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Osteoporosis is a systemic skeletal disorder characterized by increased bone fragility, which is associated with an enhanced fracture risk. The first fracture often represents indeed the clinical manifestation of this condition. In the present document we provided an overview of the economic and clinical impact of a not-adequate therapeutic appropriateness and suboptimal adherence to osteoporosis therapy, that are both widely reported in literature despite osteoporotic treatments have proved their efficacy in reducing fracture risk. Adequate treatment and adherence were reported to be associated with a lower risk of re-fracture and all-cause mortality. Moreover, healthcare costs in osteoporotic patients with previous fractures were significantly lower in those receiving osteoporosis treatment rather than among untreated patients. Nevertheless, these two key-factors are not improving over time. The measurement of indicators of adherence and therapeutic appropriateness allows to analyse the utilization profile of the drugs indicated for the treatment of osteoporosis and to evaluate the presence of possible deviation between the prescriptive behaviours observed in clinical practice and the recommendations reported in the guidelines. The periodic monitoring of such indicators together with prescribing audit activity could represent a useful tool for the optimization of osteoporosis management and to achieve a correct resource allocation.

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Atrial fibrillation (AF) is the most prevalent form of alteration in cardiac rhythm and is associated with a high economic burden resulting from both clinical consequences and impact on patients’ quality of life. Goals of treatment include symptom control and, in the high-risk patients, the prevention of thromboembolic complications. The advent of novel oral anticoagulant agents (NOACs) has improved the management of patients with non-valvular AF (NVAF) by overcoming limitations associated with traditional oral anticoagulation drugs. NOACs are associated with a lower risk of stroke, systemic embolism, and mortality compared to vitamin K antagonists (VKAs) and with a lower risk of fatal, major, and intracranial bleeding. This supplement aims at sharing the virtuous management model of AF patients in the Local Health Unit Tuscany North-West and promoting the importance of a multidisciplinary management, which involves cardiologists and general practitioners (GPs), not only in terms of clinical outcomes, but also of therapeutic appropriateness and economic sustainability.

Background: Proton pump inhibitors (PPIs) are among the most misused drugs both at the community and hospital level. Recently, possible risks have been underscored, suggesting the importance of limiting PPI use to proven indications.Objective: To survey the appropriateness of PPI use in a University hospital in Italy. Setting Azienda Ospedaliera Universitaria Policlinico 'P. Giaccone', in Palermo, Italy.Method: A one day-observational study, reviewing patients' medical records to identify treatments with PPIs and the indications for their use. After discharge, a subgroup of the cohort was followed up to assess the continuation of therapy at home. Appropriateness was evaluated according to the indications stated in the official product information sheet and supported by the AIFA notes.Main Outcome Measure: Prevalence and appropriateness of PPI use in the hospital and after discharge.Results: In the index day 62.9 % of 343 evaluable patients received a PPI. In only 29.1 % of these, the treatment could be considered appropriate. The most frequent reasons for inappropriate treatment were stress ulcer prophylaxis in low risk patients and unwarranted gastro-protection in drug treated patients. 30.9 % of patients received PPIs for uncertain indications: of these, 25.7 % were "critical" patients admitted in non-ICU wards. Furthermore, as much as 88.2 % of anticancer drug treated patients received PPIs as gastroprotective agents. At discharge 48.6 % of patients received a prescription to continue PPI therapy at home and 75.9 % of the 83 followed up patients were found to be still taking these drugs after on average 3 months from discharge.Conclusion: This study confirms a high proportion of inappropriate PPI therapy into the hospital that translates in a prolonged unnecessary administration in the community setting. Further studies are needed to assess the cost-effectiveness of PPI therapy in subgroups of patients at moderate risk for gastric complications to optimize current guidelines. [ABSTRACT FROM AUTHOR]