Osteoporosis is a chronic disease and is characterized by the presence of changes in the bone structure with consequent lower resistance to mechanical loading and an increased risk of fractures.
During the life of an individual, the bone undergoes a physiological process of continuous remodeling that sees the removal, by specialized cells called osteoclasts, of the old damaged skeletal tissue and the formation of new bone by other specialized cells called osteoblasts. As they get older, however, the a ctivity of osteoclasts tends to be greater than that of osteoblasts, which is why aging is accompanied by a loss of bone mass.
As Professor Gherardo Mazziotti, Head of the Research, Diagnosis and Treatment Section for Osteometabolic Diseases at Humanitas, points out: “Osteoporosis develops when this loss of bone mass becomes pathological due to an excessive and dominant activity of bone resorption compared to that of neoformation. Osteoporosis, therefore, is not a physiological condition inevitably associated with ageing, but a pathological condition for which a pharmacological treatment must be established to reduce the risk of fractures due to fragility”.
In fact, osteoporosis is a disease of social importance; it is estimated that in our country 1 woman out of 3 (about 5,000,000 people) and one man out of eight (about 1,000,000 people) are affected. “Unfortunately, even today, less than 50% of 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,” continues the professor.
Which treatments are available in case of osteoporosis?
“The anti-osteoporotic drugs act on skeletal remodeling with the aim of improving the balance between bone resorption and neoformation. Most of the drugs available (bisphosphonates, denosumab, estrogen receptor modulators) act by inhibiting the function of osteoclasts and thus bone resorption. Today, however, we have only one so-called anabolic drug (the teriparatide) that can stimulate osteoblastic function and thus bone neoformation. All these drugs have demonstrated significant efficacy in improving the densitometric values measured through the MOC-DEXA test and especially in reducing the risk of fractures.
The choice of drug is made according to the needs of the individual patient, based on the factors that reflect the individual fracture risk profile and the patient’s acceptability and potential tolerability. As in other chronic diseases for which the therapy is necessarily long-term, the choice of the drug should always be shared with the patient in its various aspects (rational, potential side effects and expected results).
In patients with clinical vertebral fractures or femoral fractures, in addition to the pharmacological therapy of secondary prevention of fractures, it is necessary to implement a surgical and rehabilitative therapeutic path for the treatment of fracture complications and their outcomes,” said the specialist.
The new Section for Research, Diagnosis and Treatment of Obsteometabolic Diseases belonging to the Endocrinology Unit in Humanitas
Humanitas has a great interest in osteoporosis and prepares diagnostic-therapeutic courses dedicated to the disease in addition to clinical research studies. Recently, the Section for Research, Diagnosis and Treatment of Osteometabolic Diseases, which is run by a university, has been established and is headed by Prof. Gherardo Mazziotti. The primary objective of the Centre is to meet the needs of patients with skeletal fragility. To this end, there are Endocrinology clinics and diagnostic-therapeutic courses dedicated to the evaluation of patients with primary and secondary osteoporosis.