Current clinical practices in osteoporosis management across Italy: a survey analysis and expert opinion

Summary : Brief rationale: Osteoporosis management in Italy shows regional inconsistencies. Main result: Expert surveys and meetings revealed limited access to anabolic treatments and fragmented care pathways. Significance of the paper: Findings support the need for updated national guidelines to promote equitable care and reduce the burden of osteoporotic fractures. Purpose: Osteoporosis is a progressive bone disease characterized by reduced bone density and increased fracture risk, significantly affecting quality of life and imposing a substantial burden on healthcare systems. In Italy, managing osteoporosis is a national priority due to the rising incidence of fractures among the aging population. This study evaluates clinical practices in osteoporosis management across Northern, Central, and Southern Italy, focusing on diagnostics, therapies, and access to specialized care. Method: A detailed survey was distributed across multiple centers to evaluate diagnostic, therapeutic, and follow-up practices, along with specialists’ perspectives on national guidelines and the challenges in accessing advanced treatments. Following the survey, three regional expert meetings were held to analyze the findings and gain further insight. Results: Findings show widespread use of bone mineral density (BMD) testing and laboratory assessments, with regional differences in the use of fracture risk tools (FRAX, DeFRA) and markers such as CTX. Bisphosphonates, denosumab, and anabolic agents are commonly used; however, significant disparities persist in access to anabolic treatments. The patient journey remains uneven across regions, with challenges in accessing bone specialists, timely diagnosis, and appropriate treatment. In areas lacking structured care pathways, these gaps lead to delayed or suboptimal management. Conclusion: These findings highlight the need for updated, flexible guidelines to support a tailored and equitable approach to osteoporosis care in Italy. Improving access to specialized care and standardizing treatment pathways may enhance outcomes and reduce healthcare costs associated with osteoporosis-related fractures.