Current Status of the Diagnosis and Management of Osteoporosis

Abstract

Osteoporosis has been defined as the silent disease of the 21st century, becoming a public health risk due to its severity, chronicity and progression and affecting mainly postmenopausal women and older adults. Osteoporosis is characterized by an imbalance between bone resorption and bone production. It is diagnosed through different methods such as bone densitometry and dual X-rays. The treatment of this pathology focuses on different aspects. On the one hand, pharmacological treatments are characterized by the use of anti-resorptive drugs, as well as emerging regenerative medicine treatments such as cell therapies and the use of bioactive hydrogels. On the other hand, non-pharmacological treatments are associated with lifestyle habits that should be incorporated, such as physical activity, diet and the cessation of harmful habits such as a high consumption of alcohol or smoking. This review seeks to provide an overview of the theoretical basis in relation to bone biology, the existing methods for diagnosis and the treatments of osteoporosis, including the development of new strategies.

Keywords: lifestyle habits; osteoporosis; regenerative medicine.

Figure 1

Stages of bone remodeling. In a balanced system, bone remodeling begins with bone resorption and ends with osteoblast formation. The complete cycle is composed of the phases of activation, resorption, reversion, formation and, finally, mineralization. Initially, a signal is detected which activates resorption by attracting osteoclast precursors to the area to be remodeled. This phase is of limited duration and depends on the degree of stimuli received, causing osteoclast differentiation and activity. Then, in the reversion phase, almost all of the osteoclasts disappear, and osteoblast precursors of mesenchymal origin begin to form. In the formation phase, all the osteoclasts are definitively replaced by osteoblasts. Finally, the mineralization of new bone tissue occurs. The new tissue remains at rest until the next cycle of remodeling.