How do you approach decision-making around initiation of osteoporosis therapy in patients with advanced dementia?

Great question, there are many things that I consider. First, I limit consideration of osteoporosis therapy to patients who have a life expectancy of 1 year or more. This is because the time to benefit from a bisphosphonate is estimated to be about 12 months (Deardorff et al., PMID 34807231). Assuming that the patient has more than 1 year of life expectancy, I also consider their goals of care. Most of my patients with advanced dementia are at high risk of fracture, but most also are not interes...