Magnitude of fragility fracture risk in the very old—are we meeting their needs? The Newcastle 85+ Study

Fractures due to osteoporosis are common in older people. This study assessed the management of osteoporosis in a group of 85-year-olds and found both assessment and current treatment to be suboptimal.

Fragility fractures are a major cause of excess mortality, substantial morbidity, and health and social service expenditure in older people. However, much less is known about fracture risk and its management in the very old, despite this being the fastest growing age group of our population.

Cross-sectional analysis of people who reached the age of 85 during the year of 2006 was carried out. Data were gathered by general practice record review (GPRR) and a multidimensional health assessment (MDHA).

Seven hundred thirty-nine individuals were recruited. Mean age was 85.55 years (SD 0.44), and 60.2 % were female; 33.7 % (n = 249) had experienced one or more fragility fractures (F 45.2 % vs M 16.3 % p < 0.001); in total, 332 fractures occurred in these 249 individuals. A formal documented diagnosis of osteoporosis occurred in 12.4 %, and 38 % of individuals had experienced a fall in the last 12 months. When the fracture risk assessment tool (FRAX) and National Osteoporosis Guideline Group (NOGG) guidelines were applied, osteoporosis treatment would be recommended in 35.0 %, with a further 26.1 % identified as needing bone mineral density (BMD) measurement and 38.9 % not requiring treatment or BMD assessment. Women were more likely than men to need treatment (47.4 vs 16.3 %, p < 0.001, odds ratio (OR) 4.62 (3.22–5.63)) and measurement of BMD (40.0 vs 5.1 %, p < 0.001, OR 12.4 (7.13–21.6)). Of the 259 individuals identified as requiring treatment, only 74 (28.6 %) were on adequate osteoporosis treatment.

The prevalence of high fracture risk in the very old is much higher than the documented diagnosis of osteoporosis or the use of adequate treatments.