Fractures reduction with osteoporotic treatments in patients over 75-year-old: A systematic review and meta-analysis

Abstract

Background: Osteoporosis consists in the reduction of bone mineral density and increased risk of fracture. Age is a risk factor for osteoporosis. Although many treatments are available for osteoporosis, there is limited data regarding their efficacy in older people.Objective: To evaluate the efficacy of osteoporosis treatments in patients over 75 years old.Methods: We reviewed all published studies in MEDLINE, Cochrane and EMBASE including patients over 75 years old, treated by osteoporosis drugs, and focused on vertebral fractures or hip fractures.Results: We identified 4,393 records for review; 4,216 were excluded after title/abstract review. After full text review, 19 records were included in the systematic review. Most studies showed a reduction in vertebral fracture with osteoporosis treatments, but non-significant results were observed for hip fractures. Meta-analysis of 10 studies showed that lack of treatment was significantly associated with an increased risk of vertebral fractures at one (OR = 3.67; 95%CI = 2.50–5.38) and 3 years (OR = 2.19; 95%CI = 1.44–3.34), and for hip fractures at one (OR = 2.14; 95%CI = 1.09–4.22) and 3 years (OR = 1.31, 95%CI = 1.12–1.53).Conclusion: A reduction in the risk of vertebral fractures with osteoporosis treatments was observed in most of the studies included and meta-analysis showed that lack of treatment was significantly associated with an increased risk of vertebral fractures. Concerning hip fractures, majority of included studies did not show a significant reduction in the occurrence of hip fractures with osteoporotic treatments, but meta-analysis showed an increased risk of hip fractures without osteoporotic treatment. However, most of the data derived from post hoc and preplanned analyses or observational studies.

Duration of osteoporosis treatment to reduce the risk of subsequent osteoporotic fracture and all-cause mortality in elderly hip fracture patients in a Korean real-world study

“…For example, the use of certain osteoporosis medications decreased the risk of subsequent hip fracture in patients aged > 80 years [ 26 ]. In a meta-analysis that evaluated the efficacy of osteoporosis treatment in patients aged > 75 years, osteoporosis treatment was significantly associated with a decreased risk of hip fracture at 1 and 3 years [ 27 ]. Thus, to reduce the risk of subsequent hip fractures, it is essential to choose the appropriate type of osteoporosis medication.…”

Chronic Kidney Disease in Patients with Hip Fracture: Prevalence and Outcomes

“…Te therapeutic role of antiresorptive medications in these patients remains is still debated [6,23,36,62,123,185,[205][206][207]. In non-CKD populations, aminobisphosphonates, denosumab (a fully human monoclonal antibody that, by binding to receptor activator of nuclear factor kappa-B ligand (RANKL), prevents receptor activation of RANK and resulting in potent antiresorptive activity) and romosozumab (a humanized monoclonal antibody (IgG2) that binds to sclerostin and acts as an inhibitor), the major (frst and second line) therapy in OP, have been shown to reduce OFs (HF-approximately by 40%, vertebral fracture by 45-70%, non-vertebral by 20-30%) [113,121,122,[208][209][210][211][212][213][214][215]), although the possible benefcial efects of anti-OP treatment among individuals with high fracture risk but limited life expectancy (e.g., the oldest nursing home residents) is controversial [216,217]; in patients aged >75 years, anti-OP treatment did not reduce signifcantly the occurrence of HFs [218,219]. In patients with CKD, these medications are also efective in improving BMD and reducing OFs, but there are uncertainties regarding their safety and efcacy in CKD G4-G5 [30,31,[33][34][35][36]206].…”