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What is Osteoporosis?

Giorgio Gandolini, MD
Rheumatology and Bone Metabolism Unit
"Don C. Gnocchi" Foundation - I.R.C.C.S. - ONLUS

Osteoporosis is a disease of the skeleton. In a person with osteoporosis, bone mass is lost and the strength of the bone is diminished, so that the risk of bone fractures is increased. By the World Health Organization criteria, osteoporosis is diagnosed if the bone mineral density (BMD) is more than 2.5 standard deviations below the mean BMD of young adults (i.e., the T-score is lower than -2.5).

Changes in bone mass are seen during several stages of life. In early life (up to young adulthood), bone mass continues to increase. Adequate calcium and exercise during this time helps to ensure the attainment of a high peak bone mass. At about age 40, loss of bone mass begins to be seen in both men and women, with a rapid acceleration of loss in women at menopause. If enough bone mass is lost, osteoporosis may develop.

If untreated, osteoporotic patients often experience multiple bone fractures, especially in the spine. These vertebral fractures can cause height loss, a curved spine (kyphosis or "dowager's hump"), and chronic back pain. Eventually, the patient may be substantially disabled. The risk of hip fracture is also increased in osteoporotic patients. Patients with hip fracture typically undergo hospitalization, surgery, and an extended period of rehabilitation. Many patients never regain the level of independence and mobility that they enjoyed before hip fracture. Data show that both vertebral and hip fractures are associated with increased mortality.

Many patients with osteoporosis are not being treated, despite the existence of effective therapies. Early diagnosis should be a focus of clinical efforts. If all patients were identified and treated, the burden of this disease could be substantially reduced.

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