TREATMENT OF OSTEOPOROSIS IN THE ELDERLY

The treatment of osteoporosis in subjects older than 65, defined by Al bright and Reifenstein(2) as ''senile osteoporosis,'' requires a syste matic approach that entails both short- and long-term considerations, an understanding of the needs and circumstances of the individual pati ent, and a familiarity with the pathophysiology of osteoporosis and of the treatment available. The evidence of clinical trials is of limite d value both because most of them have been conducted on normal postme nopausal women and because they take little or no account of the appar ent risk factors operating in different patients. The treatment option s described in this article are therefore based more on first principl es and clinical experience than on clinical trials. Osteoporosis repre sents a deficiency of whole bone, summed up in Albright and Reifenstei n's elegant phrase that there is ''too little bone in the bone.''(2) W ith the advent of bone densitometry, we now equate this definition wit h low bone mineral density (BMD), bearing in mind that it refers to or gan rather than tissue density and takes no account of osteomalacia. A low bone density may be genetic in origin or arise during growth, rem ain present but silent during maturity, and become clinically apparent only when routine densitometry or fracture brings it to light. Altern atively, and perhaps more often, bone density may be perfectly normal during young adult life but be subject to accelerated loss during agin g and so present as vertebral or hip fracture later.(75) In both scena rios, it is the low bone density that increases the fracture risk.