F Jakob1, L Seefried, M Schwab. 1. Orthopädische Klinik, Zentrum für Muskuloskelettale Forschung, Universität Würzburg, Brettreichstr. 11, 97074, Würzburg, Deutschland, f-jakob.klh@uni-wuerzburg.de.
Abstract
BACKGROUND: Osteoporosis is an age-associated disease, which is influenced by genetic, epigenetic and environmental factors. AIM: This article examines the evidence for specific aspects in osteoporosis diagnosis and management in higher age groups. MATERIAL AND METHODS: The study was based on extraction of data from literature databases and from the guidelines of the "Dachverband Osteologie" (DVO, Governing Body for Osteology). RESULTS: Age is a high risk factor for osteoporosis. Vitamin D insufficiency and reduced calcium absorption are common in the elderly. Loss of bone and muscle develop in a vicious circle of immobilization caused by underlying diseases. In addition deficits in cognition and coordination promote falls and fragility fractures. Clinical risk assessment including geriatric test batteries is recommended in all women > 70 and men > 80 years of age. Specific medication is indicated if the 10-year fracture risk exceeds 30 %, where in women > 75 and in men > 85 years of age bone density measurement can be relinquished. There is good evidence for the efficacy of antiosteoporotic medication even for the elderly. Prevention of falls requires multimodal management to enhance muscle power and coordination. It is essential to improve underlying cardiovascular, pulmonary and neurological diseases while critically evaluating the necessity of medication that boosts the risk of falls and fractures. There is good evidence for age and disease-adapted exercise programs such as Tai-Chi. Treating osteoporosis reduces the fracture risk, improves the quality of life, maintains independence and decreases mortality. CONCLUSION: Treating osteoporosis in the elderly is strongly recommended. Multimodal management and medication according to guidelines can be very successful, given that interdisciplinary and geriatric concepts consider the specific needs of the elderly population.
BACKGROUND:Osteoporosis is an age-associated disease, which is influenced by genetic, epigenetic and environmental factors. AIM: This article examines the evidence for specific aspects in osteoporosis diagnosis and management in higher age groups. MATERIAL AND METHODS: The study was based on extraction of data from literature databases and from the guidelines of the "Dachverband Osteologie" (DVO, Governing Body for Osteology). RESULTS: Age is a high risk factor for osteoporosis. Vitamin Dinsufficiency and reduced calcium absorption are common in the elderly. Loss of bone and muscle develop in a vicious circle of immobilization caused by underlying diseases. In addition deficits in cognition and coordination promote falls and fragility fractures. Clinical risk assessment including geriatric test batteries is recommended in all women > 70 and men > 80 years of age. Specific medication is indicated if the 10-year fracture risk exceeds 30 %, where in women > 75 and in men > 85 years of age bone density measurement can be relinquished. There is good evidence for the efficacy of antiosteoporotic medication even for the elderly. Prevention of falls requires multimodal management to enhance muscle power and coordination. It is essential to improve underlying cardiovascular, pulmonary and neurological diseases while critically evaluating the necessity of medication that boosts the risk of falls and fractures. There is good evidence for age and disease-adapted exercise programs such as Tai-Chi. Treating osteoporosis reduces the fracture risk, improves the quality of life, maintains independence and decreases mortality. CONCLUSION: Treating osteoporosis in the elderly is strongly recommended. Multimodal management and medication according to guidelines can be very successful, given that interdisciplinary and geriatric concepts consider the specific needs of the elderly population.
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