Review Article 2009 Santa Fe Bone Symposium E. Michael Lewiecki, * ,1 John P. Bilezikian, 2 Andrew J. Laster, 3 Paul D. Miller, 4 Robert R. Recker, 5 R. Graham G. Russell, 6 and Michael P. Whyte 7 1 New Mexico Clinical Research & Osteoporosis Center, Albuquerque, NM, USA; 2 Columbia University College of Physicians and Surgeons, NYC, NY, USA; 3 Arthritis and Osteoporosis Consultants of the Carolinas, Charlotte, NC, USA; 4 Colorado Center for Bone Research, Lakewood, CO, USA; 5 Creighton University School of Medicine, Omaha, NE, USA; 6 The Botnar Research Centre, University of Oxford, Oxford, UK; and 7 Washington University School of Medicine, St. Louis, MO, USA Abstract Osteoporosis is a common skeletal disease with serious clinical consequences because of fractures. Despite the availability of clinical tools to diagnose osteoporosis and assess fracture risk, and drugs proven to reduce fracture risk, it remains a disease that is underdiagnosed and undertreated. When treatment is started, it is commonly not taken correctly or long enough to be effective. Recent advances in understanding of the regulators and mediators of bone remodeling have led to new therapeutic targets and the development of drugs that may offer advantages over current agents in reducing the burden of osteoporotic fractures. Many genetic factors that play a role in the pathogenesis of osteoporosis and metabolic bone disease have now been identified. At the 2009 Santa Fe Bone Sym- posium, held in Santa Fe, New Mexico, USA, the links between advances in genetics, basic bone science, recent clinical trials, and new and emerging therapeutic agents were presented and explored. Socioeconomic challenges and opportunities in the care of osteoporosis were discussed. This is a collection of medical essays based on key presentations at the 2009 Santa Fe Bone Symposium. Key Words: Bisphosphonates; denosumab; emerging therapy; histomorphometry; odanacatib; osteoporosis; treat- ment. Introduction The Santa Fe Bone Symposium is an annual forum dedi- cated to scientific, social, political, and economic issues affecting the care of patients with osteoporosis and metabolic bone disease. It is sponsored by the Osteoporosis Foundation of New Mexico, with faculty and participants from through- out the United States and abroad. Attendees include clini- cians, academicians, house staff, researchers, ancillary health care providers, and technologists. The 10th Anniver- sary Santa Fe Bone Symposium was held from July 31 to August 1, 2009, in Santa Fe, New Mexico, USA. Faculty members were selected according to their recognized contri- butions in skeletal science and clinical practice. Each was charged with presenting topics of clinical relevance, bridging the gap between scientific advances and clinical utility. Socio- economic issues affecting the care of skeletal diseases were covered. Presenters and participants were asked to present pa- tient cases, describe clinical scenarios, challenge one another, and engage in constructive dialog. Several panel discussions were held to enhance opportunities for meaningful and lengthy interactions. Bone densitometry technologists held concurrent sessions to address quality issues associated with bone density testing. Endocrinology fellows gave oral presen- tations of abstracts from an educational event held in the days preceding the bone symposium. Topics were identified through evaluations from previous programs and new devel- opments in the field of skeletal health care. Proceedings of previous Santa Fe Bone Symposia have been presented in Received 11/16/09; Revised 12/14/09; Accepted 12/14/09. *Address correspondence to: E. Michael Lewiecki, MD, FACP, FACE, New Mexico Clinical Research & Osteoporosis Center, 300 Oak St. NE, Albuquerque, NM 87106. E-mail: lewiecki@aol.com 1 Journal of Clinical Densitometry: Assessment of Skeletal Health, vol. 13, no. 1, 1e9, 2010 Ó Copyright 2010 by The International Society for Clinical Densitometry 1094-6950/10/13:1e9/$36.00 DOI: 10.1016/j.jocd.2009.12.003