Osteoporosis in the long-lived: focus on safety and quality of life
https://doi.org/10.37586/2686-8636-2-2026-185-195
Abstract
Osteoporosis in the elderly (≥90 years) is a key factor in disability and mortality due to the high risk of fractures, particularly at the hip. The leading role in the pathogenesis is played not so much by decreased bone mineral density but by deterioration of bone microarchitecture, sarcopenia, chronic inflammation, and a high rate of falls. Diagnosis with standard methods is often difficult, and treatment requires a comprehensive geriatric approach. Modern medications (bisphosphonates, denosumab, and teriparatide) are effective; however, their use requires strict individualization, taking into account comorbidities, renal function, and life expectancy. Oral bisphosphonates, particularly ibandronic acid, with once-monthly dosing, demonstrate a favorable safety and efficacy profile even in the very elderly. Fall prevention and nutritional management are key.
About the Authors
N. V. Brailova
Pirogov Russian National Research Medical University of the Ministry of Healthcare of the Russian Federation, Russian Gerontology Clinical Research Center RNRMU
Russian Federation
Russian Federation
Moscow
E. N. Dudinskaya
Pirogov Russian National Research Medical University of the Ministry of Healthcare of the Russian Federation, Russian Gerontology Clinical Research Center RNRMU
Russian Federation
Russian Federation
Dudinskaya Ekaterina Nailievna
Moscow
M. A. Morozova
Peoples' Friendship University of Russia named after Patrice Lumumba (RUDN University)
Russian Federation
Russian Federation
Moscow
T. V. Sopetik
Peoples' Friendship University of Russia named after Patrice Lumumba (RUDN University)
Russian Federation
Russian Federation
Moscow
O. A. Dogotar
Peoples' Friendship University of Russia named after Patrice Lumumba (RUDN University)
Russian Federation
Russian Federation
Moscow
References
1. Vandenbroucke A., Luyten F. P., Flamaing J., Gielen E. Pharmacological treatment of osteoporosis in the oldest old. Clin Interv Aging. 2017 ; 12 : 1065–1077. DOI: 10.2147/CIA.S131023.
2. Ye C., Ebeling P., Kline G. Osteoporosis. Lancet. 2025 ; 406 (10514) : 2003–2016. DOI: 10.1016/S0140-6736(25)01385-6.
3. Kumar S., Wang M., Kim A. S., et al. Denosumab discontinuation in the clinic: implications of rebound bone turnover and emerging strategies to prevent bone loss and fractures. J Bone Miner Res. 2025 ; 40 (9) : 1017–1034. DOI: 10.1093/jbmr/zjaf037.
4. Mazzola P., Rea F., Merlino L., et al. Hip Fracture Surgery and Survival in Centenarians. J Gerontol A Biol Sci Med Sci. 2016 ; 71 (11) : 1514–1518. DOI: 10.1093/gerona/glw016.
5. Pineiro-Fernandez J. C., Rabunal-Rey R., Romey-Lema E., et al. Epidemiology and trends of hip fracture in centenarians: changes in clinical profile and in-hospital outcomes according to data from the Spanish national registry between 2004 and 2020. Aging Clin Exp Res. 2025 ; 37 (1) : 84. DOI: 10.1007/s40520-025-02994-w.
6. Abelleyra Lastoria D. A., Benny C.K., Smith T., Hing C. B. Outcomes of hip fracture in centenarians: a systematic review and meta-analysis. Eur Geriatr Med. 2023 ; 14( 6) : 1223–1239. DOI: 10.1007/s41999-023-00866-y.
7. Jang B. W., Kim J. W., Nho J. H., et al Hip Fractures in Centenarians: Functional Outcomes, Mortality, and Risk Factors from a Multicenter Cohort Study. Clin Orthop Surg. 2023 ;15 (6) : 910–916. DOI: 10.4055/cios23223.
8. Bermejo Boixareu C., Ojeda-Thies C., Guijarro Valtueña A., et al. Clinical and demographic characteristics of centenarians versus other age groups over 75 years with hip fractures. Clin Interv Aging. 2023 ; 18 : 441–451. DOI: 10.2147/CIA.S386563.
9. Sjölander M., Alvunger L., Eggertsen R., et al. Reduced Risk of Recurrent Fragility Fractures After a Primary Care-Based Fracture Prevention Intervention: A 20-Year Non-Randomized Controlled Follow-Up Study in Women Aged 70-100. Scand J Prim Health Care. 2026 ; 44 (1) :1–16. DOI: 10.1080/02813432.2025.2571929.
10. Barcelo M., Francia E., Romero C., et al. Hip fractures in the oldest old. Comparative study of centenarians and nonagenarians and mortality risk factors. Injury. 2018 ; 49 (12) : 2198–2202. DOI: 10.1016/j.injury.2018.09.043.
11. Serra-Vinardell J., Roca-Ayats N., De-Ugarte L., et al. Bone development and remodeling in metabolic disorders. J Inherit Metab Dis. 2020 ; 43 (1) : 133–144. DOI:10.1002/jimd.12097.
12. Boskey A. L., Donnelly E., Boskey E., et al. Examining the Relationships Between Bone Tissue Composition, Compositional Heterogeneity, and Fragility Fracture: A Matched Case-Controlled FTIRI Study. J Bone Miner Res. 2016 ; 31 (5) : 1070–1081. DOI: 10.1002/jbmr.2759.
13. Blomqvist M., Nuotio M. S., Sääksjärvi K., et al. Osteosarcopenia as a risk factor for fractures and mortality ― 19-year follow-up of a population-based sample. Aging Clin Exp Res. 2025 ; 37 (1) : 319. DOI: 10.1007/s40520-025-03229-8.
14. Compston J. E., McClung M. R., Leslie W. D. Osteoporosis. Lancet. 2019 ; 393 (10169) : 364–376. DOI: 10.1016/S0140-6736(18)32112-3.
15. Zhu M., Yea J. H., Li Z., et al. Pharmacologic or genetic targeting of peripheral nerves prevents peri-articular traumatic heterotopic ossification. Bone Res. 2024 ; 12 (1) : 54. DOI: 10.1038/s41413-024-00358-0.
16. David K., Narinx N,. Antonio L., et al. Bone health in ageing men. Rev Endocr Metab Disord. 2022 ; 23 (6) : 1173–1208. DOI: 10.1007/s11154-022-09738-5.
17. Khosla S., Hofbauer L. C. Osteoporosis treatment: recent developments and ongoing challenges. Lancet Diabetes Endocrinol. 2017 ; 5 (11) : 898–907. DOI: 10.1016/S2213-8587(17)30188-2.
18. Mi B, Xiong Y, Knoedler S, Alfertshofer M, Panayi AC, Wang H, Lin S, Li G, Liu G. Ageing-related bone and immunity changes: insights into the complex interplay between the skeleton and the immune system. Bone Res. 2024 ; 12 (1) : 42. DOI: 10.1038/s41413-024-00346-4.
19. Luo J., Wang X., Li Y., et al. Oxidative stress and inflammation: roles in osteoporosis. Front Immunol. 2025 16:1611932. DOI: 10. 3389/fimmu.2025.1611932.
20. Chevalier C., Kieser S., Colakoglu M., et al. Warmth Prevents Bone Loss Through the Gut Microbiota. Cell Metab. 2020 ; 32 (4) : 575–590.e7. DOI: 10.1016/j.cmet.2020.08.012.
21. Zhang Y. W., Li R. Y., Wu Y., et al. Gut microbiota and bone aging: Focusing on the gut-X axis modes. J Orthop Translat. 2026 ; 57 : 101064. DOI: 10.1016/j.jot.2026.101064.
22. Mosher H. A., Patel S. M., Berry S. D., et al. Screening for Osteoporosis in Nonagenarians: A Scoping Review. J Am Geriatr Soc. 2025 ; 73 (2) : 512–521. DOI: 10.1111/jgs.19621.
23. Chattaris T., Yang L., Johansson H., et al. Performance of FRAX in older adults with frailty: the Framingham Heart Study. Osteoporos Int. 2024 ; 35 (2) : 265–275. DOI: 10.1007/s00198-023-06950-0.
24. Ensrud K. E., Lui L. Y., Taylor B. C., et al. A comparison of prediction models for fractures in older women: is more better? Arch Intern Med. 2009 ; 169 (22) : 2087–2094. DOI: 10.1001/archinternmed.2009.404.
25. Masud T., Binkley N., Boonen S., Hannan M. T. Official Positions for FRAX® clinical regarding falls and frailty: can falls and frailty be used in FRAX®? From Joint Official Positions Development Conference of the International Society for Clinical Densitometry and International Osteoporosis Foundation on FRAX®. J Clin Densitom. 2011 ; 14 (3) : 194–204. DOI: 10.1016/j.jocd.2011.05.010.
26. Harvey N. C., Odén A., McCloskey E. V., et al. Trabecular bone score (TBS) as a new complementary approach for osteoporosis evaluation in clinical practice. Bone. 2015 ; 78 : 216–224. DOI: 10.1016/j.bone.2015.05.016.
27. Cooper C. Osteoporosis: disease severity and consequent fracture management. Osteoporos Int. 2010 ; 21 Suppl 2: S425–S429. DOI: 10.1007/s00198-010-1251-0.
28. Prince R, Khoo B, Brown K, Lewis J. Differences in Femoral Neck and Trochanteric Structure in Elderly Women Prior to Hip Fracture: Role in Hip Fracture Prediction. J Bone Miner Res. 2023 ; 38 (6) : 869–875. DOI :10.1002/jbmr.4789.
29. Gazzotti S, Aparisi Gómez MP, Schileo E, Taddei F, Sangiorgi L, Fusaro M, Miceli M, Guglielmi G, Bazzocchi A. High-resolution peripheral quantitative computed tomography: research or clinical practice? Br J Radiol. 2023 ; 96 (1150) : 20221016. DOI: 10.1259/bjr.20221016.
30. Szulc P., Boutroy S., Vilayphiou N., et al. Cross-sectional analysis of the association between fragility fractures and bone microarchitecture in older men: the STRAMBO study. J Bone Miner Res. 2011 ; 26 (6) :1358–1367. DOI: 10.1002/jbmr.319.
31. Ström O, Lauppe R, Ljunggren Ö, et al. Real-world effectiveness of osteoporosis treatment in the oldest old. Osteoporos Int. 2020 ; 31 (8) : 1525–1533. DOI: 10.1007/s00198-020-05380-6.
32. Park S. Y., Lee J., Lee Y., et al. Bisphosphonate Use and Reduced All-Cause Mortality in Korean Women Older than 50 Years: A Nationwide Sample Cohort Study. J Bone Metab. 2025 ; 32 (4) : 323–330. DOI: 10.11005/jbm.25.933.
33. Fuggle N., Laslop A., Rizzoli R., et al. Treatment of Osteoporosis and Osteoarthritis in the Oldest Old. Drugs. 2025 ; 85 (3) : 343–360. DOI: 10.1007/s40265-024-02138-w.
34. Morin S. N., Leslie W. D., Schousboe J. T. Osteoporosis: A Review. JAMA. 2025 ; 334 (10) : 894–907. DOI: 10.1001/jama.2025.6003.
35. Deardorff W. J., Cenzer I., Nguyen B., Lee S. J. Time to Benefit of Bisphosphonate Therapy for the Prevention of Fractures Among Postmenopausal Women With Osteoporosis: A Meta-analysis of Randomized Clinical Trials. JAMA Intern Med. 2022 ; 182 (1) : 33–41. DOI: 10.1001/jamainternmed.2021.6745.
36. Delmas P. D., Recker R. R., Chesnut C. H. 3rd, et al. Daily and intermittent oral ibandronate normalize bone turnover and provide significant reduction in vertebral fracture risk: results from the BONE study. Osteoporos Int. 2004 ; 15 (10) : 792–798. DOI: 10.1007/s00198-004-1602-9.
37. Felsenberg D., Miller P., Armbrecht G., et al. Oral ibandronate significantly reduces the risk of vertebral fractures of greater severity after 1, 2, and 3 years in postmenopausal women with osteoporosis. Bone. 2005 ; 37 (5) : 651–654. DOI: 10.1016/j.bone.2005.05.004.
38. Miller P. D., McClung M. R., Macovei L., et al. Monthly oral ibandronate therapy in postmenopausal osteoporosis: 1-year results from the MOBILE study. J Bone Miner Res. 2005 ; 20 (8) : 1315–1322. DOI: 10.1359/JBMR.050313.
39. Ettinger M. P., Felsenberg D., Harris S. T., et al. Safety and tolerability of oral daily and intermittent ibandronate are not influenced by age. J Rheumatol. 2005 ; 32 (10) : 1968–1974.
40. Takeuchi Y., Hashimoto J., Kakihata H., et al. Effectiveness of monthly intravenous ibandronate injections in a real-world setting: Subgroup analysis of a postmarketing observational study. Osteoporos Sarcopenia. 2019 ; 5 (1) : 11–18. DOI: 10.1016/j.afos.2019.02.002.
41. Miller P. D., Jamal S. A., Evenepoel P., et al. Renal safety in patients treated with bisphosphonates for osteoporosis: a review. J Bone Miner Res. 2013 ; 28 (10) : 2049–2059. DOI: 10.1002/jbmr.2058.
42. Chung Y. R., Lee H. S., Lee D. Y., et al. Podocyte Disease Following Treatment with Intravenous Ibandronate in an Older Patient. Ann Geriatr Med Res. 2024 ; 28 (2) : 228–230. DOI: 10.4235/agmr.23.0195.
43. Tankó L. B., Qin G., Alexandersen P., et al. Effective doses of ibandronate do not influence the 3-year progression of aortic calcification in elderly osteoporotic women. Osteoporos Int. 2005 ; 16 (2) : 184–190. DOI: 10.1007/s00198-004-1662-x.
44. Liang S., Hu S., Guo H., et al. Ibandronate sodium and zoledronate sodium in the treatment of senile osteoporosis: efficacy, impact on quality of life and cost-effectiveness analysis. Am J Transl Res. 2021 ; 13 (3) : 1764–1771.
45. Kim M., Jeon N., Suh H. S. Effects of bisphosphonates after denosumab discontinuation and treatment effect heterogeneity using causal machine learning. Sci Rep. 2025 ; 15 (1) : 44533. DOI: 10.1038/s41598-025-28172-6.
46. Cosman F., Nieves J. W., Dempster D. W. Treatment Sequence Matters: Anabolic and Antiresorptive Therapy for Osteoporosis. J Bone Miner Res. 2017 ; 32 (2) : 198–202. DOI: 10.1002/jbmr.3051.
47. Niimi R., Kono T, Nishihara A, et al. Usefulness of daily teriparatide treatment in elderly patients over 80 years of age. Osteoporos Int. 2016 ; 27 (5) : 1869–1874. DOI: 10.1007/s00198-015-3479-1.
48. Sheng O. C., Wu W. T., Peng C. H., et al. Therapeutic advantage of teriparatide in very elderly patients with proximal femoral fractures: a functional and BMD analysis. BMC Musculoskelet Disord. 2024 ; 25 (1) : 288. DOI: 10.1186/s12891-024-07373-6.
49. Panait C., D'Amelio P. Advancing care: optimizing osteoporosis treatment in the older and oldest old population. Aging Clin Exp Res. 2025 ; 37 (1) : 123. DOI: 10.1007/s40520-025-02973-1.
50. Reid I. R., Bolland M. J. Calcium and/or Vitamin D Supplementation for the Prevention of Fragility Fractures: Who Needs It? Nutrients. 2020 ; 12 (4) : 1011. DOI: 10.3390/nu12041011.
51. Li J. Effects of calcium supplementation on the risk of fracture in older adults. Acta Ortop Bras. 2025 ; 33 (6) : e284103. DOI: 10.1590/1413-785220253306e284103.
52. Weaver C. M., Alexander D. D., Boushey C. J., et al. Calcium plus vitamin D supplementation and risk of fractures: an updated meta-analysis from the National Osteoporosis Foundation. Osteoporos Int. 2016 ; 27 (1) : 367–376. DOI: 10.1007/s00198-015-3386-5.
53. de Souza M. M., Moraes Dantas R. L., Leão Durães V., et al. Vitamin D Supplementation and the Incidence of Fractures in the Elderly Healthy Population: A Meta-analysis of Randomized Controlled Trials. J Gen Intern Med. 2024 ; 39 (14) : 2829–2836. DOI: 10.1007/s11606-024-08933-1.
54. Yi Y. T., Zhao H. F., Wang W. Z., Li X. Osteosarcopenia: epidemiology, molecular mechanisms, and management. Front Endocrinol (Lausanne). 2025 ; 16 : 1577758. DOI: 10.3389/fendo.2025.1577758.
55. Zhao J. G., Zeng X. T., Wang J., Liu L. Association Between Calcium or Vitamin D Supplementation and Fracture Incidence in Community-Dwelling Older Adults: A Systematic Review and Meta-analysis. JAMA. 2017 ; 318 (24) : 2466–2482. DOI: 10.1001/jama.2017.19344.
56. Dawson-Hughes B. Effect of vitamin D on risk of falls and fractures ― The contribution of recent mega-trials. Metabol Open. 2024 ; 23 : 100300. DOI: 10.1016/j.metop.2024.100300.
57. Chakhtoura M., Bacha D. S., Gharios C., et al. Vitamin D Supplementation and Fractures in Adults: A Systematic Umbrella Review of Meta-Analyses of Controlled Trials. J Clin Endocrinol Metab. 2022 ; 107 (3) : 882–898. DOI: 10.1210/clinem/dgab742.
58. Roux C., Briot K. The crisis of inadequate treatment in osteoporosis. Lancet Rheumatol. 2020 ; 2 (2) : e110–e119. DOI: 10.1016/S2665-9913(19)30136-5.
59. O'Connell M. B. Prevention and treatment of osteoporosis in the elderly. Pharmacotherapy. 1999 ; 19 (1 Pt 2) : 7S–20S. DOI: 10.1592/phco.19.2.7s.30910.
60. Lips P., Ooms M. E. Non-pharmacological interventions. Baillieres Best Pract Res Clin Endocrinol Metab. 2000 ; 14 (2) : 265–277. DOI: 10.1053/beem.2000.0073.
61. Bouillon R., LeBoff M. S., Neale R. E. Health Effects of Vitamin D Supplementation: Lessons Learned From Randomized Controlled Trials and Mendelian Randomization Studies. J Bone Miner Res. 2023 ; 38 (10) : 1391–1403. DOI: 10.1002/jbmr.4888.
62. Cheng X., Chen Y., Zhou X., et al. Immunoporosis: The hidden link between aging immune cells and bone fragility. J Orthop Translat. 2025 ; 53 : 325–335. DOI: 10.1016/j.jot.2025.06.015.
63. Gregson C. L., Armstrong D. J., Bowden J., et al. UK clinical guideline for the prevention and treatment of osteoporosis. Arch Osteoporos. 2022 ; 17 (1) : 58. DOI: 10.1007/s11657-022-01061-5.
64. Papaioannou A., Feldman S., Katz P., et al. Study protocol for a pragmatic, cluster, randomized controlled trial of a multifaceted fracture prevention model for long-term care: the PREVENT trial. Trials. 2026 ; 27 (1) : 111. DOI: 10.1186/s13063-025-09398-1.
Review
For citations:
Brailova N.V., Dudinskaya E.N., Morozova M.A., Sopetik T.V., Dogotar O.A. Osteoporosis in the long-lived: focus on safety and quality of life. Russian Journal of Geriatric Medicine. 2026;(2):185-195. (In Russ.) https://doi.org/10.37586/2686-8636-2-2026-185-195
Views:
1317
JATS XML
Email this article 