In Italy, it is estimated that nearly 5 million people, two thirds of them women, are affected by osteoporosis, a condition characterized by decreased bone mass and deterioration of the microarchitecture of the bone tissue. Osteoporosis increases bone fragility and exposes you to a greater risk of pathological bone fractures, which occur in the absence of significant trauma to various skeletal areas, such as the wrist, vertebrae and femur.
Although osteoporosis is a disease with a strong epidemiological and social impact, there are still delays in diagnosis and difficulties in treatment.
What are the risk factors for osteoporosis
For women, risk factors for osteoporosis are linked to ovarian function. We think of early menopause, the late onset of the first menstruation, close pregnancies. The absence of the menstrual cycle for several months (the so-called amenorrhea, sometimes linked to eating disorders or chronic stress), or the removal of the ovaries in fertile age can also play a decisive role. Other causes are prolonged treatments with cortisone drugs, diuretics, thyroid hormones, laxatives and antacids containing aluminum salts.
The importance of lifestyle
To stem osteoporosis it is in any case important to focus on prevention from an early age. The peak of bone mass is reached early, especially in the female gender and is consolidated around the age of 25. 80% of it is attributable to genetic factors and 20% to correct lifestyle habits. This 20% that contributes to the formation of the final bone mass depends on how appropriate, during the growth period, the dietary intake of calcium through dairy products, broccoli, spinach, beans, soy, salmon, almonds and vitamin D. E then from having avoided smoking and alcohol and from having been constant in practicing physical activity, useful for maintaining an adequate body weight.
The role of estrogen deficiency in the pathogenesis of osteoporosis
The estrogen deficiency that occurs in all women at the time of menopause plays a fundamental role in the pathogenesis of osteoporosis, which is why resorting to hormone replacement therapy (HRT) appears to be an excellent preventive strategy.
Hormone therapy replaced, women who follow it are no longer at risk of dementia
by Viola Rita
01 October 2021
HRT inhibits bone resorption and reduces the rate of bone turnover, significantly reducing the risk of fractures. It is no coincidence that HRT and the use of tibolone, a C-19 derived steroid, classified as a selective regulator of estrogenic activity (STEAR) and capable of exerting an estrogenic, progestin and also weakly androgenic action thanks to its 3 different metabolites , appear to be among the most recommended therapies in the first period of the postmenopausal phase, that is, within 10 years of the onset of menopause or in any case before the age of 60.
Distrust of hormone replacement therapy
A recent research conducted by Fondazione Onda entitled “Menopause in the life of women”, however, revealed that women do not trust HRT: 80% of respondents have heard of HRT and half of them have it. perceives it as a supportive therapy for menopause. 43% consider menopause a natural phase of life, during which it is not necessary to take drugs if not essential (48%), and 35% fear possible side effects.
Menopause, symptoms forgotten in times of a pandemic
by Irma D’Aria
23 March 2022
From this survey it emerges that only 5% of the women interviewed take hormone replacement therapy, while they more willingly resort to the use of food supplements (27%) and herbal products (17%).
The teacher Anna Maria Paolettifull professor of gynecology and obstetrics at the University of Cagliari, past director of SIGO and director of the Italian society of contraception and of the Italian society of menopause explains: “The main cause of distrust towards HRT is the fear that the use hormones is a determining factor in the onset of breast cancer. The use of estrogen in combination with progestin increases the risk of breast cancer, but does not induce breast cancer. In women after 40 years of age, breast ultrasound should be performed and annual mammography to monitor breast health. If mammography and breast ultrasound are normal, along with the absence of other contraindications to HRT, this can be undertaken with annual breast health monitoring. “
But why do women often interrupt prescribed therapies without even consulting the doctor? “The reasons may be different – explains the specialist -, in addition to the fear of breast cancer, sometimes unexpected blood loss occurs, which worries the woman who knows that after menopause, blood loss must not be present”.
What to advise, therefore, to premenopausal women for effective prevention of osteoporosis? Dr Paoletti again: “We should focus a lot on lifestyle and nutrition, without forgetting the supplementation of vitamin D which is deficient or insufficient in all ages of a woman’s life. Unfortunately osteoporosis is a silent disease, it does not give signs of pain or other until it leads to the fracture. This is why from an early age it is necessary to educate to a correct lifestyle and good nutrition, rich in calcium, of course, but also in vitamins, trace elements and proteins. of vitamin D is essential at all ages of the life of women, and also of men “.
Vitamin D, when it is necessary to supplement it
by Simone Valesini
05 December 2021
What to do in case of osteoporosis-related fractures
The doctor Maria Luisa Brandi President of the Italian Observatory on Fragility Fractures (OFF) and President of the Italian Foundation for Research on Bone Diseases, she is the author of the book “And if I fracture what should I do?” (Giunti Editore). In the book you provide useful information on fragility fractures, i.e. those that often result from osteoporosis and which, if not properly treated, open the way to countless subsequent fractures. Let’s deepen with her.
What are the instrumental tests to undergo to evaluate osteoporosis?
“The gold standard for defining the osteoporotic patient is Computed Bone Mineralometry (MOC), although today we have a very reliable ultrasound technique known as REMs for measuring lumbar and femoral bone density.”
Among the women at greatest risk of osteoporosis due to taking drugs are those who, following a breast cancer, undergo five-year therapy with aromatase inhibitors. What are the best treatments for them?
“For the prevention of fractures beyond lifestyle and vitamin D there are anti-fracture drugs and among these is the denosumab antibody the one indicated as the first choice in those who start therapy with anti-hormonal drugs in the case of breast cancer”.
What happens when you go to the emergency room first and to orthopedics afterward due to an osteoporotic fracture?
“In this case, surgery or immobilization of the limb are the masters in an acute phase, but the patient must immediately be sent to a continuity of care that includes the prescription of an anti-fracture drug. What will happen in our country with the so-called Fracture Liaison Service “.
What is the Fracture Liaison Service (LFS) project
The Italian Society of Orthopedics and Traumatology (SIOT) promoted the project Fracture Liaison Service (FLS) for which at the moment 10 centers nationwide have obtained the Certification. Also the Orthopedic and Traumatological Clinic Department of the Cattinara Hospital in Trieste directed by Professor Luigi Murena is among the centers involved. We ask Murena precisely how the patient who belongs to the ward is managed.
“Patients who are hospitalized for fracture of the femur are not only treated from a surgical point of view but also initiated to a path of classification of the underlying pathology that caused the fracture. In fact, fragility fractures or those due to a minor trauma or even in the absence of trauma, they are the expression of an underlying osteoporosis framework. During hospitalization – continues the expert – first level blood tests of bone metabolism and the dosage of vitamin D are acquired. hospitalization or a densitometric examination is scheduled for discharge to assess the state of health of the skeleton. Any deficiencies in vitamin D are corrected with adequate supplementation therapy. Patients are then re-evaluated on an outpatient basis where the graduation process is completed diagnostic and where appropriate therapies are set for the osteoporosis that I am coming from no customized based on age, comorbidities and patient compliance “.
What does it mean to be treated in an FLS certified center?
“Being treated in an FLS certified center involves taking charge of the patient that is not limited to the treatment of the fracture but to a complete evaluation and classification of the patient with the implementation of all strategies aimed at reducing the risk of resorting to new fracture events. This is possible thanks to a close collaboration between the activity that is carried out in the ward and the outpatient activity and thanks to the presence of an orthopedic team sensitized not only on the surgical aspects but also on the pathologies of bone metabolism that are the cause primary of skeletal fragility “.