Treatment Considerations for Severe Osteoporosis in Older Adults.

Harnish P Patel, Mark Baxter, Nicola Smith, Stephen Lim, Heidi See, Emma Gowling, Evie Boswell, Pritti Aggarwal, Katherine King

Journal: Drugs & aging 2025;42(5):395-412

PMID: 40234371

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Abstract

Osteoporosis, a chronic metabolic bone disease, increases the predisposition to fragility fractures and is associated with considerable morbidity, high health care cost as well as mortality. An elevation in the rate of incident fragility fractures will be observed proportional with the increase in the number of older people worldwide. Severe osteoporosis is currently defined as having a bone density determined by dual-energy X-ray absorptiometry that is more than 2.5 standard deviations (SD) below the young adult mean with one or more past fractures due to osteoporosis. Nutrition, physical activity and adequate vitamin D are essential for optimal bone strength throughout life. Hormone (oestrogen/sex steroid) status is also a major determinant of bone health. This review explores mechanisms involved in bone homeostasis, followed by the assessment and management of severe osteoporosis, including an overview of several treatment options in older people that range from anti-resorptive to anabolic therapies.

Address: Medicine for Older People, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK.; Living Well Partnership, Southampton, UK.; School of Primary Care, Population Sciences and Medical Education, University of Southampton, University Road, Highfield, Southampton, SO17 1BJ, UK.; Medicine for Older People, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK.; Academic Geriatric Medicine, University of Southampton, Southampton General Hospital, Tremona Road, Mailpoint 63, G Level West Wing, Southampton, SO16 6YD, UK.; NIHR Applied Research Collaboration, University of Southampton, Southampton, UK.; Medicine for Older People, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK.; Academic Geriatric Medicine, University of Southampton, Southampton General Hospital, Tremona Road, Mailpoint 63, G Level West Wing, Southampton, SO16 6YD, UK.; Medicine for Older People, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK. [email protected].; Academic Geriatric Medicine, University of Southampton, Southampton General Hospital, Tremona Road, Mailpoint 63, G Level West Wing, Southampton, SO16 6YD, UK. [email protected].; NIHR Biomedical Research Centre, University Hospital and University of Southampton, Tremona Road, Southampton, SO16 6YD, UK. [email protected].

DOI: 10.1007/s40266-025-01205-5