A wide-ranging variety of exciting and topical clinical issues will be covered at the 2018 ECTS meeting in Valencia. In a joint session with the ASBMR, there will be a debate on the case for population-based screening in older adults, in which the latest evidence from the US and Europe will be presented. A plenary lecture on closing the treatment gap will review treatment rates in different parts of the world and look at measures, including Fracture Liaison Services, to address under-treatment of people at high risk of fracture. With the development of new anabolic therapies there is much interest in when these should be used as primary therapy and how sequential therapy with anabolic and anti-resorptive drugs can be most effectively used to maintain beneficial skeletal effects; this topic will also be covered in a plenary lecture. Clinical workshops will include talks on weight loss and bone, with a focus on anorexia nervosa and bariatric surgery, and cancer and bone, in which the management of treatment-induced bone loss in cancer patients and the use of bone active drugs to reduce skeletal morbidity in patients with bone malignancy will be reviewed. There will also be a session on the diagnosis and management of vertebral fractures that will include discussion of their definition, indications for vertebral fracture assessment and medical and surgical approaches to treatment. Other hot topics in the programme include molecular imaging of bone metastases and bone marrow adipose tissue and its interactions with bone.