Kristine E. Ensrud
80-year-old women of age and older with osteoporosis have a high probability of 5 years and have a substantial hip fracture ratio and may benefit from hip-breaking drug therapy. i published studies Internal Medicine JAMA.
“There is a high probability of five-year-old women aged 80 and over who have osteoporosis on them, including those with more conorbid medical conditions or worse prognosis, despite an account that have a competitive risk of non-spill mortality and should focus on drug treatment to prevent future hip fracture, ” t Kristine E. Ensrud, MD, MPH, professor of medicine and epidemiology / public health at the University of Minnesota and a core investigator at the Center for the Delivery of Care and Research Results at Minneapolis VA Healthcare System, told Healio Primary Care. “Among women without osteoporosis but considered to be treatment candidates on the basis of osteopenia and probability intervention thresholds or above recommended by the National Institute of Osteoporosis, the risk of competitive death is greater than the probability of hip fractures, particularly among those with more consideration or worse prognosis. The overall benefit of drug treatment is likely to be significantly lower among this substantial group of women because the probability of mortality is greater than the probability of hip fracture. ”
To examine the connection between disease definition, number of proportions and prognosis with hip fracture probability in women 80 years or older, researchers studied a potential cohort of 1,528 women (average age, 84.1 years) identified as potential candidates to begin the treatment of osteoporosis drugs and lasted until the year examination visit. The total follow-up was for a maximum of 29.9 years, and continued on an average of 4.4 years after the 16-year examination.
Participants were classified as osteoporosis (n = 761) or without osteoporosis but at high risk of fracture (n = 767).
Every 4 months, participants were contacted to provide vital status and hip fracture.
Researchers calculated a 5-year hip fracture probability accounting for competitive mortality risk, and assessed comorbid conditions through self-description and prognosis that are assessed through a mortality prediction index.
During follow-up, 287 women died before hip fracture, and 125 women were penetrated to 125 women.
Researchers found that 5-year mortality probability was 24.9% (95% CI, 21.8-28.1) among women with osteoporosis and 19.4% (95% CI, 16.6-22.3) in women without osteoporosis but at risk. broken high.
While mortality probability increased with more comorbidities and worse prognosis in both groups, 5-year hip fracture probability was 13% (95% CI, 10.7-15.5) among women with osteoporosis and 4% (95%). CI, 2.8-5.6) in women without.
Researchers noted that this difference was very significant in women with more consideration than worse prognosis; in women with three or more comorbid conditions, hip fracture probability was 18.1% (95% CI, 12.3-24.9) among women with osteoporosis 2.5% (95% CI, 1.3-4.2) in women without osteoporosis but at high fracture risk.
“Women aged 80 and over, including those with multiple illnesses or shorter estimated life expectancy, should be advised of their risk of hip fracture and be assessed. for osteoporosis screening with bone mineral density test, ”said Ensrud. “Clinicians should consider starting drug treatment to prevent the break-up of women with osteoporosis in late life (bone mass T-score -2.5 or below) and multiple companies, such as the group may have. These women have the greatest benefit from treatment to prevent future hip fractures. Research is needed to develop fracture forecasting models among adults aged 80 and over that take into account the risk of individual patients' death and incorporate late life risk factors such as multimodal as well as bone mineral density. In addition, well-designed observation studies are required to assess the efficiency and safety of osteoporosis medications in the rapidly growing patient population. ”
In related editing, Sarah D. Berry, MD, MPH, Sandra Shi, MD, and Douglas P. Kiel, MD, MPH, All medical department at Beth Israel Deaconess Medical Center, Harvard Medical School, wrote: “These findings are of great importance because of the continued recognition that clinical guidelines should look at diversity. At present, the guidelines for screening and treating adults for osteoporosis do not give any consideration to age, proportionality or weakness. In contrast, guidelines for cancer screening warnings against routine screening of older adults who are older or have limited life expectancy due to the reduction in the value of cancer screening and prevention therapies in the eighth year and t in the ninth year of life. This study suggests that there is a difference between the risk-benefit calculation for prevention in older adults and cancer. If prevention medication is equally effective in older women who have multiple bodies among them as they are in younger women, the oldest women with comorbidities are the most likely to benefit from osteoporosis treatment. ”- with Melissa J. Webb
Exposures: Ensrud does not report any material financial disclosures. See the study of the relevant financial exposure of all other authors.