Evaluating the Evidence Behind Treating Osteoporosis in the Oldest Adults.

Objective: To review clinical trial data supporting the use of drugs to treat osteoporosis in the oldest adults, 74 years of age and older.

Data sources: The PubMed database (September 1969-June 2017) was searched utilizing the following Medical Subject Headings terms: osteoporosis, postmenopausal, aged, 80 and over, and fractures, bone, in combination with diphosphonates, denosumab, parathyroid hormone, raloxifene, and calcitonin.

Study selection/data extraction: An initial search revealed 119 results, of which 18 clinical trials were included. Studies were selected that featured a randomized controlled design, fractures reported as a key outcome, and included subjects within the desired age range.

Data synthesis: Osteoporosis is common among older adults, and with an increasingly aging population, it will be imperative to know how to best manage this condition. Sparse clinical evidence exists for the impact of osteoporosis treatments in the given age range, and no clinical trials have exclusively looked at this age group as the primary target.

Conclusion: Studies that included participants in this age group were found for alendronate, risedronate, zoledronic acid, denosumab, teriparatide, and abaloparatide. Efficacy appears to be maintained with advancing age for alendronate, zoledronic acid, denosumab, and teriparatide as demonstrated by post hoc analyses of pivotal trials. Alendronate has only demonstrated benefit in patients with previous vertebral fractures because of the study design of the trial. Abaloparatide showed improvement with treatment in the overall population, but age-specific analyses have not been published at this time.