In Italy there are 500 thousand people who encounter it every year: vertebrae, wrist, femur, ankle and humerus are the most affected districts. It is caused by osteoporosis, which gives no symptoms until a fracture occurs
In Italy there are 500,000 people who suffer a fragility fracture every year: vertebrae, wrist, femur, ankle and humerus. It is caused by osteoporosis, which does not give symptoms until a fracture occurs which, in addition to pain, can cause motor disability and even mortality. It is characterized by a low mineral density and the deterioration of the bone micro-architecture with increased fragility. There are about 5 million people, 80 percent of which are post-menopausal women in our country who, due to the aging of the population, will be 25 percent more in 10 years.
Bone is not static
Bone has always been considered a static tissue with a support function, but in the last twenty years it has been understood that it is a living tissue, an endocrine organ that changes continuously. In fact, the skeleton has a dual function: it is a support tissue and ensures the normal concentration of calcium in the blood thanks to the continuous repair of microtraumas and the renewal of bone tissue. But it is not enough that the calcium levels in the blood are adequate, it is necessary that it is absorbed in the intestine and for this it is necessary that the levels of vitamin D are adequate, in particular of cholecalciferol and calcitriol. When this doesn’t happen – for example due to malabsorption – the level of calcium in the blood tends to drop and our body restores balance through the increase in parathyroid hormone, a hormone that activates the release of calcium from the bone. Careful prevention, correct diagnosis and the right level of vitamin D in the body are essential for bone health, especially in the elderly. Exposure to the sun’s rays and, in part, diet are important for synthesizing vitamin D, but despite the greater number of sunny days compared to other countries and the availability of foods with a high calcium content, a significant portion of the Italian population have a vitamin D deficiency.
bone metabolism
“Bone fragility and fragility fractures are essentially the consequence of an imbalance of bone metabolism, which occurs when in the presence of insufficient serum levels of vitamin D” – says Iacopo Chiodini, President of the Italian Society of Osteoporosis, of Mineral Metabolism and Skeletal Diseases (SIOMMMS) – “Vitamin D deficiency in patients with osteoporosis is associated with an increased risk of fracture and, conversely, adequate supplementation with vitamin D in deficient subjects, together with adequate calcium intake reduces the risk of fracture. Furthermore, inadequate levels of vitamin D and insufficient calcium intake are the main causes of a failure to respond to osteoporosis therapy.
Smoking, alcohol, obesity, sedentary lifestyle are enemies of bone health
In addition to correcting modifiable risk factors such as smoking, alcohol, obesity and a sedentary lifestyle, it is necessary to try to prevent bone fragility with a correct diet rich in calcium, three servings a day of dairy products, and vitamin D levels which must be maintained above 30 mg/ml. The pharmaceutical forms of vitamin D available are various: drops, tablets, daily, weekly, monthly and in orodispersible film and soft capsules. “An appropriate therapy must correct the modifiable risk factors and then correct any calcium or vitamin D deficiency, the supplementation of which today represents one of the cornerstones of the treatment of osteoporosis” explains Claudio Cricelli, President of the Italian Medicine Society General and Primary Care (SIMG). «For institutionalized patients, pregnant and breastfeeding women and for people with osteoporosis who are not candidates for remineralizing therapy, vitamin D is prescribed regardless of the blood dosage, while for other categories of patients it is necessary to verify the level of hypovitaminosis D. For example, note 96 of AIFA indicates the threshold of 30 ng/ml for people with osteoporosis who are candidates for remineralizing therapy, for whom it is important to correct the vitamin D deficiency before starting the treatment”. Adherence to chronic therapy remains a problematic aspect for various reasons, as in the case of an elderly patient who takes up to 15 drugs a day. In fact, the cure is often neglected or abandoned for different reasons, even of a very practical nature, such as the unpleasant taste of the oily formulations or the difficulty in opening the vials. «The formulations available to date have shown some critical issues – such as the precise counting of the drops, the loss of medicine in the case of the formulation in oil taken for example on bread, and so on – so simpler therapeutic options can increase compliance and possibility of having greater therapeutic adherence» intervenes Mario Sfrappini, President of the Italian Federation of Osteoporosis and Skeletal Diseases (FEDIOS).
March 15, 2023 (change March 15, 2023 | 12:55 am)
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