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;

Much has changed in these years about therapy for osteoporosis: new drugs have been introduced; we have more information about fracture risk and osteoporosis in not only in men but also in non white women; about the use of estrogen therapy. It is also important to underline that now a large number of people, especially women, knows the importance to prevent osteoporosis and the important to do radiological and biochemical exams to control the bone mineral density.

In the United States there is a rapid growth of the elderly and they are at risk of osteoporosis and fracture. The number of fractures observed each year is also increasing (J Bone Miner Res 22: 465-475). For these three causes cost-effectiveness considerations are warrant and the aim of this study is to identify the level of absolute fracture risk at which treatment intervention becomes cost-effective.

The use of prosthetic implants for joint replacement is one of the most significant successes of orthopaedic surgery and led to improvement of the quality of life of may patients. It is however known that these implants are not built to last forever. One of the main complications occurring in the long term after, for example, hip replacement surgery, is aseptic loosening. This occurs because of periprosthetic osteolysis and, although a few prognostic risk factors have been identified, most of them show inconsistent results.

The associations of volumetric (vBMD) and areal (aBMD) bone mineral density measures with prevalent cardiovascular disease (CVD) and subclinical peripheral arterial disease (PAD) were investigated in a cohort of older men and women enrolled in the Health, Aging and Body Composition Study. Participants were 3,075, well-functioning white and black men and women (42% black, 51% women), aged 68-80 years. The prevalence of CVD (defined by coronary heart disease, PAD, cerebrovascular disease, or congestive heart failure) was 29.8%. Among participants without CVD, 10% had subclinical PAD.

The aim of the study was to determine whether menopause is followed by endosteal resorption and periosteal apposition, and if so, whether geometric changes in bone were associated with the post-menopausal serum estradiol levels. The second aim was was to see if periosteal apposition compensated for the decrease in tissue mineral content and whether a strength index that accounts for both tissue density and geometric properties might be a better predictor than bone meneral density alone of future fracture of the distal radius.

Glucocorticoid-induced osteoporosis is the most common cause of secondary osteoporosis. To compare the effects of recombinant teriparatide (recombinant parathyroid hormone) with those of alendronate for the treatment of patients with osteoporosis who have had long-term exposure to glucocorticoids and are at high risk for fracture.

In this study annual infusions of zoledronic acid (5 mg) for 3 years were evaluated to determine whether they reduced the risk of vertebral, hip, and other types of fracture. 3,889 postmenopausal women with osteoporosis (mean age 73 years) were randomly assigned to receive a single 15-minute infusion of zoledronic acid (5 mg) and 3,876 were assigned to receive placebo at baseline, at 12 months and at 24 months; the women were followed until 36 months.

In this study annual infusions of zoledronic acid (5 mg) for 3 years were evaluated to determine whether they reduced the risk of vertebral, hip, and other types of fracture. 3,889 postmenopausal women with osteoporosis (mean age 73 years) were randomly assigned to receive a single 15-minute infusion of zoledronic acid (5 mg) and 3,876 were assigned to receive placebo at baseline, at 12 months and at 24 months; the women were followed until 36 months.