Osteoporosis is a chronic disease characterized by changes in the structure of the bone with a consequent reduction in resistance to mechanical loading and an increased risk of fractures.

Thanks to the help of Professor Gherardo Mazziotti, Head of the Research, Diagnosis and Treatment of Osteometabolic Diseases Section at Humanitas Research Hospital, we are discovering more about this disease, its causes and possible prevention measures.

“Osteoporosis is a socially relevant disease. It is estimated that in Italy 1 woman out of 3 (about 5,000,000 people) and 1 man out of 8 (about 1,000,000 people) are affected. Unfortunately, however, very few patients with osteoporosis at high risk of fractures are treated with anti-osteoporotic drugs, with significant social consequences in relation to the complications and outcomes of fracture events,” explains Prof. Mazziotti.

What are the causes of osteoporosis?

“There are two main forms of osteoporosis: a “primitive” one, which affects post-menopausal women or the elderly, and a “secondary” one, which can affect subjects of any age with chronic diseases or in therapy with drugs that directly or indirectly affect skeletal health. Chronic diseases associated with osteoporosis include many endocrinopathies (hypogonadism, Cushing’s syndrome, hyperthyroidism, primary and secondary hyperparathyroidism, growth hormone deficiency, acromegaly, hyperprolactinemia), autoimmune systemic diseases, malabsorption syndromes, chronic obstructive bronchitis and neuro-muscular diseases with reduced motor performance. Among the many drugs that can reduce skeletal resistance, it is important to remember glucocorticoids, immunosuppressive therapies and hormone therapies of estrogenic and androgenic deprivation”, stresses the professor.

Is osteoporosis preventable?

“The primary prevention acts on acquired and therefore modifiable risk factors, which affect about 50% of the health of our bones at all stages of life. The other 50% of our skeletal heritage is genetically determined and as such cannot be modified.

Adequate consumption of foods with a high calcium content (milk and dairy products, nuts, hazelnuts, almonds) can help to encourage proper skeletal remodelling and contribute to the acquisition and maintenance of the bone mass. Normal circulating levels of vitamin D are necessary to ensure that calcium introduced with food can be absorbed. Most of our daily vitamin D requirement comes from skin synthesis of cholecalciferol by an enzyme system regulated by ultraviolet rays. Regular exposure to the sun (less than 30 minutes per day are sufficient) is therefore important to ensure the synthesis of vitamin D and therefore a regular absorption of calcium. With aging, the enzymatic system of the skin is less functional and therefore it is often necessary to use drugs containing vitamin D, since most foods are poor.

Exercise is also an important part of the prevention strategy for osteoporosis and fractures, through the activation of a series of biochemical and mechanical signals that regulate the correct skeletal remodeling of the muscle. Finally, it is important to pay attention to eliminate those habits of life that lead to a progressive loss of bone mass, such as alcohol abuse and cigarette smoking.

These are prevention measures effective when undertaken in the first decades of life because they promote the constitution of the skeletal heritage and the achievement of the peak of bone mass. In the presence of osteoporosis and especially its complication with fractures, to the changes in lifestyle must be added an anti-osteoporotic drug therapy,” concluded Professor Mazziotti.

The new Research, Diagnosis and Treatment Section for Osteo-Metabolic Diseases of the Endocrinology Unit in Humanitas

Humanitas has a great interest in osteoporosis and prepares diagnostic-therapeutic courses dedicated to the disease alongside clinical research studies. Recently, a university-led Research, Diagnosis and Treatment Section for Osteo-Metabolic Diseases has been established, for which Prof. Gherardo Mazziotti is responsible. The primary objective of the Centre is to meet the needs of patients with skeletal fragility. For this purpose, there are Endocrinology clinics and diagnostic-therapeutic courses dedicated to the evaluation of patients with primary and secondary osteoporosis.