Guidelines for the management of osteoporosis and fragility fractures
Open accessAbstract
The purpose of this document, a result of the harmonisation and revision of Guidelines published separately by the SIMFER, SIOMMMS/SIR, and SIOT associations, is to provide practical indications based on specific levels of evidence and various grades of recommendations, drawn from available literature, for the management of osteoporosis and for the diagnosis, prevention, and treatment of fragility fractures. These indications were discussed and formally approved by the delegates of the Italian Scientific Associations involved in the project (SIE, SIGG, SIMFER, SIMG, SIMI, SIOMMMS, SIR, and SIOT).
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Bone mineral density loss is related to hormonal imbalance, aging, environmental factors, lifestyle, and genetic predisposition.
“It is generally accepted that BMD loss is related to hormonal imbalance, aging, environmental factors, lifestyle, and genetic predisposition [18].”
From Skeletal System Biology and Smoke Damage: From Basic Science to Medical Clinic (2021) · cites this paper as [18]
Osteoporosis is a frequently observed complication in patients with chronic liver disease, especially liver cirrhosis, cholestatic liver diseases, and hemochromatosis.
“Osteoporosis is a frequently observed complication in patients with chronic liver disease, particularly liver cirrhosis and cholestatic liver diseases.”
From Bone diseases in patients with chronic liver disease (2019) · cites this paper as [1]
The estimated prevalence of fragility fractures is approximately 10-15% in patients waiting for solid organ transplants (kidney, heart, liver and lung).
“The estimated prevalence of fragility fractures is approximately 10–15% in patients waiting for solid organ transplants (kidney, heart, liver and lung) [1].”
From Bone diseases in patients with chronic liver disease (2019) · cites this paper as [1]
The current consensus is that chronic liver disease exerts a negative effect on osteoblast differentiation and proliferation.
“Although osteoblast proliferation, differentiation, and apoptosis are not as extensively studied as in osteoclasts, the current consensus is that chronic liver disease exerts a negative effect on osteoblast differentiation and proliferation [1].”
From Bone diseases in patients with chronic liver disease (2019) · cites this paper as [1]
The guidelines of most osteoporosis societies briefly describe the causes of fractures and osteoporosis in patients with chronic liver disease as nutritional deficiencies caused by liver disease.
“The guidelines of most osteoporosis societies briefly describe the causes of fractures and osteoporosis in patients with chronic liver disease as nutritional deficiencies caused by liver disease [1,15].”
From Bone diseases in patients with chronic liver disease (2019) · cites this paper as [1]
Glucocorticoid-induced loss of bone mass begins early and is more pronounced during the first 6-12 months, particularly in trabecular bone (the vertebrae).
“Generally, the loss of bone mass caused by glucocorticoids begins early and is more pronounced during the first 6–12 months, particularly at the level of the trabecular bone (the vertebrae) [1].”
From Bone diseases in patients with chronic liver disease (2019) · cites this paper as [1]
Glucocorticoids stimulate bone resorption and reduce bone formation by inhibiting osteoblast proliferation and differentiation and by promoting apoptosis of osteoblasts and osteocytes.
“These compounds stimulate bone resorption and reduce bone formation by inhibiting osteoblast proliferation and differentiation and by promoting apoptosis of osteoblasts and osteocytes [1,151,152].”
From Bone diseases in patients with chronic liver disease (2019) · cites this paper as [1]
Guidelines from osteoporosis societies on pharmacological therapies are designed for common osteoporosis and are not specific for patients with chronic liver disease.
“Various guidelines from osteoporosis societies on pharmacological therapies are designed for the treatment [1,10,15,19] of common osteoporosis, and are not specific for patients with chronic liver disease.”
From Bone diseases in patients with chronic liver disease (2019) · cites this paper as [1]
The supplement most widely consumed by patients is calcium carbonate, which must be ingested along with foods to increase absorption.
“The supplement that is most widely consumed by patients is calcium carbonate, which must be ingested along with foods to increase absorption [1,5,10,15,19].”
From Bone diseases in patients with chronic liver disease (2019) · cites this paper as [1]
Currently available bisphosphonate preparations include alendronate, risedronate, ibandronate, pamidronate and zoledronate.
“Currently available bisphosphonate preparations include alendronate, risedronate, ibandronate, pamidronate and zoledronate [1,10,15,19].”
From Bone diseases in patients with chronic liver disease (2019) · cites this paper as [1]
SERMs have been administered as anti-resorptive therapies.
“SERMs have also been administered as anti-resorptive therapies [1,10,15,19].”
From Bone diseases in patients with chronic liver disease (2019) · cites this paper as [1]
Inhibition of osteoclast activation and bone resorption to achieve a positive balance in bone is the core of anti-resorptive treatments.
“Inhibition of osteoclast activation and bone resorption to achieve a positive balance in bone is the core of anti-resorptive treatments [1,10,15,19].”
From Bone diseases in patients with chronic liver disease (2019) · cites this paper as [1]
Intermittent administration of parathyroid hormone stimulates bone formation to a larger extent than bone resorption.
“Intermittent administration of parathyroid hormone has been shown to stimulate bone formation to a larger extent than bone resorption [1,10,15,19].”
From Bone diseases in patients with chronic liver disease (2019) · cites this paper as [1]
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Self-citationFragility Fracture Nursing: Holistic Care and Management of the Orthogeriatric Patient
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Self-citationImaging of Stress Fractures of the Spine
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Current Status of the Diagnosis and Management of Osteoporosis
Aibar-Almazán, A., Voltes-Martínez, A., Castellote-Caballero, Y., Afanador-Restrepo, D. F., Carcelén-Fraile, M. D. C., & López-Ruiz, E. (2022) · International Journal of Molecular Sciences · doi:10.3390/ijms23169465 · Cited by 412 · see citing works
International Framework for Red Flags for Potential Serious Spinal Pathologies
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Osteoporosis in Europe: a compendium of country-specific reports
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Senile Osteoporosis: The Involvement of Differentiation and Senescence of Bone Marrow Stromal Cells
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Gender Differences in Osteoporosis: A Single-Center Observational Study
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Vertebral compression fractures: Still an unpredictable aspect of osteoporosis
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Epigenetic Mechanisms of Aging and Aging-Associated Diseases
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Bone diseases in patients with chronic liver disease
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Flavonoids in Bone Erosive Diseases: Perspectives in Osteoporosis Treatment
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Prospect of Stem Cell Therapy and Regenerative Medicine in Osteoporosis
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Osteoporosis: Current and Emerging Therapies Targeted to Immunological Checkpoints
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The Endocannabinoid/Endovanilloid System in Bone: From Osteoporosis to Osteosarcoma
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Role of Physical Activity in Bone–Muscle Crosstalk: Biological Aspects and Clinical Implications
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Self-citationBone's Response to Mechanical Loading in Aging and Osteoporosis: Molecular Mechanisms
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Osteoporosis in COPD patients: Risk factors and pulmonary rehabilitation
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Metal-binding peptides and their potential to enhance the absorption and bioavailability of minerals
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The role of radiography in the study of spinal disorders
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The Belgian Bone Club 2020 guidelines for the management of osteoporosis in postmenopausal women
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Do polyunsaturated fatty acids protect against bone loss in our aging and osteoporotic population?
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Osteoporosis and Celiac Disease: Updates and Hidden Pitfalls
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RetractedUnderstanding and managing secondary osteoporosis
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Osteoporosis and Alzheimer´s disease (or Alzheimer´s disease and Osteoporosis)
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Decreased Trabecular Bone Score in Patients With Active Endogenous Cushing’s Syndrome
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Osteoporosis: Economic Burden of Disease in Italy
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Applications of Calcium-Based Nanomaterials in Osteoporosis Treatment
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The MicroRNAs in the Pathophysiology of Osteoporosis
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Timing of Osteoporotic Vertebral Fractures in Lung and Heart Transplantation: A Longitudinal Study
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Osteoporosis: prevention and personalized physiotherapy
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Self-citationFRAX assessment in people ageing with HIV
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Machine Learning for Opportunistic Screening for Osteoporosis and Osteopenia Using Knee CT Scans
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Nutrition-Based Support for Osteoporosis in Postmenopausal Women: A Review of Recent Evidence
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State of Fragility Fractures Management during the COVID-19 Pandemic
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Self-citationPotassium: A Frontier in Osteoporosis
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Trends in hip and distal femoral fracture rates in Italy from 2007 to 2017
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Self-citationMultidisciplinary management of osteoporotic vertebral fractures
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Augmentation in fragility fractures, bone of contention: a systematic review
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Self-citationSarcopenia in end-stage liver disease and after liver transplantation
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Patients’ reasons for adhering to long-term alendronate therapy
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Predicting treatment recommendations in postmenopausal osteoporosis
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- Authors
- Nuti, R., Brandi, M. L., Checchia, G., Di Munno, O., Dominguez, L., Falaschi, P., Fiore, C. E., Iolascon, G., Maggi, S., Michieli, R., Migliaccio, S., Minisola, S., Rossini, M., Sessa, G., Tarantino, U., Toselli, A., & Isaia, G. C.
- Affiliations
- Società Italiana di Medicina Interna (IT)
- Società Italiana di Endocrinologia (IT)
- Società Italiana di Medicina Generale (IT)
- Società Italiana di Reumatologia (IT)
- Corresponding author
- Minisola, Salvatore
- ORCID
- Venue
- Internal and Emergency Medicine
- Published
- 2018-06-13
- Volume
- 14
- Issue
- 1
- Pages
- 85-102
- ISSN
- 1828-0447 (ISSN-L)
- 1970-9366
- PMC
- PMC6329834
- OpenAlex
- W2807732905
- Cited by
- 328
- References
- 103
- Citations by year
- 2026: 22 · 2025: 32 · 2024: 71 · 2023: 47 · 2022: 54 · 2021: 51 · 2020: 37 · 2019: 13 · 2018: 1
- FWCI
- 27.70
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Internal and Emergency Medicine (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Florence Research (University of Florence) (submittedVersion, cc-by)
- Nova Science Publishers (Nova Science Publishers, Inc.) (submittedVersion, cc-by)
- Cineca Institutional Research Information System (Tor Vergata University) (submittedVersion)
- Archivio Istituzionale della Ricerca - Università degli Studi della Campania "Luigi Vanvitelli" (submittedVersion)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
- Topics
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
- Health Sciences › Medicine › Surgery › Hip and Femur Fractures
- Health Sciences › Medicine › Epidemiology › Bone fractures and treatments
- Keywords
- osteoporosis, fragility fractures, fracture prevention, fracture diagnosis, osteoporosis treatment, osteoporosis management, level of evidence, grades of recommendation
- MeSH terms
- Humans, Italy, Osteoporosis, Bone Density, Osteoporotic Fractures
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