Osteoporosis: Diagnosis and Therapy

After talking about osteoporosis in general, with this video we take a closer look at how to identify, treat and prevent it.

Before delving into these aspects, I would like to remind you briefly that osteoporosis is a disease characterized by a loss of bone tissue. This loss makes the bones more fragile, increasing the risk of fracture from even very minor trauma. It should be noted that a certain amount of bone mass is lost physiologically and inevitably with advancing age. However, there are factors that favor the reduction of bone volume, first of all the lack of estrogen resulting from menopause. Prolonged drug therapies with cortisone or immunosuppressants can also promote the onset of osteoporosis, as well as excessive thinness, nutritional deficiencies, alcohol abuse and some diseases, such as Cushing's syndrome and hyperthyroidism. In the previous episode we have also said that osteoporosis is a difficult disease to recognize. Most of the time, in fact, it does not cause any symptoms that could make us suspect its presence. Only over time, osteoporosis can give a sign of itself, with the onset of pain bone that worsens in the presence of load; also typical is the reduction of stature due to the curvature of the spinal column. Often, osteoporosis manifests itself suddenly with one of the typical fractures "due to bone fragility". To avoid this nasty surprise, a a certain age, the individual risk of osteoporosis should be carefully assessed. Any "risk factors" should therefore be taken into consideration, such as concomitant many presence of osteopenizing diseases or pharmacological therapies. Furthermore, for all women close to menopause, and in any case towards the age of 65 even in males, it is advisable to undergo a densitometric examination, called computerized bone mineralometry (MOC). This test measures the state of bone mineralization, a fundamental parameter for establishing the degree of osteoporosis and the risk of its occurrence; in particular, the lower the “bone mineral density”, the greater the risk of bone thinning, therefore of osteoporosis. Now let's see in more detail what this exam consists of.

Computerized bone mineralometry, commonly called bone densitometry, is a basic investigation to establish the health of the skeleton. We are talking about a minimally invasive and completely painless examination, which uses X-rays to evaluate the amount of minerals present in the bones. The areas generally evaluated are the lumbar spine and the femur. To go into more detail, the densitometric examination compares the bone "density" found in the patient with the average value of a younger reference population. The result of this ratio is expressed in the so-called T-score, a numerical value expressed in standard deviations (SD). The T-score, in addition to describing the patient's bone density, tells us how far this differs from that considered normal in a reference population. According to the World Health Organization, a T-score lower than 2.5 SD (-2.5 SD) is indicative of osteoporosis. A result between -1 and -2.5 SD is instead indicative of osteopenia; in these cases the skeleton has lost bone mineral density, but there is still no osteoporosis. The test, on the other hand, is considered normal if the T-score does not differ by more than one standard deviation (-1).

In addition to bone densitometry, the diagnosis of osteoporosis can make use of other instrumental tests, which are intended to confirm the presence of the disease, but also to understand its cause. Doctors may use an x-ray of the spine, which is useful for diagnosing and dating vertebral fractures. In other words, it can assess whether there are recent or previous injuries, since, as already described, sometimes these fractures can be asymptomatic. Some specialists use a method of analysis of the lumbar and dorsal vertebrae called vertebral morphometry. This examination is based on measuring the heights of the vertebral bodies to ascertain the presence or absence of a new vertebral fracture. Vertebral morphometry can be performed with the densitometer or on standard spine radiographs. Laboratory tests are also an important complement in the diagnostic process of osteoporosis. In fact, blood and urine tests allow to assess the state of bone metabolism, can identify possible causative factors and are particularly useful when there is a suspicion of a secondary form of osteoporosis. In addition to routine examinations, a series of parameters called “bone remodeling markers” are also evaluated. To give some examples, 24-hour phosphatemia, calcium, calcium and phosphaturia, bone alkaline phosphatase, parathyroid hormone, and metabolically active vitamin D levels can be determined.

Considering the numerous possible causes of origin, the various forms of osteoporosis require different therapeutic approaches. Common are instead the objectives of the treatment, which consist in improving the qualitative and quantitative characteristics of the bone tissue, in slowing down the pathological process, and in increasing resistance to trauma to reduce the risk of fracture. The so-called anti-osteoporotic drugs can act according to two different mechanisms; some inhibit bone resorption, thus opposing bone demolition, while others stimulate new bone formation and thus the deposition of new bone tissue. The former, called anti-resorptive drugs, have the ability to reduce the degradation of bone mass; in practice they block the processes that determine a loss of bone tissue by means of osteoclasts. Among the drugs against reabsorption we remember in the first place the bisphosphonates. On the other hand we have osteo-formative drugs, which stimulate the metabolic processes that determine the formation of new bone. Just to give other examples, we remind you that in selected cases selective estrogen receptor modulators (SERM) can be used. These drugs, such as raloxifene, reproduce the effects of estrogen on bone tissue, promoting bone regeneration. Among the most recently developed drugs used in the most severe forms of osteoporosis, we mention teriparatide, an analogue of the parathyroid hormone which acts by promoting the deposition of new bone material. Denosumab, on the other hand, works by blocking the activation of osteoclasts, thus increasing bone density and reducing the risk of developing fractures. Among all these drugs, the choice of therapy to be adopted is obviously not random, but is adapted by the physician on the basis of the individual characteristics of the patient.

Prevention of osteoporosis can be done, first of all, by practicing regular physical activity to strengthen the muscles, improve agility, posture and balance. I remind you, in fact, that prolonged immobilization can have negative effects on the skeleton. In particular, the greatest benefits are obtained by practicing weight-bearing sports activities, such as walking, running or dancing, obviously taking the appropriate precautions in case of advanced osteoporosis. In addition to physical activity, a correct lifestyle also includes avoiding smoking and alcoholic beverages. Furthermore, osteoporosis can be prevented at the table, with a healthy and balanced diet. In this sense, it is useful to follow a diet rich in fruit and vegetables, which also provides an adequate supply of calcium, contained above all in milk and derivatives, such as cheese and yogurt. It is known, in fact, that a significant deficiency in calcium can contribute to increasing the risk of osteoporosis. Together with calcium , vitamin D also plays an essential role in prevention. This vitamin can be taken with the diet, through animal foods; however, the preponderant amount of vitamin D is synthesized through exposure of the skin to sunlight. "Osteoporosis, therefore, encourages a bit of outdoor life, in addition to the consumption of foods such as milk, dairy products, salmon, sardines and eggs. If all this were not enough, an adequate dietary supplement of calcium and vitamin D through specific supplements may also be indicated, under prescription and medical supervision.

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