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Purpose: The knowledge of factors modulating the behaviour of bone mass is crucial for preventing and treating osteoporotic disease; among these factors, body weight (BW) has been shown to be of primary importance in postmenopausal women. Nevertheless, the relative effects of body composition indices are still being debated. Our aim was to analyze the relationship between body mass index (BMI), fat and lean mass and bone mineral density (BMD) in a large population of women. Moreover, this study represents a first important report on reference standard values for body composition in Italian women., Materials and Methods: Between 2005 and 2008, weight and height of 6,249 Italian women (aged 30-80 years) were measured and BMI was calculated; furthermore BMD, bone mineral content, fat and lean mass were measured by dual-energy X-ray absorptiometry. Individuals were divided into five groups by decades (group 1, 30.0-39.9; group 2, 40.0-49.9; group 3, 50.0-59.9; group 4, 60.0-69.9; group 5, 70.0-79.9). Differences among decades for all variables were calculated using a one-way analysis of variance (ANOVA) and Bonferroni test by the SPSS programme., Results: Mean BW was 66.8±12.1 kg, mean height 159.1±6.3 cm and mean BMI 26.4±4.7 kg/m(2). According to BW and BMI, there was an increase of obesity with age, especially in women older than 50 years (p<0.001). Lean mass increased until 50 years of age but significantly decreased after this age (p<0.001). The percentage of osteopenia and osteoporosis in the examined population was 43.0% and 16.7%, respectively., Conclusions: Our data show that obesity significantly decreased the risk for osteoporosis but did not decrease the risk for osteopenia. It is strongly recommended that a strong policy regarding prevention of osteopenia and osteoporosis be commenced. An overall examination of our results suggests that both fat and lean body mass can influence bone mass and that their relative effect on bone could be modulated by their absolute amount and ratio to total BW.

Prevention of osteopenia/osteoporosis in postmenopausal patients can reduce fracture risk. In this view, the use of Selective Estrogen Receptor Modulators (SERMs) appear to be important in managing this condition. Bazedoxifene Acetate (BZA) is a third-generation SERM that showed to protect bone mass in postmenopausal women with osteopenia, and to reduce vertebral fracture risk in osteoporotic postmenopausal women; moreover, BZA decreased the non-vertebral fracture risk in a subgroup of patients at high-risk for fracture in comparison to placebo. BZA showed no stimulating effects on endometrium and breast. BZA can be a valid option in management of osteopenia/osteoporosis in postmenopause.

Aim: The aim of this study was to investigate about diet assessment in the screening for osteoporosis., Methods: In 1,441 women (group A, mean age 53.5 years, mean time from menopause 3.92(+/-4.33)] the number of daily/weekly servings/cups of different foods has been collected. In 71 women (group B, mean age 59 years, mean time from menopause 6 years) diet was assessed through a detailed questionnaire. Demographic and clinical data and dietary habits were related to bone mineral density (BMD) values, using Student t-test and the chi2 test., Results: Group A: borderline/reduced BMD 40%, the percentage increasing with age and the duration of menopause (P<0.001). BMI within normal range 56.28%. BMD values were positively associated with Body Mass Index (BMI, P<0.001), education level (P<0.005), job (P<0.01), oral contraceptives use (P<0.001), negatively with family history of osteoporosis (P<0.05). BMD values showed a positive relation with the number of eggs per week (P<0.05), positive not significant trends were observed with dairy products, vegetables, red and white meat intake. A low/reduced BMD was related to low calcium food intake in less than 50% of the women. Group B: borderline/reduced BMD 55%; BMD showed positive trends, not significant, with daily calcium intake, BMI, physical exercise. Estimated calcium intake less than 700 mg/day was found in 33% of the sample., Conclusion: Diet assessment is not useful in the screening for osteoporosis. In women with borderline or reduced BMD, diet assessment helps to detect those at low calcium intake who need calcium supplementation, alone or in combination with other treatments.

Osteoporosis is a systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture. Postmenopausal osteoporosis is a major public health problem. Estrogen deficiency is a key factor in the pathogenesis of postmenopausal osteoporosis. Among the several types therapeutic intervention in osteoporosis, hormone replacement therapy (HRT) has traditionally been seen as the gold standard method of preventing osteoporotic fractures among postmenopausal women.The estrogenic effect on bone is dose-dependent. For oral therapy, studies have demonstrated that doses of 0.625 mg of conjugated equine estrogen and 2 mg of micronized estradiol prevent postmenopausal bone loss. Percutaneous 17 beta-estradiol prevents skeletal bone loss as effectively as oral HRT. Although the greatest benefits from HRT in terms of bone sparing effects can be obtained shortly after the menopause, the literature contains clear evidence that HRT prevents bone loss in all stages of postmenopausal life. However, estrogen therapy must be long-term, possibly lifelong, to have any lasting impact on bone health. One strategy to improve long term continuation of HRT is to reduce the dosage of estrogen and the consequent side-effects of the higher dose HRT. Various studies have assessed the efficacy of low-dose HRT (LD-HRT) as well as the standard dose HRT in the prevention of osteoporosis in postmenopausal women. LD-HRT may enhance patient acceptability and continuation, ensuring adequate bone protection and menopausal symptoms control, and given physicians the possibility to personalize the doses on the basis of each individual patient's needs.

Risk factors for osteoporosis and the therapies (including those still being validated) utilisable in the primary and secondary management of patients with declared osteoporosis or those at risk of the disease are reviewed. The role of oestrogens in the pathogenesis of postmenopausal osteoporosis is well documented and replacement hormonal therapy prevents the rapid bone loss that accompanies the menopause, albeit with the well-known limitations. A valid alternative would seem to be provided by a diet rich in phyto-oestrogens which as they are natural SERMs, are able to produce effects similar to the oestrogens. The drugs of the new generation are also taking on an increasingly important role in the treatment of postmenopausal osteoporosis, although it is reasonable to think that in order to define them as effective and innocuous it will be necessary to await the conclusion of ongoing trials and an adequate number of years.

Background: The purpose of the present study is to evaluate indications and contraindications, advisability and compliance of hormone replacement therapy (HRT) in women in the climacteric who, owing to the cessation of ovarian activity, face loss of the state of present and future wellbeing., Methods: A series of 602 women who have attended the Menopause Centre of the II Division of the Department of Gynaecology and Obstetrics of the Second University of Naples in the period from 1/12/1998 to 10/4/2001. The diagnostic methodology adopted is outlined and the reasons for the prescription of HRT indicated. Patients who do not present contraindications were assessed in relation to the gravity of the climacteric syndrome and the likelihood of a future pathology bound up with the lack of estrogens. The intensity of the symptomatology was assessed on the basis of Kuppermann's nomogram., Results: The cessation of ovarian activity occurred between the ages of 40 and 45 in 16.9% of cases while the percentage was 5.9% prior to the age of 40. Cases in which a climacteric syndrome was present numbered 147, or 24.2%. Women who present a cardiovascular risk represent a noteworthy percentage (27.1%). A high number of women are at osteoporotic risk: 223, or 37.0%. Although it has a great number of indications, HRT is only prescribed in about half the patients. Stress is laid on the caution exercised by physicians in prescribing HRT and the diffidence of women in accepting it. Of the well-known contraindications to HRT the most common are those relative to the mammary risk., Conclusions: HRT was only prescribed for about half the women who came to our attention both as a result of the caution of the physicians who consider even relative contraindications peremptory, and because of the diffidence of a percentage of women with regard to such therapy. Alternative therapies to HRT are in fact a second valid choice, especially in the prevention of osteoporosis.

Food phytestrogens and prevention of postmenopausal osteoporotic and cardiovascular disease. Phytestrogens are diphenolic compounds, widely found in plants and foods, with structural and biological estrogen-like similarities. Their anti-estrogenic effects are well known and studied due to the possibility to prevent some tumors such as breast and prostate cancer. In menopause they have an estrogenic-like action on lipidic and bone metabolism. Phytestrogens rich foods can positively affect the postmenopausal osteoporotic and cardiovascular pathology.

Normal bone mass is one of the principal factors in the prevention of osteoporosis for women in advanced age. Therefore, it is necessary to have efficacious serum and urinary markers available to screen the bone development and the bone resorption. Even if we are also far from identifying an ideal marker, the measurement of some substances such as pyridinoline (Pyr) and deoxypyridinoline (D-Pyr) seems to be a first progress for efficacious and rather simple techniques.

The preventive and therapeutical measures to be implemented the post-menopausal osteoporosis are varied, although there is no clear, single protocol of intervention. ESTROGENS AND PROGESTOGENS: It si verify that the administration of estrogens and/or progestogens prevents bone loss with an action on mineral components of bone and on collagenic metabolism. BIPHOSPONATES: Operate inhibiting mineralization and, particularly, bone reabsorption. At present its use, in low dosages, is reserved to "fast bone loser" patients. CALCITONIN: It increases bone mass and significantly reduces the frequency of fractures in comparison with only calcium, but its use is limited by high costs. IPRIFLAVONE: Anti-reabsorption effects has on bone and stimulates osteoblastic activity; besides, it seems to developed the effect of estrogens on the bone. FLUORIDES: Fluorides also operate on both components of bone turnover, with a most important action on bone formation. An interesting approach is the association of low doses of monofluorophosphate with calcium. However, further confirmation of the "quality" of neoformed bone is necessary. CALCIUM: Calcium supplementation is obligatory where the alimentary supply of calcium is lower then 1 g/die or where an osteomalacic component coexists; only dosages higher than 15 g/die can produce/pharmacological effects on bone turnover. CALCITRIOL: The use is still disputed. The calcitriol-calcium association seems convincing haveved. ORG: OD 14. The efficacy of this synthetic steroid to prevent bone loss is probably superimposable on the efficacy of classic estrogen therapy.

The authors present a review referring to cellular and biochemical control systems of bone remodeling as well as the effect of estrogens on modulation of bone metabolism. Systemic and local control factors such as PTH, calcitonin, vitamin D, prostaglandins, insulin-like growth factor-1, transforming growth factor-beta are analyzed as possible indirect targets for the estrogen induced inhibition of bone resorption. A direct receptor-linked action of estrogens on the osteoblast-lining cell unit, the most important modulator or bone metabolism, is furtherwise examined. The precise mechanism of the beneficial effect of estrogens for the prevention of postmenopausal bone loss and the treatment of established osteoporosis has not yet been clearly identified, but it seems likely that multiple mechanisms may be involved since postmenopausal osteoporosis itself appears as a heterogenic clinical condition related to multiple pathogenetic factors.

The Authors consider the etiology postmenopause osteoporosis and the drugs for a modern therapy of this disease. They also analyse the effectiveness and the unfavourable effects of these drugs and suggest a personal treatment for osteoporosis.

The authors consider postmenopausal replacement oestrogen therapy to be appropriate provided that in non-hysterectomised women it is associated with a progestin compound. For this purpose they studied the endometrial changes in women treated randomly with dihydrogesterone and medroxyprogesterone acetate. Having performed a pre-treatment biopsy, in order to include only those cases with hypotrophic endometrium or with residual proliferative activity, cyclical treatment was commenced with transdermic estradiol and dihydrogesterone or medroxyprogesterone acetate. An endometrial follow-up was performed after 6 months to control the maturation of the endometrium which was free from atypical transformations although medroxyprogesterone acetate was preferable due to its effects on the metabolism in general and because it allowed a higher percentage of conversion into secreting endometrium without evolving towards hyperplasia.

The authors evaluate the efficacy of salmon calcitonin and aminosuberic analogue of eel calcitonin in the prevention of post-oophorectomy osteoporosis in rats. Both drugs, administered at the same dosage, are equally effective in preventing oophorectomy bone loss in rats. Besides, plasma biochemical evaluations demonstrate that calcitonins reduce bone turnover in treated rats, compared with control oophorectomized ones.

The aim of the present research was to underline the importance of physical activity in the prevention and treatment of osteoporosis. Therefore the authors considered age-related bone loss and the value of weight-bearing exercise on bone-remodeling. Moreover the authors examined current world literature on physical exercise in post-menopausal age and bone mineral content in athletes, reporting their study's results.

In the present report, the current approach to the prevention of metabolic damage deriving from oestrogen deficiency involves the use of protocols that vary in the type of hormone employed and the mode of its administration. A homogenous group of 28 postmenopausal women was treated with natural conjugates oestrogen (0.625 mg per diem per os) on a continuous basis plus MAP (10 mg per diem per os) for 12 days a month. The metabolic effect of the oestrogen replacement therapy was assessed annually by blood chemical screening of the lipid situation and the phosphocalcium balance. Computerised radial bone mineralometry using SPA technique was also performed. A smaller group of 19 court of the 28 patients was also subjected to transversal assessment of vertebral BMD using the DXA technique. The results in this latter group were compared with those in 19 women not given oestrogen treatment who had been postmenopausal from 5-7 years. Results after 60 months of treatment confirm the efficacy of oestrogen therapy in preventing the deterioration of the lipid profile and the loss of bone mass after menopause.

The authors selected 18 women in surgical menopause in order to evaluate the validity of estrogen treatment for the prevention of postmenopausal osteoporosis. Ten of these patients were given transdermal estradiol continuously for 12 months while the remaining eight served as untreated controls. Urinary hydroxyproline and bone density were assessed before and at previously determined intervals during treatment: the results showed the importance of estrogen replacement therapy for the prevention of postmenopausal osteoporosis.

The use of estrogens in menopausal women leads to a marked improvement in the quality of life, with the short-term disappearance of vasomotory phenomena and changes in psychomotive equilibrium. This therapy offers two long-term advantages: the prevention of osteoporosis and the cardiovascular diseases.

Bone mineral content (CMO, mg/cm2) was measured at the distal radius by dual photon absorptiometry (DPA, I125, Am241) in 1.161 women (w), aged 20-87 years. Women were subdivided into different groups according to the presence and duration of menopause. For gross evaluation of spinal osteoporosis (OP), the results of spinal X-rays were graded as follows: score 0: no signs of OP; score 1: aspecific signs of OP; score 2: typical signs of OP; score 3: wedging or collapse of one or more vertebrae. Women in postmenopausal state showed significantly reduced CMO (p less than .0005) when compared to women in premenopausal state; a significant correlation was found between CMO and years since menopause (p less than .0001). Concerning the relationship between CMO and spinal score, a progressive decreases in CMO from score 0 to score 3 was present and the correlation was significant (p less than .0001). In addition, women with score 3 showed a mean CMO below the "fracture threshold", in spite of the large overlap in individual CMO values. Our data suggest that radial DPA should be maintained as a "screening" procedure for OP.

Pharmacological treatments of osteoporosis can improve bone mineral content, but are not able to restore trabecular bone structure in presence of microfractures. It is therefore necessary to carry out at the right moment some preventive actions to increase peak bone mass in premenopausal age: adequate calcium intake, systematic physical activity and, if necessary, oestrogen administration before menopause are correct prophylactic measures against osteoporosis; moreover risk factors identification allows to perform a preliminary screening. Serial bone absorptiometry at lumbar level is able to identify fast losers women by means of integrating densitometric data and some metabolic results. Utilizing these methods it is possible to activate proper preventive or therapeutic measures and prevent osteoporotic complications.

In order to assess the correlation between menopause and osteoporosis, both in pathogenetic and therapeutical terms, a study was carried out in four comparable group of patients at Department B of the Institute of Gynaecology and Obstetrics at the University of Turin. Patients were divided as follows: 24 patents affected by evident osteoporosis, 39 patients with the first symptoms of osteoporosis, 27 with hypercalcemia and 33 healthy controls. The following tests were performed in all subjects: serum assay of androstenedione, estrone, 17-beta-estradiol, PTH, calcium, phosphorus, alkaline phosphatase and creatinine. Laboratory tests were repeated monthly in all patients and control subjects. Dual chromatic ray bone densitometry was performed in all patients at the start and end of treatment. With regard to therapy, each group was subdivided into two equal subgroups which were treated with carbocalcitonin or conjugated estrogens. From the findings, it is clear that there is a non-significant difference between serum levels of androstenedione, estrone and estradiol in the three groups examined and control subjects. Although the possibility that the fall in steroid hormones might contribute to bone load cannot be excluded, it is not possible to demonstrate that this is the most important factor in the pathogenesis of osteoporosis given that many women do not develop osteoporotic symptoms after menopause. In addition, in therapeutic terms, all bone density parameters considered in patient osteoporosis improved after therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

The epidemiological research of the last years points to a significant increase of involutional osteoporosis and related fractures. The rational treatment of osteoporosis consists either in preventive management or in early pharmacological therapy, preventive screening of at risk subjects by means of bone mineral content measurement.