Bone Anabolic Treatment in Older Subjects: a narrative review.

Abstract

The combination of an increasing life expectancy and an increasing risk of fractures in the aging population collides with the still inadequate primary and secondary fracture prevention in Europe. Osteoporotic fractures have a major impact not only on morbidity, quality of life and mortality but also on healthcare costs. Therefore, an improvement of fracture prevention is warranted. Osteoanabolic drugs are particularly beneficial in patients with very high fracture risk and are recommended by numerous current guidelines as first-line treatment options. Osteoanabolic treatment leads to a significant improvement of bone mineral density (BMD), microstructure and biomechanics and a superiority compared to antiresorptive treatment options have been demonstrated in clinical trials. However, the application of these therapies in the geriatric population addresses specific questions regarding efficacy, safety in terms of comorbidities and feasibility regarding the route of administrations. This narrative review aims to explore the efficacy and safety profiles of the anabolic osteoporosis medications teriparatide, abaloparatide and romosozumab in older adults. Overall, data of this patient population from post hoc analyses show promising and comparable results regarding safety and the efficacy on fracture reduction and increase in BMD. However, data is limited and especially in romosozumab the contraindication in patients with a history of stroke or myocardial infarction should be kept in mind. Furthermore, a promising new anabolic oral treatment is currently under development and would further increase the armamentarium of osteoanabolic options. Osteoanabolic agents show positive effects on fracture healing and perioperative management for instrumentation surgery. Therefore, osteoanabolic therapies should be individually evaluated in all patients with a very high risk for fracture, especially in the context of sequential therapy, since fracture risk declines rapidly, which is warranted not only for the individual health outcome but also for socioeconomic aspects.