Bisphosphonates benefit over-80s

Congress on Osteoporosis Treatment for elderly patients and questions for assessing fracture risk.

Treatment for the secondary prevention of osteoporosis is as successful in very elderly patients as it is in the 65-75 age group, according to the results of a sub-group analysis presented at the European Congress on Clinical and Economic Aspects of Osteoporosis in Vienna.

The analysis included data from more than 1,000 high-risk women aged 70-100 years. They had established osteoporosis and at least one prior vertebral fracture and were treated with the bisphosphonate risedronate (Actonel). Over 500 women were given placebo.

The results showed that women treated with the bisphosphonate had a 46 per cent reduction in their risk of hip fracture.

The patients were a sub-group included in the Hip Intervention Program (HIP) study, which involved 9,331 women followed up over three years.

These patients were aged 70-79 and had low femoral neck bone mineral density (BMD) or were 80 or over with low femoral neck BMD or a clinical risk factor for hip fracture.

All patients received 1,000mg of calcium and 500IU of vitamin D daily if their baseline levels were low.

Professor Tahir Masud, professor of musculoskeletal gerontology at the University of Derby and consultant physician at Nottingham City Hospital, said: 'It is reassuring that one of the first-line treatments for osteoporosis, the bisphosphonates, appear to be as effective in this older age group of women as in the women under 75 who have been the subjects of most of the clinical trials.

'Until now we have not had any evidence to support the use of bisphosphonates in women over 80. We now have data that bisphosphonate treatment is effective in older women.'

He said the sub-group analysis data was not as good as if it had been from a prospective study, but added that better data would be difficult to come by.

'It would be unethical to carry out a placebo-controlled trial in women at high risk of osteoporosis now,' he said.

The study also showed that older women should take vitamin D and calcium supplements to protect against fractures.


- Women who have had one hip fracture run four times risk of another one.

- One in five women who have a hip fracture are dead within a year.

- The risk of hip fracture rises substantially with age.

- Daily bisphosphonate reduces hip fracture in 70-100 year olds by 46%.

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