Abstract
BackgroundThe Italian Society for Orthopaedics and Traumatology conceived this guidance—which is primarily addressed to Italian orthopedic surgeons, but should also prove useful to other bone specialists and to general practitioners—in order to improve the diagnosis, prevention, and treatment of osteoporosis and its consequences.Materials and methodsLiterature reviews by a multidisciplinary team.ResultsThe following topics are covered: the role of instrumental, metabolic, and genetic evaluations in the diagnosis of osteoporosis; appraisal of the risk of fracture and thresholds for intervention; general strategies for the prevention and treatment of osteoporosis (primary and secondary prevention); the pharmacologic treatment of osteoporosis; the setting and implementation of fracture liaison services for tertiary prevention. Grade A, B, and C recommendations are provided based on the main levels of evidence (1–3). Toolboxes for everyday clinical practice are provided.ConclusionsThe first up-to-date Italian guidelines for the primary, secondary, and tertiary prevention of osteoporosis and osteoporotic fractures are presented.
Highlights
The Italian Society for Orthopaedics and Traumatology conceived this guidance—which is primarily addressed to Italian orthopedic surgeons, but should prove useful to other bone specialists and to general practitioners—in order to improve the diagnosis, prevention, and treatment of osteoporosis and its consequences
These recommendations were conceived by the Italian Society for Orthopaedics and Traumatology (Società Italiana di Ortopedia e Traumatologia, SIOT), which was founded in Rome (Italy) in 1892 to promote continuous education in the field of modern orthopedics [1]
In a Cochrane systematic review of 60 randomized controlled trials (RCTs), multifactorial interventions performed in hospitals significantly reduced the rate of falls, but there is no evidence for a reduced risk of falling [110]
Summary
The most significant differences from BPs are (a) the effect, which ceases immediately upon the disappearance of the drug from circulation (if treatment is discontinued and the patient is still at a high risk of fracture, a rapid re-evaluation to consider whether to start an alternative treatment is recommended), (b) its uniform action on all skeletal structures irrespective of bone turnover, which results in greater pharmacological activity in the cortical bone, and (c) that chronic therapy is associated with a continuous densitometric increase, in contrast to what happens with other antiresorptive drugs, which plateau in BMD after 3–4 years of therapy, at the cortical level. Teriparatide induces an improvement in certain geometric features of cortical bone related to resistance to fracture It is approved for the treatment of osteoporosis in postmenopausal women at a high risk of fracture and is given as a subcutaneous injection at a dose of 20 μg/day (grade A recommendation).
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