To Treat or Not to Treat

Angie SzumlinskiNews

A long-standing debate continues to brew around the country, do we perform dexascans on elderly patients and if so, do we treat a diagnosis of osteoporosis aggressively? I’m not sure there is an answer that meets every situation but it does raise the question, what impact would treatment have on outcomes? Elderly females are a higher risk for hip fractures than their male counterparts and more females have a diagnosis of osteoporosis than do their male counterparts. This data is proven and not debatable, but we also have polypharmacy issues and work hard to decrease the number of medications that may not be of value long-term. 

A study published online in the Journal of Clinical Endocrinology and Metabolism, found that long-term osteoporosis medications are associated with a reduced mortality risk following a fracture. Hmmm…. According to Dr. Chih-Hsing Wu, MD of the Institute of Gerontology at National Cheng Kung University, Tainan, Taiwan, “treatment for osteoporosis has the potential to minimize mortality risk in people of all ages and sexes for any type of fracture. The longer-acting treatments could lower mortality risk.” 

Dr. Robert A. Adler, chief of endocrinology at the Central Virginia Veterans Affairs Health Care System, Richmond said “these data should help reinforce the advice already given in professional guidelines that their (medications) benefit outweigh any risks.” He went on to say “we don’t know all the reasons why people die after a fracture. These are older people who often have multiple medical problems, so it is hard to dissect that out”. True, who really knows why someone dies after a fracture, right? BUT, if there is a chance for a longer, productive life, what’s the risk? We can always stop taking a medication if we choose!  

We have had this discussion before, meds or no meds, but with all the new research being done, it is worth a second look. Talk to your medical director, assess your at-risk residents first, maybe do a trial on one unit and see if there are negative outcomes related to the treatment, AND remember, men have bones too, add them to your list of residents to assess! Stay informed and stay tuned!