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Neuprez A., Hiligsmann M., Bruyere O., Ethgen O., Reginster J. Y.
Department of Public Health Epidemiology and Health Economics CHU Sart Tilman University of Liège, Liège, Belgium
Hip fracture is the major clinical consequence of osteoporosis. It is linked with decreased life expectancy and quality of life, placing an ever-increasing burden on health services. Few medications have unequivocally demonstrated their ability to reduce hip fracture risk in osteoporotic subjects. Daily alendronate and risedronate reduce hip fracture in patients with low bone mineral density (BMD) and prevalent vertebral fractures. Intravenous bisphosphonates have been developed in response to long-term poor adherence to oral anti-osteoporotic treatments. Once-yearly zoledronic acid reduces fracture rates at the spine, non-spine and hip locations. Strontium ranelate, the first drug to uncouple bone formation from bone resorption has also demonstrated its ability to reduce hip fractures in patients above 74 years old, with prevalent low BMD. Calcium and vitamin D supplementation are prerequisite for the management of elderly subjects and should always been associated to anti-resorptive or bone forming agents. Non-pharmacological management of osteoporosis is recommended, but it cannot be considered a substitute for pharmacological treatment of osteoporosis, not even in old age.