Stopping Osteoporosis Treatment: Timeline Considerations
In the journey of aging, maintaining bone health becomes increasingly important. Osteoporosis, a condition characterized by weakened bones, can lead to fractures, pain, and possible disability, making it crucial to seek early treatment.
Current recommendations suggest that osteoporosis treatment, often with antiresorptive agents like bisphosphonates or denosumab, should be continued in older individuals if the risk of fracture remains high. The decision to discontinue or continue therapy is typically based on an individual's benefit-risk assessment rather than chronological age alone.
For those at high fracture risk, treatment is recommended and should be continued as long as the benefits outweigh the risks. After stopping certain treatments like denosumab, fracture risk can increase rapidly, so transitioning to an alternative therapy is advised to avoid multiple vertebral fractures.
Osteoanabolic therapies, such as teriparatide, abaloparatide, and romosozumab, are given for a limited period (e.g., 1–2 years) and followed by antiresorptive therapy to maintain bone density gains.
It's essential to note that there is no explicit recommended age to discontinue treatment. Instead, the approach is individualized, taking into account ongoing fracture risk, side effects, patient health status, and life expectancy.
Guidelines also emphasize the importance of calcium and vitamin D supplementation and the incorporation of lifestyle factors like exercise and fall prevention, alongside pharmacotherapy, for all ages.
A fracture can make it more difficult to exercise and maintain healthy lifestyle habits, potentially worsening other chronic illnesses like heart disease. Certain fractures, such as vertebral fractures, can be especially dangerous, potentially affecting breathing and leading to infections like pneumonia. Fracture complications can increase mortality.
When considering osteoporosis treatment, it's essential to discuss potential medication interactions, side effects, and cost with a healthcare provider. Questions to consider asking a doctor include: "Will treatment interact negatively with any other medications I am taking?", "What should I do if I experience side effects?", "What is my risk of a bone fracture?", "Is there anything I can do to reduce my fracture risk?", "How often should we re-evaluate treatment?", and "What should I do if I experience side effects?". Speaking with a pharmacist when picking up medication can provide additional information.
The risk of developing osteoporosis and bone fractures increases with age. It's recommended to re-evaluate osteoporosis treatment every 5 years for most treatment protocols, and every 3 years for zoledronic acid. However, there is no age at which a person needs to stop treatment for osteoporosis.
In palliative care or hospice, people may no longer need osteoporosis treatment if the treatment side effects are unpleasant or if they have a low risk of a fracture. Treatment in older age is particularly important in maintaining quality of life and reducing the risk of fractures.
A 2017 narrative review highlighted that the risk of fractures increases as a person ages, and the benefits of treatment also increase since treatment can reduce the risk of a bone fracture. Older adults with hip fractures are three to four times more likely to die within a year. Adding calcium and vitamin D to a person's diet may further reduce the risk of a fracture.
In conclusion, continuing osteoporosis treatment in older adults is often beneficial, particularly in those with persistent high fracture risk, and stopping treatment should involve careful individualized evaluation rather than a fixed age threshold. By prioritizing bone health, we can help older adults maintain their quality of life and independence.
