<p>Osteoporosis and osteoarthritis increase in prevalence with age. While a number of therapies have been investigated for the management of these conditions, evidence of the safety and effectiveness in the oldest old is limited due to an underrepresentation of patients in this age group in clinical trials. The evidence thus far, suggest comparable efficacy between age groups of first-line treatments in osteoporosis (i.e. alendronate, risedronate, zoledronate), while the data in osteoarthritis is lacking in the oldest old and are mostly extrapolated from trials in younger patients. Treatments should be tailored to a patient’s risk profile, with consideration for comorbidities.</p>