Loading...
 
Toggle Health Problems and D

Vitamin D can quickly deal with Osteoporosis in the very old – Europe working group review – July 2014

Management of osteoporosis of the oldest old.

Osteoporos Int. 2014 Jul 15. [Epub ahead of print]
Rizzoli R1, Branco J, Brandi ML, Boonen S, Bruyère O, Cacoub P, Cooper C, Diez-Perez A, Duder J, Fielding RA, Harvey NC, Hiligsmann M, Kanis JA, Petermans J, Ringe JD, Tsouderos Y, Weinman J, Reginster JY.
1Service of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland, Rene.Rizzoli at unige.ch.


This consensus article reviews the diagnosis and treatment of osteoporosis in geriatric populations. Specifically, it reviews the risk assessment and intervention thresholds, the impact of nutritional deficiencies, fall prevention strategies, pharmacological treatments and their safety considerations, the risks of sub-optimal treatment adherence and strategies for its improvement.

INTRODUCTION:
This consensus article reviews the therapeutic strategies and management options for the treatment of osteoporosis of the oldest old. This vulnerable segment (persons over 80 years of age) stands to gain substantially from effective anti-osteoporosis treatment, but the under-prescription of these treatments is frequent.

METHODS:
This report is the result of an ESCEO (European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis) expert working group, which explores some of the reasons for this and presents the arguments to counter these beliefs. The risk assessment of older individuals is briefly reviewed along with the differences between some intervention guidelines. The current evidence on the impact of nutritional deficiencies (i.e. calcium, protein and vitamin D) is presented, as are strategies to prevent falls. One possible reason for the under-prescription of pharmacological treatments for osteoporosis in the oldest old is the perception that anti-fracture efficacy requires long-term treatment. However, a review of the data shows convincing anti-fracture efficacy already by 12 months.

RESULTS:
The safety profiles of these pharmacological agents are generally satisfactory in this patient segment provided a few precautions are followed.

CONCLUSION:
These patients should be considered for particular consultation/follow-up procedures in the effort to convince on the benefits of treatment and to allay fears of adverse drug reactions, since poor adherence is a major problem for the success of a strategy for osteoporosis and limits cost-effectiveness.

PMID: 25023900


Publisher charges $28 for the study
Introduction
Ageing and age-related changes to the body
Osteoporosis in older individuals
Therapeutic approaches to osteoporosis: nutritional supplementation and vitamin D
Strategies to prevent falls in older individuals
Therapeutic approaches to osteoporosis: pharmacological strategies
The onset of anti-fracture efficacy
Safety of anti-osteoporotic drugs
Pain management
Optimising therapeutic adherence in osteoporosis
Conclusions on goals and challenges of osteoporosis treatment in the oldest old

References

  1. Chevalley T, Guilley E, Herrmann FR, Hoffmeyer P, Rapin CH, Rizzoli R (2007) Incidence of hip fracture over a 10-year period (1991–2000): reversal of a secular trend. Bone 40:1284–1289
  2. Abrahamsen B, van Staa T, Ariely R, Olson M, Cooper C (2009) Excess mortality following hip fracture: a systematic epidemiological review. Osteoporos Int 20:1633–1650
  3. Rizzoli R, Bruyere O, Cannata-Andia JB, Devogelaer J, Lyritis G, Ringe JD, Vellas B, Reginster J (2009) Management of osteoporosis in the elderly. Curr Med Res Opin 25:2373–2387
  4. OECD (2011) Health at a glance 2011: OECD indicators. OECD Publishing. doi:10.1787/health_glance-2011-en. Accessed 1 Feb 2013
  5. Rechel B, Grundy E, Robine JM, Cylus J, Mackenbach JP, Knai C, McKee M (2013) Ageing in the European Union. Lancet 381:1312–1322
  6. Administration of Aging (2012) A profile of older Americans: 2012. U.S. Department of Health and Human Services. http://www.aoa.gov/Aging_Statistics/Profile/index.aspx. Accessed 17 June 2013
  7. Roche JJ, Wenn RT, Sahota O, Moran CG (2005) Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study. BMJ. doi:10.1136/bmj.38643.663843.55
  8. Kannegaard PN, van der Mark S, Eiken P, Abrahamsen B (2010) Excess mortality in men compared with women following a hip fracture. National analysis of comedications, comorbidity and survival. Age Ageing 39:203–209
  9. Di Monaco M, Castiglioni C, Vallero F, Di Monaco R, Tappero R (2012) Sarcopenia is more prevalent in men than in women after hip fracture: a cross-sectional study of 591 inpatients. Arch Gerontol Geriatr 55:e48–e52
  10. Berry SD, Samelson EJ, Hannan MT, McLean RR, Lu M, Cupples LA, Shaffer ML, Beiser AL, Kelly-Hayes M, Kiel DP (2007) Second hip fracture in older men and women: the Framingham Study. Arch Intern Med 167:1971–1976
  11. Cauley JA, Lui LY, Barnes D, Ensrud KE, Zmuda JM, Hillier TA, Hochberg MC, Schwartz AV, Yaffe K, Cummings SR, Newman AB (2009) Successful skeletal aging: a marker of low fracture risk and longevity. the Study of Osteoporotic Fractures (SOF). J Bone Miner Res 24:134–143
  12. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA (2001) Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 56:M146–M156
  13. Tom SE, Adachi JD, Anderson FA Jr, Boonen S, Chapurlat RD, Compston JE, Cooper C, Gehlbach SH, Greenspan SL, Hooven FH, Nieves JW, Pfeilschifter J, Roux C, Silverman S, Wyman A, LaCroix AZ (2013) Frailty and fracture, disability, and falls: a multiple country study from the global longitudinal study of osteoporosis in women. J Am Geriatr Soc 61:327–334
  14. Macklai NS, Spagnoli J, Junod J, Santos-Eggimann B (2013) Prospective association of the SHARE-operationalized frailty phenotype with adverse health outcomes: evidence from 60+ community-dwelling Europeans living in 11 countries. BMC Geriatr. doi:10.1186/1471-2318-13-3
  15. Santos-Eggimann B, Cuenoud P, Spagnoli J, Junod J (2009) Prevalence of frailty in middle-aged and older community-dwelling Europeans living in 10 countries. J Gerontol A Biol Sci Med Sci 64:675–681
  16. Romero-Ortuno R, Walsh CD, Lawlor BA, Kenny RA (2010) A frailty instrument for primary care: findings from the Survey of Health, Ageing and Retirement in Europe (SHARE). BMC Geriatr 10:57
  17. Seeman E (1999) The structural basis of bone fragility in men. Bone 25:143–147
  18. Falahati-Nini A, Riggs BL, Atkinson EJ, O’Fallon WM, Eastell R, Khosla S (2000) Relative contributions of testosterone and estrogen in regulating bone resorption and formation in normal elderly men. J Clin Invest 106:1553–1560
  19. Clarke BL, Khosla S (2010) Physiology of bone loss. Radiol Clin N Am 48:483–495
  20. Ryan CS, Petkov VI, Adler RA (2011) Osteoporosis in men: the value of laboratory testing. Osteoporos Int 22:1845–1853
  21. Kanis JA, Bianchi G, Bilezikian JP, Kaufman JM, Khosla S, Orwoll E, Seeman E (2011) Towards a diagnostic and therapeutic consensus in male osteoporosis. Osteoporos Int 22:2789–2798
  22. Kanis JA, McCloskey EV, Johansson H, Cooper C, Rizzoli R, Reginster JY (2013) European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 24:23–57
  23. Kanis JA, Johnell O, Oden A, Dawson A, De LC, Jonsson B (2001) Ten year probabilities of osteoporotic fractures according to BMD and diagnostic thresholds. Osteoporos Int 12:989–995
  24. Schuit SC, van der Klift M, Weel AE, de Laet CE, Burger H, Seeman E, Hofman A, Uitterlinden AG, van Leeuwen JP, Pols HA (2004) Fracture incidence and association with bone mineral density in elderly men and women: the Rotterdam Study. Bone 34:195–202
  25. Kanis JA, Johansson H, Oden A, McCloskey EV (2012) The distribution of FRAX®-based probabilities in women from Japan. J Bone Miner Metab 30:700–705
  26. Hiligsmann M, Kanis JA, Compston J, Cooper C, Flamion B, Bergmann P, Body JJ, Boonen S, Bruyere O, Devogelaer JP, Goemaere S, Kaufman JM, Rozenberg S, Reginster JY (2013) Health technology assessment in osteoporosis. Calcif Tissue Int 93:1–14
  27. Kanis JA, Borgstrom F, Compston J, Dreinhofer K, Nolte E, Jonsson L, Lems WF, McCloskey EV, Rizzoli R, Stenmark J (2013) SCOPE: a scorecard for osteoporosis in Europe. Arch Osteoporos 8:144–0144
  28. Melton LJ III, Atkinson EJ, Achenbach SJ, Kanis JA, Therneau TM, Johansson H, Khosla S, Amin S (2012) Potential extensions of the US FRAX algorithm. J Osteoporos. doi:10.1155/2012/528790
  29. Berry SD, Ngo L, Samelson EJ, Kiel DP (2010) Competing risk of death: an important consideration in studies of older adults. J Am Geriatr Soc 58:783–787
  30. National Osteoporosis Foundation (2013) Clinician’s guide to prevention and treatment of osteoporosis. National Osteoporosis Foundation, Washington DC. http://www.nof.org/files/nof/public/content/resource/913/files/580.pdf. Accessed 2 July 2013
  31. Compston J, Bowring C, Cooper A, Cooper C, Davies C, Francis R, Kanis JA, Marsh D, McCloskey EV, Reid DM, Selby P (2013) Diagnosis and management of osteoporosis in postmenopausal women and older men in the UK: National Osteoporosis Guideline Group (NOGG) update 2013. Maturitas 75:392–396
  32. Chopin F, Biver E, Funck-Brentano T, Bouvard B, Coiffier G, Garnero P, Thomas T (2012) Prognostic interest of bone turnover markers in the management of postmenopausal osteoporosis. Joint Bone Spine 79:26–31
  33. Kanis JA, Burlet N, Cooper C, Delmas PD, Reginster JY, Borgstrom F, Rizzoli R (2008) European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 19:399–428
  34. Guggina P, Flahive J, Hooven FH, Watts NB, Siris ES, Silverman S, Roux C, Pfeilschifter J, Greenspan SL, Diez-Perez A, Cooper C, Compston JE, Chapurlat R, Boonen S, Adachi JD, Anderson FA Jr, Gehlbach S (2012) Characteristics associated with anti-osteoporosis medication use: data from the Global Longitudinal Study of Osteoporosis in Women (GLOW) USA cohort. Bone 51:975–980
  35. Lippuner K, Johansson H, Borgstrom F, Kanis JA, Rizzoli R (2012) Cost-effective intervention thresholds against osteoporotic fractures based on FRAX® in Switzerland. Osteoporos Int 23:2579–2589
  36. Boucher BJ (2012) The problems of vitamin D insufficiency in older people. Aging Dis 3:313–329
  37. Lappe JM, Heaney RP (2012) Why randomized controlled trials of calcium and vitamin D sometimes fail. Dermatoendocrinology 4:95–100
  38. Bischoff-Ferrari HA, Willett WC, Orav EJ, Lips P, Meunier PJ, Lyons RA, Flicker L, Wark J, Jackson RD, Cauley JA, Meyer HE, Pfeifer M, Sanders KM, Stahelin HB, Theiler R, Dawson-Hughes B (2012) A pooled analysis of vitamin D dose requirements for fracture prevention. N Engl J Med 367:40–49
  39. Looker AC (2013) Serum 25-hydroxyvitamin D and risk of major osteoporotic fractures in older U.S. adults. J Bone Miner Res 28:997–1006
  40. Bischoff-Ferrari HA, Dawson-Hughes B, Staehelin HB, Orav JE, Stuck AE, Theiler R, Wong JB, Egli A, Kiel DP, Henschkowski J (2009) Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomised controlled trials. BMJ. doi:10.1136/bmj.b3692
  41. Boersma D, Demontiero O, Mohtasham AZ, Hassan S, Suarez H, Geisinger D, Suriyaarachchi P, Sharma A, Duque G (2012) Vitamin D status in relation to postural stability in the elderly. J Nutr Health Aging 16:270–275
  42. Rejnmark L, Avenell A, Masud T, Anderson F, Meyer HE, Sanders KM, Salovaara K, Cooper C, Smith HE, Jacobs ET, Torgerson D, Jackson RD, Manson JE, Brixen K, Mosekilde L, Robbins JA, Francis RM, Abrahamsen B (2012) Vitamin D with calcium reduces mortality: patient level pooled analysis of 70,528 patients from eight major vitamin D trials. J Clin Endocrinol Metab 97:2670–2681
  43. Avenell A, MacLennan GS, Jenkinson DJ, McPherson GC, McDonald AM, Pant PR, Grant AM, Campbell MK, Anderson FH, Cooper C, Francis RM, Gillespie WJ, Robinson CM, Torgerson DJ, Wallace WA (2012) Long-term follow-up for mortality and cancer in a randomized placebo-controlled trial of vitamin D(3) and/or calcium (RECORD trial). J Clin Endocrinol Metab 97:614–622
  44. Diez-Perez A, Olmos JM, Nogues X, Sosa M, Diaz-Curiel M, Perez-Castrillon JL, Perez-Cano R, Munoz-Torres M, Torrijos A, Jodar E, Del RL, Caeiro-Rey JR, Farrerons J, Vila J, Arnaud C, Gonzalez-Macias J (2012) Risk factors for prediction of inadequate response to antiresorptives. J Bone Miner Res 27:817–824
  45. Dawson-Hughes B, Mithal A, Bonjour JP, Boonen S, Burckhardt P, Fuleihan GE, Josse RG, Lips P, Morales-Torres J, Yoshimura N (2010) IOF position statement: vitamin D recommendations for older adults. Osteoporos Int 21:1151–1154
  46. Ross AC, Manson JE, Abrams SA, Aloia JF, Brannon PM, Clinton SK, Durazo-Arvizu RA, Gallagher JC, Gallo RL, Jones G, Kovacs CS, Mayne ST, Rosen CJ, Shapses SA (2011) The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know. J Clin Endocrinol Metab 96:53–58
  47. Rizzoli R, Boonen S, Brandi ML, Bruyere O, Cooper C, Kanis JA, Kaufman JM, Ringe JD, Weryha G, Reginster JY (2013) Vitamin D supplementation in elderly or postmenopausal women: a 2013 update of the 2008 recommendations from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). Curr Med Res Opin 29:305–313
  48. Johansson H, Oden A, Kanis J, McCloskey E, Lorentzon M, Ljunggren O, Karlsson MK, Thorsby PM, Tivesten A, Barrett-Connor E, Ohlsson C, Mellstrom D (2012) Low serum vitamin D is associated with increased mortality in elderly men: MrOS Sweden. Osteoporos Int 23:991–999
  49. Steingrimsdottir L, Gunnarsson O, Indridason OS, Franzson L, Sigurdsson G (2005) Relationship between serum parathyroid hormone levels, vitamin D sufficiency, and calcium intake. JAMA 294:2336–2341
  50. Bischoff-Ferrari HA, Kiel DP, Dawson-Hughes B, Orav JE, Li R, Spiegelman D, Dietrich T, Willett WC (2009) Dietary calcium and serum 25-hydroxyvitamin D status in relation to BMD among U.S. adults. J Bone Miner Res 24:935–942
  51. Bolland MJ, Avenell A, Baron JA, Grey A, MacLennan GS, Gamble GD, Reid IR (2010) Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis. BMJ. doi:10.1136/bmj.c3691
  52. Burckhardt P (2011) Potential negative cardiovascular effects of calcium supplements. Osteoporos Int 22:1645–1647
  53. Wolfe F, Bolster MB, O’Connor CM, Michaud K, Lyles KW, Colon-Emeric CS (2013) Bisphosphonate use is associated with reduced risk of myocardial infarction in patients with rheumatoid arthritis. J Bone Miner Res 28:984–991
  54. Morley JE (2012) Undernutrition in older adults. Fam Pract 29:i89
  55. Genaro PS, Martini LA (2010) Effect of protein intake on bone and muscle mass in the elderly. Nutr Rev 68:616–623
  56. Waters DL, Baumgartner RN, Garry PJ, Vellas B (2010) Advantages of dietary, exercise-related, and therapeutic interventions to prevent and treat sarcopenia in adult patients: an update. Clin Interv Aging 5:259–270
  57. Fiatarone Singh MA, Singh NA, Hansen RD, Finnegan TP, Allen BJ, Diamond TH, Diwan AD, Lloyd BD, Williamson DA, Smith EU, Grady JN, Stavrinos TM, Thompson MW (2009) Methodology and baseline characteristics for the Sarcopenia and Hip Fracture study: a 5-year prospective study. J Gerontol A Biol Sci Med Sci 64:568–574
  58. Raynaud-Simon A, Revel-Delhom C, Hebuterne X (2011) Clinical practice guidelines from the French Health High Authority: nutritional support strategy in protein-energy malnutrition in the elderly. Clin Nutr 30:312–319
  59. Cuervo M, Garcia A, Ansorena D, Sanchez-Villegas A, Martinez-Gonzalez M, Astiasaran I, Martinez J (2009) Nutritional assessment interpretation on 22,007 Spanish community-dwelling elders through the Mini Nutritional Assessment test. Public Health Nutr 12:82–90
  60. Wijnhoven HA, Schilp J, van Bokhorst-de van der Schueren MA, de Vet HC, Kruizenga HM, Deeg DJ, Ferrucci L, Visser M (2012) Development and validation of criteria for determining undernutrition in community-dwelling older men and women: the Short Nutritional Assessment Questionnaire 65+. Clin Nutr 31:351–358
  61. Livingstone C (2013) Insulin-like growth factor-I (IGF-I) and clinical nutrition. Clin Sci (Lond) 125:265–280
  62. Rodondi A, Ammann P, Ghilardi-Beuret S, Rizzoli R (2009) Zinc increases the effects of essential amino acids-whey protein supplements in frail elderly. J Nutr Health Aging 13:491–497
  63. Chevalley T, Hoffmeyer P, Bonjour JP, Rizzoli R (2010) Early serum IGF-I response to oral protein supplements in elderly women with a recent hip fracture. Clin Nutr 29:78–83
  64. Food and Nutrition Board (2005) Protein and amino acids. Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids (macronutrients). Institute of Medicine, National Academy of Sciences. http://www.nal.usda.gov/fnic/DRI//DRI_Energy/589-768.pdf. Accessed 6 Aug 2013
  65. Morais JA, Chevalier S, Gougeon R (2006) Protein turnover and requirements in the healthy and frail elderly. J Nutr Health Aging 10:272–283
  66. Gaffney-Stomberg E, Insogna KL, Rodriguez NR, Kerstetter JE (2009) Increasing dietary protein requirements in elderly people for optimal muscle and bone health. J Am Geriatr Soc 57:1073–1079
  67. Mithal A, Bonjour JP, Boonen S, Burckhardt P, Degens H, El Hajj FG, Josse R, Lips P, Morales TJ, Rizzoli R, Yoshimura N, Wahl DA, Cooper C, Dawson-Hughes B (2013) Impact of nutrition on muscle mass, strength, and performance in older adults. Osteoporos Int 24:1555–1566
  68. Body JJ, Bergmann P, Boonen S, Boutsen Y, Bruyere O, Devogelaer JP, Goemaere S, Hollevoet N, Kaufman JM, Milisen K, Rozenberg S, Reginster JY (2011) Non-pharmacological management of osteoporosis: a consensus of the Belgian Bone Club. Osteoporos Int 22:2769–2788
  69. Gerdhem P, Ringsberg KA, Akesson K (2006) The relation between previous fractures and physical performance in elderly women. Arch Phys Med Rehabil 87:914–917
  70. AGS/BGS/AAOS (2001) Guideline for the prevention of falls in older persons. American Geriatrics Society, British Geriatrics Society, and American Academy of Orthopaedic Surgeons Panel on Falls Prevention. J Am Geriatr Soc 49:664–672
  71. Frost M, Abrahamsen B, Masud T, Brixen K (2012) Risk factors for fracture in elderly men: a population-based prospective study. Osteoporos Int 23:521–531
  72. Ensrud KE, Ewing SK, Taylor BC, Fink HA, Stone KL, Cauley JA, Tracy JK, Hochberg MC, Rodondi N, Cawthon PM (2007) Frailty and risk of falls, fracture, and mortality in older women: the study of osteoporotic fractures. J Gerontol A Biol Sci Med Sci 62:744–751
  73. Karlsson MK, Ribom E, Nilsson JA, Ljunggren O, Ohlsson C, Mellstrom D, Lorentzon M, Mallmin H, Stefanick M, Lapidus J, Leung PC, Kwok A, Barrett-Connor E, Orwoll E, Rosengren BE (2012) Inferior physical performance tests in 10,998 men in the MrOS study is associated with recurrent falls. Age Ageing 41:740–746
  74. Landi F, Cruz-Jentoft AJ, Liperoti R, Russo A, Giovannini S, Tosato M, Capoluongo E, Bernabei R, Onder G (2013) Sarcopenia and mortality risk in frail older persons aged 80 years and older: results from ilSIRENTE study. Age Ageing 42:203–209
  75. Michael YL, Whitlock EP, Lin JS, Fu R, O’Connor EA, Gold R (2010) Primary care-relevant interventions to prevent falling in older adults: a systematic evidence review for the U.S. Preventive Services Task Force. Ann Intern Med 153:815–825
  76. Howe TE, Rochester L, Neil F, Skelton DA, Ballinger C (2011) Exercise for improving balance in older people. Cochrane Database Syst Rev. doi:10.1002/14651858.CD004963.pub3
  77. Sherrington C, Henschke N (2013) Why does exercise reduce falls in older people? Unrecognised contributions to motor control and cognition? Br J Sports Med 47:730–731
  78. Robertson MC, Campbell AJ, Gardner MM, Devlin N (2002) Preventing injuries in older people by preventing falls: a meta-analysis of individual-level data. J Am Geriatr Soc 50:905–911
  79. Trombetti A, Hars M, Herrmann FR, Kressig RW, Ferrari S, Rizzoli R (2011) Effect of music-based multitask training on gait, balance, and fall risk in elderly people: a randomized controlled trial. Arch Intern Med 171:525–533
  80. Hagen KB, Dagfinrud H, Moe RH, Osteras N, Kjeken I, Grotle M, Smedslund G (2012) Exercise therapy for bone and muscle health: an overview of systematic reviews. BMC Med. doi:10.1186/1741-7015-10-167
  81. Liu CK, Fielding RA (2011) Exercise as an intervention for frailty. Clin Geriatr Med 27:101–110
  82. Kanemaru A, Arahata K, Ohta T, Katoh T, Tobimatsu H, Horiuchi T (2010) The efficacy of home-based muscle training for the elderly osteoporotic women: the effects of daily muscle training on quality of life (QoL). Arch Gerontol Geriatr 51:169–172
  83. American Geriatrics Society 2012 Beers Criteria Update Expert Panel (2012) American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 60:616–631
  84. Shiek Ahmad B, Hill KD, O’Brien TJ, Gorelik A, Habib N, Wark JD (2012) Falls and fractures in patients chronically treated with antiepileptic drugs. Neurology 79:145–151
  85. Ettinger B, Black DM, Mitlak BH, Knickerbocker RK, Nickelsen T, Genant HK, Christiansen C, Delmas PD, Zanchetta JR, Stakkestad J, Gluer CC, Krueger K, Cohen FJ, Eckert S, Ensrud KE, Avioli LV, Lips P, Cummings SR (1999) Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial. Multiple Outcomes of Raloxifene Evaluation (MORE) Investigators. JAMA 282:637–645
  86. Black DM, Cummings SR, Karpf DB, Cauley JA, Thompson DE, Nevitt MC, Bauer DC, Genant HK, Haskell WL, Marcus R, Ott SM, Torner JC, Quandt SA, Reiss TF, Ensrud KE (1996) Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Fracture Intervention Trial Research Group. Lancet 348:1535–1541
  87. Cummings SR, Black DM, Thompson DE, Applegate WB, Barrett-Connor E, Musliner TA, Palermo L, Prineas R, Rubin SM, Scott JC, Vogt T, Wallace R, Yates AJ, LaCroix AZ (1998) Effect of alendronate on risk of fracture in women with low bone density but without vertebral fractures: results from the Fracture Intervention Trial. JAMA 280:2077–2082
  88. Harris ST, Watts NB, Genant HK, McKeever CD, Hangartner T, Keller M, Chesnut CH III, Brown J, Eriksen EF, Hoseyni MS, Axelrod DW, Miller PD (1999) Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. Vertebral Efficacy With Risedronate Therapy (VERT) Study Group. JAMA 282:1344–1352
  89. Reginster J, Minne HW, Sorensen OH, Hooper M, Roux C, Brandi ML, Lund B, Ethgen D, Pack S, Roumagnac I, Eastell R (2000) Randomized trial of the effects of risedronate on vertebral fractures in women with established postmenopausal osteoporosis. Vertebral Efficacy with Risedronate Therapy (VERT) Study Group. Osteoporos Int 11:83–91
  90. McClung MR, Geusens P, Miller PD, Zippel H, Bensen WG, Roux C, Adami S, Fogelman I, Diamond T, Eastell R, Meunier PJ, Reginster JY (2001) Effect of risedronate on the risk of hip fracture in elderly women. Hip Intervention Program Study Group. N Engl J Med 344:333–340
  91. Chesnut CH III, Skag A, Christiansen C, Recker R, Stakkestad JA, Hoiseth A, Felsenberg D, Huss H, Gilbride J, Schimmer RC, Delmas PD (2004) Effects of oral ibandronate administered daily or intermittently on fracture risk in postmenopausal osteoporosis. J Bone Miner Res 19:1241–1249
  92. Black DM, Delmas PD, Eastell R, Reid IR, Boonen S, Cauley JA, Cosman F, Lakatos P, Leung PC, Man Z, Mautalen C, Mesenbrink P, Hu H, Caminis J, Tong K, Rosario-Jansen T, Krasnow J, Hue TF, Sellmeyer D, Eriksen EF, Cummings SR (2007) Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis. N Engl J Med 356:1809–1822
  93. Chesnut CH III, Silverman S, Andriano K, Genant H, Gimona A, Harris S, Kiel D, LeBoff M, Maricic M, Miller P, Moniz C, Peacock M, Richardson P, Watts N, Baylink D (2000) A randomized trial of nasal spray salmon calcitonin in postmenopausal women with established osteoporosis: the prevent recurrence of osteoporotic fractures study. PROOF Study Group. Am J Med 109:267–276
  94. Cummings SR, San Martin J, McClung MR, Siris ES, Eastell R, Reid IR, Delmas P, Zoog HB, Austin M, Wang A, Kutilek S, Adami S, Zanchetta J, Libanati C, Siddhanti S, Christiansen C (2009) Denosumab for prevention of fractures in postmenopausal women with osteoporosis. N Engl J Med 361:756–765
  95. Neer RM, Arnaud CD, Zanchetta JR, Prince R, Gaich GA, Reginster JY, Hodsman AB, Eriksen EF, Ish-Shalom S, Genant HK, Wang O, Mitlak BH (2001) Effect of parathyroid hormone (1-34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med 344:1434–1441
  96. Meunier PJ, Roux C, Seeman E, Ortolani S, Badurski JE, Spector TD, Cannata J, Balogh A, Lemmel EM, Pors-Nielsen S, Rizzoli R, Genant HK, Reginster JY (2004) The effects of strontium ranelate on the risk of vertebral fracture in women with postmenopausal osteoporosis. N Engl J Med 350:459–468
  97. Reginster JY, Seeman E, De Vernejoul MC, Adami S, Compston J, Phenekos C, Devogelaer JP, Curiel MD, Sawicki A, Goemaere S, Sorensen OH, Felsenberg D, Meunier PJ (2005) Strontium ranelate reduces the risk of nonvertebral fractures in postmenopausal women with osteoporosis: Treatment of Peripheral Osteoporosis (TROPOS) study. J Clin Endocrinol Metab 90:2816–2822
  98. Boonen S, Reginster JY, Kaufman JM, Lippuner K, Zanchetta J, Langdahl B, Rizzoli R, Lipschitz S, Dimai HP, Witvrouw R, Eriksen E, Brixen K, Russo L, Claessens F, Papanastasiou P, Antunez O, Su G, Bucci-Rechtweg C, Hruska J, Incera E, Vanderschueren D, Orwoll E (2012) Fracture risk and zoledronic acid therapy in men with osteoporosis. N Engl J Med 367:1714–1723
  99. McCloskey EV, Beneton M, Charlesworth D, Kayan K, deTakats D, Dey A, Orgee J, Ashford R, Forster M, Cliffe J, Kersh L, Brazier J, Nichol J, Aropuu S, Jalava T, Kanis JA (2007) Clodronate reduces the incidence of fractures in community-dwelling elderly women unselected for osteoporosis: results of a double-blind, placebo-controlled randomized study. J Bone Miner Res 22:135–41
  100. Seeman E, Vellas B, Benhamou C, Aquino JP, Semler J, Kaufman JM, Hoszowski K, Varela AR, Fiore C, Brixen K, Reginster JY, Boonen S (2006) Strontium ranelate reduces the risk of vertebral and nonvertebral fractures in women eighty years of age and older. J Bone Miner Res 21:1113–1120
  101. Lyles KW, Colon-Emeric CS, Magaziner JS, Adachi JD, Pieper CF, Mautalen C, Hyldstrup L, Recknor C, Nordsletten L, Moore KA, Lavecchia C, Zhang J, Mesenbrink P, Hodgson PK, Abrams K, Orloff JJ, Horowitz Z, Eriksen EF, Boonen S (2007) Zoledronic acid in reducing clinical fracture and mortality after hip fracture. N Engl J Med 357:1799–1809
  102. Boonen S, Adachi JD, Man Z, Cummings SR, Lippuner K, Törring O, Gallagher JC, Farrerons J, Wang A, Franchimont N, San Martin J, Grauer A, McClung M (2011) Treatment with denosumab reduces the incidence of new vertebral and hip fractures in postmenopausal women at high risk. J Clin Endocrinol Metab 96:1727–36
  103. McClung MR, Boonen S, Torring O, Roux C, Rizzoli R, Bone HG, Benhamou CL, Lems WF, Minisola S, Halse J, Hoeck HC, Eastell R, Wang A, Siddhanti S, Cummings SR (2012) Effect of denosumab treatment on the risk of fractures in subgroups of women with postmenopausal osteoporosis. J Bone Miner Res 27:211–218
  104. Ensrud KE, Black DM, Palermo L, Bauer DC, Barrett-Connor E, Quandt SA, Thompson DE, Karpf DB (1997) Treatment with alendronate prevents fractures in women at highest risk: results from the Fracture Intervention Trial. Arch Intern Med 157:2617–2624
  105. Hochberg MC, Thompson DE, Black DM, Quandt SA, Cauley J, Geusens P, Ross PD, Baran D (2005) Effect of alendronate on the age-specific incidence of symptomatic osteoporotic fractures. J Bone Miner Res 20:971–976
  106. Greenspan SL, Schneider DL, McClung MR, Miller PD, Schnitzer TJ, Bonin R, Smith ME, DeLucca P, Gormley GJ, Melton ME (2002) Alendronate improves bone mineral density in elderly women with osteoporosis residing in long-term care facilities. A randomized, double-blind, placebo-controlled trial. Ann Intern Med 136:742–746
  107. Boonen S, McClung MR, Eastell R, El-Hajj FG, Barton IP, Delmas P (2004) Safety and efficacy of risedronate in reducing fracture risk in osteoporotic women aged 80 and older: implications for the use of antiresorptive agents in the old and oldest old. J Am Geriatr Soc 52:1832–1839
  108. Boonen S, Black DM, Colon-Emeric CS, Eastell R, Magaziner JS, Eriksen EF, Mesenbrink P, Haentjens P, Lyles KW (2010) Efficacy and safety of a once-yearly intravenous zoledronic acid 5 mg for fracture prevention in elderly postmenopausal women with osteoporosis aged 75 and older. J Am Geriatr Soc 58:292–299
  109. Boonen S, Marin F, Mellstrom D, Xie L, Desaiah D, Krege JH, Rosen CJ (2006) Safety and efficacy of teriparatide in elderly women with established osteoporosis: bone anabolic therapy from a geriatric perspective. J Am Geriatr Soc 54:782–789
  110. Black DM, Thompson DE, Bauer DC, Ensrud K, Musliner T, Hochberg MC, Nevitt MC, Suryawanshi S, Cummings SR (2000) Fracture risk reduction with alendronate in women with osteoporosis: the Fracture Intervention Trial. FIT Research Group. J Clin Endocrinol Metab 85:4118–4124
  111. Roux C, Seeman E, Eastell R, Adachi J, Jackson RD, Felsenberg D, Songcharoen S, Rizzoli R, Di MO, Horlait S, Valent D, Watts NB (2004) Efficacy of risedronate on clinical vertebral fractures within six months. Curr Med Res Opin 20:433–439
  112. Boonen S, Orwoll E (2013) Fracture risk and zoledronic acid in men with osteoporosis. N Engl J Med 368:873
  113. Maricic M, Adachi JD, Sarkar S, Wu W, Wong M, Harper KD (2002) Early effects of raloxifene on clinical vertebral fractures at 12 months in postmenopausal women with osteoporosis. Arch Intern Med 162:1140–1143
  114. Cooper C, Reginster JY, Cortet B, Diaz-Curiel M, Lorenc RS, Kanis JA, Rizzoli R (2012) Long-term treatment of osteoporosis in postmenopausal women: a review from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) and the International Osteoporosis Foundation (IOF). Curr Med Res Opin 28:475–491
  115. McClung M, Harris ST, Miller PD, Bauer DC, Davison KS, Dian L, Hanley DA, Kendler DL, Yuen CK, Lewiecki EM (2013) Bisphosphonate therapy for osteoporosis: benefits, risks, and drug holiday. Am J Med 126:13–20
  116. Rizzoli R, Reginster JY, Boonen S, Breart G, Diez-Perez A, Felsenberg D, Kaufman JM, Kanis JA, Cooper C (2011) Adverse reactions and drug-drug interactions in the management of women with postmenopausal osteoporosis. Calcif Tissue Int 89:91–104
  117. Abrahamsen B (2010) Adverse effects of bisphosphonates. Calcif Tissue Int 86:421–435
  118. Woo C, Gao G, Wade S, Hochberg MC (2010) Gastrointestinal side effects in postmenopausal women using osteoporosis therapy: 1-year findings in the POSSIBLE US study. Curr Med Res Opin 26:1003–1009
  119. Cryer B, Bauer DC (2002) Oral bisphosphonates and upper gastrointestinal tract problems: what is the evidence? Mayo Clin Proc 77:1031–1043
  120. Bauer DC, Black D, Ensrud K, Thompson D, Hochberg M, Nevitt M, Musliner T, Freedholm D (2000) Upper gastrointestinal tract safety profile of alendronate: the fracture intervention trial. Arch Intern Med 160:517–525
  121. Kanis JA, Reginster JY, Kaufman JM, Ringe JD, Adachi JD, Hiligsmann M, Rizzoli R, Cooper C (2012) A reappraisal of generic bisphosphonates in osteoporosis. Osteoporos Int 23:213–221
  122. Imai K (2013) Alendronate sodium hydrate (oral jelly) for the treatment of osteoporosis: review of a novel, easy to swallow formulation. Clin Interv Aging 8:681–688
  123. Knopp-Sihota JA, Cummings GG, Homik J, Voaklander D (2013) The association between serious upper gastrointestinal bleeding and incident bisphosphonate use: a population-based nested cohort study. BMC Geriatr 13:36
  124. Cohen FJ, Lu Y (2000) Characterization of hot flashes reported by healthy postmenopausal women receiving raloxifene or placebo during osteoporosis prevention trials. Maturitas 34:65–73
  125. Komm BS, Chines AA (2012) Bazedoxifene: the evolving role of third-generation selective estrogen-receptor modulators in the management of postmenopausal osteoporosis. Ther Adv Musculoskelet Dis 4:21–34
  126. Adomaityte J, Farooq M, Qayyum R (2008) Effect of raloxifene therapy on venous thromboembolism in postmenopausal women. A meta-analysis. Thromb Haemost 99:338–342
  127. Breart G, Cooper C, Meyer O, Speirs C, Deltour N, Reginster JY (2010) Osteoporosis and venous thromboembolism: a retrospective cohort study in the UK General Practice Research Database. Osteoporos Int 21:1181–1187
  128. Vestergaard P, Schwartz K, Pinholt EM, Rejnmark L, Mosekilde L (2010) Use of bisphosphonates and raloxifene and risk of deep venous thromboembolism and pulmonary embolism. Osteoporos Int 21:1591–1597
  129. Heit JA, Silverstein MD, Mohr DN, Petterson TM, Lohse CM, O’Fallon WM, Melton LJ III (2001) The epidemiology of venous thromboembolism in the community. Thromb Haemost 86:452–463
  130. Naess IA, Christiansen SC, Romundstad P, Cannegieter SC, Rosendaal FR, Hammerstrom J (2007) Incidence and mortality of venous thrombosis: a population-based study. J Thromb Haemost 5:692–699
  131. Bock O, Boerst H, Thomasius FE, Degner C, Stephan-Oelkers M, Valentine SM, Felsenberg D (2007) Common musculoskeletal adverse effects of oral treatment with once weekly alendronate and risedronate in patients with osteoporosis and ways for their prevention. J Musculoskelet Neuronal Interact 7:144–148
  132. Food and Drug Administration (2008) Severe pain with osteoporosis drugs. http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/psn/transcript.cfm?show=73. Accessed 25 June 2013
  133. Sieber P, Lardelli P, Kraenzlin CA, Kraenzlin ME, Meier C (2013) Intravenous bisphosphonates for postmenopausal osteoporosis: safety profiles of zoledronic acid and ibandronate in clinical practice. Clin Drug Investig 33:117–122
  134. Musette P, Brandi ML, Cacoub P, Kaufman JM, Rizzoli R, Reginster JY (2010) Treatment of osteoporosis: recognizing and managing cutaneous adverse reactions and drug-induced hypersensitivity. Osteoporos Int 21:723–732
  135. Cacoub P, Descamps V, Meyer O, Speirs C, Belissa-Mathiot P, Musette P (2013) Drug rash with eosinophilia and systemic symptoms (DRESS) in patients receiving strontium ranelate. Osteoporos Int 24:1751–1757
  136. Anastasilakis AD, Toulis KA, Polyzos SA, Anastasilakis CD, Makras P (2012) Long-term treatment of osteoporosis: safety and efficacy appraisal of denosumab. Ther Clin Risk Manag 8:295–306
  137. Tsourdi E, Rachner TD, Gruber M, Hamann C, Ziemssen T, Hofbauer LC (2011) Seizures associated with zoledronic acid for osteoporosis. J Clin Endocrinol Metab 96:1955–1959
  138. Wright E, Schofield PT, Seed P, Molokhia M (2012) Bisphosphonates and risk of upper gastrointestinal cancer–a case control study using the General Practice Research Database (GPRD). PLoS One. doi:10.1371/journal.pone.0047616
  139. Cardwell CR, Abnet CC, Cantwell MM, Murray LJ (2010) Exposure to oral bisphosphonates and risk of esophageal cancer. JAMA 304:657–663
  140. Foster SA, Shi N, Curkendall S, Stock J, Chu BC, Burge R, Diakun DR, Krege JH (2013) Fractures in women treated with raloxifene or alendronate: a retrospective database analysis. BMC Womens Health. doi:10.1186/1472-6874-13-15
  141. Andrews EB, Gilsenan AW, Midkiff K, Sherrill B, Wu Y, Mann BH, Masica D (2012) The US postmarketing surveillance study of adult osteosarcoma and teriparatide: study design and findings from the first 7 years. J Bone Miner Res 27:2429–2437
  142. Falk RH (2001) Atrial fibrillation. N Engl J Med 344:1067–1078
  143. Rizzoli R, Burlet N, Cahall D, Delmas PD, Eriksen EF, Felsenberg D, Grbic J, Jontell M, Landesberg R, Laslop A, Wollenhaupt M, Papapoulos S, Sezer O, Sprafka M, Reginster JY (2008) Osteonecrosis of the jaw and bisphosphonate treatment for osteoporosis. Bone 42:841–847
  144. Shane E, Burr D, Ebeling PR, Abrahamsen B, Adler RA, Brown TD, Cheung AM, Cosman F, Curtis JR, Dell R, Dempster D, Einhorn TA, Genant HK, Geusens P, Klaushofer K, Koval K, Lane JM, McKiernan F, McKinney R, Ng A, Nieves J, O’Keefe R, Papapoulos S, Sen HT, van der Meulen MC, Weinstein RS, Whyte M (2010) Atypical subtrochanteric and diaphyseal femoral fractures: report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res 25:2267–2294
  145. Rizzoli R, Akesson K, Bouxsein M, Kanis JA, Napoli N, Papapoulos S, Reginster JY, Cooper C (2011) Subtrochanteric fractures after long-term treatment with bisphosphonates: a European Society on Clinical and Economic Aspects of Osteoporosis and Osteoarthritis, and International Osteoporosis Foundation Working Group Report. Osteoporos Int 22:373–390
  146. Meier RP, Perneger TV, Stern R, Rizzoli R, Peter RE (2012) Increasing occurrence of atypical femoral fractures associated with bisphosphonate use. Arch Intern Med 172:930–936
  147. Park-Wyllie LY, Mamdani MM, Juurlink DN, Hawker GA, Gunraj N, Austin PC, Whelan DB, Weiler PJ, Laupacis A (2011) Bisphosphonate use and the risk of subtrochanteric or femoral shaft fractures in older women. JAMA 305:783–789
  148. Lewiecki EM (2010) Bisphosphonates for the treatment of osteoporosis: insights for clinicians. Ther Adv Chronic Dis 1:115–128
  149. Rastogi R, Meek BD (2013) Management of chronic pain in elderly, frail patients: finding a suitable, personalized method of control. Clin Interv Aging 8:37–46
  150. Montagu A, Speirs A, Baldock J, Corbett J, Gosney M (2012) A review of vertebroplasty for osteoporotic and malignant vertebral compression fractures. Age Ageing 41:450–455
  151. Pergolizzi J, Boger RH, Budd K, Dahan A, Erdine S, Hans G, Kress HG, Langford R, Likar R, Raffa RB, Sacerdote P (2008) Opioids and the management of chronic severe pain in the elderly: consensus statement of an International Expert Panel with focus on the six clinically most often used World Health Organization Step III opioids (buprenorphine, fentanyl, hydromorphone, methadone, morphine, oxycodone). Pain Pract 8:287–313
  152. World Health Organization (2003) Adherence to long-term therapies: evidence for action. World Health Organisation. http://www.who.int/chp/knowledge/publications/adherence_full_report.pdf. Accessed 24 June 2013
  153. Cramer JA, Gold DT, Silverman SL, Lewiecki EM (2007) A systematic review of persistence and compliance with bisphosphonates for osteoporosis. Osteoporos Int 18:1023–1031
  154. Rabenda V, Vanoverloop J, Fabri V, Mertens R, Sumkay F, Vannecke C, Deswaef A, Verpooten GA, Reginster JY (2008) Low incidence of anti-osteoporosis treatment after hip fracture. J Bone Joint Surg Am 90:2142–2148
  155. Rabenda V, Mertens R, Fabri V, Vanoverloop J, Sumkay F, Vannecke C, Deswaef A, Verpooten GA, Reginster JY (2008) Adherence to bisphosphonates therapy and hip fracture risk in osteoporotic women. Osteoporos Int 19:811–818
  156. Audran M, Jakob FJ, Palacios S, Brandi ML, Broll H, Hamdy NA, McCloskey EV (2013) A large prospective European cohort study of patients treated with strontium ranelate and followed up over 3 years. Rheumatol Int 33:2231–2239
  157. Siris ES, Selby PL, Saag KG, Borgstrom F, Herings RM, Silverman SL (2009) Impact of osteoporosis treatment adherence on fracture rates in North America and Europe. Am J Med 122:S3–S13
  158. Imaz I, Zegarra P, Gonzalez-Enriquez J, Rubio B, Alcazar R, Amate JM (2010) Poor bisphosphonate adherence for treatment of osteoporosis increases fracture risk: systematic review and meta-analysis. Osteoporos Int 21:1943–1951
  159. Ross S, Samuels E, Gairy K, Iqbal S, Badamgarav E, Siris E (2011) A meta-analysis of osteoporotic fracture risk with medication nonadherence. Value Health 14:571–581
  160. Hiligsmann M, McGowan B, Bennett K, Barry M, Reginster JY (2012) The clinical and economic burden of poor adherence and persistence with osteoporosis medications in Ireland. Value Health 15:604–612
  161. Horne R, Weinman J (1999) Patients’ beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness. J Psychosom Res 47:555–567
  162. Yood RA, Mazor KM, Andrade SE, Emani S, Chan W, Kahler KH (2008) Patient decision to initiate therapy for osteoporosis: the influence of knowledge and beliefs. J Gen Intern Med 23:1815–1821
  163. McHorney CA, Spain CV (2011) Frequency of and reasons for medication non-fulfillment and non-persistence among American adults with chronic disease in 2008. Health Expect 14:307–320
  164. Gellad WF, Grenard JL, Marcum ZA (2011) A systematic review of barriers to medication adherence in the elderly: looking beyond cost and regimen complexity. Am J Geriatr Pharmacother 9:11–23
  165. Sale JE, Gignac MA, Frankel L, Hawker G, Beaton D, Elliot-Gibson V, Bogoch E (2012) Patients reject the concept of fragility fracture—a new understanding based on fracture patients’ communication. Osteoporos Int 23:2829–2834
  166. Besser SJ, Anderson JE, Weinman J (2012) How do osteoporosis patients perceive their illness and treatment? Implications for clinical practice. Arch Osteoporos 7:115–124
  167. MacLaughlin EJ, Raehl CL, Treadway AK, Sterling TL, Zoller DP, Bond CA (2005) Assessing medication adherence in the elderly: which tools to use in clinical practice? Drugs Aging 22:231–255
  168. Kinnersley P, Edwards A, Hood K, Cadbury N, Ryan R, Prout H, Owen D, Macbeth F, Butow P, Butler C (2007) Interventions before consultations for helping patients address their information needs. Cochrane Database Syst Rev. doi:10.1002/14651858.CD004565.pub2
  169. Haynes RB, Ackloo E, Sahota N, McDonald HP, Yao X (2008) Interventions for enhancing medication adherence. Cochrane Database Syst Rev. doi:10.1002/14651858.CD000011.pub3
  170. Gleeson T, Iversen MD, Avorn J, Brookhart AM, Katz JN, Losina E, May F, Patrick AR, Shrank WH, Solomon DH (2009) Interventions to improve adherence and persistence with osteoporosis medications: a systematic literature review. Osteoporos Int 20:2127–2134
  171. Edelberg HK, Shallenberger E, Wei JY (1999) Medication management capacity in highly functioning community-living older adults: detection of early deficits. J Am Geriatr Soc 47:592–596
  172. Carlson MC, Fried LP, Xue QL, Tekwe C, Brandt J (2005) Validation of the Hopkins Medication Schedule to identify difficulties in taking medications. J Gerontol A Biol Sci Med Sci 60:217–223
  173. Orwig D, Brandt N, Gruber-Baldini AL (2006) Medication management assessment for older adults in the community. Gerontologist 46:661–668
  174. Hopkins RB, Goeree R, Pullenayegum E, Adachi JD, Papaioannou A, Xie F, Thabane L (2011) The relative efficacy of nine osteoporosis medications for reducing the rate of fractures in post-menopausal women. BMC Musculoskelet Disord 12:209–212
  175. Freemantle N, Cooper C, Diez-Perez A, Gitlin M, Radcliffe H, Shepherd S, Roux C (2013) Results of indirect and mixed treatment comparison of fracture efficacy for osteoporosis treatments: a meta-analysis. Osteoporos Int 24:209–217
  176. Tsai JN, Uihlein AV, Lee H, Kumbhani R, Siwila-Sackman E, McKay EA, Burnett-Bowie SA, Neer RM, Leder BZ (2013) Teriparatide and denosumab, alone or combined, in women with postmenopausal osteoporosis: the DATA study randomised trial. Lancet 382:50–56
  177. Akesson K, Marsh D, Mitchell PJ, McLellan AR, Stenmark J, Pierroz DD, Kyer C, Cooper C (2013) Capture the Fracture: a Best Practice Framework and global campaign to break the fragility fracture cycle. Osteoporos Int 24:2135–2152
  178. International Osteoporosis Foundation (2013) Capture the fracture: a global campaign to break the fragility fracture cycle. http://share.iofbonehealth.org/WOD/2012/report/WOD12-Report.pdf. Accessed 10 July 2013
  179. Lee DB, Lowden MR, Patmintra V, Stevenson K (2013) National bone health alliance: an innovative public-private partnership improving America’s bone health. Curr Osteoporos Rep 11:348–353
  180. National Bone Health Alliance (2013) Fracture prevention central. http://www.nbha.org/fpc. Accessed 2 Oct 2013
  181. International Osteoporosis Foundation (2013) About OsteoLink. IOF International. http://www.iofbonehealth.org/about-osteolink. Accessed 2 Oct 2013

I agree: Henry Lahore July 2014

I play duplicate bridge each week with about 25 other senior citizens
Last month one of the players had fallen and broken her pelvis, so did not show up to play
I told the other players that just a little vitamin D would decrease their chance of similar broken bones by 3X
While statistically about 5 of the players will get broken bones during the next decade,
not ONE of them asked for any information about vitamin D.
They appeared to believe that they cannot change their destiny - as was indicated in this study

See also Vitamin D Life

Note: Osteoporosis causes bones to become fragile and prone to fracture
  Osteoarthritis is a disease where damage occurs to the joints at the end of the bones

See any problem with this page? Report it (FINALLY WORKS)