Epidemiología de la faringitis estreptocócica. Período enero de 2018 - diciembre de 2021 / Epidemiology of streptococcal pharyngitis. January 2018 - December 21

La faringoamigdalitis es uno de los motivos más frecuentes de consulta en pediatría. Aproximadamente un 70-80% de las faringoamigdalitis son de etiología viral. El 20-30% restante son de origen bacteriano. El agente causal más frecuente es Streptococcus pyogenes (estreptococo ß-hemolítico del grupo A). El rol de Streptococcus dysgalactiae subsp. equisimilis, (estreptococos ß-hemolíticos grupos C y G) fue claramente establecido como agente etiológico en la faringitis bacteriana, tanto en niños como en adultos. Se realizó un análisis descriptivo y retrospectivo entre enero 2018 y diciembre de 2021. Se evaluó la prevalencia de faringitis estreptocócica, la edad, el período estacional, los agentes etiológicos y la resistencia a macrólidos durante los períodos pre-COVID-19 (2018-2019) y COVID-19 (2020-2021). Se analizaron 11 396 muestras de exudados de fauces de pacientes con sospecha de faringitis bacteriana; las mismas se procesaron mediante el uso de técnicas microbiológicas convencionales. En el período estudiado el porcentaje de positividad de los cultivos de exudados de fauces se mantuvo constante. Al comparar los períodos pre-COVID-19 (2018-2019) y COVID-19 (2020-2021) se observó una disminución en el número de aislados de S. pyogenes con un aumento de S. dysgalactiae subsp. equisimilis, mientras que la resistencia a macrólidos encontrada fue superior en S. pyogenes y para S. dysgalactiae subsp. equisimilis se mantuvo constante. Es importante realizar el cultivo para la identificación del agente etiológico y determinar la sensibilidad antibióticapara continuar con la vigilancia epidemiológica de la resistencia a los macrólidos, porque representan una opción en pacientes alérgicos a ß-lactámicos (AU)

Pharyngotonsillitis is one of the most frequent reasons for consultation in children. Approximately 70-80% of pharyngotonsillitis are of viral etiology. The remaining 20-30% are bacterial in origin. The most frequent causative agent is Streptococcus pyogenes (group A ß-hemolytic streptococcus). Streptococcus dysgalactiae subsp. equisimilis (ß-hemolytic streptococcus groups C and G) was clearly established as an etiologic agent in bacterial pharyngitis in both children and adults. A descriptive and retrospective analysis was conducted between January 2018 and December 2021. The prevalence of streptococcal pharyngitis, age, seasonal period, etiologic agents, and macrolide resistance during the pre-COVID-19 (2018-2019) and COVID-19 (2020-2021) periods were evaluated. We analyzed 11 396 specimens of swabs from patients with suspected bacterial pharyngitis. Conventional microbiological techniques were used. In the study period, the percentage of positivity of swab cultures remained constant. When comparing the preCOVID-19 (2018-2019) and COVID-19 (2020-2021) periods, a decrease in the number of S. pyogenes isolates was observed with an increase in S. dysgalactiae subsp. equisimilis, while the resistance to macrolides found was higher for S. pyogenes and remained constant for S. dysgalactiae subsp. equisimilis. The identification of the etiologic agent and determination of antibiotic sensitivity are important for epidemiological surveillance of macrolide resistance, as they are a treatment option in patients who are allergic to ß-lactams (AU)

Effect of obesity on fragility fractures, BMD and vitamin D levels in postmenopausal women. Influence of type 2 diabetes mellitus.

AIMS: To see the effects of obesity on risk fracture, bone density (BMD), and vitamin D levels in a group of postmenopausal women, and consider how comorbid type 2 diabetes mellitus (T2DM) modifies them. METHODS: 679 postmenopausal women were grouped into obese and non-obese. Obese women were grouped into those with T2DM and those without. 25(OH)-vitamin D, PTH and BMD were measured, and prevalent fragility fractures were gathered. RESULTS: Obese women had higher prevalence of T2DM, than non-obese women. Levels of 25(OH)-vitamin D were lower and those of PTH higher in obese women, BMD values were higher in obese women. Diabetic-obese women had a higher prevalence of non-vertebral fractures than non-diabetic-obese. Multivariate logistic regression model showed association of fragility fractures with age, total hip BMD, BMI and T2DM. Obese women have higher BMD and lower 25(OH)-vitamin D values (and higher PTH) than non-obese, without diabetes. CONCLUSIONS: T2DM confers an increased risk of non-vertebral fractures in postmenopausal obese women.

Radiosensitisation of human colorectal cancer cells by ruthenium(II) arene anticancer complexes.

Some of the largest improvements in clinical outcomes for patients with solid cancers observed over the past 3 decades have been from concurrent treatment with chemotherapy and radiotherapy (RT). The lethal effects of RT on cancer cells arise primarily from damage to DNA. Ruthenium (Ru) is a transition metal of the platinum group, with potentially less toxicity than platinum drugs. We postulated that ruthenium-arene complexes are radiosensitisers when used in combination with RT. We screened 14 ruthenium-arene complexes and identified AH54 and AH63 as supra-additive radiosensitisers by clonogenic survival assays and isobologram analyses. Both complexes displayed facial chirality. At clinically relevant doses of RT, radiosensitisation of cancer cells by AH54 and AH63 was p53-dependent. Radiation enhancement ratios for 5-10 micromolar drug concentrations ranged from 1.19 to 1.82. In p53-wildtype cells, both drugs induced significant G2 cell cycle arrest and apoptosis. Colorectal cancer cells deficient in DNA damage repair proteins, EME1 and MUS81, were significantly more sensitive to both agents. Both drugs were active in cancer cell lines displaying acquired resistance to oxaliplatin or cisplatin. Our findings broaden the potential scope for these drugs for use in cancer therapy, including combination with radiotherapy to treat colorectal cancer.

Deoxygenation of waste cooking oil and non-edible oil for the production of liquid hydrocarbon biofuels.

Deoxygenation of waste cooking vegetable oil and Jatropha curcas oil under nitrogen atmosphere was performed in batch and semi-batch experiments using CaO and treated hydrotalcite (MG70) as catalysts at 400 °C. In batch conditions a single liquid fraction (with yields greater than 80 wt.%) was produced containing a high proportion of hydrocarbons (83%). In semi-batch conditions two liquid fractions (separated by a distillation step) were obtained: a light fraction and an intermediate fraction containing amounts of hydrocarbons between 72-80% and 85-88% respectively. In order to assess the possible use of the liquid products as alternative fuels a complete chemical characterization and measurement of their properties were carried out.

Electrochemical performance of hierarchical porous carbon materials obtained from the infiltration of lignin into zeolite templates.

Hierarchical porous carbon materials prepared by the direct carbonization of lignin/zeolite mixtures and the subsequent basic etching of the inorganic template have been electrochemically characterized in acidic media. These lignin-based templated carbons have interesting surface chemistry features, such as a variety of surface oxygen groups and also pyridone and pyridinic groups, which results in a high capacitance enhancement compared to petroleum-pitch-based carbons obtained by the same procedure. Furthermore, they are easily electro-oxidized in a sulfuric acid electrolyte under positive polarization to produce a large amount of surface oxygen groups that boosts the pseudocapacitance. The lignin-based templated carbons showed a specific capacitance as high as 250 F g(-1) at 50 mA g(-1) , with a capacitance retention of 50 % and volumetric capacitance of 75 F cm(-3) at current densities higher than 20 A g(-1) thanks to their suitable porous texture. These results indicate the potential use of inexpensive biomass byproducts, such as lignin, as carbon precursors in the production of hierarchical carbon materials for electrodes in electrochemical capacitors.

[Applications of diffusion techniques in magnetic resonance imaging of musculoskeletal tumors]. / Aplicaciones de la técnica de difusión por resonancia magnética en el manejo de la patología tumoral osteomuscular.

Magnetic resonance imaging (MRI) is the technique of choice in the diagnosis, staging, and follow-up of musculoskeletal tumors. Diffusion imaging is a new functional MRI technique that provides information that is complementary to that obtained in conventional MRI sequences. Diffusion imaging has proven useful in different clinical situations like the characterization of disease involving the bone marrow (bone metastases, benign fractures, or hematological disease), the evaluation of tumors of the bones and soft tissues, and the monitoring of the response to treatment in patients with tumors. The aim of this article is to review the diffusion technique in MRI and its current clinical applications in the management of musculoskeletal tumors.

Oxidative species increase arginase activity in endothelial cells through the RhoA/Rho kinase pathway.

BACKGROUND AND PURPOSE: NO produced by endothelial NOS is needed for normal vascular function. During diabetes, aging and hypertension, elevated levels of arginase can compete with NOS for available l-arginine, reducing NO and increasing superoxide (O(2) (.-)) production via NOS uncoupling. Elevated O(2) (.-) combines with NO to form peroxynitrite (ONOO(-)), further reducing NO. Oxidative species increase arginase activity, but the mechanism(s) involved are not known. Our study determined the mechanism involved in peroxynitrite and hydrogen peroxide-induced enhancement in endothelial arginase activity. We hypothesized that oxidative species increase arginase activity through PKC-activated RhoA/Rho kinase (ROCK) pathway. EXPERIMENTAL APPROACH: Arginase activity/expression was analysed in bovine aortic endothelial cells (BAEC) treated with an ONOO(-) generator (SIN-1) or H(2) O(2). Pretreatment with inhibitors of Rho kinase (Y-27632) or PKC (Gö6976) was used to investigate the mechanism involved in arginase activation. KEY RESULTS: Exposure to SIN-1 (25 µM, 24 h) or H(2) O(2) (25 µM, 8 h) increased arginase I expression and arginase activity (35% and 50%, respectively), which was prevented by ROCK inhibitor, Y-27632, PKC inhibitor, Gö6976 or siRNA to p115-Rho GEF. There was an early activation of p115-Rho GEF (SIN-1, 2 h; H(2) O(2), 1 h) and Rho A (SIN-1, 4 h; H(2) O(2), 1 h) that was prevented by using the PKC inhibitor. Exposure to SIN-1 and H(2) O(2 ) also reduced NOS activity, which was blocked by pretreatment with p115-RhoGEF siRNA. CONCLUSIONS AND IMPLICATIONS: Our data indicate that the oxidative species ONOO(-) and H(2) O(2) increase arginase activity/expression through PKC-mediated activation of RhoA/Rho kinase pathway.

Normal values in ambulatory oesophageal pH monitoring at two levels in Spain.

AIM: Upper oesophageal pH monitoring may play a significant role in the study of extra-oesophageal GERD, but limited normal data are available to date. Our aim was to develop a large series of normal values of proximal oesophageal acidification. METHODS: 155 healthy volunteers (74 male) participated in a multi-centre national study including oesophageal manometry and 24 hours oesophageal pH monitoring using two electrodes individually located 5 cm above the LOS and 3 cm below the UOS. RESULTS: 130 participants with normal manometry completed all the study. Twelve of them were excluded for inadequate pH tests. Twenty-seven subjects had abnormal conventional pH. The remaining 91 subjects (37 M; 18-72 yrs age range) formed the reference group for normality. At the level of the upper oesophagus, the 95th percentile of the total number of reflux events was 30, after eliminating the meal periods 22, and after eliminating also the pseudo-reflux events 18. Duration of the longest episodes was 5, 4 and 4 min, respectively (3.5 min in upright and 0.5 min in supine). The upper limit for the percentage of acid exposure time was 1.35, 1.05 and 0.95%, respectively. No reflux events were recorded in the upper oesophagus in 8 cases. CONCLUSION: This is the largest series of normal values of proximal oesophageal reflux that confirm the existence of acid reflux at that level in healthy subjects, in small quantity and unrelated to age or gender. Our data support the convenience of excluding pseudo-reflux events and meal periods from analysis.

[Evidenced based medicine and drugs approved for the treatment of osteoporosis. Role of calcium and vitamin D]. / La medicina basada en la evidencia y los fármacos aprobados para el tratamiento de la osteoporosis. Papel del calcio y la vitamina D.

Osteoporosis is a very common disease, which affects aged elderly people. Fractures are the main clinical manifestation of osteoporosis, being the more frequent fractures, vertebral fractures, distal forearm fractures and proximal femur fractures. The main objective in the treatment of osteoporosis is to avoid or to reduce new fractures. To obtain this, an integral approach should be done, including non-pharmacological measures, as a well balanced diet, the practising of regular exercise, avoiding or suppressing toxic habits (excess of alcohol and tobacco), and when indicated, patients should take a drug. There are several drugs available whose reduce the risk of fracture, all of them evaluated under the "Evidence-Based Medicine" criteria. Not all the drugs reduce the risk of all fracture. Thus, there are drugs that reduce only the risk of vertebral fractures, drugs that reduce the risk of non-vertebral fractures and finally, drugs that reduce the risk of hip fracture. All the studies performed on osteoporosis, the drugs have been always prescribed together with a supplement of calcium and Vitamin D. So, the correct prescription of a treatment for osteoporosis should include general measurements, the chosen drug and a supplement of calcium and Vitamin D.

La medicina basada en la evidencia y los fármacos aprobados para el tratamiento de la osteoporosis. Papel del calcio y la vitamina D / Evidenced based medicine and drugs approved for the treatment of osteoporosis. Role of calcium and vitamin D

La osteoporosis es una enfermedad muy frecuente, que afecta sobre todo a personas de edad de ambos sexos. La manifestación clínica de la osteoporosis la constituyen las fracturas, entre las cuales, las más frecuentes son las de vértebras, extremidad distal del radio y fémur proximal. El objetivo principal en el tratamiento de la osteoporosis es evitar o reducir la aparición de fracturas. Para ello, se deben integrar medidas no farmacológicas, como una dieta equilibrada, la realización habitual de ejercicio, la supresión o moderación de hábitos tóxicos (tabaco, exceso de alcohol) y en los casos en los que esté indicado, tomar un fármaco. Disponemos de varios fármacos que reducen el riesgo de fractura, que han sido evaluados siguiendo los criterios de la "Medicina Basada en la Evidencia". Debe tenerse en cuenta que no todos los fármacos reducen el riesgo de todas las fracturas. Así, algunos sólo reducen el riesgo de las fracturas vertebrales, otros las fracturas no vertebrales y otros, el riesgo de fractura de cadera. En todos los estudios realizados con todos los fármacos, siempre se ha acompañado a los mismos de un suplemento de calcio y vitamina D. Por ello, la correcta prescripción de un tratamiento para la osteoporosis incluye las medidas generales no farmacológicas, el fármaco elegido y un suplemento de calcio y vitamina D (AU)

Osteoporosis is a very common disease, which affects aged elderly people. Fractures are the main clinical manifestation of osteoporosis, being the more frequent fractures, vertebral fractures, distal forearm fractures and proximal femur fractures. The main objective in the treatment of osteoporosis is to avoid or to reduce new fractures. To obtain this, an integral approach should be done, including non-pharmacological measures, as a well balanced diet, the practising of regular exercise, avoiding or suppressing toxic habits (excess of alcohol and tobacco), and when indicated, patients should take a drug. There are several drugs available whose reduce the risk of fracture, all of them evaluated under the "Evidence-Based Medicine" criteria. Not all the drugs reduce the risk of all fracture. Thus, there are drugs that reduce only the risk of vertebral fractures, drugs that reduce the risk of non­vertebral fractures and finally, drugs that reduce the risk of hip fracture. All the studies performed on osteoporosis, the drugs have been always prescribed together with a supplement of calcium and Vitamin D. So, the correct prescription of a treatment for osteoporosis should include general measurements, the chosen drug and a supplement of calcium and Vitamin D (AU)

[Evaluation of the management of inhalers by the nursing personnel in a reference hospital]. / Valoración del manejo de los inhaladores por el personal de enfermería en un hospital de referencia.

OBJECTIVES: To evaluate the knowledge and skills of nurses on the management of inhaled therapy in different hospitalization wards. MATERIAL AND METHODS: We carried out a cross-sectional study, in which nurses were asked to perform a practical demonstration of the management of a pressurized canister with an inhalation chamber, without previous theoretical instruction about the technique. The inhalation technique was evaluated step by step following the recommendations of the Spanish Society of Pneumologists and Chest Surgeons (SEPAR). RESULTS: We could obtain the participation of 144 of the 177 nurses working in different wards (29 males, 115 females, mean age 42.5 + 7 years). Previous knowledge of the management of inhalers was declared by 85.4%. We found that 70.8% of the nurses did not correctly perform all the steps: 24.5% made only one mistake, while the rest had mistakes in two or more steps. The most common mistakes were: not to perform a slow and deep exhalation before using the inhaler (27.3%), not to hold the breath after the inhalation (24.4%), and not to wait 30 seconds between inhalation manoeuvres (21.5%). When evaluating different wards, we found that 44.4% of the nurses in the Short Stay Unit performed the technique correctly in contrast to 31.3% of the nurses in the Pneumology Ward. CONCLUSIONS: The percentage of mistakes in the inhalation technique by the nursing personnel was high. The health personnel must have an adequate level of training in order to correctly instruct the patient, because the efficacy of inhaled treatment greatly depends on the adequacy of the technique.

Valoración del manejo de los inhaladores por el personal de enfermería en un hospital de referencia / Evaluation of the managemente of inhalers by the nursing personner in a reference hospital

Objetivo: valorar los conocimientos y adiestramiento del personal de enfermería con el paciente respiratorio en el manejo de la terapia inhalada en distintas salas de hospitalización.Material y métodos: se diseñó un estudio prospectivo con 144 enfermos/as mediante una encuesta individual en la que se solicitó a cada unode ellos una demostración práctica del manejo del cartucho presurizado con cámara inhalatoria, sin realizar una instrucción teórica previa sobrela técnica. Se revisó la técnica inhalatoria siguiendo los pasos establecidos en la normativa SEPAR.Resultados: participaron 144 de los 177 enfermeros/as (81,4%) que trabajan en las diferentes salas de hospitalización (29 varones, 115 mujeres,edad media 42,5 + 7 años). El 85,4% (123/144) reconocía tener conocimientos previos del manejo de los inhaladores. Tras la demostración práctica se comprobó que el 70,8% de los enfermeros realizaban incorrectamente algún paso de la maniobra inhalatoria; de ellos el 24,5% cometió un sólo error y el resto dos o más. Los errores más frecuentes fueron: no efectuar una espiración lenta y profunda antes de iniciar la inhalación (27,3%), no aguantar la respiración durante 10 segundos (24,4%), y no esperar 30 segundos antes de iniciar la siguiente inhalación (21,5%). Analizando estos resultados por salas de hospitalización, el 44,4% de la Unidad de Corta Estancia efectuaba correctamente la técnica frente al 31,3% en Neumología. Conclusiones: el porcentaje de errores en la técnica de inhalación es elevado por parte del personal de enfermería. Es importante que el personal sanitario posea un grado de conocimientos adecuado para poder instruir adecuadamente al paciente, ya que de ello depende en gran medida la eficacia del tratamiento

Objectives: To evaluate the knowledge and skills of nurses on the management of inhaled therapy in different hospitalization wards. Material and methods: We carried out a cross-sectional study, in which nurses were asked to perform a practical demonstration of the management of a pressurized canister with an inhalation chamber, without previous theoretical instruction about the technique. The inhalation technique was evaluated step by step following the recommendations of the Spanish Society of Pneumologists and Chest Surgeons (SEPAR). Results: We could obtain the participation of 144 of the 177 nurses working in different wards (29 males, 115 females, mean age 42.5 + 7 years). Previous knowledge of the management of inhalers was declared by 85.4%. We found that 70.8% of the nurses did not correctly perform all the steps: 24.5% made only one mistake, while the rest had mistakes in two or more steps. The most common mistakes were: not to perform a slow and deep exhalation before using the inhaler (27.3%), not to hold the breath after the inhalation (24.4%), and not to wait 30 seconds between inhalation manoeuvres (21.5%). When evaluating different wards, we found that 44.4% of the nurses in the Short Stay Unit performed the technique correctly in contrast to 31.3% of the nurses in the Pneumology Ward. Conclusions: The percentage of mistakes in the inhalation technique by the nursing personnel was high. The health personnel must have an adequate level of training in order to correctly instruct the patient, because the efficacy of inhaled treatment greatly depends on the adequacy of the technique

[Simultaneous pulmonar, laryngeal and lingual affectation by Mycobacterium tuberculosis]. / Afectación simultánea pulmonar, laríngea y lingual por Mycobacterium tuberculosis.

The incidence of tuberculosis has lately increased in developed countries. The most frequent affectation is the pulmonar one and in the ORL area the laryngeal. The lingual affectation is exceptional. We present a case of a man 39 years old, with bilateral pulmonar, left vocal cord and mobile tongue affectation, negative Mantoux, positive spit culture and presence of acido-alcohol resistent bacillus in lingual and laryngeal biopsies. After antituberculosis treatment during 6 months the laryngeal and lingual lesions disappeared. We have only found two cases published of simultaneous tuberculosis in these three localisations in the last 30 years.

Proteolytic activity in salivary gland products of sheep bot fly (Oestrus ovis) larvae.

This study identified and characterized hydrolytic enzymes in salivary gland products of Oestrus ovis larvae. Third instars were collected from the heads of slaughtered goats. Salivary glands were extracted, their products obtained by centrifugation and the enzymatic profile determined. Optimum pH, temperature of maximum proteolytic activity, thermal stability, and resistance of salivary gland products were determined on collagen and subclasses of proteases were identified using protease inhibitors. Zymograms were used to determine the molecular weight of proteases. Antigenic protein bands were revealed by immunoblotting using sera obtained from experimentally infested goats. Seven positive enzymatic activities were detected in salivary gland products: acid phosphatase, naphthol-AS-BI-phosphohydrolase, esterase (C4), esterase lipase (C8), leucine arylamidase, alpha-glucosidase and N-acetyl-beta-glucosaminidase. Optimum pH for proteolytic activity was 8.0; proteolytic activity increased with temperature (10-50 degrees C) then drastically decreased at 60 degrees C. Proteases in O. ovis salivary gland products belong to the serine subclass. In Zymograms, bands of proteolytic activity were detected in the 20-63 kDa range; the immunoblot showed three antigenic bands, one of them related to a protease band (63 kDa). Serine proteases in O. ovis salivary gland products are most likely involved in larval nutrition and host immuno-modulation.

Empiric treatment in hospitalized community-acquired pneumonia. Impact on mortality, length of stay and re-admission.

OBJECTIVE: To evaluate adherence to guidelines when choosing an empirical treatment and its impact upon the prognosis of community-acquired pneumonia (CAP). METHODS: A prospective multicentre study was conducted in 425 CAP patients hospitalized on ward. Initial empirical treatment was classified as adhering or not to Spanish guidelines. Adherent treatment was defined as an initial antimicrobial regimen consisting of beta-lactams plus macrolides, beta-lactam monotherapy and quinolones. Non-adherent treatments included macrolide monotherapy and other regimens. Initial severity was graded according to pneumonia severity index (PSI). The end point variables were mortality, length of stay (LOS) and re-admission at 30 days. RESULTS: Overall 30-day mortality was 8.2%, the mean LOS was 8+/-5 days, and the global re-admission rate was 7.6%. Adherence to guidelines was 76.5%, and in most cases the empirical treatment consisted of beta-lactam and macrolide in combination (57.4%). Logistic regression analysis showed that other regimens were associated with higher mortality OR=3 (1.2-7.3), after adjusting for PSI and admitting hospital. Beta-lactam monotherapy was an independent risk factor for re-admission. LOS was independently associated with admitting hospital and not with antibiotics. CONCLUSIONS: A high adherence to CAP treatment guidelines was found, though with considerable variability in the empirical antibiotic treatment among hospitals. Non-adherent other regimens were associated with greater mortality. Beta-lactam monotherapy was associated with an increased re-admission rate.

Influencia de los diferentes regímenes de administración de los bifosfonatos sobre la tolerabilidad / Influence of the different bisphosphonates dose regimens on its tolerability

La osteoporosis es la enfermedad ósea más frecuente cuya complicación clínica son las fracturas, siendo la vertebral la más prevalerte. Disponemos hoy en día de un número de fármacos que reducen la aparición de nuevas fracturas y entre estos ocupan un papel fundamental los bifosfonatos. Sin embargo para que se produzca la reducción de fracturas, el tratamiento debe realizarse correctamente a largo plazo, y una gran proporción de pacientes abandonan la medicación al cabo de pocos meses por distintas razones. La introducción en el arsenal terapéutico contra la osteoporosis de bifosfonatos que permiten la administración más separada en el tiempo, semanal e incluso mensualmente, ha mejorado notablemente la adherencia al tratamiento

Osteoporosis is the most prevalent metabolic bone disease and fractures are its clinical complication. We have nowadays some drugs that reduce the incidence of new fractures: Bisphosphonates. Nevertheless, treatment must be taken properly in the long run to reduce the incidente of new fractures and a few months alter starting the treatment, a great number of patients stop it because of different reasons. The introduction of new bisphosphonates that can be taken weekly or even better monthly, has improved notably the adherence and compliance to osteoporosis treatment