Management of Osteoporosis in Older People

Osteoporosis is characterised by low bone mass and microarchitectural deterioration of bone tissue leading to enhanced bone fragility and a consequent increase in fracture risk. Osteoporosis and fracture risk increase exponentially in postmenopausal women. Osteoporosis is under‐diagnosed and under‐treated and advancing age is a risk factor for under‐management. Osteoporosis management in older people (75 years and over) must focus on non‐pharmacological and pharmacological interventions. The aim of treatment is to reduce morbidity and mortality associated with the first fracture and prevent subsequent fractures. Successful non‐pharmacological measures include falls risk assessment and management, participation in exercise programs and the use of hip protectors. Pharmacotherapies such as calcium, vitamin D, alendronate, risedronate, zoledronic acid, teriparatide and strontium ranelate are safe in older people and significantly reduce fractures, especially vertebral fractures. There is less evidence for risk reduction in non‐vertebral and hip fractures, which are more relevant in older people. The body of evidence in this cohort is small and further studies are needed to provide more evidence.