Skip Navigation
Menu
Editorials |18 November 2014

Comparative Effectiveness of Pharmacologic Treatments to Prevent Fractures: Is This All We Need to Know?

Heike A. Bischoff-Ferrari, MD, DrPH; Otto Meyer, MD

Article, Author, and Disclosure Information
Author, Article, and Disclosure Information
This article was published online first at www.annals.org on 9 September 2014.
  • From Geriatric Clinic, University Hospital Zurich, Centre on Aging and Mobility, University of Zurich, and City Hospital Waid, Zurich, Switzerland.

    Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-1942.

    Requests for Single Reprints: Heike A. Bischoff-Ferrari, MD, DrPH, Geriatric Clinic, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; e-mail, Heike.Bischoff@usz.ch.

    Current Author Addresses: Drs. Bischoff-Ferrari and Meyer: Geriatric Clinic, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.

×
FULL TEXT
Nearly 75% of all osteoporotic fractures occur among adults aged 65 years or older, contributing significantly to illness and death in the senior population. After age 75 years, hip fractures are the most frequent, and severe fractures cause permanent functional impairment in 50%, loss of autonomy in 30%, and death in 15% to 20% of cases. The exponential increase in hip fractures after age 75 years translates into an estimated 1 in 3 women and 1 in 6 men who will have a hip fracture by their 90th year. Likewise, other osteoporotic fractures, including those of the spine, show a steep increase with age (1).
The strong effect of age on fracture incidence and the aging of the populations in most Western countries warrant the inclusion of persons aged 80 years or older in clinical trials of pharmacologic treatments for the prevention of fractures. However, to date, few clinical trials have included very elderly persons, and in clinical practice, they rarely receive these treatments (2). In general, the systematic exclusion of very elderly persons from clinical trials is driven by the concern that comorbid conditions may camouflage a benefit of the intervention or that medication risks may be increased in persons with an increased likelihood of impaired kidney and gastrointestinal function. For the common pharmacologic treatments to prevent fractures (bisphosphonates, denosumab, and teriparatide), competing nonskeletal risk factors for fractures, such as gait impairment and falls, are a concern because they are not addressed by these treatments....
FULL TEXT
PDF
Not Available
Citations
Citation

Bischoff-Ferrari HA, Meyer O. Comparative Effectiveness of Pharmacologic Treatments to Prevent Fractures: Is This All We Need to Know?. Ann Intern Med. 2014;161:755–756. doi: https://doi.org/10.7326/M14-1942

Download citation file:

© 2020

×
Permissions

Published: Ann Intern Med. 2014;161(10):755-756.

DOI: 10.7326/M14-1942

4 Citations

Related Articles
Comparative Effectiveness of Pharmacologic Treatments to Prevent Fractures: An Updated Systematic Review
Annals of Internal Medicine; 161 (10): 711-723
Benefits and Harms of Osteoporosis Medications in Patients With Chronic Kidney Disease: A Systematic Review and Meta-analysis
Annals of Internal Medicine; 166 (9): 649-658
Pharmacologic Treatment of Low Bone Density or Osteoporosis to Prevent Fractures: A Clinical Practice Guideline from the American College of Physicians
Annals of Internal Medicine; 149 (6): 404-415
Bone Health and Bone-Targeted Therapies for Nonmetastatic Prostate Cancer: A Systematic Review and Meta-analysis
Annals of Internal Medicine; 167 (5): 341-350
View MoreView Less

Journal Club
Review: Teriparatide reduces fractures in postmenopausal women with osteoporosis
Annals of Internal Medicine; 157 (6): JC3-4
Tibolone reduced risk for fractures and breast cancer but increased risk for stroke in older women with osteoporosis
Annals of Internal Medicine; 149 (10): JC5-8
In postmenopausal women with osteoporosis, romosozumab followed by alendronate reduced fractures vs alendronate alone
Annals of Internal Medicine; 168 (2): JC3
Review: Osteoporosis drugs may improve BMD and reduce fractures in some patients with CKD
Annals of Internal Medicine; 167 (4): JC19
View MoreView Less

Related Point of Care
Osteoporosis
Annals of Internal Medicine; 167 (3): ITC17-ITC32
Osteoporosis
Annals of Internal Medicine; 155 (1): ITC1-1
Hip Fracture
Annals of Internal Medicine; 155 (11): ITC6-1
View MoreView Less

Related Topics
Endocrine and Metabolism
Healthcare Delivery and Policy
Metabolic Bone Disorders
Prevention/Screening

Endocrine and Metabolism, Healthcare Delivery and Policy, Metabolic Bone Disorders, Prevention/Screening.

PubMed Articles
Biomechanical and Clinical Comparative Study of the New Elastic Stable Intramedullary Nailing "MJ-FLEX Orthofix".
J Pediatr Orthop 2020;40(3):149-155.
Three-dimensional-Printed Computed Tomography-Based Bone Models for Spine Surgery Simulation.
Simul Healthc 2020;15(1):61-66.
View More

Results provided by: PubMed

CONTINUE WITH LIMITED ACCESS
Annals of Internal Medicine
To receive access to the full text of freely available articles, alerts, and more. You will be directed to acponline.org to complete your registration.
×
acp link acp
silverchair link silverchair

Copyright © 2020 American College of Physicians. All Rights Reserved.

Print ISSN: 0003-4819 | Online ISSN: 1539-3704

Privacy Policy

|

Conditions of Use

This site uses cookies. By continuing to use our website, you are agreeing to our privacy policy. | Accept
×

You need a subscription to this content to use this feature.

×
PDF Downloads Require Access to the Full Article.
Annals of Internal Medicine
To receive access to the full text of freely available articles, alerts, and more. You will be directed to acponline.org to complete your registration.
×
Access to this Free Content Requires Users to be Registered and Logged In. Please Choose One of the Following Options
Annals of Internal Medicine
To receive access to the full text of freely available articles, alerts, and more. You will be directed to acponline.org to complete your registration.
×