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The epidemiology of osteoporosis in Italian postmenopausal women according to the National Bone Health Alliance (NBHA) diagnostic criteria: a multicenter cohort study

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Abstract

Purpose

The study was aimed at evaluating the prevalence of osteoporosis, defined by BMD and the National Bone Health Alliance (NBHA) criteria, and the prevalence of clinical risk factors for fractures in Italian postmenopausal women.

Methods

This is a cross-sectional, multicenter, cohort study evaluating 3247 postmenopausal women aged ≥ 50 and older in different areas of Italy in the period 2012–2014. All the participants were evaluated as far as anthropometrics; questionnaires for FRAX® and DeFRA calculation were administered and bone mineral density was measured at lumbar spine, femoral neck and total hip by DXA.

Results

The prevalence of osteoporosis, as assessed by BMD and NBHA criteria was 36.6 and 57%, respectively. Mean ± SD values of FRAX® and DeFRA were: 10.2 ± 7.3 and 11 ± 9.4 for major fractures, and 3.3 ± 4.9 and 3.9 ± 5.9 for hip fractures, respectively. Among clinical risk factors for fracture, the presence of previous fracture, particularly non-spine/non-hip fracture, parental history of hip fracture and current smoking were the most commonly observed.

Conclusions

Our study showed that more that the half of postmenopausal women aged 50 and older in Italy has osteoporosis on the basis of the NBHA criteria. There is a relevant high risk of femur fracture, as assessed by the FRAX® and DeFRA and previous fracture, parental history of hip fracture and current smoking are the most common risk factors. The data should be considered particularly in relation to the need to increase prevention strategies on modifiable risk factors and therapeutic intervention.

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References

  1. Johnston CC Jr, Slemenda CW, Melton LJ 3rd (1991) Clinical use of bone densitometry. N Engl J Med 324(16):1105–1109. doi:10.1056/NEJM199104183241606

    Article  PubMed  Google Scholar 

  2. WHO Study Group (1994) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. World Health Organization technical report series 843:1–129

    Google Scholar 

  3. Nih Consensus Development Panel on Osteoporosis Prevention D, Therapy (2001) Osteoporosis prevention, diagnosis, and therapy. JAMA 285(6):785–795

    Article  Google Scholar 

  4. Siris ES, Boonen S, Mitchell PJ, Bilezikian J, Silverman S (2012) What’s in a name? What constitutes the clinical diagnosis of osteoporosis? Osteoporos Int 23(8):2093–2097. doi:10.1007/s00198-012-1991-0

    Article  CAS  PubMed  Google Scholar 

  5. Siris ES, Adler R, Bilezikian J, Bolognese M, Dawson-Hughes B, Favus MJ, Harris ST, Jan de Beur SM, Khosla S, Lane NE, Lindsay R, Nana AD, Orwoll ES, Saag K, Silverman S, Watts NB (2014) The clinical diagnosis of osteoporosis: a position statement from the National Bone Health Alliance Working Group. Osteoporos Int 25(5):1439–1443. doi:10.1007/s00198-014-2655-z

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Lewiecki EM, Binkley N (2016) What we don’t know about osteoporosis. J Endocrinol Invest 39(5):491–493. doi:10.1007/s40618-016-0442-8

    Article  CAS  PubMed  Google Scholar 

  7. Kanis JA, Oden A, Johnell O, Johansson H, De Laet C, Brown J, Burckhardt P, Cooper C, Christiansen C, Cummings S, Eisman JA, Fujiwara S, Gluer C, Goltzman D, Hans D, Krieg MA, La Croix A, McCloskey E, Mellstrom D, Melton LJ 3rd, Pols H, Reeve J, Sanders K, Schott AM, Silman A, Torgerson D, van Staa T, Watts NB, Yoshimura N (2007) The use of clinical risk factors enhances the performance of BMD in the prediction of hip and osteoporotic fractures in men and women. Osteoporos Int 18(8):1033–1046. doi:10.1007/s00198-007-0343-y

    Article  CAS  PubMed  Google Scholar 

  8. Adami S, Bianchi G, Brandi ML, Di Munno O, Frediani B, Gatti D, Giannini S, Girasole G, Minisola G, Minisola S, Nuti R, Pedrazzoni M, Rossini M, Varenna M (2010) Validation and further development of the WHO 10-year fracture risk assessment tool in Italian postmenopausal women: project rationale and description. Clin Exp Rheumatol 28(4):561–570

    CAS  PubMed  Google Scholar 

  9. Vescini F, Attanasio R, Balestrieri A, Bandeira F, Bonadonna S, Camozzi V, Cassibba S, Cesareo R, Chiodini I, Francucci CM, Gianotti L, Grimaldi F, Guglielmi R, Madeo B, Marcocci C, Palermo A, Scillitani A, Vignali E, Rochira V, Zini M (2016) Italian association of clinical endocrinologists (AME) position statement: drug therapy of osteoporosis. J Endocrinol Invest 39(7):807–834. doi:10.1007/s40618-016-0434-8

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Nevitt MC, Ross PD, Palermo L, Musliner T, Genant HK, Thompson DE (1999) Association of prevalent vertebral fractures, bone density, and alendronate treatment with incident vertebral fractures: effect of number and spinal location of fractures. The Fracture Intervention Trial Research Group. Bone 25(5):613–619

    Article  CAS  PubMed  Google Scholar 

  11. Kanis JA, Johansson H, Johnell O, Oden A, De Laet C, Eisman JA, Pols H, Tenenhouse A (2005) Alcohol intake as a risk factor for fracture. Osteoporos Int 16(7):737–742. doi:10.1007/s00198-004-1734-y

    Article  PubMed  Google Scholar 

  12. Vestergaard P, Mosekilde L (2003) Fracture risk associated with smoking: a meta-analysis. J Intern Med 254(6):572–583

    Article  CAS  PubMed  Google Scholar 

  13. Dennison E, Cooper C (2002) Epidemiology of glucocorticoid-induced osteoporosis. Front Hormone Res 30:121–126

    CAS  Google Scholar 

  14. Yuen SY, Rochwerg B, Ouimet J, Pope JE (2008) Patients with scleroderma may have increased risk of osteoporosis. A comparison to rheumatoid arthritis and noninflammatory musculoskeletal conditions. J Rheumatol 35(6):1073–1078

    PubMed  Google Scholar 

  15. Borba VZ, Matos PG, da Silva Viana PR, Fernandes A, Sato EI, Lazaretti-Castro M (2005) High prevalence of vertebral deformity in premenopausal systemic lupus erythematosus patients. Lupus 14(7):529–533

    Article  CAS  PubMed  Google Scholar 

  16. Cooper C, Cole ZA, Holroyd CR, Earl SC, Harvey NC, Dennison EM, Melton LJ, Cummings SR, Kanis JA, Epidemiology ICWGoF (2011) Secular trends in the incidence of hip and other osteoporotic fractures. Osteoporos Int 22(5):1277–1288. doi:10.1007/s00198-011-1601-6

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Kanis JA, Oden A, McCloskey EV, Johansson H, Wahl DA, Cooper C, Epidemiology IOFWGo, Quality of L (2012) A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporos Int 23(9):2239–2256. doi:10.1007/s00198-012-1964-3

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Curtis EM, van der Velde R, Moon RJ, van den Bergh JP, Geusens P, de Vries F, van Staa TP, Cooper C, Harvey NC (2016) Epidemiology of fractures in the United Kingdom 1988–2012: variation with age, sex, geography, ethnicity and socioeconomic status. Bone 87:19–26. doi:10.1016/j.bone.2016.03.006

    Article  PubMed  PubMed Central  Google Scholar 

  19. Wright NC, Looker AC, Saag KG, Curtis JR, Delzell ES, Randall S, Dawson-Hughes B (2014) The recent prevalence of osteoporosis and low bone mass in the United States based on bone mineral density at the femoral neck or lumbar spine. J Bone Miner Res 29(11):2520–2526. doi:10.1002/jbmr.2269

    Article  PubMed  PubMed Central  Google Scholar 

  20. Wright NC, Saag KG, Dawson-Hughes B, Khosla S, Siris ES (2016) The impact of the new National Bone Health Alliance (NBHA) diagnostic criteria on the prevalence of osteoporosis in the USA. Osteoporos Int. doi:10.1007/s00198-016-3865-3

    Google Scholar 

  21. D’Amelio P, Spertino E, Martino F, Isaia GC (2013) Prevalence of postmenopausal osteoporosis in Italy and validation of decision rules for referring women for bone densitometry. Calcif Tissue Int 92(5):437–443. doi:10.1007/s00223-013-9699-5

    Article  PubMed  Google Scholar 

  22. Bonaccorsi G, Fila E, Cervellati C, Romani A, Giganti M, Rossini M, Greco P, Massari L (2015) Assessment of fracture risk in a population of postmenopausal Italian women: a comparison of two different tools. Calcif Tissue Int 97(1):50–57. doi:10.1007/s00223-015-0009-2

    Article  CAS  PubMed  Google Scholar 

  23. Maggi S, Noale M, Giannini S, Adami S, Defeo D, Isaia G, Sinigaglia L, Filipponi P, Crepaldi G, Group ES (2006) Quantitative heel ultrasound in a population-based study in Italy and its relationship with fracture history: the ESOPO study. Osteoporos Int 17(2):237–244. doi:10.1007/s00198-005-1985-2

    Article  CAS  PubMed  Google Scholar 

  24. Genant HK, Grampp S, Gluer CC, Faulkner KG, Jergas M, Engelke K, Hagiwara S, Van Kuijk C (1994) Universal standardization for dual X-ray absorptiometry: patient and phantom cross-calibration results. J Bone Miner Res 9(10):1503–1514. doi:10.1002/jbmr.5650091002

    Article  CAS  PubMed  Google Scholar 

  25. Pedrazzoni M, Girasole G, Bertoldo F, Bianchi G, Cepollaro C, Del Puente A, Giannini S, Gonnelli S, Maggio D, Marcocci C, Minisola S, Palummeri E, Rossini M, Sartori L, Sinigaglia L (2003) Definition of a population-specific DXA reference standard in Italian women: the Densitometric Italian Normative Study (DINS). Osteoporos Int 14(12):978–982. doi:10.1007/s00198-003-1521-1

    Article  CAS  PubMed  Google Scholar 

  26. Looker AC, Orwoll ES, Johnston CC Jr, Lindsay RL, Wahner HW, Dunn WL, Calvo MS, Harris TB, Heyse SP (1997) Prevalence of low femoral bone density in older U.S. adults from NHANES III. J Bone Miner Res 12(11):1761–1768. doi:10.1359/jbmr.1997.12.11.1761

    Article  CAS  PubMed  Google Scholar 

  27. Kanis JA, McCloskey EV, Johansson H, Oden A, Melton LJ 3rd, Khaltaev N (2008) A reference standard for the description of osteoporosis. Bone 42(3):467–475. doi:10.1016/j.bone.2007.11.001

    Article  CAS  PubMed  Google Scholar 

  28. Curtis EM, Moon RJ, Harvey NC, Cooper C (2017) The impact of fragility fracture and approaches to osteoporosis risk assessment worldwide. Bone. doi:10.1016/j.bone.2017.01.024

    Google Scholar 

  29. Wright NC, Saag KG, Curtis JR, Smith WK, Kilgore ML, Morrisey MA, Yun H, Zhang J, Delzell ES (2012) Recent trends in hip fracture rates by race/ethnicity among older US adults. J Bone Miner Res 27(11):2325–2332. doi:10.1002/jbmr.1684

    Article  PubMed  Google Scholar 

  30. Ballane G, Cauley JA, Luckey MM, Fuleihan Gel H (2014) Secular trends in hip fractures worldwide: opposing trends east versus west. J Bone Miner Res 29(8):1745–1755. doi:10.1002/jbmr.2218

    Article  PubMed  Google Scholar 

  31. Pepe J, Cipriani C, Cantatore FP, Fabbri A, Pola E, Vinicola V, Raimo O, Biamonte F, Pascone R, Ferrara C, Minisola S (2017) The effect of parathyroid hormone (1–84) treatment on serum bone morphogenetic protein 4 and vascular endothelial growth factor in postmenopausal women with established osteoporosis. J Endocrinol Invest 40(6):663–667. doi:10.1007/s40618-017-0636-8

    Article  CAS  PubMed  Google Scholar 

  32. Ralston SH, Uitterlinden AG (2010) Genetics of osteoporosis. Endocr Rev 31(5):629–662. doi:10.1210/er.2009-0044

    Article  CAS  PubMed  Google Scholar 

  33. Cauley JA, Chalhoub D, Kassem AM, Fuleihan Gel H (2014) Geographic and ethnic disparities in osteoporotic fractures. Nat Rev Endocrinol 10(6):338–351. doi:10.1038/nrendo.2014.51

    Article  PubMed  Google Scholar 

  34. Alonso N, Ralston SH (2014) Unveiling the mysteries of the genetics of osteoporosis. J Endocrinol Invest 37(10):925–934. doi:10.1007/s40618-014-0149-7

    Article  CAS  PubMed  Google Scholar 

  35. Cavalli L, Guazzini A, Cianferotti L, Parri S, Cavalli T, Metozzi A, Giusti F, Fossi C, Black DM, Brandi ML (2016) Prevalence of osteoporosis in the Italian population and main risk factors: results of BoneTour Campaign. BMC Musculoskeletal Disord 17(1):396. doi:10.1186/s12891-016-1248-8

    Article  Google Scholar 

  36. Romagnoli E, Caravella P, Scarnecchia L, Martinez P, Minisola S (1999) Hypovitaminosis D in an Italian population of healthy subjects and hospitalized patients. Br J Nutr 81(2):133–137

    CAS  PubMed  Google Scholar 

  37. Carnevale V, Modoni S, Pileri M, Di Giorgio A, Chiodini I, Minisola S, Vieth R, Scillitani A (2001) Longitudinal evaluation of vitamin D status in healthy subjects from southern Italy: seasonal and gender differences. Osteoporos Int 12(12):1026–1030. doi:10.1007/s001980170012

    Article  CAS  PubMed  Google Scholar 

  38. Pedrazzoni M, Girasole G, Giusti A, Barone A, Pioli G, Passeri G, Palummeri E, Bianchi G (2011) Assessment of the 10-year risk of fracture in Italian postmenopausal women using FRAX(R): a north Italian multicenter study. J Endocrinol Invest 34(11):e386–e391. doi:10.3275/7862

    CAS  PubMed  Google Scholar 

  39. Adler RA (2016) Osteoporosis treatment: complexities and challenges. J Endocrinol Invest 39(7):719–720. doi:10.1007/s40618-016-0437-5

    Article  CAS  PubMed  Google Scholar 

  40. Yang S, Leslie WD, Yan L, Walld R, Roos LL, Morin SN, Majumdar SR, Lix LM (2016) Objectively verified parental hip fracture is an independent risk factor for fracture: a linkage analysis of 478,792 parents and 261,705 offspring. J Bone Miner Res 31(9):1753–1759. doi:10.1002/jbmr.2849

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors thank the Società Italiana dell’Osteoporosi, del Metabolismo Minerale e delle Malattie dello Scheletro (SIOMMMS) for funding the project.

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Authors and Affiliations

  1. Department of Internal Medicine and Medical Disciplines, “Sapienza” University of Rome, Viale del Policlinico 155, 00161, Rome, Italy

    C. Cipriani, J. Pepe & S. Minisola

  2. Internal Medicine, Department of Medicine, University of Verona, p.le L. Scuro 2, 37134, Verona, Italy

    F. Bertoldo

  3. Division of Rheumatology, Department of Locomotor System, ASL3-Azienda Sanitaria Genovese, Genoa, Italy

    G. Bianchi & G. Girasole

  4. Rheumatologic Clinic “M. Carrozzo”, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy

    F. P. Cantatore & A. Corrado

  5. Gerontology and Bone Metabolic Disease Section, Molinette Hospital, University of Turin, 10126, Turin, Italy

    M. Di Stefano & G. Isaia

  6. Department of Rheumatology, Policlinico Le Scotte, University of Siena, Siena, Italy

    B. Frediani

  7. Rheumatology Section, Department of Medicine, University of Verona, Piazzale L. Scuro 10, 37134, Verona, Italy

    D. Gatti & M. Rossini

  8. Vita-Salute University San Raffaele Milan, Milan, Italy

    A. Giustina

  9. Presidio Ospedaliero di Montichiari, Via G. Ciotti, 154, 25018, Montichiari, Brescia, Italy

    T. Porcelli

  10. Faculty of Economics, UNINT University, Via Cristoforo Colombo 200, 00147, Rome, Italy

    L. Nieddu

  11. Department of Clinical and Experimental Medicine, University of Parma, Via Gramsci 14, 43126, Parma, Italy

    M. Pedrazzoni

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  1. C. Cipriani
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  2. J. Pepe
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Corresponding author

Correspondence to C. Cipriani.

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Conflict of interest

Francesco Bertoldo declares the following conflicts of interest: advisory board, consulting fees: Abiogen, Amgen, Bayer, Italfarmaco; lecture fees: Abiogen, Amgen, Lilly. Gerolamo Bianchi has received honoraria and/or consulting fees from Abbvie, Abiogen, Alfa-Sigma, Amgen, BMS, Celgene, Chiesi, Eli Lilly, GSK, Janssen, Medac, Merck Sharp & Dohme, Novartis, Pfizer, Roche, Sanofi Genzyme, and Servier. Andrea Giustina: Abiogen, IPSEN, Pfizer. Salvatore Minisola served as speaker for Abiogen, Amgen, Bruno Farmaceutici, Diasorin, Eli Lilly, Fujii and in advisory board of Abiogen. He received consultancy from Bruno Farmaceutici. Cristiana Cipriani, Jessica Pepe, Francesco Paolo Cantatore, Addolorata Corrado, Marco Di Stefano, Bruno Frediani, Davide Gatti, Teresa Porcelli, Giancarlo Isaia, Maurizio Rossini, Luciano Nieddu, Giuseppe Girasole, Mario Pedrazzoni declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Cipriani, C., Pepe, J., Bertoldo, F. et al. The epidemiology of osteoporosis in Italian postmenopausal women according to the National Bone Health Alliance (NBHA) diagnostic criteria: a multicenter cohort study. J Endocrinol Invest 41, 431–438 (2018). https://doi.org/10.1007/s40618-017-0761-4

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