Efficacy and safety of osteoporosis treatment in older adults. Approach for the secondary prevention of fractures in older populations. A proposal by SEFRAOS.

Osteoporosis is a systemic skeletal disease characterized by low bone mass and deterioration of the microarchitecture, resulting in bone fragility and risk of fractures. As the life expectancy of the population increases, fragility fractures are expected to become more common. Indeed, the incidence rate for major fracture (hip, vertebra, pelvis, etc.) is highest among the population of adults aged 80 and over. Despite this, in Spain, three out of four patients who have experienced a fragility fracture do not receive drug treatment for the secondary prevention of new fractures. Therefore, it is crucial to raise awareness among healthcare professionals of the need to assess imminent fracture risk in older patients who have already sustained a fragility fracture and to initiate a rapid, appropriate, effective, and safe secondary fracture prevention strategy. The various clinical guidelines on secondary prevention of fragility fractures published to date do not reflect the heterogeneity of older adults. The aim of this paper is to provide a brief description of the available scientific evidence on the efficacy and safety of pharmacological treatments for osteoporosis in older adults and to submit a position paper proposed by the Spanish Society of Osteoporotic Fractures (SEFRAOS), which places greater emphasis on the specifics of the approach to and treatment of older adults who have sustained a fragility fracture.