Alessandro Scialdoni

Bone mineral density evaluation in osteoporosis: why yes and why not?

Osteoporosis is a diffuse skeletal disease in which a decrease in bone strength leads to an increased risk of fractures. A wide variety of types of bone densitometry measurements are available, including quantitative computed tomography measurements of the spine, quantitative ultrasound devices for measurements of the heel and other peripheral sites and dual-energy X-ray absorptiometry (DXA) for measurement of bone mineral density (BMD) at the lumbar spine, proximal femur, forearm and total body scans. Compared with alternative bone densitometry techniques, hip and spine DXA examinations have a number of advantages that include a consensus that BMD results can be interpreted using the World Health Organization T score definition of osteoporosis, a proven ability to predict fracture risk, proven effectiveness at targeting anti-fracture therapies, and the ability to monitor response to treatment. However, in recent years, the authors have raised some important questions about the objective limits of this method that have led to doubts about its effectiveness in terms of clinical outcome.

I.S.Mu.L.T - Rotator cuff tears guidelines

Despite the high level achieved in the field of shoulder surgery, a global consensus on rotator cuff tears management is lacking. This work is divided into two main sessions: in the first, we set questions about hot topics involved in the rotator cuff tears, from the etiopathogenesis to the surgical treatment. In the second, we answered these questions by mentioning Evidence Based Medicine. The aim of the present work is to provide easily accessible guidelines: they could be considered as recommendations for a good clinical practice developed through a process of systematic review of the literature and expert opinion, in order to improve the quality of care and rationalize the use of resources.

Fragility fractures: the clinical pathway

The clinical management of fragility fracture is simple but complex at the same time. Patients are different from one another, and advancing age increases the prevalence of comorbidities and conditions that can impair bone quality and healing, while increasing the risk of falls and fractures. Keeping in mind some principles and key points can help identify patients at risk, thus following an ideal path for the identification, treatment and prevention of fragility fractures.

Fracture healing in elderly patients: new challenges for antiosteoporotic drugs

Osteoporosis is a major public health concern, characterized by low bone mass and structural deterioration of bone tissue, leading to bone fragility and an increased susceptibility to fracture. Fracture repair progresses through different pathways, striking a balance between bone formation and bone remodeling mechanisms. Conventionally, fracture repair is divided into defined stages, each characterized by a specific set of cellular and molecular events. In postmenopausal women and elderly patients, bone healing rates are conditioned by cellular and molecular alterations to bone tissue that result in a progressive deterioration of fracture healing ability. In addition, in elderly patients, comorbidities and drugs therapies may also affect fracture healing. For this reason, pharmacological research is now focused on the possible use of antiosteoporotic drugs to promote bone healing in frail patients.

Stress fractures in the elderly: different pathogenetic features compared with young patients

Stress fractures mainly occur in the lower limb as a result of cyclic submaximal stresses. Most commonly affected by this specific type of fractures are young athletes, military or elderly subjects with metabolic bone diseases like osteoporosis. In consideration of the heterogeneity of affected patients is presumable that there are different pathogenic mechanisms. In young person bone tissue, although metabolically intact, is not able to withstand the stresses to which it is chronically subjected, also because of muscle fatigue. This leads to a macrostructural failure and to the development of “fatigue” fractures. Instead, in elderly patients, there are numerous physiological conditions that determine a bone metabolism alteration. This is the main reason for the structural changes in trabecular and cortical bone, which is reflected in reduced biomechanical strength. In addition, muscular situation, such as muscle fiber atrophy, is unable to correctly support bone tissue, leading to the development of insufficiency fractures.