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New Treatments Available for Older Adults with Osteoporosis

Research shows that nearly 80% of nursing home residents have osteoporosis and 10.8% have a hip fracture.  Dementia significantly increases residents’ risk of a hip fracture.  Although treating osteoporosis in nursing homes was proven to be feasible by the Vitamin D and Osteoporosis Study (ViDOS), only one-third of residents prone to hip fracture were treated. Moreover, a number of these residents were given calcitonin or raloxifene, which are not as effective as alendronate or zolendronic acid.

Low vitamin D levels is pandemic in nursing home residents and a combination of calcium and vitamin D has been shown to reduce hip fractures.  The recommended daily intake of vitamin D is limited to 1000 IU and calcium or yogurt should be served just before bed for optimum replacement. Too high a calcium replacement increases risk of cardiovascular disease.

Sarcopenia is an epidemic among older adults and increases their propensity to fall.  Resistance exercise has been proven to improve strength and remarkably improve outcomes in patients with hip fracture. The loss of muscle reduces mechanical loading and causes reduced bone formation.  This has led to the assessment that osteosarcopenia is doubly hazardous for the onset of fractures.  Weight loss and malnutrition are huge factors that increase risk of osteosarcopenia in older adults.  The SARC-F questionnaire is proven to be an effective screening tool for sarcopenia.

To prevent further bone loss, selective serotonin reuptake inhibitors (SSRIs) should be avoided, as well as thiazolidinediones and proton pump inhibitors (PPIs).  These three drugs encourage the loss of calcium from bone, which causes hip fractures.  SSRIs and PPIs produce hyponatremia, which increases not only hip fracture and osteoporosis, but also the risk of developing delirium and poor mobility, further increasing the risk of falls and hip fractures.  Diabetics are especially at risk for developing osteosarcoma due to having poor-quality bone, sarcopenia, and often hyponatremia.

Overall, awareness and treatment of osteosarcopenia in nursing homes is needed.  Research on falls and fractures and their prevention among nursing home residents is also needed.