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This article reviews current osteoporosis treatments tailored for these age groups, emphasizing the balance between efficacy and safety, while considering cost\/benefit aspects. We discuss pharmacological therapies available nowadays and their respective benefits and risks in the old population, based on the available literature on the subject. Special attention is given to specific features of this age category, like challenges of polypharmacy, physiological changes associated with age, comorbidities and patient adherence. This paper highlights the need for individualised treatment plans that consider the patient\u2019s overall health status, life expectancy and quality of life and the importance of continued innovation and personalized care in managing osteoporosis especially among the \u201colder\u201d population.<\/jats:p>","DOI":"10.1007\/s40520-025-02973-1","type":"journal-article","created":{"date-parts":[[2025,4,11]],"date-time":"2025-04-11T23:35:53Z","timestamp":1744414553000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Advancing care: optimizing osteoporosis treatment in the older and oldest old population"],"prefix":"10.1007","volume":"37","author":[{"given":"Claudia","family":"Panait","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4467-8337","authenticated-orcid":false,"given":"Patrizia","family":"D\u2019Amelio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,4,12]]},"reference":[{"key":"2973_CR1","doi-asserted-by":"publisher","first-page":"112964","DOI":"10.1016\/j.socscimed.2020.112964","volume":"253","author":"L Liou","year":"2020","unstructured":"Liou L, Joe W, Kumar A, Subramanian SV (2020) Inequalities in life expectancy: an analysis of 201 countries, 1950\u20132015. 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