AACE MENA 2025-Treatment of Osteoporosis in the Oldest Old

Video Transcription

Video Summary

The speaker, an endocrinologist and geriatrician, reviews osteoporosis management in the “oldest old” (defined here as age ≥80) and emerging research on skeletal aging. Fracture risk rises sharply with age, especially hip and vertebral fractures (women after ~65–70; men about a decade later). Older adults also face high risk of recurrent fractures in the first two years, reduced functional recovery, increased nursing home placement, and higher mortality after hip or spine fractures.<br /><br />Non-pharmacologic priorities include adequate calcium (about 1200 mg/day) and vitamin D (generally ≥800 IU/day), while noting conflicting trial data and that benefits appear clearer in institutionalized and very old groups. A major clinical focus is frailty and fall prevention; the speaker uses simple bedside assessment (e.g., chair-stand with arms crossed) and routinely prescribes physical therapy emphasizing balance, core strengthening, and a sustainable home program.<br /><br />Pharmacologic evidence in patients ≥80 is limited because most RCTs enrolled few very old adults. Still, bisphosphonates—especially zoledronate—are favored for efficacy and adherence; denosumab is reserved for patients who can reliably return every six months or who have low GFR. Anabolic agents are used selectively for very low BMD or vertebral fractures.<br /><br />Looking ahead, the talk highlights cellular senescence (“zombie cells”) in bone and senolytics (dasatinib+quercetin). Early mouse and a small phase 2 trial in women ≥70 suggest senolytics may transiently improve bone turnover and modestly increase radius BMD, especially in those with higher senescence burden.

Keywords

osteoporosis management in adults aged 80 and older

hip and vertebral fracture risk with aging

frailty assessment and fall prevention

calcium and vitamin D supplementation in the very old

bisphosphonates (zoledronate) and adherence

denosumab use in older adults with low GFR

cellular senescence in bone and senolytics (dasatinib quercetin)