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Aging bone and osteoporosis: strategies for preventing fractures in the elderly.
Arch Intern Med 2003; 163(18):2237-46AI

Abstract

As the older population increases, the incidence of osteoporotic fractures is expected to dramatically rise during the next few decades. Older patients are much more susceptible to fracture at any given bone mineral density (BMD) than are younger patients because of various factors, including the quality of aging bone, which involves more than BMD. Suppression of increased bone turnover by antiresorptive therapies, even with only small changes in BMD, can reduce fracture risk, especially in the lumbar spine. Bisphosphonate treatment can significantly reduce vertebral and nonvertebral fractures, including hip fractures, even in the very elderly. Prospective analyses show that risedronate therapy consistently and significantly reduces the risk of new morphometric vertebral fractures after 1 year in postmenopausal women. Post hoc analyses report significant reductions in the risk of 1 new clinical vertebral fracture after 6 months of risedronate therapy and after 1 year of alendronate therapy. Oral raloxifene therapy and salmon calcitonin nasal spray therapy have been shown to reduce the risk of vertebral fracture after 3 and 5 years, respectively, and post hoc data show a significant reduction in clinical vertebral fracture risk at 1 year with raloxifene use. However, neither raloxifene therapy nor calcitonin therapy reduce the risk of nonvertebral and hip fractures at currently approved doses. Bisphosphonates have been shown to be safe and efficacious with 7 years' risedronate sodium and 10 years' alendronate sodium data published, and bisphosphonates reduce bone turnover and increase BMD to a greater degree than raloxifene and calcitonin, which may partly account for their nonvertebral and hip fracture reduction effect. Therefore, bisphosphonate therapy with risedronate or alendronate should be considered in patients with low BMD at the hip and in older patients with osteoporosis and osteopenia, particularly those with an existing fracture.

Authors+Show Affiliations

Regional Osteoporosis Center of South Florida and Radiant Research Stuart Florida, Stuart 34996, USA. markettinger@radiantresearch.com

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

14557222

Citation

Ettinger, Mark P.. "Aging Bone and Osteoporosis: Strategies for Preventing Fractures in the Elderly." Archives of Internal Medicine, vol. 163, no. 18, 2003, pp. 2237-46.
Ettinger MP. Aging bone and osteoporosis: strategies for preventing fractures in the elderly. Arch Intern Med. 2003;163(18):2237-46.
Ettinger, M. P. (2003). Aging bone and osteoporosis: strategies for preventing fractures in the elderly. Archives of Internal Medicine, 163(18), pp. 2237-46.
Ettinger MP. Aging Bone and Osteoporosis: Strategies for Preventing Fractures in the Elderly. Arch Intern Med. 2003 Oct 13;163(18):2237-46. PubMed PMID: 14557222.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Aging bone and osteoporosis: strategies for preventing fractures in the elderly. A1 - Ettinger,Mark P, PY - 2003/10/15/pubmed PY - 2003/11/8/medline PY - 2003/10/15/entrez SP - 2237 EP - 46 JF - Archives of internal medicine JO - Arch. Intern. Med. VL - 163 IS - 18 N2 - As the older population increases, the incidence of osteoporotic fractures is expected to dramatically rise during the next few decades. Older patients are much more susceptible to fracture at any given bone mineral density (BMD) than are younger patients because of various factors, including the quality of aging bone, which involves more than BMD. Suppression of increased bone turnover by antiresorptive therapies, even with only small changes in BMD, can reduce fracture risk, especially in the lumbar spine. Bisphosphonate treatment can significantly reduce vertebral and nonvertebral fractures, including hip fractures, even in the very elderly. Prospective analyses show that risedronate therapy consistently and significantly reduces the risk of new morphometric vertebral fractures after 1 year in postmenopausal women. Post hoc analyses report significant reductions in the risk of 1 new clinical vertebral fracture after 6 months of risedronate therapy and after 1 year of alendronate therapy. Oral raloxifene therapy and salmon calcitonin nasal spray therapy have been shown to reduce the risk of vertebral fracture after 3 and 5 years, respectively, and post hoc data show a significant reduction in clinical vertebral fracture risk at 1 year with raloxifene use. However, neither raloxifene therapy nor calcitonin therapy reduce the risk of nonvertebral and hip fractures at currently approved doses. Bisphosphonates have been shown to be safe and efficacious with 7 years' risedronate sodium and 10 years' alendronate sodium data published, and bisphosphonates reduce bone turnover and increase BMD to a greater degree than raloxifene and calcitonin, which may partly account for their nonvertebral and hip fracture reduction effect. Therefore, bisphosphonate therapy with risedronate or alendronate should be considered in patients with low BMD at the hip and in older patients with osteoporosis and osteopenia, particularly those with an existing fracture. SN - 0003-9926 UR - https://www.unboundmedicine.com/medline/citation/14557222/Aging_bone_and_osteoporosis:_strategies_for_preventing_fractures_in_the_elderly_ L2 - https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/vol/163/pg/2237 DB - PRIME DP - Unbound Medicine ER -