Management of Osteoporosis in Geriatric Patients

Identification and Risk Assessment

• The American College of Rheumatology recommends that every patient aged ≥50 years with a recent fragility fracture requires systematic fracture risk evaluation 1, 2
• The National Osteoporosis Foundation suggests that risk assessment includes: clinical risk factors review, DXA of spine and hip, spine imaging for vertebral fractures, falls risk evaluation, and screening for secondary osteoporosis 2

Pharmacologic Management

• The American Geriatrics Society recommends oral bisphosphonates as the initial treatment of choice because they reduce vertebral, non-vertebral, and hip fractures by approximately 50% over 3 years 6, 3
• The National Osteoporosis Foundation suggests dosing options for alendronate (70 mg weekly or 10 mg daily) and risedronate (35 mg weekly, 150 mg monthly, or 5 mg daily) 3

Non-Pharmacologic Interventions

• The American College of Rheumatology recommends calcium (1,000-1,200 mg/day) and vitamin D (800-1,000 IU/day) supplementation for all patients 4, 2, 6, 3
• The National Institute on Aging suggests a combination exercise program including balance training, flexibility/stretching exercises, endurance exercise, and resistance/progressive strengthening exercises 4, 2

Multidisciplinary Care Structure

• The American Geriatrics Society recommends implementation of a Fracture Liaison Service (FLS) to increase medication initiation and adherence 1
• The National Osteoporosis Foundation suggests that FLS components include a designated local responsible lead coordinating care, liaison between surgeons, rheumatologists/endocrinologists, geriatricians, and general practitioners, and systematic invitation and follow-up of all fracture patients 1

Monitoring and Follow-Up

• The American College of Rheumatology recommends repeat DXA scan in 1-2 years to assess treatment response and continue monitoring every 1-2 years during treatment 3
• The National Osteoporosis Foundation suggests assessing adherence and tolerance at regular intervals 2, 3

Special Considerations in Geriatric Population

• The American Geriatrics Society recommends that frail elderly with major fractures warrant orthogeriatric and multidisciplinary approach 1
• The National Institute on Aging suggests that poor adherence is common in geriatric patients with polypharmacy and cognitive impairment, and consideration of simpler regimens or alternative agents may be necessary 7, 6