Osteoporosis is a metabolic bone diseasewhich poses a very significant health problem on a global scale. Between 26 and 32% of Spanish women over 50 suffer from osteoporosis; while the prevalence among men of the same age is 6%, which is “clearly an underdiagnosed and undertreated disease, particularly in men. Osteoporosis increases with age, so due to the aging population, the incidence is estimated to will continue to increase in the coming years.
However, it seems thatthe number of young men and women is increasing“, even those under 50 years old, diagnosed with osteoporosis”, according to Dr. Enrique Casado, from the Rheumatology Department of the Parc Taulí University Hospital (Barcelona) and one of the coordinators of the “VI Course on Osteoporosis and Bone Metabolic Pathology” of the Spanish Society of Rheumatology, which took place on September 20 and 21, with the collaboration of the biopharmaceutical company UCB and the biotechnology company Amgen.
According to the specialist, “osteoporosis is diagnosed in younger people, because the population is increasingly aware of this disease and its devastating consequences in the form of fractures.” In addition, nowadays, Some young people have habits that are unhealthy for their bones.: They are more sedentary, have less exposure to the sun, consume less milk and dairy products in general, and an increasing number of young people are vegetarian or vegan. With these diets, you have to be strict and check that you are reaching the recommended amounts of calcium. (1 gram per day) to achieve a good “peak” of bone mass or not to lose it.
Likewise, adds Dr. Casado, “among young people who do sports, there are more and more elite athletes or very intensive athletes, which in the case of women can lead to anorexia and amenorrhea, a situation of Hypoestrogenism leading to loss of bone mineral density. It also appears that due to increased pollution, food handling, infections, stress etc. it is increased incidence of autoimmune diseases which, both due to the disease itself and certain treatments, such as corticosteroids, are associated with a “a higher frequency of osteoporosis and fractures.”
Symptoms and their impact on patients
Osteoporosis is a “silent” disease, which does not causes symptoms perceived by the patient until its main complication occurs: the development of fragility fractures. “Currently, 782 fragility fractures occur every day in the Spanish population (approximately 33 fractures per hour); however, only 36% of these people receive treatment for osteoporosis, leaving 64% without studies or treatment,” warns Dr. Laia Gifre, also coordinator of the course and rheumatologist at the Germans Trias i Pujol University Hospital (Barcelona).
Experts agree the importance of identifying and treating the patient as early as possible after the first fracturewith the use of effective and fast-acting drugs, because there is an imminent risk of new fractures within the first year.
Dr. Gifre also recommends assess risk factors for osteoporosis, such as female genderage, family history of hip fracture, having diseases associated with osteoporosis or receiving treatments associated with this pathology (such as glucocorticoids, aromatase inhibitors or androgen deprivation), among others.
Some fractures are particularly serious, such as a spinal fracture or a hip fracturebecause in addition to pain, they cause functional loss or disability in the patient, which in many cases will be permanent and will undoubtedly have an impact on their quality of life. “We must not forget that it has an impact on morbidity but also on mortality, especially hip fractures, which lead to death the following year in 25% of patients who suffer from them,” warns Dr. Casado.
Classification and evolution of treatments
For Dr. Núria Guañabens, senior consultant in the Rheumatology Department of the University Hospital of Barcelona, changes have been observed in recent years in terms of the profile of those affected. “It is encouraged to identify the fracture risk of each patient based on the history, location and age of the fractures, the magnitude of the reduction in the T-score in densitometry and other fracture risk factors. Based on these parameters, the patient is classified as having a moderate, high or very high risk of fracture, which allows the initial treatment to be recommended according to the degree of risk. Better knowledge of the degree of fracture risk, drugs and their optimal sequence now allow effective treatment.” he maintains.
Among the advances in knowledge of osteoporosis drugs, Dr. Guañabens highlights a study that compares the effectiveness of all drugs to reduce the risk of fracture, analyzing 69 trials involving more than 80,000 patients. “The main thing is that everyone Approved drugs are effective in reducing clinical and vertebral fracturesbut bone formers are more effective than oral bisphosphonates and, furthermore, this research shows that there is no evidence to limit the use of bone formers to patients at very high fracture risk,” he emphasizes. Finally, he comments on a position paper from the American Society for Bone and Mineral Research (ASBMR) on targeted treatment, with an algorithm based on fracture risk.
On the other hand, Dr. Gifre insists on the importance of setting up second fragility fracture prevention units in Spain. “These units focus on identifying people who have suffered recent fragility fractures (due to minimal trauma) and evaluating the treatment of osteoporosis if necessary,” he emphasizes and advocates for continue to promote basic research in the field of osteoporosis to identify biomarkers and signaling pathways that could be considered as future therapeutic targets.
