Management of Osteoporosis in Elderly Patients with Comorbidities

Immediate Post-Fracture Management

The American College of Rheumatology recommends implementing orthogeriatric co-management immediately in frail elderly patients with multiple comorbidities, such as CKD, IHD, HTN, and DM, to improve outcomes 1, 2, 4
Initiate appropriate pain control with acetaminophen as first-line, avoiding NSAIDs in patients with CKD and cardiovascular disease, as recommended by the American Heart Association 5
Avoid prolonged bed rest, as it accelerates bone loss, muscle weakness, and increases risk of deep vein thrombosis and pressure ulcers, according to the American College of Physicians 5
Begin range-of-motion exercises for shoulder, elbow, wrist, and hand within the first postoperative days, as suggested by the American Academy of Orthopaedic Surgeons 1

The National Osteoporosis Foundation recommends calcium supplementation of 1000-1200 mg/day and vitamin D 800 IU/day, as these reduce non-vertebral fractures by 15-20% and falls by 20% 1, 2, 4, 6
For patients with GFR ≥30 mL/min, the American College of Rheumatology suggests first-line treatment with oral bisphosphonates, such as alendronate or risedronate, which reduce vertebral, non-vertebral, and hip fractures 2, 4, 3
For patients with GFR <30 mL/min or oral intolerance, the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines recommend denosumab 60 mg subcutaneously every 6 months, which has demonstrated efficacy in reducing vertebral, non-vertebral, and hip fractures 2, 4, 3

The American College of Sports Medicine recommends smoking cessation, limiting alcohol intake, and weight-bearing exercise programs to improve BMD and muscle strength, and reduce fall risk 1, 2, 4
The Centers for Disease Control and Prevention suggest implementing multidimensional fall prevention programs, which reduce fall frequency by approximately 20% 2, 3
The American Geriatrics Society recommends addressing environmental hazards in the home and reviewing medications that may increase fall risk 1, 4

The National Osteoporosis Foundation recommends educating patients about osteoporosis burden, fracture risk factors, importance of medication adherence, and expected duration of therapy 1, 2, 4
The American College of Rheumatology suggests establishing collaboration between orthopedic surgery, rheumatology/endocrinology, nephrology, cardiology, and primary care to improve outcomes 1, 2, 4