Secondary prevention of fractures and compliance to treatment in osteoporosis.

Osteoporosis is a mechanical incompetence of bone which finally leads to fracture. The occurrence of a fracture for a minor trauma is the definitive evidence of bone fragility and an indication of an higher probability for other fractures. Fracture at any site is a strong risk factor for a subsequent fracture, therefore any patient with a prevalent fracture is an ideal candidate for treatment due to the high risk for recurrence and to a favourable cost-benefit ratio. Most of the available pharmacological agents approved for osteoporosis treatment are effective in reducing fracture risk in this class of patients. Unfortunately, poor compliance is very common in patients treated for osteoporosis and this leads to reduced benefits and ineffectual costs. Dose regimen simplification is neither the only nor the most important solution to improve compliance, and a multifaceted strategy targeting cognitive, behavioural and emotional factors should be employed.