Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions
Consider drug treatment in late-life women with osteoporosis
Key clinical point: Medical treatment to prevent osteoporotic hip fracture in women over age 80 likely is worthwhile.
Major finding: Five-year hip fracture probability was 13% among women with osteoporosis and 4% among women without osteoporosis but at high fracture risk.
Study details: A prospective cohort study of 1,528 women 80 years and older who were potential candidates for osteoporosis drug treatment.
Disclosures: Dr. Cynthia M. Boyd reported receiving royalties from UpToDate and a grant from the National Institutes of Aging Dr. Katie L. Stone reported receiving grant support from Merck, and Dr. Lisa Langsetmo reported receiving grants from the National Institutes of Health and Merck. No other authors reported any relevant financial disclosures. The Study of Osteoporotic Fractures was supported by NIH and grants from NIA.
Ensrud KE et al. JAMA Intern Med. 2019 Jun 17. doi: 10.1001/jamainternmed.2019.0682.
Older patients with osteoporosis with multimorbidities are the most at risk for hip fractures, which should place an emphasis on research into their treatment, Sarah D. Berry, MD, MPH; Sandra Shi, MD; and Douglas P. Kiel, MD, MPH, of Harvard Medical School, Boston, wrote in an invited commentary.
The coauthors noted that the study by Ensrud et al. is of “great clinical importance, given the ongoing recognition that clinical guidelines should consider multimorbidity.” Currently, the guidelines for treating osteoporosis do not consider age, comorbidities, or frailty, but this study indicates that older women can see benefits from treatment.
They also acknowledged the value of patient preference, referencing a study where 80% of older women “would prefer death as opposed to a hip fracture leading to institutionalization.” All in all, the work of Ensrud et al. is a reminder of “the dangers in ignoring the problem” and the need for future guidelines in osteoporosis treatment to address osteoporosis treatment for older patients with multimorbidity.
These comments are adapted from an invited commentary accompanying the article by Ensrud et al. (JAMA Intern Med. 2019 Jun 17. doi: 10.1001/jamainternmed.2019.0688 ). Dr. Berry reported receiving royalties from UpToDate outside the submitted work. Dr. Kiel reported receiving royalties from UpToDate, along with grants from the Dairy Council and Radius Health, and personal fees from Springer outside the submitted work. Dr. Shi reported no relevant financial disclosures. No funding for this editorial was reported.