Osteoporosis in the elderly: practical approach to prevention and treatment

A major public health issue: Osteoporosis in the elderly limits independence and quality of life. Preventive and curative treatment should be adapted to the patient's age. Therapeutic objectives: The goal of preventive like curative treatment is to reduce the risk of fracture. Risk can best be assessed from personal history of fracture or with bone densitometry. Therapeutic methods: Non-drug methods are based on physical activity diet reduction of alcohol intake or smoking, and limiting the risk of fails. Drugs used include calcium, vitamin D, hormone replacement therapy and bisphosphonates. Therapeutic strategy: Prevention programs should focus first on non-drug methods, adapted to the patient's age. For drug regimens, hormone replacement therapy is rarely used after 70 years of age while calcium and vitamin D are widely used. Drugs inhibiting bone resorption, e.g. bisphosphonates, are added on for curative treatment. After the age of 80 years, the calcium vitamin D combination atone is useful. Follow-up: A simple surveillance scheme should include a check-up of renal function every year in patients taking bisphosphonates. it is most difficult to assess treatment efficacy on an individual basis. (C) 2001, Masson, Paris.