October 20th is World Osteoporosis Day, a disease characterized by a progressive reduction and structural modification of bone mass with compromised bone strength which predisposes to an increased risk of spontaneous fractures or fractures induced by minimal trauma, also defined as fragility fractures. The skeletal sites most affected by fragility fractures are the vertebrae, proximal femur, proximal humerus, wrist and ankle. Osteoporosis generally runs asymptomatic for years and, if not looked for through specific tests, is often diagnosed on the occasion of a fracture or fortuitously through x-rays taken for other reasons.
The theme of World Day 2023 is “Build better bones” (“Build better bones”) to raise awareness among the population of the importance of adopting, from childhood, healthy lifestyles to improve the state of bone health, in particular through correct nutrition, adequate and regular physical activity , maintaining an optimal body weight, as well as paying attention to individual risk factors (genetic, smoking, risky and harmful consumption of alcohol, reduction in height of 4 cm or more, menopause, diseases and/or particular pharmacological therapies).
The World Health Organization (WHO) has repeatedly drawn attention to osteoporosis and related fragility fractures, which have significant consequences both in terms of mortality and motor disability, with high health and social costs. Osteoporosis, in fact, is very widespread globally and it is estimated that in our country it affects approximately 5 million peopleof which the80% I am post-menopausal women. According to the ISTAT Multiscope survey “Aspects of daily life” relating to the year 2021, 7.8% (2.1% of males and 13.2% of females) of the Italian population declared to be affected from osteoporosis, with a prevalence that progressively increases with advancing age, particularly in women over the age of 55, up to reaching 30.5% (9.2% of males and 44.9% of females) over 74 years old.
The main risk factors
Osteoporosis is characterized by a multifactorial etiopathogenesis. The main modifiable risk factors are a sedentary lifestyle and poor physical activity, an unbalanced diet low in calcium and high in salt, risky and harmful consumption of alcohol, abuse of caffeine, excess weight (overweight and obesity ), excessive thinness, eating disorders and smoking.
Non-modifiable risk factors are represented by age, gender (women have lower bone mass than men and the reduction in sexual hormones that occurs with menopause causes a more rapid and early loss of bone mass) and family history. .
What to do to prevent and deal with osteoporosis
To avoid or delay the onset of the disease, which generally occurs with the onset of menopause in women and in senile age in men, primary prevention of osteoporosis must begin from the early stages of life. In fact, bone tissue develops during childhood and adolescence to reach the maximal bone mineral density (defined as “peak bone mass”) around 20-25 years of age, the value of which influences the probability of manifesting followed by osteoporosis. After reaching the “peak” and until menopause in women and 65-70 years of age in men, the bone remodeling processes remain in balance, unless particular diseases, conditions or pharmacological therapies are present.
Subsequently, bone resorption tends to prevail over the formation of new bone and the skeleton begins to lose minerals with a consequent reduction in bone mass. Therefore, suboptimal bone growth early in life impacts skeletal health as negatively as bone loss later in life.
With the onset of menopause in women and after the age of 70 in men it is useful to contact your doctor for an evaluation of the condition of your bones. The early identification of osteoporosis can, in fact, allow the implementation of measures aimed at slowing down or stopping the disease and preventing fragility fractures, possibly resorting, where necessary according to the doctor’s judgment, to drugs that allow increase the density of the skeleton, taking into account gender, age, the severity of osteoporosis, the presence of additional risk factors (for example risk of falls) and the patient’s comorbidities.
A periodic check should always be carried out in those patients suffering from particular pathologies or who take drugs that can cause osteoporosis in the medium-long term.
To protect bone health you need to: Adopt and/or maintain one active lifestyle, regularly practicing adequate physical activity; follow a varied and balanced dietassuming, in particular, adequate quantities of calcium and vitamin D (for the latter, appropriate exposure to sunlight is also important), as well as reducing excessive salt consumption (which increases the elimination of calcium in urine); maintain a optimal body weight, avoiding excessive thinness or overweight and obesity; do not smoke and limit or avoid the consumption of alcoholic beverages (which decrease the absorption of calcium and reduce the activity of the cells that “build bone”); pay attention to individual risk factors (genetic/family factors, reduction in height of 4 cm or more, menopause, particular diseases and/or pharmacological therapies). Initiatives on osteoporosis
To encourage an overall systematic approach to the disease, the document containing “An intervention strategy for osteoporosis”, which provides elements of direction aimed at the connection and programmatic coordination of interventions for the prevention, diagnosis and treatment of osteoporosis and its complications, with a view to integrating and enhancing the skills and professionalism involved.
In implementation of the aforementioned Agreement and the National Prevention Plan (PNP) 2020-2025, the Regional Prevention Plan (PRP) 2021-2025 of the Marche Region, adopted with DGR n.1640 of 28 December 2021, provides a specific program on osteoporosis and fragility fractures ( Free program PL13 – “Prevent and take care of: the PPDTA of Osteoporosis and fragility fractures as a regional participatory model for the management of chronic pathologies”), the implementation and related monitoring of which is underway.
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