Characteristics and treatment options of 272,152 geriatric patients with very high and high fracture risk.

UNLABELLED

Our study of 272,152 geriatric patients assessed osteoporosis treatment requirement and eligibility. Over 75% qualified for therapy, with 54% at very high fracture risk, classifying for bone anabolic treatment. Despite contraindications in 8-20%, most were suitable for treatment. Especially in geriatric patients, early risk-assessment and timely intervention are essential.

PURPOSE

The German osteoporosis guideline defines high and very high fracture-risk based on quantifiable evidence-based risk-factors, recommending bone anabolic treatment as first-line therapy for the latter. Given age as a major risk factor, we investigated the proportion of geriatric patients with very high fracture risk, their characteristics, and the percentage suitable for bone anabolic treatment considering contraindications.

METHODS

Data from the Geriatrics in Bavaria-Database (GiB-DAT, Geriatrie in Bayern Datenbank) included 272,152 participants (mean age 82 ± 7 years) between 2013 and 2023. Risk-factors and contraindications were evaluated using ICD-10- (International Statistical Classification of Diseases) and ATC-codes (Anatomical Therapeutical Chemical Classification). We analyzed the proportion in the high-risk and very high-risk group, their characteristics, and the share with a contraindication for specific anti-osteoporotic treatments.

RESULTS

 75% of the patients qualified for specific anti-osteoporotic treatment, with the majority (54%) at very high-risk requiring bone anabolic treatment. Patients in the very high-risk group had the lowest mini mental status examination (MMSE) (23 ± 5 points) and activities of daily living (ADL) scores (45 ± 20 points). Contraindications for bone anabolic treatments were found in 20% of women and 8% of all very high-risk patients. Seventy percent of the total study population had no contraindication for any specific anti-osteoporotic medications.

CONCLUSION

The majority of geriatric patients is at a very high-risk for osteoporotic fractures, characterized by cognitive impairment, ADL limitations, and increased vulnerability. While some patients had contraindications, most were eligible for anti-osteoporotic and particularly bone anabolic treatments. Timely risk-assessment and treatment initiation is crucial and barriers need to be addressed.