Health science reports · 2026
Effectiveness and Safety of Pharmacological Therapy for Osteoporosis in Frail Elderly Individuals: Systematic Review and Meta-Analysis.
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Freire Anna Julia Lacerda Raposo, Gazoni Fernanda Martins, Carvalho Eduardo de Holanda, Santos Fânia Cristina
Аннотация
BACKGROUND: Frailty and osteoporosis are interrelated conditions that predominantly affect older adults. The greater the individual's frailty, the greater the probability of suffering a fracture and the greater the risk of fractures occurring in the future. Therefore, this study aimed to verify whether anti-fracture pharmacological therapies in frail individuals with osteoporosis are effective and safe.
METHODS: A systematic review of the literature was conducted using randomized clinical trials and observational studies. Participants aged 60 years or older, living in the community or in a long-term care facility, diagnosed with frailty and osteoporosis and with a history of anti-fracture medication use were evaluated. A meta-analysis was performed when appropriate. This review was conducted and reported following the PRISMA 2020 guidelines.
RESULTS: Six studies with 42,851 frail elderly were included. Five were conducted in long-term care facilities (3 observational and 2 randomized clinical trials) and 1 observational study included community-dwelling elderly after hospitalization due to fragility fracture. All studies assessed fractures; four evaluated mortality, and one assessed bone mineral density. Three studies compared bisphosphonates to a non-antiosteoporotic treatment; one compared bisphosphonate, denosumab, and teriparatide to placebo; one compared denosumab and zoledronic acid to teriparatide; and one compared sequential teriparatide with alendronate to alendronate. Meta-analysis pointed to a potential reduction in hip fracture risk and mortality with bisphosphonates in institutionalized frail elderly. It also demonstrated that bisphosphonates can be safe with limited nonserious side effects.
CONCLUSION: The findings suggest a possible benefit of pharmacological treatment in reducing hip fractures and mortality in frail elderly. The real impact of the anti-fracture therapies on those individuals still needs to be better studied.
METHODS: A systematic review of the literature was conducted using randomized clinical trials and observational studies. Participants aged 60 years or older, living in the community or in a long-term care facility, diagnosed with frailty and osteoporosis and with a history of anti-fracture medication use were evaluated. A meta-analysis was performed when appropriate. This review was conducted and reported following the PRISMA 2020 guidelines.
RESULTS: Six studies with 42,851 frail elderly were included. Five were conducted in long-term care facilities (3 observational and 2 randomized clinical trials) and 1 observational study included community-dwelling elderly after hospitalization due to fragility fracture. All studies assessed fractures; four evaluated mortality, and one assessed bone mineral density. Three studies compared bisphosphonates to a non-antiosteoporotic treatment; one compared bisphosphonate, denosumab, and teriparatide to placebo; one compared denosumab and zoledronic acid to teriparatide; and one compared sequential teriparatide with alendronate to alendronate. Meta-analysis pointed to a potential reduction in hip fracture risk and mortality with bisphosphonates in institutionalized frail elderly. It also demonstrated that bisphosphonates can be safe with limited nonserious side effects.
CONCLUSION: The findings suggest a possible benefit of pharmacological treatment in reducing hip fractures and mortality in frail elderly. The real impact of the anti-fracture therapies on those individuals still needs to be better studied.