Management of Osteoporosis among the Elderly with Other Chronic Medical Conditions

Abstract

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.

MicroRNA-188 regulates age-related switch between osteoblast and adipocyte differentiation

“…However, the roles of miRNAs in the age- With the progressive aging of the general population, agerelated bone loss becomes a growing public problem (32). A major requirement for the treatment of age-related bone loss is to identify anabolic agents that can increase bone formation and decrease fat accumulation in bone marrow via targeting BMSCs (33).…”

Drug therapies in older adults (part 1)

“…49 Specifi cally, it establishes the 10-year probability of any major osteoporotic fracture (clinically relevant spine, forearm, hip or shoulder fracture) while delineating the 10-year risk of hip fracture in isolation. 49 Based on current evidence, the consensus opinion for the prevention of osteoporosis is to recommend avoidance of smoking, excess alcohol and caffeine; 50 fall prevention measures should also be adopted along with structured exercise. 50 Calcium (1,000-1,200 mg) should be consumed on a daily basis (either via diet or supplementation) along with 800-1,000 U vitamin D; however, the evidence for this specifi c measure in osteoporosis has recently been called into question.…”

“…49 Based on current evidence, the consensus opinion for the prevention of osteoporosis is to recommend avoidance of smoking, excess alcohol and caffeine; 50 fall prevention measures should also be adopted along with structured exercise. 50 Calcium (1,000-1,200 mg) should be consumed on a daily basis (either via diet or supplementation) along with 800-1,000 U vitamin D; however, the evidence for this specifi c measure in osteoporosis has recently been called into question. 50,51 The treatment of postmenopausal osteoporosis should include the correction of any calcium defi ciency, continuation of preventative measures and additional pharmacological therapy.…”

“…50 Calcium (1,000-1,200 mg) should be consumed on a daily basis (either via diet or supplementation) along with 800-1,000 U vitamin D; however, the evidence for this specifi c measure in osteoporosis has recently been called into question. 50,51 The treatment of postmenopausal osteoporosis should include the correction of any calcium defi ciency, continuation of preventative measures and additional pharmacological therapy. 50 Drugs that have been licenced in addition to preventative oestrogen therapy (for women) include the bisphosphonates, raloxifene, parathyroid hormone, denosumab and calcitonin.…”

“…50,51 The treatment of postmenopausal osteoporosis should include the correction of any calcium defi ciency, continuation of preventative measures and additional pharmacological therapy. 50 Drugs that have been licenced in addition to preventative oestrogen therapy (for women) include the bisphosphonates, raloxifene, parathyroid hormone, denosumab and calcitonin.…”