Osteoporosis: Prevention, Diagnosis, Therapies for Healthy Bones
Osteoporosis is a silent disease that affects the bones, making them fragile and more prone to fractures. In Italy, it is estimated that around 3.5 million women and 1 million men suffer from osteoporosis, with increasing incidence in an aging population. Each year, about 90,000 hip fractures occur, most of which are related to this condition. Recognizing this widespread problem in a timely manner is crucial to avoid serious complications.
What is Osteoporosis?
Bones are living tissues that constantly regenerate through a process called bone remodeling, where old bone tissue is replaced by new. Osteoporosis occurs when this process can no longer keep up: the body loses bone tissue faster than it can replace it, leading to a decrease in bone density.
Risk Factors
Several factors increase the risk of developing osteoporosis. These include:
- Age: The risk increases with age, especially after menopause in women and after age 70 in men.
- Sex: Women are more predisposed than men.
- Body Frame: Individuals with thin bones or a small frame are at higher risk.
- Lifestyle: A diet low in calcium and vitamin D, smoking, excessive alcohol consumption, and a sedentary lifestyle negatively impact bone health.
- Family History: A family history of osteoporosis can increase risk.
Chronic diseases and prolonged use of certain medications can also compromise bone health.
Symptoms and Diagnosis
One of the most insidious aspects of osteoporosis is the lack of obvious symptoms until fractures occur. Hip, vertebral, and wrist fractures are among the most common and can have debilitating consequences, such as difficulty moving, chronic pain, and a stooped posture.
To diagnose osteoporosis before fractures happen, the bone density test (DEXA - Dual-Energy X-ray Absorptiometry) is the most effective method.
When is DEXA Recommended?
- Women over 65: Menopause leads to a decrease in estrogen levels, increasing the risk of bone loss. For this reason, women over 65 should undergo a DEXA scan even in the absence of other risk factors.
- Men over 70: Although osteoporosis is less common in men than in women, the risk increases with age. Men over 70 should consider a DEXA scan, especially if they have other risk factors. In addition to age, DEXA is recommended for:
- Fractures with no significant trauma: If a fracture occurs from minimal trauma or without apparent cause, it is important to investigate bone health.
- Presence of chronic diseases: Conditions like rheumatoid arthritis, hormonal disorders (e.g., hyperthyroidism), diabetes, or certain forms of cancer can increase the risk of osteoporosis.
- Long-term use of medications: Prolonged use of corticosteroids (like prednisone) or other medications that reduce bone density requires monitoring of bone health.
- Family history: If there are cases of osteoporosis or frequent bone fractures in the family, personal risk may be higher.
- Early menopause or prolonged absence of menstrual cycle: Women who enter menopause before age 45 or who have had prolonged periods without menstruation (amenorrhea) are at greater risk of bone loss.
If the first DEXA scan indicates a moderate or high risk of osteoporosis, the doctor may recommend repeating the test every 1-2 years to monitor bone density changes and the effectiveness of any treatments.
Treatments for Osteoporosis
While osteoporosis cannot be cured, various treatment options exist to slow bone loss, reduce fracture risk, and improve quality of life. Some of the most commonly used medications include:
- Bisphosphonates: These help reduce the rate of bone loss and promote bone mineralization. They can be administered orally or via infusion.
- Denosumab: A subcutaneous injection given every six months that inhibits cells responsible for bone destruction.
- Anabolic therapies: Medications like teriparatide stimulate the formation of new bone tissue and are reserved for more severe cases or for those who do not respond to other treatments.
- Hormonal therapies: Estrogens can also help but are often avoided due to potential side effects.