What is the effectiveness of pharmacological treatment of osteoporosis in elderly patients? Do bisphosphonates reduce the risk of fractures if started late in life, eg, in patients aged >80 years?
Alexandra Papaioannou, MD: The effectiveness of pharmacological treatment in older adults is number one: Does it work? Does the drug for some reason pose a challenge because people are older? There are some drugs like bisphosphonates that are difficult to swallow. If you are frail, 40% of those individuals, say, in a nursing home, will not be able to swallow the medications. They should not be crushed or put in apple juice. Adherence poses a major challenge for individuals, especially those with cognitive impairment and dementia. In those individuals the drugs such as denosumab may be more preferable.
Having said that, looking at the most cost-effective drugs, the bisphosphonates are all generic and are often very cost-effective first-line drugs. Do these drugs work after the age of 80? Looking at the systematic reviews there is no signal with sensitivity analysis that they do not continue to prevent fractures over the age of 80.