Effectiveness and Safety of Pharmacological Therapy for Osteoporosis in Frail Elderly Individuals: Systematic Review and Meta‐Analysis

ABSTRACT Background Frailty and osteoporosis are interrelated conditions that predominantly affect older adults. The greater the individual's frailty, the greater the probability of suffering a fracture and the greater the risk of fractures occurring in the future. Therefore, this study aimed to verify whether anti‐fracture pharmacological therapies in frail individuals with osteoporosis are effective and safe. Methods A systematic review of the literature was conducted using randomized clinical trials and observational studies. Participants aged 60 years or older, living in the community or in a long‐term care facility, diagnosed with frailty and osteoporosis and with a history of anti‐fracture medication use were evaluated. A meta‐analysis was performed when appropriate. This review was conducted and reported following the PRISMA 2020 guidelines. Results Six studies with 42,851 frail elderly were included. Five were conducted in long‐term care facilities (3 observational and 2 randomized clinical trials) and 1 observational study included community‐dwelling elderly after hospitalization due to fragility fracture. All studies assessed fractures; four evaluated mortality, and one assessed bone mineral density. Three studies compared bisphosphonates to a non‐antiosteoporotic treatment; one compared bisphosphonate, denosumab, and teriparatide to placebo; one compared denosumab and zoledronic acid to teriparatide; and one compared sequential teriparatide with alendronate to alendronate. Meta‐analysis pointed to a potential reduction in hip fracture risk and mortality with bisphosphonates in institutionalized frail elderly. It also demonstrated that bisphosphonates can be safe with limited nonserious side effects. Conclusion The findings suggest a possible benefit of pharmacological treatment in reducing hip fractures and mortality in frail elderly. The real impact of the anti‐fracture therapies on those individuals still needs to be better studied.