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World Congress on Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (WCO‐IOF‐ESCEO 2021): Educational Lectures Abstracts © International Osteoporosis Foundation and National Osteoporosis Foundation 2021 EL1 DIETARY PATTERNS AND FRAC TUR E RISK S. Maggi1 1CNR Aging Branch-IN, Padua, Italy Objective: This study aims to review the role of selected dietary patterns in the pathogenesis of fragility fractures. Material and methods: This is a narrative review of concepts and controversies in the most recent scientific literature. Results: Osteoporosis and sarcopenia are two important determinants of falls and fragility fractures that recognize several common risk factors, including malnutrition. In particular, malnutrition is associated to a higher risk of osteoporosis and sarcopenia in a life-course perspective, leading to an increased risk of fragility fracture at older ages. Diet is therefore one of the modifiable lifestyle factors that could represent an effective preventive strategy. Besides calcium and vitamin D, proteins, magnesium, and potassium, zinc, and possibly vitamins A, C, and K play a role. Good dietary intakes of calcium (1,000 mg/day before age 50, 1,200 mg/day beyond 50) and vitamin D (600 IU/day before the age of 70 and 800 IU/day thereafter) are crucial to prevent fragility fractures. Moreover, scientific evidence supports the protective role of n-3 fatty acids, flavonoids, and antioxidants and a negative role of saturated fatty acids and sugar. However, we consume selected foods within a dietary pattern, and recent epidemiological studies have focused on the assessment of selected dietary patterns and risk of fractures, more than of single components. This approach is very important, for two main reasons: first, dietary pattern that prevent not only musculoskeletal diseases, but also cardiovascular diseases, diabetes, and inflammatory bowel diseases might lessen the risk of fractures; therefore, we might consider several pathways, besides those typical of musculoskeletal health, explaining the association of diet and fractures. Specifically, bone loss might occur as a result of impaired calcium homeostasis, if the supply of calcium with the diet is inadequate, but also as a consequence of increased inflammatory cytokines and oxidative stress. Second, the analysis of dietary pattern, more than of single components, makes easier to translate the research findings into dietary recommendations for the general population. One of the most studied dietary patterns is the Mediterranean diet, assessed usually through the Mediterranean diet scores. Although in general there is a strong evidence supporting a protective effect of the Med diet on fracture risk, the comparison between studies is difficult, due to the different scoring systems used and the differences in the definition of the Med diet (traditional versus alternative). Evidence of the negative association between “healthy diets” (such as the Med diet) and the positive association between the dietary inflammatory index (DII) and fractures has been reported recently in large, longitudinal studies in the USA, Europe and China. Therefore, diets rich on fruits and vegetables, and low on saturated fats and sugars, are consistently reported as protective, but some concerns, and the need for further studies, are expressed for strict vegetarian, and vegan diets, which seems to be have deleterious effects on bone. Conclusions: According to this literature review, the adherence to a dietary pattern according to the Mediterranean diet principles, supporting large intake of vegetables, fruits, and cereals, daily intake of one/ two services of dairy, and moderate to low intake of meat and wine, seems to offer the best life-course approach to the prevention of fragility fractures. However, several methodological problems, related to the design, sampling, and instruments assessing the dietary pattern, must be acknowledged, and more studies are needed to fully elucidate the pathophysiological association with fragility fractures. EL2 MEET THE EVIDENCE OF PHARMA-GRADE CHONDROITIN SULPHATE N. Veronese1 1Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy Objectives: Osteoarthritis (OA) represents the major cause of chronic pain and disability among the musculoskeletal diseases with a considerable impact on the public health burden. According to ESCEO algorithm, the initial therapy for the treatment of knee OA is the use of SYSADOAs, in line also with other international recommendations. In particular, the ESCEO affords a strong recommendation for the use of prescription, pharma-grade chondroitin sulphate (CS) as long-term background therapy. Material and methods: The MEDLINE and PubMed databases were searched for randomized controlled trials (RCTs), meta-analyses and review articles on pharma-grade CS to evaluate its benefit–risk profile in OA. Results: The available data shows that CS 800mg/day is effective and safe in the treatment of knee and hand OA, with increasing evidences available for hip OA. The evidence so far suggested an efficacy comparable between CS and some NSAIDs (i.e. celecoxib). The chronic use (2 years) of CS for knee OA is associated not only with a positive effect on symptoms, but also on articular cartilage. The pharma-grade CS is thus endowed of both SYSADOA and SMOAD effects. Even at higher dosages (1200 mg/day), CS of pharma-grade shows a favourable benefit risk profile together with an improved compliance thanks to a new oral gel pharmaceutical formulation. CS high tolerability is also supported by its long marketing experience in different countries worldwide. Several products containing CS are available on the market, but the scientific evidences and considerations here analysed cannot be extrapolated to support other forms of CS (e.g. food supplements) but only attributed to CS of pharma-grade. Osteoporosis International (2022) 32 (Suppl 1):S35-S36 1 3 Conclusions: In line with the recent ESCEO algorithm and thanks to a robust scientific background, pharma-grade CS confirms its role as reference drug in the management of OA acting positively on signs, symptoms and structural changes of the disease. References • J.Y. Reginster and N. Veronese. Aging Clin Exp Res 2021; 33 (1): 37-47. • Chevalier X. and Conrozier T. Medicine Access@Point of Care 2017; 1 (1): e134-e144. Disclosures: Dr. Veronese reports personal fees from Mylan, Viatris,