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Osteoporosis: Prevention, Diagnosis, Therapies for Healthy Bones

Last Updated: 5 March 2025

Osteoporosis is a silent disease that progressively weakens the bones, making them fragile and more prone to fractures. This occurs due to the reduction in bone density, caused by a slowed process of tissue regeneration.

In Italy, it is estimated that almost 5 million people suffer from osteoporosis, of which around 3.5 million are women and over 1 million are men. The condition particularly affects women in menopause and is on the rise with the aging population. Every year, about 90,000 hip fractures are recorded, often linked to this condition.
Recognizing osteoporosis in time is crucial to prevent serious complications and protect bone health.

Risk Factors

Several factors can increase the risk of developing osteoporosis, including:

  • 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: having relatives with osteoporosis increases the likelihood of developing it.

Chronic diseases and prolonged use of certain medications can also affect bone density, increasing the risk of fractures.

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.
  • 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

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.

Take advantage of the endocrinology package to undergo a specialist visit and a bone mineral density test (MOC) as part of the Promotion about Women's Health at UPMC Salvator Mundi International Hospital.