Innovative aspects for the treatment of osteoporosis have been presented during the National Congress of the Italian Society of Endocrinology, held in Sorrento (Italy), on May 21st, 2009. During his presentation, Claudio Mecocci, Associate professor of Endocrinology, University of Pisa, Italy, illustrated the different treatments of osteoporosis and focused on the new drugs to prevent fractures caused by osteoporosis.

• Bisphosphonates, the first effective drugs for the treatment of osteoporosis, act by inhibiting bone resorption;
• drugs that stimulate the synthesis of new bone;
• drugs with dual effect;
• denosumab, a monoclonal antibody able to block the maturation of osteoclasts; a six months administration significantly reduces the risk of vertebral, non-vertebral and femoral fracture.

Another innovative aspect of the treatment of osteoporosis is the use of the so called “intermittent treatment”: bisphosphonates may be administered at monthly intervals, every forth months or even annually, and this treatment has been demonstrated to be effective. This innovation is of great interest for the treatment of elderly people who are at increased risk of fracture because it reduces the number of drugs they assume. "The main diagnostic investigation (gold standard) – professor Mecocci explained - is bone densitometry by X-ray (DEXA), performed at the lumbar spine and femur. Over the last few years it has acquired a valid measures with ultrasound equipment, which are generally carried out at the calcaneus or phalanges.
In addition to bone density, the reduction of bone density is an important risk factor for osteoporotic fracture, but other factors such as age, previous fragility fractures, treatment with cortisone, reduced body weight, early menopause are to keep under observation.
Current guidelines suggest to perform densitometric analysis in women aged over 65 years. In younger women and in men the investigation is recommended only at presence of risk factors. The estimate of risk and therefore the need to treat a patient should be based on the value of densitometric analysis and on clinical risk factors. In a recent publication, the World Health Organization has developed an algorithm called FRAX that allows to calculate the risk of fracture at 10 years regardless of the measurement of bone mass. The FRAX tool has been developed by WHO to evaluate fracture risk of patients. It is based on individual patient models that integrate the risks associated with clinical risk factors as well as bone mineral density (BMD) at the femoral neck. The FRAX models have been developed from studying population-based cohorts from Europe, North America, Asia and Australia. For this algorithm are important: age, sex, weight, height, previous fracture, parent fracture hip, current smoking, the use of glucocorticoids, rheumatoid arthritis, secondary osteoporosis, femoral neck BMD, consumption of alcohol (3 or more units per day).