New proposals for the definition of severe osteoporosis.

At present, severe osteoporosis is considered bone mineral density below a t-score of -2,5 existing together with a prevalent fragility fracture. This is a rough categorization of a wide range of clinical conditions. In osteoporotic patients, two different severities may be considered: prognostic severity, i.e., the risk of the occurrence of other fragility fractures and clinical severity, i.e. the degree of pain and disability experienced by the patient. While the former is currently under investigation in several studies, the latter has not been clearly defined in the current literature. Nevertheless, assessment of disease severity is useful for at least 3 purposes: identification of high-risk patients who deserve immediate attention and intervention; motivation of patients to follow prescribed therapies; and modulation of care intensity. The introduction of pharmacological treatments with varying degrees of efficacy and costs, reimbursement of which by the national health system is managed by regulatory agencies, calls for a consensus of the scientific community for a comprehensive classification of osteoporotic severity.