Although providing the patients with their individual fracture risk information was not statistically effective, further studies on additional interventions able to improve the patients' perceived risk of fracture are warranted.

To improve adherence, we propose a multifaceted approach, which includes the Triad Model suggested by the World Health Organization, direct observed therapy and the use of drugs with longer administration intervals, e.g., zoledronic acid. The integration of these strategies may provide the basis for a marked increase in adherence to osteoporosis therapy, and improved clinical outcomes in a real-life scenario.

Background The treatment of trapeziometacarpal joint osteoarthritis (TMO) often consists of intra-articular injections of corticosteroids and/or hyaluronic acid (HA) or oral intake of chondroprotector agents. Several studies have shown that ultrasound-guided injections have greater accuracy and effectiveness compared to the blind technique. Objectives The purpose of our retrospective study was to observe if the concomitant administration of two treatments, ultrasound-guided infiltration of HA and the co-administration of chondroitin sulfate (CS) 800 mg daily orally gives superior results compared to the single treatment of infiltrative HA. Methods The patients, aged between 49 and 70 years, were divided into two groups: 12 men and 40 women received only the intra-articular infiltration treatment with 1 ml of HA 0.8% (Sinovial® Mini, one infiltration/month for 6 months) and 8 men and 21 women received the infiltrative treatment combined with oral administration of CS (Condrosulf®) 800 mg/day for 90 days. Hyaluronic acid has been administered by using an ultrasound transducer coupled with a 23G spinal needle, tangentially positioned to the skin (between 15° and 20°), following the course of the needle and the placement of the substance in real time. The patients were evaluated before treatment and at one, three and six months after the first infiltration by using a Visual Analogue Scale (VAS). One month after the end of treatment the patients’ subjective response to therapy was assessed in a 6-point Likert scale, as secondary endpoint. A daily questionnaire was also provided to record the compliance and possible side effects occurring during the treatment. Results A statistically significant reduction in the VAS score from 70 to 30 was observed at 1-3 months (p<0.02) and at the follow up of 6 months (p<0.03) in patients treated only with HA injection, while an even more statistically significant reduction in VAS from 70 to 10 was observed at 3 months (p<0.01) and at the follow up of six months (p<0.02) in patients who received the combined treatment with oral CS and infiltrative HA. None of the patients in the study had problems with respect to the tolerability of both treatments. Conclusions The intra-articular injections of hyaluronic acid has a significant relief from pain by restoring the joint function during the whole follow-up. A more marked reduction of symptoms was observed in patients concomitantly treated with ultrasound-guided infiltration of hyaluronic acid and oral chondroitin sulfate. The new technique of ultrasound-guided infiltration of the trapeziometacarpal joint is easy to implement and shows an excellent precision. References Uebelhart D., Thonar E.J., Delmas P.D. et al. Osteoarthritis Cartilage 1998; 6(Suppl A): 39–46. Morreale P., Manopulo R., Galati M. et al. J. Rheumatol. 1996; 23: 1385–91. Leeb B.F., Petera P., Neumann K. Wien Med Wochenschr 1996; 146: 609–14. Pipitone V., Ambanelli U., Cervini C. et al. Curr. Ther. Res. 1992; 52: 608–38. Grevenstein J., Michiels I., Arens-Corell M., ...

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