OBJECTIVES: To describe prevalence and to evaluate pattern of use and sanitary costs of patients treated with osteoporosis drugs, using advanced reporting tools and methodologies integrating Big Data (coreReports) METHODS: Starting from ARNO Observatory, an Italian Database that collects health data on a population of 13 million Italian citizens, a new automated analytical tools (CoreReports)  has been developed in order to manage, catalog and find the strategic indicators of healthcare costs and patients care pathways related to Diseases, Populations, Drugs with benchmarking among different geographical areas. All web-based Reports are  automatically generated on-the-fly according to analytical needs and validated by a Scientific Committee with experts in various diseases. Among different diseases some results related to osteoporosis will be presented. RESULTS: Of the 5,364,167 subjects over 40 years, 176,831 (prevalence 3.3%) were treated with osteoporosis drugs with the following pattern of use:  bisphosphonates (80%), strontium ranelatum (18%), parathyroid hormone (1.2%), SERMs (0.8%), denosumab (0.4%). A considerable percentage (21.8%) didn’t received vitamin D supplements in association. Patients with osteoporosis received many drugs expression of comorbidity (cardiovascular drugs 67% of patients, corticosteroids 25%, nervous system drugs 33%). More than 1/6 of patients were hospitalized during 2012 (fractures 2,2%). Less than 50% of patients controlled their serum calcium levels in the last three years, 34% performed a densitometry. The average yearly cost/patient is 2.332€, 37% due to drugs (30% specific drugs, 70% others), 45% due to hospitalization and 18.8% to lab tests and diagnostic examinations. CONCLUSIONS: Osteoporosis represents a condition of high epidemiological prevalence and with a strong impact on the social welfare, on prevention and on pharmaceutical costs. A big data infrastructure represents a tool to evaluate patient care pathways with osteoporosis and estimate cost of illness and can be a valid instrument to support clinical governance