Pharmacological treatment of osteoporosis in the oldest old.

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Term Occurence Count Dictionary
Denosumab 6 endocrinologydiseasesdrugs
Teriparatide 5 endocrinologydiseasesdrugs
hyperparathyroidism 1 endocrinologydiseases
osteoporosis 53 endocrinologydiseases
strontium ranelate 9 endocrinologydiseasesdrugs
zoledronic acid 12 endocrinologydiseasesdrugs

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Select Drug Character Offset Drug Term Instance
Denosumab 21664 is the greater influence of nonskeletal risk factors for hip fractures with increasing age.[52],[56] Denosumab Denosumab has been established as a safe and effective intervention by the FREEDOM trial by Cummings
Denosumab 21673 greater influence of nonskeletal risk factors for hip fractures with increasing age.[52],[56]Denosumab Denosumab has been established as a safe and effective intervention by the FREEDOM trial by Cummings et al, with
Denosumab 31668 specified that this therapy is contraindicated in patients with a creatinine clearance <35 mL/min.[73] Denosumab In general, denosumab was well tolerated by the subjects in the FREEDOM trial.[59] In the post hoc analysis
Denosumab 40527 Pinteract <70 and≥75 years = SSHR =0.73; 95%CI =0.60–0.90;P=0.002;Pinteract <70 and ≥75 years = NS Denosumab Postmenopausal women aged <80 yearsFREEDOM (3 years)[59]Women aged 60–90 years with T-score <−2.5,
Denosumab 43630 currently available osteoporosis treatments in very elderly womenAERisedronate[52]Zoledronic acid[56] Denosumab [60]Strontium ranelate 3 years[65]–5 years[5]Teriparatide[67]PlaceboRisedronateP-valuePlaceboZoledronic
Denosumab 43763 years[65]–5 years[5]Teriparatide[67]PlaceboRisedronateP-valuePlaceboZoledronic acidP-valuePlacebo Denosumab P-valueReferencePlaceboSRP-valuePlaceboTeriparatideP-value≥1 adverse event89.7%90.9%NS91.8%92.6%0.3493.0%93.4%0.86Seeman
Teriparatide 25226 both vertebral and nonvertebral fractures in persons aged ≥80 years treated with strontium ranelate. Teriparatide Daily subcutaneous injections of teriparatide, a biosynthetic PTH analog, reduces the risk of vertebral
Teriparatide 34162 history of ischemic heart disease, peripheral arterial disease, and/or cerebrovascular disease.[78] Teriparatide In the post hoc analysis of the FPT in women aged ≥75 years,[67] there was no increase in adverse events
Teriparatide 42191 years1,48983.5RR =0.69; 95%CI =0.52–0.92RR =0.76; 95%CI =0.50–1.15; (not powered)RR =0.73; 95%CI =0.57–0.95 Teriparatide Postmenopausal women aged <80 yearsFPT (21 months)[66]Postmenopausal women with 1 moderate or 2 mild
Teriparatide 43686 elderly womenAERisedronate[52]Zoledronic acid[56]Denosumab[60]Strontium ranelate 3 years[65]–5 years[5] Teriparatide [67]PlaceboRisedronateP-valuePlaceboZoledronic acidP-valuePlaceboDenosumabP-valueReferencePlaceboSRP-valuePlaceboTeriparatideP-value≥1
Teriparatide 43811 years[5]Teriparatide[67]PlaceboRisedronateP-valuePlaceboZoledronic acidP-valuePlaceboDenosumabP-valueReferencePlaceboSRP-valuePlacebo Teriparatide P-value≥1 adverse event89.7%90.9%NS91.8%92.6%0.3493.0%93.4%0.86Seeman et al[65]Seeman et al[5]89.2%90%86.8%88%NSNS91%83%NSNausea8.3%9.4%NS5.9%7.5%0.05Seeman
strontium ranelate 23698 nonvertebral fracture risk, including hip fracture risk.Strontium ranelateThe antifracture efficacy of strontium ranelate , which has a dual mode of action of both increasing bone formation and reducing bone resorption, was
strontium ranelate 24739 was lower in women aged ≥80 years than in younger women. This is because a similar RR reduction of strontium ranelate in both age-groups will avert more fractures in the older age-group that has a higher baseline fracture
strontium ranelate 25207 reduction in the risk of both vertebral and nonvertebral fractures in persons aged ≥80 years treated with strontium ranelate .TeriparatideDaily subcutaneous injections of teriparatide, a biosynthetic PTH analog, reduces the risk
strontium ranelate 32623 ranelateThe preplanned pooled analysis of SOTI and TROPOS in women aged 80–100 years showed that strontium ranelate safely reduces the risk of vertebral and nonvertebral fractures during 3 and 5 years.[5],[65] After
strontium ranelate 32848 years, headaches, deep venous thromboembolic events, and seizures were significantly more common in the strontium ranelate group, but no case of allergic reaction was reported. Treatment with strontium ranelate increased the
strontium ranelate 32936 common in the strontium ranelate group, but no case of allergic reaction was reported. Treatment with strontium ranelate increased the number and quality of remaining years of life.[5] However, in patients who were frail
strontium ranelate 33522 finding of an increased risk of cardiac events, including myocardial infarction, has limited the use of strontium ranelate in the very elderly.[77] This safety concern emerged from new safety data from additional clinical studies
strontium ranelate 33784 osteoarthritis. The analysis of the cardiovascular data led the EMA to recommend a change in the indication of strontium ranelate .[77] Strontium ranelate remains a useful therapeutic alternative in elderly patients with severe osteoporosis
strontium ranelate 45357 significance.Abbreviations: AE, adverse event; DVT, deep venous thromboembolic events; NS, not significant; SR, strontium ranelate ; SS, statistically significant
zoledronic acid 19525 therapy is prescribed have discontinued the treatment after 1 year.[55] These factors make parenteral zoledronic acid an attractive choice in the treatment of osteoporosis, especially in the elderly and disabled, demented,
zoledronic acid 19870 Incidence with Zoledronic Acid Once Yearly – Pivotal Fracture Trial (HORIZON-PFT) has shown that zoledronic acid is an effective treatment in postmenopausal osteoporotic women (mean age =73 years), with, after 3 years,
zoledronic acid 20244 (HORIZON-RFT) in patients with a surgical repair of a low-trauma hip fracture (mean age =74.4 years), zoledronic acid significantly reduced the risk of new vertebral and nonvertebral fractures.[58]In 2010, Boonen et al
zoledronic acid 20749 After 3 years, the incidence of vertebral and nonvertebral fracture was significantly lower in the zoledronic acid group than in the placebo group (HR =0.34; 95% CI =0.21–0.55; P<0.001 and HR =0.73; 95% CI =0.6–0.9;
zoledronic acid 21018 comparable with the RR reduction in subjects aged <75 years in the HORIZON-PFT and HORIZON-RFT, presenting zoledronic acid as an effective treatment option for the prevention of vertebral and nonvertebral fractures in the elderly.
zoledronic acid 21227 in the elderly. However, in patients aged ≥75 years, the incidence of hip fractures was lower with zoledronic acid , but this did not meet statistical significance (HR =0.82; 95% CI =0.56–1.2; P=0.297), contrary to
zoledronic acid 23133 bisphosphonates where no significant reduction in hip fracture risk could be shown for risedronate and zoledronic acid in the elderly, although, as mentioned, this might be explained by the lack of statistical power in
zoledronic acid 30454 burden in the very elderly, which may lead to lower compliance. An intravenous bisphosphonate, such as zoledronic acid , is an alternative in the very elderly that cannot tolerate or adhere to oral bisphosphonates.Zoledronic
zoledronic acid 30834 days of study drug infusion, such as pyrexia, myalgia, and influenza-like illness, was higher with zoledronic acid than with placebo. However, the incidence of serious adverse events and death were similar in the two
zoledronic acid 31138 the HORIZON-PFT,[57] which could be a concern in the elderly, was not observed in the very elderly on zoledronic acid .[56]In this post hoc analysis, which excluded individuals with a creatinine clearance <30 mL/min, the
zoledronic acid 31347 mL/min, the incidence of renal events, such as an increase in creatinine clearance, was similar in the zoledronic acid and the placebo groups.[56] There were no data in patients with severe kidney impairment. Due to some
zoledronic acid 31514 patients with severe kidney impairment. Due to some very rare cases of acute renal failure following zoledronic acid , the European Medicine Agency (EMA) specified that this therapy is contraindicated in patients with
Select Disease Character Offset Disease Term Instance
hyperparathyroidism 8603 insufficient dietary calcium intake. This stimulates the secretion of parathyroid hormone (PTH; age-related hyperparathyroidism ), which enhances bone turnover, advances osteoporosis, and increases fracture risk.[20] Poor vitamin
osteoporosis 67 Title: Clinical Interventions in AgingPharmacological treatment of osteoporosis in the oldest oldA VandenbrouckeFP LuytenJ FlamaingE Gielen1Clinical Department of Internal Medicine,
osteoporosis 686 global prevalence of osteoporotic fractures will increase with the aging of the population. In old age, osteoporosis is associated with a substantial burden in terms of morbidity and mortality. Nevertheless, osteoporosis
osteoporosis 790 osteoporosis is associated with a substantial burden in terms of morbidity and mortality. Nevertheless, osteoporosis in old age continues to be underdiagnosed and undertreated. This may, at least partly, be explained
osteoporosis 961 undertreated. This may, at least partly, be explained by the fact that evidence of the antifracture efficacy of osteoporosis treatments comes mainly from randomized controlled trials in postmenopausal women with a mean age of
osteoporosis 1222 subgroup analyses of these landmark trials have been published investigating the efficacy and safety of osteoporosis treatment in the very elderly. Based on this evidence, this narrative review discusses the pharmacological
osteoporosis 1356 elderly. Based on this evidence, this narrative review discusses the pharmacological management of osteoporosis in the oldest old (≥80 years). Because of the high prevalence of calcium and/or vitamin D deficiency
osteoporosis 1537 calcium and/or vitamin D deficiency in old age, these supplements are essential in the management of osteoporosis in the elderly people. Adding antiresorptive or anabolic treatments or combinations, thereof, reduces
osteoporosis 1735 thereof, reduces the risk of vertebral fractures even more, at least in the elderly with documented osteoporosis . The reduction of hip fracture risk by antiresorptive treatments is less convincing, which may be explained
osteoporosis 2214 baseline fracture risk. Therefore, the elderly will benefit more of treatment. In addition, current osteoporosis therapies also appear to be safe in the elderly. Although more research is required to further clarify
osteoporosis 2344 appear to be safe in the elderly. Although more research is required to further clarify the effect of osteoporosis drugs in the elderly, especially with respect to hip fractures, there is currently sufficient evidence
osteoporosis 2514 fractures, there is currently sufficient evidence to initiate appropriate treatment in the elderly with osteoporosis and osteoporotic fractures.Osteoporosis and osteoporotic fractures in old age: a challengeAlong with
osteoporosis 3070 bone fragility and fracture risk.[1] The incidence of osteoporotic fractures increases with age, and osteoporosis in old age is a challenge because of the extent of the problem and the significant burden in terms of
osteoporosis 4112 they become increasingly at a risk of hip fracture and other non-vertebral fractures.[6]The burden of osteoporosis will only increase in the future because of the aging of the population. In Belgium, it is expected
osteoporosis 4612 considered as frail elderly, with a high prevalence of underlying comorbidities.[8] Indeed, in old age, osteoporosis and osteoporotic fractures tend to occur in a particularly frail subset of population.[9] This frailty
osteoporosis 5456 because of the underlying comorbidities in these frail elderly.[14]Underdiagnosis and undertreatment of osteoporosis in old ageDespite the increasing evidence for the high prevalence and severity of osteoporosis in the
osteoporosis 5551 undertreatment of osteoporosis in old ageDespite the increasing evidence for the high prevalence and severity of osteoporosis in the elderly, osteoporosis continues to be underdiagnosed and undertreated in old age. Even in older
osteoporosis 5580 ageDespite the increasing evidence for the high prevalence and severity of osteoporosis in the elderly, osteoporosis continues to be underdiagnosed and undertreated in old age. Even in older individuals admitted to the
osteoporosis 5864 the available treatment options, particularly in women aged >80 years.[15]Since elderly persons with osteoporosis constitute a particularly frail subset of population, there is an urgent requirement for convenient
osteoporosis 6042 urgent requirement for convenient treatment options with documented efficacy and safety. Available osteoporosis treatments should be proven to be effective in the elderly, not only against vertebral fractures but
osteoporosis 6274 against nonvertebral fractures, as these account for most of the morbidity and mortality associated with osteoporosis in old age. Treatment options should also be proven to be safe in the elderly who are frail, with underlying
osteoporosis 6467 who are frail, with underlying comorbidities, and at an increased risk of adverse events.Treatment of osteoporosis in the oldest oldIn the following sections, the existing evidence on efficacy and safety of the currently
osteoporosis 6618 sections, the existing evidence on efficacy and safety of the currently available treatment options for osteoporosis in the oldest old (≥80 years) is evaluated. Of note, nonpharmacological interventions such as fall
osteoporosis 6798 nonpharmacological interventions such as fall prevention strategies play an essential role in the management of osteoporosis , also in the elderly, but are outside the scope of this manuscript.Calcium and vitamin D supplementation
osteoporosis 8664 parathyroid hormone (PTH; age-related hyperparathyroidism), which enhances bone turnover, advances osteoporosis , and increases fracture risk.[20] Poor vitamin D status may also increase fracture risk by increasing
osteoporosis 13554 become an essential component to reduce bone loss and fracture risk in elderly individuals. However, osteoporosis treatment, on top of calcium and vitamin D, should be considered in the elderly with osteoporosis and
osteoporosis 13652 However, osteoporosis treatment, on top of calcium and vitamin D, should be considered in the elderly with osteoporosis and osteoporotic fractures. In the following section, the evidence on the efficacy (Table 1) and safety
osteoporosis 13806 following section, the evidence on the efficacy (Table 1) and safety (Table 2) of the currently available osteoporosis treatments in the oldest old is discussed.Pharmacological osteoporosis treatment in old ageEfficacy
osteoporosis 13877 2) of the currently available osteoporosis treatments in the oldest old is discussed.Pharmacological osteoporosis treatment in old ageEfficacy of osteoporosis drugsAlendronateThe efficacy of alendronate as an antiresorptive
osteoporosis 13922 treatments in the oldest old is discussed.Pharmacological osteoporosis treatment in old ageEfficacy of osteoporosis drugsAlendronateThe efficacy of alendronate as an antiresorptive agent was established by the Fracture
osteoporosis 16387 increased substantially by quartile of age.These results illustrated that alendronate is an effective osteoporosis treatment in the elderly with proven vertebral and hip fracture reduction and also indicated that the
osteoporosis 17917 trials by Boonen et al.[52] This analysis included 1,392 women aged ≥80 (mean age =83 years) with osteoporosis (T-score <−2.5 or at least one prevalent vertebral fracture). The risk of vertebral fractures was
osteoporosis 19582 1 year.[55] These factors make parenteral zoledronic acid an attractive choice in the treatment of osteoporosis , especially in the elderly and disabled, demented, or frail patients in whom polypharmacy, nonadherence,
osteoporosis 20552 elderly.[56] Inclusion criteria were postmenopausal women aged ≥75 years (mean age =79.4 years) with osteoporosis (T-score ≤−2.5 at the femoral neck or ≥1 prevalent vertebral or hip fracture). After 3 years,
osteoporosis 26861 not affect the efficacy of teriparatide in preventing vertebral and nonvertebral fractures.Safety of osteoporosis drugsThe large pivotal fracture trials have shown that, in general, osteoporosis treatment is well tolerated,
osteoporosis 26942 fractures.Safety of osteoporosis drugsThe large pivotal fracture trials have shown that, in general, osteoporosis treatment is well tolerated, with adverse events that tend to be mild to moderate. For an in-depth review
osteoporosis 27104 that tend to be mild to moderate. For an in-depth review of the adverse reactions in postmenopausal osteoporosis , the present study refers to some recent overviews.[68],[69] However, there are limited data on how
osteoporosis 27822 safety.[71]In the next section, the available evidence on the safety of the currently available pharmacological osteoporosis therapies in the very elderly is discussed. Table 2 summarizes the most relevant adverse events reported
osteoporosis 30254 individuals, inappropriate administration increases the risk of these adverse events.[71] Furthermore, oral osteoporosis medication (together with calcium and vitamin D supplementation) increases the pill burden in the very
osteoporosis 33656 elderly.[77] This safety concern emerged from new safety data from additional clinical studies in male osteoporosis and osteoarthritis. The analysis of the cardiovascular data led the EMA to recommend a change in the
osteoporosis 33900 ranelate.[77] Strontium ranelate remains a useful therapeutic alternative in elderly patients with severe osteoporosis who are unable to take other osteoporosis treatments, but it is contraindicated in those with uncontrolled
osteoporosis 33942 useful therapeutic alternative in elderly patients with severe osteoporosis who are unable to take other osteoporosis treatments, but it is contraindicated in those with uncontrolled hypertension, established, current
osteoporosis 35007 the daily subcutaneous administration, which may be a burden for older patients.Summary of safety of osteoporosis drugsData from the post hoc and preplanned analyses in the very elderly showed that currently available
osteoporosis 35124 drugsData from the post hoc and preplanned analyses in the very elderly showed that currently available osteoporosis therapies are relatively safe, with no significant differences in the incidence of most adverse events
osteoporosis 35699 is one of the most common age-associated conditions and a major cause of fracture risk. In old age, osteoporosis and osteoporotic fractures tend to occur in a particularly frail subset of population. The treatment
osteoporosis 35816 osteoporotic fractures tend to occur in a particularly frail subset of population. The treatment of osteoporosis is of particular concern in the elderly because of the substantial burden of osteoporotic fractures
osteoporosis 36011 osteoporotic fractures in terms of morbidity, mortality, and economic cost.It is never too late to treat osteoporosis , not even in elderly patients with the most severe degree of osteoporosis and who have already sustained
osteoporosis 36085 is never too late to treat osteoporosis, not even in elderly patients with the most severe degree of osteoporosis and who have already sustained osteoporotic fractures. Calcium and vitamin D supplementation is an essential
osteoporosis 36257 Calcium and vitamin D supplementation is an essential but not sufficient component of the management of osteoporosis in old age. Adding osteoporosis treatment appears to be safe and reduces the risk of fractures even
osteoporosis 36289 supplementation is an essential but not sufficient component of the management of osteoporosis in old age. Adding osteoporosis treatment appears to be safe and reduces the risk of fractures even more, at least in older individuals
osteoporosis 36422 be safe and reduces the risk of fractures even more, at least in older individuals with documented osteoporosis and for vertebral fractures, and possibly also for hip fractures. Osteoporosis treatment may even be
osteoporosis 36593 fractures. Osteoporosis treatment may even be more effective in frail elderly patients with documented osteoporosis than in younger patients, with more fractures averted and even lower numbers to treat, ultimately leading
osteoporosis 36929 fractures compared with placebo in postmenopausal and very elderly women receiving the currently available osteoporosis treatmentsRCTIncluded participantsnMean age (years)Vertebral fracturesHip fracturesNonvertebral fracturesAlendronatePostmenopausal
osteoporosis 43549 VERT – North America.Table 2Summary of most relevant adverse events from the currently available osteoporosis treatments in very elderly womenAERisedronate[52]Zoledronic acid[56]Denosumab[60]Strontium ranelate

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