Abstract
Our study of 272,152 geriatric patients assessed osteoporosis treatment requirement and eligibility. Over 75% qualified for therapy, with 54% at very high fracture risk, classifying for bone anabolic treatment. Despite contraindications in 8-20%, most were suitable for treatment. Especially in geriatric patients, early risk-assessment and timely intervention are essential. PURPOSE: The German osteoporosis guideline defines high and very high fracture-risk based on quantifiable evidence-based risk-factors, recommending bone anabolic treatment as first-line therapy for the latter. Given age as a major risk factor, we investigated the proportion of geriatric patients with very high fracture risk, their characteristics, and the percentage suitable for bone anabolic treatment considering contraindications. METHODS: Data from the Geriatrics in Bavaria-Database (GiB-DAT, Geriatrie in Bayern Datenbank) included 272,152 participants (mean age 82 ± 7 years) between 2013 and 2023. Risk-factors and contraindications were evaluated using ICD-10- (International Statistical Classification of Diseases) and ATC-codes (Anatomical Therapeutical Chemical Classification). We analyzed the proportion in the high-risk and very high-risk group, their characteristics, and the share with a contraindication for specific anti-osteoporotic treatments. RESULTS: > 75% of the patients qualified for specific anti-osteoporotic treatment, with the majority (54%) at very high-risk requiring bone anabolic treatment. Patients in the very high-risk group had the lowest mini mental status examination (MMSE) (23 ± 5 points) and activities of daily living (ADL) scores (45 ± 20 points). Contraindications for bone anabolic treatments were found in 20% of women and 8% of all very high-risk patients. Seventy percent of the total study population had no contraindication for any specific anti-osteoporotic medications. CONCLUSION: The majority of geriatric patients is at a very high-risk for osteoporotic fractures, characterized by cognitive impairment, ADL limitations, and increased vulnerability. While some patients had contraindications, most were eligible for anti-osteoporotic and particularly bone anabolic treatments. Timely risk-assessment and treatment initiation is crucial and barriers need to be addressed.