IBMS BoneKEy | Perspective
Fracture prevention in frail older adults: Why, when and how
Cathleen S Colón-Emeric
DOI:10.1138/20080349
Abstract
Frail, older adults are at the highest risk of fracture, but osteoporosis treatment decisions are complicated by this group's limited life expectancy, co-morbidities, and under-representation in clinical trials. This Perspective attempts to review the rationale for fracture prevention, provide a framework for making individual osteoporosis treatment decisions, and discuss practical issues in preventing fractures in frail older adults. While clinical trial evidence is not optimal, available data does suggest that osteoporosis therapies have similar safety, efficacy, and cost-effectiveness even at older ages and in the presence of common co-morbidities. Using life tables and validated fracture prediction tools, fracture risk in the remaining years can be estimated. Considering the lag time to efficacy, patient compliance and preference, and incorporating non-pharmacologic fracture prevention strategies such as fall prevention, appropriate treatment decisions can be made for this high risk population.
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