Osteoporosis in the elderly: practical approach to prevention and treatment

A major public health issue: Osteoporosis in the elderly limits independenc e 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 t o reduce the risk of fracture. Risk can best be assessed from personal hist ory of fracture or with bone densitometry. Therapeutic methods: Non-drug methods are based on physical activity diet r eduction of alcohol intake or smoking, and limiting the risk of fails. Drug s used include calcium, vitamin D, hormone replacement therapy and bisphosp honates. Therapeutic strategy: Prevention programs should focus first on non-drug me thods, 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 a re widely used. Drugs inhibiting bone resorption, e.g. bisphosphonates, are added on for curative treatment. After the age of 80 years, the calcium vi tamin 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 difficul t to assess treatment efficacy on an individual basis. (C) 2001, Masson, Pa ris.