Osteoporosis is a metabolic osteopathy characterized by an alteration in skeletal trabecular microarchitecture (qualitative alteration) and reduced bone mass (quantitative alteration) hence increased skeletal fragility that is the cause of the most serious complication: fractures.
By definition, osteoporosis fractures are called fragility fractures, occurring in the absence of trauma or due to mild trauma. The most common sites of fragility fractures are the spine, femur and wrist; to a lesser extent the ribs and pelvis.
From an epidemiological point of view, living in an increasingly elderly society andosteoporosis being a late-life disease, the socioeconomic impact of the latter has also become increasingly pressing and preponderant in terms of pharmaco-economics: just think of the economic implications related to the resources used in the treatment of a femoral fracture, whether resulting from the surgery itself but also from the subsequent rehabilitative therapies not to mention the impact quoad valetudinem “of the fracture event” (post-fracture outcomes that affect the performance of daily life and thus welfare) and sometimes even quoad vitam (post-surgery complications, such as cardiovascular and/or infectious causes that can lead to the patient’s death).
Classically, a distinction is made between primary (post-menopausal osteoporosis, the preserve of the female sex, and senile osteoporosis) and secondary forms of osteoporosis (pharmacological especially from cortisone, from endocrine dysfunction see primitive hyperparathyroidism and hyperthyroidism, hematological diseases, etc.). Also playing an important role in the development of osteoporosis are lifestyle and especially constant aerobic physical activity (osteoporosis related to protracted and prolonged immobilization,” see disabling outcomes of cerebrovascular disease and/or cerebro-muscular disease causing allurement and poor motor capacity) and diet (adequate intake of calcium “about 1000 mg/day – and VitD about 800 IU/day”). Toxicants important to bone in many ways are alcohol and chronic smoking.
The diagnosis of osteoporosis is made through appropriate instrumental tests such as bone densitometry, or Computerized Bone Mineralometry (MOC), and with clinical-instrumental aid: targeted laboratory tests and appropriate evaluation by clinicians with expertise in the field. Today for the treatment of OP we have an extensive pharmacological armamentarium that allows us not only to treat it but more importantly to prevent complications, namely fragility fractures.
Among the most studied and tested drugs with positive outcomes are the amino-bisphosphonates (Alendronate, Residronate, Ibandronate etc.) and the more recent Denosumab (Prolia); the latter although not bisphosphonate, has greater antiresorptive capabilities than bisphosphonates themselves and is therefore recommended in osteoporosicomplicated conditions. Other antiresorptive agents, admittedly less potent than aminobisphosphonates, are SERMs, the progenitor of which is Raloxifene. Last but not least is Teriparatide (Forsteo), a drug that can stimulate the osteoblast to produce new bone and therefore intended for very complex cases of osteoporosis where multiple vertebral and/or femoral fractures are present.
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