Approccio globale alla fragilità scheletrica

Skeletal fragility is characterized by reduced bone’s resistance to mechanical stress, resulting in an increased risk of fracture. The mechanical strength of bone tissue depends on its mass, density, and quality. A fracture might occur when the amount of load exceeds bone strength (traumatic fracture) or when strength is so significantly reduced that a minimal trauma may cause a bone fracture (pathological fracture). Fragility fracture risk could be diminished by reducing mechanical stress on bone or increasing the strength of bone tissue. The first aim could be achieved by decreasing risk of falls (i.e. improving indoor safety, using mobility aids, such as crutches, canes, and walkers, or performing physical exercise that improves balance, coordination, mobility, aerobic capacity, and acquisition of an adequate walking ability) or by reducing the impact damage from falling (modifying points of application of mechanical stress by falling, for example using a trochanteric pad). Moreover, bone strength might be increased by pharmacological therapy or physical exercise, that both might improve bone quantity and quality. The global approach to osteoporotic patient with or without fragility fractures is primarily based on multifactorial interventions targeted to patient specific problems in order to formulate an appropriate therapeutic combination of drugs, physical activity, use of aids, educational and behavioral interventions, including nutrition.