Anti-osteoporosis medications reduce fracture risk similarly, regardless of whether patients are younger or older than 70 years.


  • Investigators conducted the study as part of a joint UK and US project to assess bone mineral density as a surrogate marker for fracture risk.
  • Analyses used individual patient data from 23 randomised placebo-controlled trials of anti-osteoporosis medications (11 of bisphosphonates, four of selective oestrogen receptor modulators, three of anabolic medications, two of hormone replacement therapy, and one each of odanacatib, denosumab, and romosozumab).
  • Overall, 43% of the included 123,164 patients were aged 70 years or older.
  • The main outcomes were fractures and bone mineral density.


  • Anti-osteoporosis medication roughly halved the risk for vertebral fracture among both patients younger than 70 years and patients aged 70 years or older (odds ratio, 0.47 vs 0.51; P for interaction = .19).
  • There was also a similar benefit regardless of age when it came to the reduction in risks for hip fracture (odds ratio, 0.65 vs 0.72; P for interaction = .50) and any fracture (odds ratio, 0.72 vs 0.70; P for interaction = .20).
  • Findings were comparable in analyses restricted to bisphosphonate trials, except that the reduction in hip fracture risk was greater among the younger group (hazard ratio, 0.44 vs 0.79; P for interaction = .02).
  • The benefit of anti-osteoporosis medication in increasing hip and spine bone mineral density at 24 months was significantly greater among the older patients.


Taken together, the study results “strongly support treatment in those over age 70,” the authors wrote. “These are important findings with potential impact in patient treatment since it goes against a common misconception that medications are less effective in older people,” they added.


The study was led by Marian Schini, MD, PhD, FHEA, University of Sheffield, Sheffield, UK, and was published online in the Journal of Bone and Mineral Research.


Limitations included a preponderance of female patients (99%), possible residual confounding, a lack of analysis of adverse effects, and potentially different findings using alternate age cutoffs.


The study was funded by the American Society for Bone Mineral Research. Some authors disclosed affiliations with companies that manufacture anti-osteoporosis drugs.

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