[The endocannabinoid system in obesity].

The endocannabinoid system is involved in the regulation of energy balance and metabolism. Endocannabinoids have central effects with raising appetite and hunger. On the other hand, different components of the endocannabinoid system are also found in peripheral organs and tissues and they could impact the lipid and glucose metabolism.

[Incidence of hip fracture: reversal of a secular trend].

Hip fractures are a major cause of burden associated with osteoporosis in terms of mortality, disability, and costs. Many studies reveal an increase of the age-adjusted hip fracture incidence but long-term data on secular changes in women and men within a well-defined community are still rare. From 1991 to 2000, 4115 hip fractures were recorded in Geneva in 2981 women and 822 men 50 years and older.

[Vitamine D in patients with osteoporosis: sufficient or necessary?].

Vitamin D is essential for intestinal calcium absorption, bone mineralisation and plays an important role in neuromuscular functions. Vitamin D insufficiency is highly prevalent among postmenopausal women with osteoporosis and in the elderly. In turn, supplements of vitamin D3 (cholecalciferol), and to a lesser extent vitamin D2 (ergocalciferol), may decrease falls and fracture risk by 25%.

[Rehabilitation of elderly patients after fracture].

Hip fracture in the elderly is associated with increased mortality and disability. The rate of recovery of the pre-fracture functional or ambulatory level is less than 70%. Different intervention programs accelerate the recovery and decrease the mortality; these programs include early ambulation, recovery of the activities of daily living, muscle training and correction of malnutrition (protein supplements, vitamin D).

[Anorexia nervosa and its consequences on bone: a therapeutic challenge].

It has been estimated that osteoporosis is present in 20 to 50% of women with anorexia nervosa, with an increased fracture risk particularly at non vertebral sites. Thus, bone loss is a major clinical concern in anorexia nervosa patients, justifying systematic evaluation. However, evidence-based therapeutic options are limited.

[Osteoporosis treatment].

As for any chronic disease, adherence to osteoporosis treatment is low. Folates and vitamin B12 decrease hip fracture risk in elderly Japanese with stroke. Raloxifene (Evista) decreases the incidence of positive estrogen receptor breast cancer and could prevent cardiovascular events in patients at high risk.

[Parathyroid hormone for osteroporsis: why and who to treat?].

Osteoporosis treatment with anti-catabolic agents, such as bisphosphonates and SERMS, inhibits bone remodeling, resulting in increased bone mineral density and preservation of bone micro-architecture. On another side, daily subcutaneous injections of parathyroid hormone (and PTH(1-34), teriparatide) stimulate osteoblastic functions and bone remodeling, resulting in new bone formation, increased bone mineral density and improved microarchitecture, thereby reducing fracture risk. However, the effects on PTH on cortical bone structure and its use in the context of anticatabolic treatments for osteoporosis remain complex.

[Bisphosphonates and combined treatments osteoporosis].

Bisphosphonates are inhibitors of bone resorption, which reduce vertebral and non-vertebral fracture risk. Their efficacity has been shown in controlled trials up to 5 years, and their safety up to ten years. There is no proven benefit of combining two bone resorption inhibitors.

[Osteoporosis and anti-androgenic therapy in case of prostate cancer].

Anti-androgenic therapy for prostate cancer is associated with an increased risk of osteoporosis and of fracture. A fracture occurence has negative influence on survival. An antiresorptive agent like zoledronate, prevents bone loss consecutive to anti-androgenic therapy.

[Is vertebral fracture diagnosed?].

Vertebral fractures are the most common osteoporotic fractures. Higher morbidity, higher mortality and higher risk of future osteoporotic fractures are associated to them. However, vertebral fractures are largely under-recognized and therefore, a large part of osteoporotic patients remains untreated.