Vandenbroucke A, Luyten F P, Flamaing J, Gielen E
Clinical Department of Internal Medicine, UZ Leuven.
Skeletal Biology and Engineering, Department of Development and Regeneration, KU Leuven.
Clin Interv Aging. 2017 Jul 6;12:1065-1077. doi: 10.2147/CIA.S131023. eCollection 2017.
The incidence of osteoporotic fractures increases with age. Consequently, the global prevalence of osteoporotic fractures will increase with the aging of the population. In old age, osteoporosis is associated with a substantial burden in terms of morbidity and mortality. Nevertheless, osteoporosis in old age continues to be underdiagnosed and undertreated. This may, at least partly, be explained by the fact that evidence of the antifracture efficacy of osteoporosis treatments comes mainly from randomized controlled trials in postmenopausal women with a mean age of 70-75 years. However, in the last years, subgroup analyses of these landmark trials have been published investigating the efficacy and safety of osteoporosis treatment in the very elderly. Based on this evidence, this narrative review discusses the pharmacological management of osteoporosis in the oldest old (≥80 years). Because of the high prevalence of calcium and/or vitamin D deficiency in old age, these supplements are essential in the management of osteoporosis in the elderly people. Adding antiresorptive or anabolic treatments or combinations, thereof, reduces the risk of vertebral fractures even more, at least in the elderly with documented osteoporosis. The reduction of hip fracture risk by antiresorptive treatments is less convincing, which may be explained by insufficient statistical power in some subanalyses and/or a higher impact of nonskeletal risk factors in the occurrence of hip fractures. Compared with younger individuals, a larger absolute risk reduction is observed in the elderly because of the higher baseline fracture risk. Therefore, the elderly will benefit more of treatment. In addition, current osteoporosis therapies also appear to be safe in the elderly. Although more research is required to further clarify the effect of osteoporosis drugs in the elderly, especially with respect to hip fractures, there is currently sufficient evidence to initiate appropriate treatment in the elderly with osteoporosis and osteoporotic fractures.
骨质疏松性骨折的发生率随年龄增长而增加。因此，随着人口老龄化，全球骨质疏松性骨折的患病率将会上升。在老年人群中，骨质疏松症在发病率和死亡率方面带来了沉重负担。然而，老年骨质疏松症仍然诊断不足且治疗不充分。这至少部分可以解释为，骨质疏松症治疗的抗骨折疗效证据主要来自平均年龄为70 - 75岁的绝经后女性的随机对照试验。然而，在过去几年中，这些具有里程碑意义的试验的亚组分析已经发表，研究了骨质疏松症治疗在高龄老人（≥80岁）中的疗效和安全性。基于这些证据，本叙述性综述讨论了高龄老人（≥80岁）骨质疏松症的药物治疗。由于老年人中钙和/或维生素D缺乏的患病率很高，这些补充剂在老年人骨质疏松症的管理中至关重要。添加抗吸收或促合成治疗或两者联合使用，至少在已确诊骨质疏松症的老年人中，能进一步降低椎体骨折的风险。抗吸收治疗对降低髋部骨折风险的说服力较小，这可能是由于一些亚分析中的统计效力不足和/或非骨骼风险因素对髋部骨折发生的影响较大。与年轻人相比，由于老年人基线骨折风险较高，因此观察到的绝对风险降低幅度更大。因此，老年人将从治疗中获益更多。此外，目前的骨质疏松症治疗方法在老年人中似乎也是安全的。尽管需要更多研究来进一步阐明骨质疏松症药物对老年人的影响，特别是对于髋部骨折，但目前有足够的证据对患有骨质疏松症和骨质疏松性骨折的老年人启动适当治疗。
