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• W2023907581 abstract "To the Editor: We are pleased to respond to the thoughtful comments of Drs. Shil and Greer.1 First, we agree that traditional screening tools were not developed in this cohort, which is why we undertook the present study and believe that the results are important.2 Second, the authors express concern about exclusion of individuals using bisphosphonates. Because this study comprises baseline data for evaluation of another bisphosphonate, individuals taking a bisphosphonate were excluded, and data are not available from them, although the effect should be small because only 11% of potential participants took such an agent.3 Third, we agree that screening and treating before long-term placement is optimal, but long-term care residents should not be ignored. Although the rate of bone loss and fractures varies with age and race,4 the important point is that older women continue to lose bone and experience fractures.5 Fourth, atypical fractures and osteonecrosis of the jaw are a concern, but both are rare even after 5 years of bisphosphonate therapy. Because life expectancy in skilled or assisted living facilities is 2–3 years,6, 7 such rare events are even less of a worry in this population. By contrast, therapy with several bisphosphonates and denosumab reduces vertebral fracture rates in 1 year8-10 and hip fracture rates in 1–1.5 years.11, 12 If similar efficacy is established for nursing home residents, screening and treating such individuals may well be appropriate. Finally, the authors raise the most important point: the challenge of treating such vulnerable individuals. We agree. In addition to the barriers they describe, there are limited data regarding the efficacy and safety of treating such a frail population in which the incidence of fracture and the prevalence of comorbidity such as dementia, immobility, and renal impairment are so high. A randomized controlled trial is thus being conducted in this population that it is hoped will help to guide future decisions and therapy. Conflict of Interest: S. Greenspan: Grants received from Lilly, Sanofi Aventis, Warner Chilcott; consultant for Amgen, Lilly, and Merck. Author Contributions: Both authors participated equally in the response. Sponsor's Role: None." @default.
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• W2023907581 date "2012-12-01" @default.
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• W2023907581 title "Response to Shil and Greer" @default.
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• W2023907581 doi "https://doi.org/10.1111/jgs.12016" @default.
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