Osteoporosis is a chronic disease, of great social importance, and is characterized by an altered bone structure with a consequent reduction in resistance to mechanical loading and an increased risk of fractures. 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.
As Professor Gherardo Mazziotti, Head of the Research, Diagnosis and Treatment Section of Osteometabolic Diseases at Humanitas, explains: “Osteoporosis is a silent disease and the onset of symptoms corresponds to the appearance of a fracture from frailty. All skeletal districts are affected by osteoporosis and may be affected by fracture events. However, the most common fractures from frailty affect the spine, the proximal femur (neck) and the wrist.
How is the diagnosis made?
“The diagnosis involves first performing bone densitometry (DEXA or MOC), an examination that allows you to calculate bone mineral density and that is routinely assessed at the level of the lumbar spine and proximal femur. The data obtained are compared with those expected, and then express a numerical value called T-score for patients over 50 years of age and Z-score for younger subjects. Based on the T-score values, the densitometric values are defined as normal (T-score > -1 SD), in osteopenia (T-score between -1.0 SD and -2.5 SD) or in osteoporosis (T-score < -2.5 SD). In young subjects, the diagnosis of osteoporosis is based on the finding of a Z-score value equal to or less than -2.0 SD. The risk of fracture increases progressively with the reduction of T-score (the patient with osteoporosis has a greater risk of fracture than the subject with osteopenia and even more than the subject with normal T-score) or Z-score.
However, other factors may influence the risk of fracture regardless of bone mineral density values. In the case of secondary osteoporosis, for example, the patient may experience a fracture even in the absence of a densitometric diagnosis of osteoporosis. This is why it is important not only to perform the MOC-DEXA examination, but also to identify the presence of risk factors for skeletal fragility and fractures through a careful history, also with the help of a simple questionnaire.
In patients with densitometric diagnosis of osteoporosis or in those with suspected secondary osteoporosis, an X-ray of the spinal column should also be carried out in order to allow early diagnosis of vertebral fractures, which represent the most frequent complications of osteoporosis. Finally, simple blood and urine tests allow to study the calcium-phosphorus metabolism and to exclude or confirm the clinical suspicion of secondary forms of osteoporosis”, underlines Professor Mazziotti.
Who should undergo MOC-DEXA?
“The examination should be prescribed to all those subjects, regardless of age, who present at least one of the following risk factors for skeletal fragility: former fractures from fragility; history of chronic diseases or therapies known to be causes of secondary osteoporosis; radiological finding of bone demineralization. For post-menopausal women, other major criteria for directing the execution of the MOC-DEXA examination are: familiarity with fractures of the femur or vertebra, menopause before the age of 45, thinness (BMI ≤ 19 Kg/m2). There are also so-called minor criteria, such as reduced calcium intake through diet, smoking and alcohol; in subjects where these elements coexist, it is advisable to perform the MOC test after the age of 60-65 years,” the specialist specified.
The new Research, Diagnosis and Treatment Section of Osteo-Metabolic Diseases belonging to the Endocrinology Unit in Humanitas
Humanitas has a strong interest in osteoporosis and is preparing diagnostic-therapeutic courses devoted 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 satisfy the needs of skeletally fragile patients. To this end, there are Endocrinology clinics and diagnostic-therapeutic courses dedicated to the evaluation of patients with primary and secondary osteoporosis.