노인의 골다공증 관리

Abstract

The prevalence of osteoporosis increases with growing elderly population. Osteoporosis-related fractures causes significant mor-bidity and disability, impedes quality of life, and even leads to death among older people with osteoporosis. As health care expenditures sharply increase in developed countries, osteoporosis and related fractures has become to the top public health issues in these countries. In particular, Asians are expected to be the most commonly affected race and ethnicity by osteoporotic fractures with rapidly aging population of their countries. Nevertheless, osteoporosis and osteoporotic fractures are still both underdiagnosed and undertreated. Osteoporosis management can be divided into non-pharmacological and pharmacological treatments. Non-pharmacological treatments include nutrition, exercise, and fall prevention. Older people tend to have low calcium intake and vitamin D deficiency. Furthermore, sarcopenia, gait and balance impairment of osteoporotic older people lead to negative consequences, including falls, injuries, and disability. Pharmacological treatments include selective estrogen receptor modulators, bisphosphonates, anti-receptor activator of nuclear factor-kappa B ligand antibody, and parathyroid hormone. Compared with the youngers, the absolute risk reduction of osteoporotic fractures by pharmacological agents is larger among older people because older people pose higher risk of falls and injuries even after falling risk is adjusted by age. Therefore, older people obtain more benefits from anti-osteoporotic agents than the counterpart youngers. We need further researches to provide more accurate assessment of osteoporosis and allow more proactive managements for older people with osteoporosis.