdrawal reduce the vertebral fractures incidence. Eur J Endocrinol. 2021;185(3):387–96.

    CAS  PubMed  Google Scholar 

  68. Solling AS, Harslof T, Langdahl B. Treatment with zoledronate subsequent to denosumab in osteoporosis: a 2-year randomized study. J Bone Miner Res. 2021;36(7):1245–54.

    PubMed  Google Scholar 

  69. Low A. Should all elderly women receive bisphosphonates to prevent osteoporotic fractures? Can J Hosp Pharm. 2012;65(1):45–8.

    Google Scholar 

  70. Sanchez-Rodriguez D, Bergmann P, Body JJ, Cavalier E, Gielen E, Goemaere S, et al. The Belgian Bone Club 2020 guidelines for the management of osteoporosis in postmenopausal women. Maturitas. 2020;139:69–89.

    CAS  PubMed  Google Scholar 

  71. Neer RM, Arnaud CD, Zanchetta JR, Prince R, Gaich GA, Reginster JY, et al. Effect of parathyroid hormone (1-34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med. 2001;344(19):1434–41.

    CAS  PubMed  Google Scholar 

  72. Boonen S, Marin F, Mellstrom D, Xie L, Desaiah D, Krege JH, et al. Safety and efficacy of teriparatide in elderly women with established osteoporosis: bone anabolic therapy from a geriatric perspective. J Am Geriatr Soc. 2006;54(5):782–9.

    PubMed  Google Scholar 

  73. Miller PD, Hattersley G, Riis BJ, Williams GC, Lau E, Russo LA, et al. Effect of abaloparatide vs placebo on new vertebral fractures in postmenopausal women with osteoporosis: a randomized clinical trial. JAMA. 2016;316(7):722–33.

    CAS  PubMed  Google Scholar 

  74. McClung MR, Harvey NC, Fitzpatrick LA, Miller PD, Hattersley G, Wang Y, et al. Effects of abaloparatide on bone mineral density and risk of fracture in postmenopausal women aged 80 years or older with osteoporosis. Menopause. 2018;25(7):767–71.

    PubMed  PubMed Central  Google Scholar 

  75. Cosman F, Hattersley G, Hu MY, Williams GC, Fitzpatrick LA, Black DM. Effects of Abaloparatide-SC on fractures and bone mineral density in subgroups of postmenopausal women with osteoporosis and varying baseline risk factors. J Bone Miner Res. 2017;32(1):17–23.

    CAS  PubMed  Google Scholar 

  76. Cosman F, Crittenden DB, Adachi JD, Binkley N, Czerwinski E, Ferrari S, et al. Romosozumab treatment in postmenopausal women with osteoporosis. N Engl J Med. 2016;375(16):1532–43.

    CAS  PubMed  Google Scholar 

  77. Lewiecki EM, Dinavahi RV, Lazaretti-Castro M, Ebeling PR, Adachi JD, Miyauchi A, et al. One year of romosozumab followed by two years of denosumab maintains fracture risk reductions: results of the FRAME extension study. J Bone Miner Res. 2019;34(3):419–28.

    CAS  PubMed  Google Scholar 

  78. Saag KG, Petersen J, Brandi ML, Karaplis AC, Lorentzon M, Thomas T, et al. Romosozumab or alendronate for fracture prevention in women with osteoporosis. N Engl J Med. 2017;377(15):1417–27.

    CAS  PubMed  Google Scholar 

  79. Watts NB, Adler RA, Bilezikian JP, Drake MT, Eastell R, Orwoll ES, et al. Osteoporosis in men: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2012;97(6):1802–22.

    CAS  PubMed  Google Scholar 

  80. Nayak S, Greenspan SL. Osteoporosis treatment efficacy for men: a systematic review and meta-analysis. J Am Geriatr Soc. 2017;65(3):490–5.

    PubMed  Google Scholar 

  81. Boonen S, Reginster JY, Kaufman JM, Lippuner K, Zanchetta J, Langdahl B, Rizzoli R, Lipschitz S, Dimai HP, Witvrouw R, Eriksen E, Brixen K, Russo L, Claessens F, Papanastasiou P, Antunez O, Su G, Bucci-Rechtweg C, Hruska J, Incera E, Vanderschueren D, Orwoll E. N. Fracture risk and zoledronic acid therapy in men with osteoporosis. Engl J Med. 2012;367(18):1714–23.

    Google Scholar 

  82. Orwoll E, Teglbjaerg CS, Langdahl BL, Chapurlat R, Czerwinski E, Kendler DL, et al. A randomized, placebo-controlled study of the effects of denosumab for the treatment of men with low bone mineral density. J Clin Endocrinol Metab. 2012;97(9):3161–9.

    CAS  PubMed  Google Scholar 

  83. Orwoll ES, Scheele WH, Paul S, Adami S, Syversen U, Diez-Perez A, et al. The effect of teriparatide [human parathyroid hormone (1-34)] therapy on bone density in men with osteoporosis. J Bone Miner Res. 2003;18(1):9–17.

    CAS  PubMed  Google Scholar 

  84. Lewiecki EM, Blicharski T, Goemaere S, Lippuner K, Meisner PD, Miller PD, et al. A phase III randomized placebo-controlled trial to evaluate efficacy and safety of romosozumab in men with osteoporosis. J Clin Endocrinol Metab. 2018;103(9):3183–93.

    PubMed  Google Scholar 

  85. Strom O, Lauppe R, Ljunggren O, Spangeus A, Ortsater G, O'Kelly J, et al. Real-world effectiveness of osteoporosis treatment in the oldest old. Osteoporos Int. 2020;31(8):1525–33.

    CAS  PubMed  PubMed Central  Google Scholar 

  86. Deardorff WJ, Cenzer I, Nguyen B, Lee SJ. Time to benefit of bisphosphonate therapy for the prevention of fractures among postmenopausal women with osteoporosis: a meta-analysis of randomized clinical trials. JAMA Intern Med. 2022;182(1):33–41.

    CAS  PubMed  Google Scholar 

  87. Gielen E, Bergmann P, Bruyere O, Cavalier E, Delanaye P, Goemaere S, et al. Osteoporosis in frail patients: a consensus paper of the Belgian Bone Club. Calcif Tissue Int. 2017;101(2):111–31.

    CAS  PubMed  PubMed Central  Google Scholar 

  88. Eurostat; 2017. https://ec.europa.eu/eurostat/web/products-eurostat-news/-/EDN-20170930-1?inheritRedirect=true&redirect=%2Feurostat%2F.

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Evelien Gielen .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2023 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Dejaeger, M., Dupont, J., Laurent, M.R., Gielen, E. (2023). Pharmacological Treatment of Osteoporosis in Older Patients. In: Cherubini, A., Mangoni, A.A., O’Mahony, D., Petrovic, M. (eds) Optimizing Pharmacotherapy in Older Patients. Practical Issues in Geriatrics. Springer, Cham. https://doi.org/10.1007/978-3-031-28061-0_21

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-28061-0_21

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-28060-3

  • Online ISBN: 978-3-031-28061-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics