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The incidence of osteoporotic fracture increases exponentially throughout life, as does the risk of the devastating consequences of these fractures, including functional decline, institutionalization, mortality, and destitution.1 Adults in their eighth and ninth decades of life are less likely to be screened and treated for osteoporosis than younger individuals. Guidelines for pharmacologic treatment suggest using 10-year fracture risk estimations, but they do not address decision making for patients with life expectancies less than 10 years. Further, existing fracture risk calculators do not include many comorbidities or frailty characteristics common in older adults that influence risk-benefit assessment when considering pharmacologic treatment as a preventive measure for osteoporosis.
An approach to fracture prevention in older community-dwelling adults is reviewed, including an estimation of fracture risk and life expectancy, shared decision making for pharmacologic interventions, and important nonpharmacologic prevention strategies.
