Musculoskeletal Health Conditions Represent a Global Threat to Healthy Aging: A Report for the 2015 World Health Organization World Report on Ageing and Health

Effectiveness of a comprehensive health promotion intervention for managing risk factors associated with musculoskeletal disorders in Iranian housewives: A four-arm randomized controlled trial

Full-time housework includes long hours of musculoskeletal effort that can lead to intense pain, poor workability, stress and reduced quality of life. A comprehensive intervention that included biomechanical and psychosocial educational training was designed and evaluated using a four-arm randomized control trial. A total of 160 housewives recruited from a musculoskeletal disorders clinic were randomly assigned to one of four intervention groups: control, biomechanical, psychosocial and comprehensive (biomechanical and psychosocial). Measures were collected before the seven weekly training sessions, immediately after, and three months and six months later. There were significant sustained improvements compared to baseline in the biomechanical and the psychosocial groups for six risk factors, and all seven risk factors in the comprehensive group providing evidence of independent contributions from biomechanical and psychosocial training approaches. This supported the overarching hypothesis that a comprehensive educational intervention can effectively reduce risk factors associated with musculoskeletal disorders in full-time housewives.

Global, regional, and national burdens of hip fractures in elderly individuals from 1990 to 2021 and predictions up to 2050: A systematic analysis of the Global Burden of Disease Study 2021

PURPOSE

We aimed to analyse the global, regional, and national burdens of hip fractures in older adults from 1990 to 2021, with projections to 2050, on the basis of data from the GBD 2021 study.

METHODS

We employed a joinpoint model to analyse trends in the burden of hip fractures from 1990‒2021. The estimated annual percentage change (EAPC) was used to quantify temporal trends over this period. We evaluated the relationship between the social development index and the burden of hip fracture in elderly people and conducted a health inequality analysis. Additionally, we applied Long-short Term Memory (LSTM) networks to forecast burden trends of hip fractures up to 2050.

RESULTS

The global age-standardized incidence rate (ASIR) for hip fractures in older adults rose from 781.56 per 100,000 in 1990 to 948.81 in 2021. The 2021 age-standardized prevalence rate (ASPR) was 1,894.07, and the age-standardized YLD rate (ASDR) was 173.52. From 1990 to 2021, the incidence and prevalence increased by 168.71 % and 173.07 %, respectively, while the burden of DALYs decreased. Future trends were projected via the LSTM. The burden and risk factors for hip fractures varied significantly by sex, country, and region. Population and aging are primary contributors to the rising incidence of elderly hip fractures, with falls being the leading direct cause.

CONCLUSION

From 1990 to 2021, the global burden of hip fractures in the elderly population, especially among older women, steadily increased. Population ageing highlights the urgent need for targeted public health interventions and resource allocation, including early diagnosis, effective prevention strategies, and region-specific management approaches.

Identifying progression subphenotypes of Alzheimer's disease from large-scale electronic health records with machine learning

OBJECTIVE

Identification of clinically meaningful subphenotypes of disease progression can enhance the understanding of disease heterogeneity and underlying pathophysiology. In this study, we propose a machine learning framework to identify subphenotypes of Alzheimer's disease progression based on longitudinal real-world patient records.

METHODS

The framework, dynaPhenoM, extracts coherent clinical topics across patient visits and employs a time-aware latent class analysis to characterize subphenotypes. We validated dynaPhenoM using three patient databases with a total of 3952 AD patients across the United States, demonstrating its effectiveness in revealing mild cognitive impairment (MCI) progression to AD.

RESULTS

Our study identified five subphenotypes associated with distinct organ systems for disease progression from MCI to AD, including common subtypes across cohorts-respiratory, musculoskeletal, cardiovascular, and endocrine/metabolic-as well as a cohort-specific digestive subtype.

CONCLUSION

Our study unravels the complexity and heterogeneity of the progression from MCI to AD. These findings highlight disease progression heterogeneity and can inform both diagnostic and therapeutic strategies, thereby advancing precision medicine for Alzheimer's disease.

Pilates lessens pain and disability and improves quality of life in people with musculoskeletal conditions in the extremities: A systematic review

BACKGROUND

Pilates has gained popularity for its benefits in reducing pain and disability among people with low back pain. However, conflicting evidence exists regarding its efficacy for musculoskeletal conditions in the upper and lower limbs.

OBJECTIVES

Investigate the effect of Pilates on pain, disability, quality of life, and physical function in people with musculoskeletal conditions in the extremities.

METHODS

A systematic review and meta-analysis of experimental studies using Pilates for musculoskeletal conditions in the extremities. Our outcomes included pain, disability, quality of life, and physical function. We searched eleven databases from inception to December 2023. Evidence was synthesised as standardised mean differences (SMD) with 95% confidence intervals (CI) using random-effects models. Risk of bias was assessed using the Revised Cochrane risk of bias tool or the ROBINS-I tool. GRADE was used to determine evidence certainty.

RESULTS

Eleven studies (n = 444) were included. Studies had moderate to high risk of bias. Pilates lessened pain (5 studies; SMD 1.41, 95% CI, 0.54-2.28), and disability (5 studies; SMD 0.83, 95% CI, 0.15-1.50), and improved quality of life (2 studies; SMD 2.10, 95% CI, 0.34-3.86) compared to the control group. The effect of Pilates on strength compared to the control the group was estimated to be small (3 studies; SMD 0.35), with unclear true effect due to uncertainty (95% CI, -0.27-0.98). The effects of Pilates on further aspects of physical function, including balance, proprioception, and range of motion remain unclear due to a lack of data which prevented meta-analysis.

CONCLUSION

Pilates was found to lessen pain and disability and improve quality of life in people with musculoskeletal conditions in the extremities compared to control. However, this evidence is of a very low certainty. The effect of Pilates on physical function remains uncertain. The evidence supporting the superiority of Pilates over other exercise interventions is inconclusive.

REVIEW REGISTRATION

PROSPERO (CRD42022375925).

Treatment Considerations for Severe Osteoporosis in Older Adults

Osteoporosis, a chronic metabolic bone disease, increases the predisposition to fragility fractures and is associated with considerable morbidity, high health care cost as well as mortality. An elevation in the rate of incident fragility fractures will be observed proportional with the increase in the number of older people worldwide. Severe osteoporosis is currently defined as having a bone density determined by dual-energy X-ray absorptiometry that is more than 2.5 standard deviations (SD) below the young adult mean with one or more past fractures due to osteoporosis. Nutrition, physical activity and adequate vitamin D are essential for optimal bone strength throughout life. Hormone (oestrogen/sex steroid) status is also a major determinant of bone health. This review explores mechanisms involved in bone homeostasis, followed by the assessment and management of severe osteoporosis, including an overview of several treatment options in older people that range from anti-resorptive to anabolic therapies.

Notopterol mitigates osteoarthritis progression and relieves pain in mice by inhibiting PI3K/Akt/GPX4-mediated ferroptosis

Ferroptosis-induced lipid peroxidation in chondrocytes exacerbates intra-articular inflammation, oxidative stress, and articular cartilage degradation, accelerating osteoarthritis (OA) progression. Effective anti-inflammatory and antioxidant interventions can alleviate both joint pain and cartilage damage. This study aims to elucidate the therapeutic effects of Notopterol (NP), a bioactive compound extracted from the rhizome of Notopterygium incisum, a traditional Chinese medicine known for its potent anti-inflammatory and antioxidant properties, in treating OA. An in vivo mouse model of OA was established through medial meniscus destabilization (DMM). Intra-articular injections of NP over a 4-week treatment period significantly alleviated pain and gait abnormalities, reduced subchondral osteosclerosis, and attenuated cartilage degradation compared to the untreated DMM group. In vitro, chondrocytes treated with IL-1β to simulate OA conditions exhibited increased viability following NP pretreatment, with concurrent reductions in apoptosis, reactive oxygen species (ROS) accumulation, and chondrocyte catabolic dysfunction, along with enhanced extracellular matrix (ECM) synthesis. Mechanistically, NP exerts its anti-OA effects by inhibiting PI3K/Akt phosphorylation, suppressing ferroptosis, and improving antioxidant defense via upregulation of glutathione (GSH) and glutathione peroxidase 4 (GPX4), thereby preventing lipid peroxidation. In conclusion, NP modulates the PI3K/Akt/GPX4 axis to protect against lipid peroxidation, inhibit ferroptosis, and preserve cartilage integrity, thus delaying OA progression.

Risk factors for the development of knee osteoarthritis across the lifespan: a systematic review and meta-analysis

OBJECTIVE

To identify and quantify risk factors for incident knee osteoarthritis (KOA) across the lifespan.

METHODS

This systematic review and meta-analysis identified eligible studies from seven electronic databases and three registries. Longitudinal cohort studies or randomised controlled trials evaluating participants who developed incident symptomatic and/or radiographic KOA were included. Two independent reviewers completed data screening and extraction. Estimates were pooled using a random effects model and reported as odds ratio (OR), hazard ratio (HR), or risk ratio (RR) and corresponding 95% confidence intervals (95% CI). Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used to determine the certainty of evidence. Population attributable fractions (PAFs) were calculated, including risk factors significantly associated with radiographic KOA based on the pooled meta-analysis and where we could determine communality scores using existing clinical datasets.

RESULTS

We identified 132 studies evaluating >150 risk factors. Higher body mass index (BMI), previous knee injury, older age and high bone mineral density were associated with an increased risk of incident radiographic KOA based on the pooled analysis [OR (95% CI): 1.56 (1.25, 1.95), 3.02 (1.93, 4.71), 1.15 (1.00, 1.33) and 1.82 (1.12, 2.94), respectively], with moderate-to-high certainty. Two risk factors (overweight/obesity and previous knee injury) accounted for 14% of incident radiographic KOA. Other modifiable risk factors including occupational physical activity also contribute to radiographic or symptomatic KOA.

CONCLUSION

Novel strategies addressing known modifiable risk factors including overweight/obesity, knee injuries and occupational physical activity are needed to reduce overall burden of KOA.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO ID: CRD42023391187 FUNDING: Sydney Musculoskeletal Health, Faculty of Medicine and Health, The University of Sydney.

Cost Analysis of Direct Anterior versus Direct Lateral Approach for Outpatient Total Hip Arthroplasty: Does Surgical Approach Impact Cost?

BACKGROUND

Total hip arthroplasty (THA) is an effective surgery for advanced osteoarthritis. The rising demand for THA and increasing wait times are having a substantial impact on healthcare resources, resulting in increased pressure to move to outpatient care. This has most commonly been enabled through a minimally invasive, direct anterior (DA) surgical approach; however, recently, the direct lateral (DL) approach has also been used in outpatient THA. The purpose of this study was to compare costs between outpatient THA using a DA compared to a DL approach.

METHODS

The present study is a secondary analysis of a randomized controlled trial and a prospective cohort study. Participants undergoing primary THA using the DA approach were randomly assigned to be discharged on the same day as surgery (outpatient) or on day one post-surgery (inpatient). The cohort study included patients undergoing outpatient THA using the DL approach. We compared patients in the outpatient arm of the randomized trial to the prospective cohort of outpatient DL THAs. We recorded all costs associated with each surgical approach. Following discharge, participants also completed a self-reported cost diary regarding any resource utilization such as emergency department visits or subsequent hospitalizations, tests and procedures, consultations or follow-up, healthcare professional services, rehabilitation, medications, informal care, productivity losses, and out-of-pocket expenditures up to three months postoperative. There were 127 patients in the DA group and 51 patients in the DL group. The mean age of patients in the DA group was 66 years compared to 59 years in the DL group (P < 0.01).

RESULTS

There were no statistically significant differences in costs between groups from either the healthcare payer (DA = 7,910.19, DL = 7,847.17, P = 0.80) or societal perspectives (DA = 14,657.21, DL = 14,581.21, P = 0.96).

CONCLUSION

Our results suggest similar overall mean costs over 90 days postoperative between outpatient THA using a DL or DA surgical approach.

Regulating AMPA Receptors with Isoxazole-4-Carboxamide Derivatives: An Electrophysiological Study

Isoxazole carboxamide derivatives are intriguing modulators of ionotropic glutamate receptors; more specifically, their prospective analgesic activities based on non-opioid pathways have sparked widespread research. α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptors, especially Ca2+-permeable subtypes that are highly expressed in the spinal dorsal horn, play a critical role in nociceptive transmission and inflammatory pain. Herein, the neuromodulatory effects of these derivatives on AMPA receptor activity have been studied, focusing on their potential as modulators of AMPA receptors, a target implicated in pain and neurological disorders. The whole-cell patch clamp technique for electrophysiological recordings was used to investigate the effect of twelve isoxazole-4-carboxamide derivatives (CIC-1-12) on AMPA receptors' whole-cell currents and kinetics, including deactivation and desensitization. The isoxazole-4-carboxamide derivatives tested as inhibitors of AMPA receptor activity were very potent, with an 8-fold inhibition by CIC-1 and a 7.8-fold reduction by CIC-2. Additionally, these compounds profoundly altered the biophysical gating properties of both homomeric and heteromeric receptor subunits. These findings emphasize the therapeutic promise of isoxazole-4-carboxamide derivatives due to their potential as AMPA receptor modulators. Their ability to affect receptor activity and gating properties makes them promising candidates for future treatments for controlling pain.

Doctor, when can I drive? - compensation capability while driving with restricted elbow - a biomechanical analysis

Background

Every joint participates in a specific range of motion (ROM) while operating a motor vehicle safely. In current literature, there is a paucity of how movement restrictions of the elbow flexion and extension can be compensated by adjacent joints to ensure safe driving. The aim of this study was to analyze movement patterns of the kinematic chain consisting of wrist, elbow, and shoulder while driving with restricted elbow joint.

Methods

Twenty participants completed a driving course in a driving simulator in two conditions: a) free ROM of all joints vs. b) restricted right elbow in 90° flexion but with free pronation and supination. To evaluate driving performance, speed, lane accuracy, and shifting time was measured. To analyze the movement pattern, ROM of wrist, elbow, and shoulder were recorded using a full-body motion capture system. Each driving course consisted of three maneuvers, as follows: I shifting, II left turns, and III right turns. Driving performance and movement patterns of condition a) and b) were compared on maneuver I-III.

Results

Driving performance: Participants drove their car slower while driving right turns with elbow restriction (a) 37.45 ± 1.66 km/h vs. b) 32.53 ± 1.18 km/h; P = .02). Driving performance was not affected while driving left turns or shifting gears (P > .05). Movement pattern: Participants used their right shoulder in a higher ROM while driving turns with restricted right elbow (P < .05) but the left arm showed no significant different movement pattern (P > .05). The ROM of the left elbow and both shoulders were significantly higher when shifting gears with restricted right elbow (P < .05).

Conclusion

This study first describes the changes in movement patterns of the upper extremity while driving with a restricted right elbow. Our data suggest that restricted right elbow flexion or extension can be compensated by the left arm and a different posture of the right shoulder when driving left turns. A different movement pattern of the left elbow and both shoulders is used when changing gears while driving straight. Drivers should be aware when driving turns while shifting gears, and special attention should be paid to the shoulders and left elbow when evaluating the driving capability of patients with movement restriction of the right elbow by physicians.

Evaluation of the Short-Term Restorative Care program: Effects on physical functioning

OBJECTIVE

The Short-Term Restorative Care program is an 8-week multidisciplinary early intervention funded by the Australian Government that aims to reverse or slow the functional decline of older Australians. Despite the large investment of tax-payer money to fund the program, very little peer-reviewed literature exists examining the ability of the program to deliver on its aims.

METHODS

This was a retrospective cohort study.

SETTING

Data were collected from an aged care provider (BallyCara Ltd) located in Australia.

PARTICIPANTS

Historical data from 1074 participants were analysed.

OUTCOME MEASURES

This study reported descriptives of the population that undertook the program and the activities completed by participants during the program, and investigated if the program is associated with changes across four domains of function (Modified Barthel Index, Lower Extremity Functional Scale, Upper Extremity Functional Index and Berg Balance Scale).

RESULTS

Findings suggest the program results in statistically significant improvements (p ≤ .0001) in disability and physical functioning as measured by the Modified Barthel Index, Lower Extremity Functional Scale, Upper Extremity Functional Index and Berg Balance Scale tools. Such findings validate the ability of the program to slow or reverse functional decline.

CONCLUSIONS

This study will help to inform future modifcations to the Short-Term Restorative Care program as well as inform program development of similar interventions.

Two-decade health-related quality of life and performance on physical function tests in midaged women: findings from a prospective cohort study

OBJECTIVES

Health-related quality of life (HRQoL) is more commonly measured in younger populations than objective physical function tests. However, associations between HRQoL and the performance on physical function tests are unclear. This study investigates the association between HRQoL measures across adulthood and performance on physical function tests in midaged women.

METHODS

Data were derived from 499 women born during 1973-1978 from the Menarche-to-PreMenopause Study, a substudy of the Australian Longitudinal Study on Women's Health. HRQoL was assessed every 3 years from ages 18-23 years to 40-45 years using the eight Short Form Health Survey subscales. Generalized estimating equation models examined the associations between HRQoL over 22 years and three performance tests at a mean age 44.6 years: handgrip strength (kg), chair rise (sec), and standing balance (sec). Worse performance was defined by the lowest tertile of the sample.

RESULTS

Several HRQoL subscales showed longitudinal associations with performance. Repeatedly lower scores on nearly all subscales were linked to worse chair rise performance, except for social functioning and mental health. Bodily pain was associated with all three tests; women reporting more pain across the 22-year follow-up showed 50% higher odds of worse chair rise and 30% higher odds of both worse handgrip strength and balance. Women with lower physical functioning scores had higher odds of worse grip (odds ratio 1.4, 95% CI 1.1-1.9) and worse chair rise performances (odds ratio 1.4, 95% CI 1.4-2.6).

CONCLUSION

This study showed poorer HRQoL from early-to-mid adulthood was associated with worse physical performance in midaged Australian women, particularly in the chair rise test.

The Mediating Role of Anger and Anxiety in the Association of Social Support with Mobility Among Middle-Age and Older Adults with Knee Osteoarthritis

INTRODUCTION

Osteoarthritis (OA) is one of the leading causes of chronic disability in older adults, often causing significant impairment of mobility. OA symptoms have been linked to mental functioning, including depression, anxiety, and negative affect.

METHOD

To examine whether anger and anxiety mediate the relationship between social support and mobility among older adults with knee osteoarthritis, data from the Everyday Quality of Life in Older Blacks and Whites with Osteoarthritis (EQUAL) study (N = 336) were analyzed using Hayes' PROCESS model in SPSS to test the direct effect of social support on mobility as well as mediation by anxiety and anger.

RESULTS

While univariate models for both anxiety and anger were significant, only anxiety mediated the relationship between social support and mobility.

CONCLUSION

Although limited by their cross-sectional nature, the findings suggest that at least part of the association of social support with mobility may be explained by the role of support in alleviating anxiety.

Can Wearable Device Promote Physical Activity and Reduce Pain in People with Chronic Musculoskeletal Conditions?

Objective: The purpose of this systematic review is to identify and appraise the evidence on the effectiveness of using wearable devices to promote physical activity and reduce pain in people with chronic musculoskeletal pain. Methods: Systematic searches of electronic databases PubMed, CINAHL, and Medline (Ovid) were undertaken for randomised control trials and observational studies of wearable-based interventions in patients with chronic musculoskeletal conditions. Result: Thirteen studies were included in this review. The methodological quality of the included articles was found to vary between moderate and high quality. Studies included patients with osteoarthritis hip/knee (number; n = 5), low back pain (n = 3), rheumatoid arthritis (n = 1), juvenile idiopathic arthritis (n = 1), inflammatory arthritis (n = 1), spondylarthritis (n = 1), and ankylosing spondylitis (n = 1). The intervention group of some of the studies included additional components associated with the use of wearable devices such as step or diet diary, motivational interviewing or counselling, goal setting, and multidimensional and tailored exercise programme interventions delivered in person, remotely, or in a hybrid format. Intervention duration ranged from 1 week to 28 weeks. There were no serious adverse events related to the use of wearables. Overall, evidence from this systematic review shows that wearable technology intervention was effective in increasing physical activity significantly, especially where extra components (counselling, coaching, prescribed physical activity, goal setting, physiotherapist) were used among clinical and non-clinical populations. However, no significant effect was found in pain reduction with the use of wearable devices. Conclusions: It is concluded that the use of wearable technology should be encouraged in patients with chronic musculoskeletal conditions. Additional research is needed, such as increasing the duration of the intervention, which may have an impact on pain.

Identifying determinants of physical activity in older patients with musculoskeletal disorders undergoing rehabilitation: Comparison of two distinct models using structural equation modeling

AIM

Mobility restrictions cause older adults with musculoskeletal disorders to have lower levels of physical activity. However, the determinants of their physical activity during hospitalization are unclear. We aimed to compare two conceptual frameworks using structural equation modeling to identify factors influencing physical activity in older patients with musculoskeletal disorders.

METHODS

This cross-sectional study included older patients with musculoskeletal disorders at a single convalescent rehabilitation hospital. Physical activity was objectively measured using a triaxial accelerometer. We utilized structural equation modeling to contrast two conceptual frameworks: (i) the sarcopenia/nutrition/activities of daily living model, and (ii) the age-related deconditioning/activities of daily living model. The models' goodness-of-fit was evaluated, including root mean square approximation error, goodness-of-fit index (GFI), adjusted GFI and Akaike information criterion.

RESULTS

We enrolled 274 older patients (age 78.0 years; 42 men, 232 women) with musculoskeletal disorders. Among them, 123 (44.9%) were diagnosed with sarcopenia and 69 (25.2%) with malnutrition. The goodness-of-fit of the (ii) model (root mean square approximation error = 0.068, GFI = 0.958, adjusted GFI = 0.909, Akaike information criterion = 5780.875) was superior to the (i) model (root mean square approximation error = 0.080, GFI = 0.953, adjusted GFI = 0.887, Akaike information criterion = 5791.429).

CONCLUSIONS

We discovered that the age-related deconditioning/activities of daily living model effectively explained physical activity in hospitalized older patients with musculoskeletal disorders. A comprehensive approach considering age-related changes, such as sarcopenia and malnutrition, might offer a simpler and more effective framework for understanding and promoting physical activity in this demographic. Geriatr Gerontol Int 2025; 25: 160-166.

Risk prediction of functional disability among middle-aged and older adults with arthritis: A nationwide cross-sectional study using interpretable machine learning

BACKGROUND

Arthritis is a common chronic disease among middle-aged and older adults and is strongly related to functional decline.

METHODS

The research sample and data were derived from the China Health and Retirement Longitudinal Study (CHARLS) 2015. We employed the least absolute shrinkage and selection operator (LASSO) and multifactor logistic regression analysis to identify features for model construction. We proposed six machine learning (ML) predictive models. The optimal model was selected using various learning metrics and was further interpreted using the SHapley Additive exPlanations (SHAP) method.

RESULTS

A total of 5111 subjects were included in the analysis, of which 1955 developed functional disability. Among the six models, XGBoost showed the best performance, achieving a test set area under the curve (AUC) of 0.74. SHAP analysis ranked the features by their contribution as follows: waist circumference, handgrip strength, self-reported health status, age, body pains, depression, history of falls, sleeping duration, and availability of care resources. SHAP dependence plots indicated that individuals over 60 with increased waist circumference (>85 cm), short sleeping duration (<5 h), and lower handgrip strength (<25 kg) had a higher probability of functional disability.

CONCLUSION

This study presents an interpretable machine learning-based model for the early detection of functional disability in patients with arthritis and informs the development of care strategies aimed at delaying functional disability in this population.

Keeping It Simple-Pain Science Education for Patients with Chronic Pain Referred to Community-Based Rehabilitation: Translation, Adaptation, and Clinical Feasibility Testing of PNE4Adults

Background/Objectives: Pain science education accommodating low health literacy is needed for people with chronic pain. The purpose of this study was to translate PNE4Kids, contextually adapt it into PNE4Adults, and test the feasibility of the newly developed pain science education program (PNE4Adults) for adult patients with chronic musculoskeletal pain in the municipality. Methods: A three-step approach was used to (1) translate PNE4Kids into Danish, (2) adapt to age and context (PNE4Adults), and (3) test the feasibility. (1) Translation was performed by a native Dane fluent in Dutch. (2) Two think-aloud group sessions were held, with therapists and end users. (3) Feasibility was tested amongst twenty adult patients with chronic musculoskeletal pain consecutively referred for rehabilitation in the municipality. The a priori success criteria were determined to be 70% acceptability and 70% understandability. Prior to inclusion of the first patient, the study was pre-registered on clinicaltrial.gov [NCT05140031]. Results: Translation was successfully performed. Both the therapist and end users found the program easy to grasp, the simplicity and interactive nature of the program ingenious, and the program to be well suited to an adult population. All patients (100%), across health literacy levels, found PNE4Adults comprehensible and acceptable. Conclusions: The aims were successfully met. Progression to a full trial is warranted and is underway.

Evaluation of musculoskeletal complaints, treatment approaches, and patient perceptions in family medicine clinics in a tertiary center in Jordan: a cross-sectional study

BACKGROUND

Musculoskeletal (MSK) conditions, such as back pain and joint disorders, are common globally and significantly burden healthcare systems. Family medicine clinics serve as the first point of care, requiring providers to manage diverse MSK issues and address gender-specific differences, especially in regions with limited resources, like the Middle East. This study evaluates MSK management, gender differences, and patient perceptions in Jordanian family medicine clinics, aiming to improve care strategies and outcomes in similar settings.

METHODS

This cross-sectional study included 500 adults with musculoskeletal complaints at a Jordanian teaching hospital (January-June 2024). Data were collected via interviews and records, focusing on patient perceptions and health profiles. Ethical approval and informed consent were obtained. Analysis was conducted in SPSS with p < 0.05 as the significance threshold.

RESULTS

In our study of 500 patients (mean age 46.1 years, 61.5% female), key gender differences emerged. Females had a higher prevalence of low back pain (61.9% vs. 38.1%, p = 0.024) and hip pain (100%, p = 0.008), as well as greater anxiety about disease progression (62.2% vs. 37.8%, p = 0.045) and fear of disability (64.2% vs. 35.8%, p = 0.048). Females also reported lower mental health (p = 0.036), sleep quality (p = 0.044), and overall quality of life (p = 0.019). In contrast, males showed higher workload (54.4% vs. 45.6%, p = 0.020), more work-related injuries (82.8%, p < 0.001), and greater disability (p = 0.024) with lower functional status (p = 0.041). These findings underscore significant gender-specific needs in MSK care.

CONCLUSION

Our study reveals notable gender-based differences in musculoskeletal complaints and treatment experiences in a Jordanian tertiary setting. Females reported higher rates of low back and hip pain, more frequent referrals, and lower quality of life, while males experienced greater occupational strain, work-related injuries, and disability.

Musculoskeletal Diseases: Aetiology, Clinical Implications, Rehabilitation and Treatment

Musculoskeletal diseases (MDs) are a wide range of conditions affecting bones, muscles, joints, and connective tissues and are among the leading causes of disability worldwide [...].

Associations between surrogate insulin resistance indexes and osteoarthritis: NHANES 2003-2016

Insulin resistance (IR) and abdominal obesity are key in osteoarthritis (OA) development. The triglyceride glucose (TyG) index, along with indicators such as the visceral adiposity index (VAI), and lipid accumulation product (LAP), are increasingly used to measure IR. This study aims to explore the associations between surrogate IR indexes and OA, assessing their diagnostic efficacy within American populations. This study included 14,715 adults from the National Health and Nutrition Examination Survey 2003-2016. Logistic regression models and restricted cubic spline were used to explore the relationship between surrogate IR indexes and OA. Receiver operating characteristic curves were constructed to assess the diagnostic efficacy of these indices, with the area under the curve (AUC) as the metric. TyG, glucose triglyceride-waist circumference (TyG-WC), glucose triglyceride-body mass index (TyG-BMI), glucose triglyceride-waist height ratio (TyG-WHtR), VAI and LAP were significantly and positively associated with the prevalence of OA (all p < 0.01). After adjusting for various potential confounders, TyG-WC, TyG-BMI, TyG-WHtR and LAP remained significantly correlated with the prevalence of OA. Furthermore, restricted cubic spline revealed a nonlinear association between TyG-BMI, TyG-WHtR and LAP (all P-non-linear < 0.05). Receiver operating characteristic curves indicated that TyG-WHtR (AUC 0.633) demonstrated more robust diagnostic efficacy. Additionally, the sensitivity analysis produced results consistent with the primary findings. TyG and its combination with obesity indicators and LAP, are positively associated with the prevalence of OA, with TyG-WHtR showing the highest diagnostic efficacy.

Circadian Rhythms and Lung Cancer in the Context of Aging: A Review of Current Evidence

Circadian rhythm is the internal homeostatic physiological clock that regulates the 24-hour sleep/wake cycle. This biological clock helps to adapt to environmental changes such as light, dark, temperature, and behaviors. Aging, on the other hand, is a process of physiological changes that results in a progressive decline in cells, tissues, and other vital systems of the body. Both aging and the circadian clock are highly interlinked phenomena with a bidirectional relationship. The process of aging leads to circadian disruptions while dysfunctional circadian rhythms promote age-related complications. Both processes involve diverse physiological, molecular, and cellular changes such as modifications in the DNA repair mechanisms, mechanisms, ROS generation, apoptosis, and cell proliferation. This review aims to examine the role of aging and circadian rhythms in the context of lung cancer. This will also review the existing literature on the role of circadian disruptions in the process of aging and vice versa. Various molecular pathways and genes such as BMAL1, SIRT1, HLF, and PER1 and their implications in aging, circadian rhythms, and lung cancer will also be discussed.

Osteoarthritis of the knee joint and its association with metabolic syndrome: A case control study

Background

Osteoarthritis of the knee joint (OAK) represents a leading cause of pain, functional limitation, and diminished quality of life, particularly among older adults. The association between metabolic syndrome (MetS) and OAK is of growing interest due to the potential impact of MetS components on joint health. While evidence suggests that MetS and its components may influence the development of osteoarthritis (OA), the specific relationship between MetS and the likelihood of progressing to a stage of OAK that requires Total knee replacement (TKA) remains underexplored.

Aim

This study aimed to evaluate the association between osteoarthritis of the knee joint (OAK) and metabolic syndrome (MetS) and to know whether the presence of MetS (or its components) increases the risk of OAK requiring Total knee replacement (TKA).

Methodology

It is a cross-sectional study that includes patients (males and females) above 50. Data collection was done including demographic details, medical history, physical examinations, and laboratory tests. OAK (≥grade 2 Kellgren-Lawrence) and severe OAK (≥grade 3 Kellgren-Lawrence) were evaluated based on radiological findings.

Statistical Analysis

Mean, standard deviation, frequencies, and percentages were calculated for baseline characteristics. To analyze the association between qualitative factors and MetS, the Chi-Square test was used. For comparing quantitative factors, the unpaired t-test was employed. A P value of less than 0.05 was considered statistically significant.

Results

The study involved 107 primary osteoarthritis patients categorized into cases (N = 57), requiring TKA, and controls (N = 50), not requiring TKA. MetS was significantly more prevalent among cases than controls, with 68.4% of cases and 36% of controls testing positive for MetS (P = 0.001). The odds of having MetS were 3.9 times higher in the cases compared to the controls.

Conclusion

The results of our research could shed light on how MetS affects the onset and course of OAK, guiding primary care and prevention measures. It might also emphasize how critical it is to treat MetS symptoms to lessen the severity of OAK. Understanding whether MetS or its components are linked to an increased risk of TKA could provide crucial insights into preventive and therapeutic strategies for managing severe OAK.

Prevalence of Musculoskeletal Disorders in Heavy Vehicle Drivers and Office Workers: A Comparative Analysis Using a Machine Learning Approach

PURPOSE: Job profiles such as heavy vehicle drivers and transportation office workers that involve prolonged static and inappropriate postures and forceful exertions often impact an individual's health, leading to various disorders, most commonly musculoskeletal disorders (MSDs). In the present study, various individual risk factors, such as age, weight, height, BMI, sleep patterns, work experience, smoking status, and alcohol intake, were undertaken to see their influence on MSDs. METHODS: The modified version of the Nordic Questionnaire was administered in the present cross-sectional study to collect data from 48 heavy vehicle drivers and 40 transportation office workers. RESULTS: The analysis revealed low back pain (LBP), knee pain (KP), and neck pain (NP) to be the dominant pains suffered by the participants from both occupational groups. LBP, KP, and NP were suffered by 56%, 43.75%, and 39% heavy vehicle drivers and 47.5%, 40%, and 27.5% transport office workers, respectively. From the insignificant value of Chi-square, it can be inferred that the participants from both occupations experience similar levels of LBP, KP, and NP. The Bayesian model applied to the total sample showed that NP influenced KP, which further influenced the LBP of the workers. Age was predicted as LBP's most significant risk factor by the logistic regression model when applied to the total sample, while NP was found to decrease with an increase in per unit sleep. CONCLUSIONS: The overall results concluded that heavy vehicle drivers and office workers, irrespective of their different job profiles, endured pain similarly.

A prospective study of associations between accelerated biological aging and twenty musculoskeletal disorders

BACKGROUND

Musculoskeletal disorders pose major public health challenges, and accelerated biological aging may increase their risk. This study investigates the association between biological aging and musculoskeletal disorders, with a focus on sex-related differences.

METHODS

We analyzed data from 172,332 UK Biobank participants (mean age of 56.03 ± 8.10 years). Biological age was calculated using the KDM-BA and PhenoAge algorithms based on blood biomarkers. Musculoskeletal disorders were diagnosed using the ICD-10 criteria, with sample sizes ranging from 1,182 to 23,668. Logistic regression assessed cross-sectional associations between age acceleration (AA) metrics and musculoskeletal disorders. Accelerated Failure Time (AFT) model was used for survival analysis to evaluate the relationships between AAs and musculoskeletal disorders onset. Models were adjusted for demographic, lifestyle, and socio-economic covariates. The threshold of P-values were set by the Holm-Bonferroni correction.

RESULTS

Cross-sectional analyses reveal significant associations between AAs and fourteen musculoskeletal disorders. Survival analyses indicate that AAs significantly accelerate the onset of nine musculoskeletal disorders, including inflammatory polyarthropathies (RTKDM-BA = 0.993; RTPhenoAge = 0.983), systemic connective tissue disorders (RTKDM-BA = 0.987; RTPhenoAge = 0.980), spondylopathies (RTPhenoAge= 0.994), disorders of bone density and structure (RTPhenoAge= 0.991), gout (RTPhenoAge= 0.968), arthritis (RTPhenoAge= 0.991), pain in joint (RTPhenoAge= 0.989), low back pain (RTPhenoAge= 0.986), and osteoporosis (RTPhenoAge= 0.994). Sensitivity analyses are consistent with the primary findings. Sex-specific variations are observed, with AAs accelerating spondylopathies, arthritis, and low back pain in females, while osteoporosis is accelerated in males.

CONCLUSION

Accelerated biological aging is significantly associated with the incidence of several musculoskeletal disorders. These insights highlight the importance of biological age assessments in gauging musculoskeletal disorder risk, aiding early detection, prevention, and management.

A benchmarking and evidence-informed gap analysis of the hemodialysis care provision in Iran

BACKGROUND

Patients with end stage renal disease (ESRD) are increasing worldwide. This is especially paramount in low and middle income countries in which ESRD patients are struggling to access specialist services e.g. hemodialysis (HD). Benchmarking analysis of the offered healthcare packages in several countries and comparison of the utilized alternative healthcare models for ESRD patients may be auspicious for institutional capacity-building in the existing healthcare facilities. Main aim of this study was to perform a benchmarking and evidence-informed gap analysis of the ESRD care provision in Iran and recognize the gaps that cause diversification in care quality for ESRD patients that hinder efforts for care quality improvement in the Iranian National Healthcare System.

METHODS

Dimensions of the Australian Anglicare Southern Queensland Clinical and Care Governance Framework (ASQCGF) were utilized as corner stones of a comprehensive clinical care plan that is essential in responding to HD patients' needs in Iran. An extensive literature search was performed at the next stage to recognize the gold standard core elements. The ascertained components were assigned to the five separate dimensions of the ASQCGF and a preliminary draft (comprehensive package of care for HD patients) was prepared. A checklist was developed at a later stage which was sent to a panel of expert consisting professional healthcare providers in nephrology and hemodialysis wards for their opinions. A gap analysis was conducted to evaluate current care processes of the Iranian HD patients align with the elements of the gold standard framework.

RESULTS

The identified deficits were classified in five areas in accord with the elements of ASQCGF as follow: A) supply of resources, medical devices and equipment support B) recruitment and endorsement of clinics and general work force C) infection prevention and controlling procedures D) care effectiveness monitoring and quality improvement E) provision of safe environment for both HD patients and hospitals' staff.

CONCLUSIONS

The study findings revealed considerable gaps in providing quality HD services to the Iranian HD patients that herald their therapeutic unmet needs and the shift that is needed to narrow down the widening organizational failure which fuels the current disenchantment among the both healthcare providers and HD patients.

Same patient but different worlds: A state-of-the-art review translating best practice psychosocial care from musculoskeletal care to the orthopaedic context

BACKGROUND

Individuals with chronic musculoskeletal conditions experience persistent pain and disability that has deleterious impacts on physical function, psychological health, social engagement, relationships, and work participation. This impact is greater in people with psychosocial risk factors, and best practice musculoskeletal care recommends a biopsychosocial approach to management. Orthopaedic surgery is often an effective management approach for chronic musculoskeletal conditions, but research has only recently explored the links between differing patient outcomes after orthopaedic surgery and psychosocial risk factors. Implementing biopsychosocial approaches to musculoskeletal care has taken great strides in the primary care setting however, implementation of the biopsychosocial approach in orthopaedic surgery brings complexity as the context changes from primary care to hospital based secondary care. The aim of this review therefore is to explore implementation of psychosocial care in the elective orthopaedic surgery context, informed by evidence in musculoskeletal care.

ASSESSMENT AND MANAGEMENT OF PSYCHOSOCIAL FACTORS

Several composite screening tools for psychosocial factors or 'yellow flags' are recommended for use in primary care for musculoskeletal conditions alongside a comprehensive patient interview. However, in the orthopaedic surgery context, composite measures have focused on discharge destination, and there is not a universal approach to comprehensive patient interview incorporating a biopsychosocial approach. A range of biopsychosocial approaches to musculoskeletal conditions have been developed for the primary care setting, yet few have been explored in the context of orthopaedic surgery.

IMPLEMENTATION OF PSYCHOSOCIAL CARE

Implementing best practice psychosocial care into the orthopaedic context has enormous potential for all stakeholders, but several barriers exist at the level of the individual patient and practitioner, workforce, health service and society. We have discussed key considerations for implementation including workforce composition, patient-centred care and shared decision making, health literacy, continuity of care, and consideration of preferences for women and culturally diverse communities.

CONCLUSION

This review considers current literature exploring implementation of psychosocial care into the orthopaedic surgery context, informed by current research in musculoskeletal care. This presents a critical opportunity for orthopaedic surgery to provide optimised, equitable, high-value, patient-centred care.

Effects of three types of resistance training on knee osteoarthritis: A systematic review and network meta-analysis

BACKGROUND

Resistance training (RT) is recognized in clinical guidelines as a beneficial treatment for knee osteoarthritis (KOA), but the efficacy of different RT types is not well-established.

OBJECTIVE

This network meta-analysis (NMA) aimed to compare the effects of different types of RT, namely, isometric muscle strengthening (IMMS), isokinetic muscle strengthening (IKMS) and isotonic muscle strengthening (ITMS), on pain, function and quadriceps muscle strength of patients with KOA.

METHODS

A systematic search was conducted up to September 2023 on databases, including PubMed, Cochrane Library, EMbase, Web of Science and China National Knowledge Infrastructure. The included studies comprised randomised controlled trials (RCTs) comparing RT with conventional rehabilitation and physiotherapy or other types of RT.

RESULTS

Compared with the control group (CG) that received conventional physiotherapy, IKMS was optimal in terms of pain relief (MD = -1.33, 95% CI: -1.83 to -0.83), function (MD = -12.24, 95% CI: -17.29 to -7.19) and knee extension torque (SMD = -0.44, 95% CI: -0.74 to -0.14).

CONCLUSIONS

Compared with conventional rehabilitation therapy, all three types of RT can improve pain and knee-joint function in KOA patients. IKMS demonstrated the best results among the different RT modalities.

PROSPERO REGISTRATION

PROSPERO registration number: CRD42023448579.

Treatment Algorithms for Continuous Low-Level Heat Wrap Therapy for the Management of Musculoskeletal Pain: An Italian Position Paper

Musculoskeletal pain (MSP), which impacts bones, muscles, tendons, and ligaments, is a substantial worldwide pain disorder, characterized by muscle soreness, fatigue, inflammation, muscle spasms, sleep disruptions, and functional limitations. MSP is predominantly managed within the primary care setting. Recent consensus recognizes that heat therapy (HT) may provide potential benefits, especially in treating chronic MSP. To develop shared algorithms for the treatment of MSP through local superficial HT (SHT) using continuous low-level heat wrap therapy, a four-member board of experts was designated. Three anatomical sites have been deemed of particular interest regarding potential response to exogenous SHT. Neck and shoulder pain are commonly attributed to traumatic experiences, muscle spasms, postural defects, or poor posture as common potential causes. HT may be helpful for painful contractures, although treatment should be limited in duration to prevent instability. Low back pain, the leading cause of disability, may have either specific or non-specific etiology. SHT, physical therapy, instrumental therapy, manual therapy, therapeutic exercise, motor activity, and trunk orthoses are all potential treatment options. SHT should be considered in chronic degenerative disc disease, non-specific LBP with muscle spasm or contracture, postural and overuse myalgia, and osteoarthritis (OA), excluding the inflammatory phase. Assessment of knee pain includes both a review of the patient's medical history and a careful physical examination. SHT of the knee should be considered in case of muscle spasms, overuse pathology, early OA, and indirect muscle lesions. Patients who receive SHT may experience a reduction in pain, restoration of muscle strength, loosening of stiffness, and an overall improvement in their quality of life. This expert opinion proposes shared algorithms for MSP treatment via local SHT with the aiming to provide practical guidance on its proper application, highlighting specific potentialities as well as contraindications.

Promoting musculoskeletal health and preventing ill health

Musculoskeletal conditions are highly prevalent among older adults and can have a significant impact on their quality of life. Musculoskeletal health is an important component of maintaining well-being and independence. A proactive approach is required, with nurses implementing strategies such as healthy diets and physical exercise that will support optimal health. This article considers the importance of musculoskeletal health, examines the risk factors for a decline in musculoskeletal health, and explores approaches that can improve outcomes and promote healthy ageing.

' … You become a prisoner of your life': A qualitative study exploring the experience of joint pain and accessing care in Hai, Tanzania

The increased prevalence of non-communicable diseases (NCDs) in recent years has led many Low- and Middle-Income Countries (LMICs), including Tanzania, to develop policies to manage their burden. Musculoskeletal (MSK) conditions, such as arthritis, account for 20% of all years lived with disability in LMICs, but the NCD strategies rarely address them. There is substantial research on the disruption MSK conditions cause to people's lives within High-Income Countries, but very little is known about the lived experiences in LMICs. We investigated the experience of MSK conditions in 48 in-depth qualitative interviews with participants from the Hai District in Tanzania, East Africa, all of whom had a MSK disorder (confirmed through clinical examination as part of a broader study). We found that loss of mobility and pain associated with MSK disorders severely limits people's everyday lives and livelihoods. Help from others, mainly those within a household, is necessary for most tasks and those with limited or no support experience particular problems. We found barriers to accessing care and treatment in the form of high direct and indirect (through travel) care costs within formal health services in Tanzania. We argue for increased attention to the growing problem of MSK disorders in LMICs and that this agenda should be driven by a patient-centred approach which designs services accessible to the target population and designed to recognise their embodied expertise.

Costs of physician and diagnostic imaging services for shoulder, knee, and low back pain conditions: A population-based study in Alberta, Canada

Objectives

To 1) estimate the utilization and costs of physician and diagnostic imaging (DI) services for shoulder, knee, and low-back pain (LBP) conditions; and 2) examine determinants of the utilization and costs of these services.

Methods

All patients visiting a physician for shoulder, knee, or LBP conditions (identified by the ICD-9 codes) in Alberta, Canada, in fiscal year (FY) 2022/2023 were included. Interested outcomes included numbers and costs of physician visits and DI exams stratified by condition, physician specialty, DI modality, and patients' sex and age. Multivariate regressions were used to examine determinants of the outcomes.

Results

In FY 2022/2023, 10.4%, 7.0%, and 6.7% of the population saw physicians for shoulder, knee, and LBP conditions, respectively. This costs Alberta $307.04 million ($67.93 per capita), of which shoulder accounted for 41%, knee 28%, and LBP 31%. In the same FY, 17,734 computed tomography (CT), 43,939 magnetic resonance imaging (MRI), 686 ultrasound (US), and 170,936 X-ray exams related to shoulder/knee/LBP conditions were ordered for these patients, costing another $29.07 million, of which CT accounted for 14%, MRI 48%, US 0%, and X-ray 37%. Female, older age, comorbidity scores, and capital zone used physician services more frequently. Patients with a higher comorbidity index scores or more physician visits were more likely being referred for CT or MRI.

Conclusion

Musculoskeletal conditions are common and result in patients seeking healthcare services. Visits to family physicians, specialists, and the ordering of DI contribute to extensive utilization of health services, contributing to considerable health system costs.

Cellular senescence impairs tendon extracellular matrix remodeling in response to mechanical unloading

Musculoskeletal injuries, including tendinopathies, present a significant clinical burden for aging populations. While the biological drivers of age-related declines in tendon function are poorly understood, it is well accepted that dysregulation of extracellular matrix (ECM) remodeling plays a role in chronic tendon degeneration. Senescent cells, which have been associated with multiple degenerative pathologies in musculoskeletal tissues, secrete a highly pro-inflammatory senescence-associated secretory phenotype (SASP) that has potential to promote ECM breakdown. However, the role of senescent cells in the dysregulation of tendon ECM homeostasis is largely unknown. To assess this directly, we developed an in vitro model of induced cellular senescence in murine tendon explants. This novel technique enables us to study the isolated interactions of senescent cells and their native ECM without interference from age-related systemic changes. We document multiple biomarkers of cellular senescence in induced tendon explants including cell cycle arrest, apoptosis resistance, and sustained inflammatory responses. We then utilize this in vitro senescence model to compare the ECM remodeling response of young, naturally aged, and induced-senescent tendons to an altered mechanical stimulus. We found that both senescence and aging independently led to alterations in ECM-related gene expression, reductions in protein synthesis, and tissue compositional changes. Furthermore, MMP activity was sustained, thus shifting the remodeling balance of aged and induced-senescent tissues towards degradation over production. Together, this demonstrates that cellular senescence plays a role in the altered mechano-response of aged tendons and likely contributes to poor clinical outcomes in aging populations.

Effectiveness and clinical relevance of kinesio taping in musculoskeletal disorders: a protocol for an overview of systematic reviews and evidence mapping

INTRODUCTION

Kinesio taping (KT) has been extensively applied in the management of musculoskeletal disorders (MSDs). Although plentiful systematic reviews (SRs) have evaluated its efficacy, there are no convincing conclusions due to dispersed and inconclusive results, and its clinical relevance remains unclear. Hence, there is a need to summarise all the SRs for comprehensive and consistent evidence. This overview aims to appraise the overall effectiveness of KT in MSDs and provide evidence maps to visualise the findings.

METHOD AND ANALYSIS

Electronic databases (Cochrane Database of Systematic Reviews, MEDLINE, Embase, Epistemonikos, PEDro, Scopus and ISI Web of Science) and reference lists will be searched from inception to September 2024 for the SRs of randomised controlled trials (RCTs). The SRs involving comparisons of the effectiveness between single or adjunctive KT and other interventions for patients with MSDs will be included. The primary and additional outcomes to be considered will be the core outcome set, and the patient-reported outcome measure and patient-important outcome, respectively. Two reviewers will independently screen and select studies, extract the data and evaluate the reporting and methodological quality of eligible SRs as well as the risk of bias of included RCTs. For the SRs without meta-analysis, we will collate the number of RCTs that showed any differences in outcomes. For the SRs with meta-analysis, we will provide the original summary of evidence (eg, pooled effects and heterogeneity) for outcomes with an evaluation of missing results and clinical relevance. The certainty of each outcome will be measured, and user-friendly maps of findings will be presented graphically.

ETHICS AND DISSEMINATION

Formal ethical approval for this study is not required since the data will be only collected from published literature in public databases. The results will be disseminated in the peer-reviewed academic journal, and relevant datasets will be preserved in the online repository.

PROSPERO REGISTRATION NUMBER

CRD42024517528.

Spinal pain prevalence and associated determinants: A population-based study using the National Survey for Wales

Spinal pain (SP) remains the leading cause of disability worldwide. The present study aimed to establish a current prevalence of SP and associated determinants in Wales by retrospectively analyzing data from the National Survey for Wales Dataset (NSWD). The NSWD is a large-scale cross-sectional, representative sample of adults across Wales, UK. A univariable and multivariable regression analysis was carried out on self-reported answers to health and well-being questions contained within the NSWD (2016-2020) to determine the strength of association of various determinants and comorbidities related to spinal pain. A total population of 38,954 of adults were included in the analysis. The study population included interview responses of 21,735 females and 17,219 males. The prevalence of SP in Wales was 4.95% (95% CI: 4.74%-5.15%) with a total of 847 males (4.92%, CI: 4.60%-5.24%) and 1082 females (4.98%, CI: 4.69%-5.27%) reporting spinal pain. The age group with the highest prevalence of SP was in the 70+ years age group for both males (5.44%, CI: 4.82%-6.07%) and females (5.95%, CI: 5.37%-6.54%). The strength of association between age and SP reaches its peak at 50-59 years with an adjusted Odds Ratio (aOR) of 3.74 (p = <0.001), that decreases slightly at 60-69 years and 70+ years. For various comorbidities included in the NSWD, significant associations with SP were confirmed for: mental illness (aOR = 1.42, p = <0.001), migraine (aOR = 2.73, p = <0.001), nervous system issues (aOR = 1.61, p = <0.001), arthritis (aOR = 1.30, p = <0.001) and issues with bones/joints/muscles (aOR = 1.93, p = <0.001). For lifestyle factors, associations were confirmed for current smokers (aOR = 1.41, p = <0.001) and ex-smokers (aOR = 1.23, p = 0.003). This study demonstrates a low prevalence of SP in Wales when compared to global estimates and strong associations to a variety of determinants. This still represents a significant societal burden and these findings may help inform public health initiatives to encourage prevention and evidence-based interventional strategies and ultimately, improve the quality of life for those suffering with SP in Wales.

A calculator for musculoskeletal injuries prediction in surgeons: a machine learning approach

BACKGROUND

Surgical specialists experience significant musculoskeletal strain as a consequence of their profession, a domain within the healthcare system often recognized for the pronounced impact of such issues. The aim of this study is to calculate the risk of presenting musculoskeletal injuries in surgeons after surgical practice.

METHODS

Cross-sectional study carried out using an online form (12/2021-03/2022) aimed at members of the Spanish Association of Surgeons. Demographic variables on physical and professional activity were recorded, as well as musculoskeletal pain (MSP) associated with surgical activity. Univariate and multivariate analysis were conducted to identify risk factors associated with the development of MSP based on personalized surgical activity. To achieve this, a risk algorithm was computed and an online machine learning calculator was created to predict them. Physiotherapeutic recommendations were generated to address and alleviate each MSP.

RESULTS

A total of 651 surgeons (112 trainees, 539 specialists). 90.6% reported MSP related to surgical practice, 60% needed any therapeutic measure and 11.7% required a medical leave. In the long term, MSP was most common in the cervical and lumbar regions (52.4, 58.5%, respectively). Statistically significant risk factors (OR CI 95%) were for trunk pain, long interventions without breaks (3.02, 1.65-5.54). Obesity, indicated by BMI, to lumbar pain (4.36, 1.84-12.1), while an inappropriate laparoscopic screen location was associated with cervical and trunk pain (1.95, 1.28-2.98 and 2.16, 1.37-3.44, respectively). A predictive model and an online calculator were developed to assess MSP risk. Furthermore, a need for enhanced ergonomics training was identified by 89.6% of surgeons.

CONCLUSIONS

The prevalence of MSP among surgeons is a prevalent but often overlooked health concern. Implementing a risk calculator could enable tailored prevention strategies, addressing modifiable factors like ergonomics.

The Top 100 Most Cited Articles on Musculoskeletal Radiology: A Bibliometric Analysis

The number of citations an article receives is reflective of its impact on the scientific community. The top 100 most cited articles were identified using the Web of Science database. Data relating to the publication year, publishing journal, number of citations, primary institution, journal impact factor, authorship, country of origin, radiological modality, and keywords were collected. In the top 100 list, the number of citations per article ranged from 149 to 709 (median 208; mean 240). Per article, the average number of citations per year ranged from five to 60 (median 12; mean 26). The United States was the most common country of origin (n=74). The journal with the greatest number of articles was Radiology (n=34). The University of California contributed the most articles (n=11). This study presents a detailed analysis of the top 100 most cited articles published in musculoskeletal radiology. It affords clinicians and researchers an understanding of the characteristics of the current most influential research papers in this field. It also highlights research trends and areas that may benefit from further research.

Ultra-low dose hip CT-based automated measurement of volumetric bone mineral density at proximal femoral subregions

BACKGROUND

Forty to fifty percent of women and 13%-22% of men experience an osteoporosis-related fragility fracture in their lifetimes. After the age of 50 years, the risk of hip fracture doubles in every 10 years. x-Ray based DXA is currently clinically used to diagnose osteoporosis and predict fracture risk. However, it provides only 2-D representation of bone and is associated with other technical limitations. Thus, alternative methods are needed.

PURPOSE

To develop and evaluate an ultra-low dose (ULD) hip CT-based automated method for assessment of volumetric bone mineral density (vBMD) at proximal femoral subregions.

METHODS

An automated method was developed to segment the proximal femur in ULD hip CT images and delineate femoral subregions. The computational pipeline consists of deep learning (DL)-based computation of femur likelihood map followed by shape model-based femur segmentation and finite element analysis-based warping of a reference subregion labeling onto individual femur shapes. Finally, vBMD is computed over each subregion in the target image using a calibration phantom scan. A total of 100 participants (50 females) were recruited from the Genetic Epidemiology of COPD (COPDGene) study, and ULD hip CT imaging, equivalent to 18 days of background radiation received by U.S. residents, was performed on each participant. Additional hip CT imaging using a clinical protocol was performed on 12 participants and repeat ULD hip CT was acquired on another five participants. ULD CT images from 80 participants were used to train the DL network; ULD CT images of the remaining 20 participants as well as clinical and repeat ULD CT images were used to evaluate the accuracy, generalizability, and reproducibility of segmentation of femoral subregions. Finally, clinical CT and repeat ULD CT images were used to evaluate accuracy and reproducibility of ULD CT-based automated measurements of femoral vBMD.

RESULTS

Dice scores of accuracy (n = 20), reproducibility (n = 5), and generalizability (n = 12) of ULD CT-based automated subregion segmentation were 0.990, 0.982, and 0.977, respectively, for the femoral head and 0.941, 0.970, and 0.960, respectively, for the femoral neck. ULD CT-based regional vBMD showed Pearson and concordance correlation coefficients of 0.994 and 0.977, respectively, and a root-mean-square coefficient of variation (RMSCV) (%) of 1.39% with the clinical CT-derived reference measure. After 3-digit approximation, each of Pearson and concordance correlation coefficients as well as intraclass correlation coefficient (ICC) between baseline and repeat scans were 0.996 with RMSCV of 0.72%. Results of ULD CT-based bone analysis on 100 participants (age (mean ± SD) 73.6 ± 6.6 years) show that males have significantly greater (p < 0.01) vBMD at the femoral head and trochanteric regions than females, while females have moderately greater vBMD (p = 0.05) at the medial half of the femoral neck than males.

CONCLUSION

Deep learning, combined with shape model and finite element analysis, offers an accurate, reproducible, and generalizable algorithm for automated segmentation of the proximal femur and anatomic femoral subregions using ULD hip CT images. ULD CT-based regional measures of femoral vBMD are accurate and reproducible and demonstrate regional differences between males and females.

Strengthening the pain care ecosystem to support equitable, person-centered, high-value musculoskeletal pain care

ABSTRACT

Improving health and wellbeing outcomes for people experiencing chronic musculoskeletal pain requires collective efforts across multiple levels of a healthcare ecosystem. System-wide barriers to care equity must however be addressed (eg, lack of co-designed services; overuse of low value care/underuse of high value care; inadequate health workforce; inappropriate funding models; inequitable access to medicines and technologies; inadequate research and innovation). In this narrative review, utilizing a systems' thinking framework, we synthesize novel insights on chronic musculoskeletal pain research contextualized through the lens of this complex, interconnected system, the "pain care ecosystem." We examine the application of systems strengthening research to build capacity across this ecosystem to support equitable person-centred care and healthy ageing across the lifespan. This dynamic ecosystem is characterized by three interconnected levels. At its centre is the person experiencing chronic musculoskeletal pain (micro-level). This level is connected with health services and health workforce operating to co-design and deliver person-centred care (meso-level), underpinned further upstream by contemporary health and social care systems (macro-level context). We provide emerging evidence for how we, and others, are working towards building ecosystem resilience to support quality musculoskeletal pain care: at the macro-level (eg, informing musculoskeletal policy and health strategy priorities); at the meso-level (eg, service co-design across care settings; health workforce capacity); and downstream, at the micro-level (eg, person-centred care). We outline the mechanisms and methodologies utilized and explain the outcomes, insights and impact of this research, supported by real world examples extending from Australian to global settings.

Unlocking the Potential of the Elderly Population in Serbia: A Modeling Study on Musculoskeletal Disorders and Associated Factors

Background/Objectives: A properly functioning musculoskeletal system is imperative for human well-being at every stage of life, including at an older age. This study's aim was to assess the relationship between sociodemographic and physical functioning variables and the presence of individual musculoskeletal disorders (MSDs), MSD comorbidity, and multimorbidity, as well as to determine factors that are independent predictors of the presence of MSDs in people over 65 years old. Methods: This population-based study included 3701 participants aged 65 years and older. Data on individual MSDs addressed cervical and lumbosacral spine regions and degenerative joint disease (arthrosis). The subjects were categorized into four groups: those without any diseases; those with one MSD; those with two MSDs (comorbidities); and those with three MSDs (multimorbidities). The sociodemographic and physical functioning variables were analyzed. Results: Females were more likely to have MSDs (two: OR 1.95 and three: OR 2.25) than men. Elderly people aged 75 and above were 1.49 times more likely to have three MSDs. Elderly people with elementary school education were more likely to have MSDs (two: OR 1.34 and three: OR 2.06) than those with high school/university education. The low-income population was 2.47 times more likely to have three MSDs. Individuals with partial activity limitations because of health problems had greater chances of having one, two, or three MSDs (OR 1.60, 1.59, and 1.94, respectively), and elderly individuals with severe limitations had an OR of 1.43, 2.17, and 4.12, respectively. Individuals with some/many difficulties in walking up or down 12 steps were more likely to have MSDs (two: OR 2.26 and three: OR 2.28). Conclusions: The significant predictors of experiencing a single MSD, MSD comorbidity, or MSD multimorbidity include residing in the Serbian capital city and having limitations in activities due to health problems. A significant predictor of having a single MSD or MSD comorbidity is residing in the northern region of Serbia. A significant predictor of MSD comorbidity is residing in the southeastern region of Serbia. Significant predictors of MSD comorbidity or MSD multimorbidity include female gender, an elementary school educational level, and experiencing difficulty in walking up or down 12 steps. Significant predictors of MSD multimorbidity are being 75 years of age and above and having a lower income.

Relationship Between Frequency of Physical Activity, Functional Mobility, and Self-Perceived Health in People with Different Levels of Pain: A Cross-Sectional Study

Background: Habits including regular physical activity are necessary for maintaining good health. Functional mobility, including walking and going up and down stairs, is essential for personal autonomy and well-being. Pain is a condition related to biological and psychosocial aspects that influence people's lives. Objective: The main objectives of this study were (1) to analyse the associations between physical activity frequency (PAF) and self-perceived health (SPH) and functional mobility (walking and going up and down stairs) in middle-aged and older people living in Spain with different pain levels; and (2) to analyse the risk factors for having a negative SPH and functional mobility difficulties by calculating the probabilistic risks adjusted by different variables (sex, body mass index, social class, civil status, smoking status, pain level, and PAF). Methods: A cross-sectional study based on the European Health Survey data in Spain (EHSS 2014-2020) and The Spanish National Health Survey (SNHS 2017) was carried out, with a final sample of 21,152 participants with ages between 40 and 79 years. Results: Associations between high pain levels and worse SPH and difficulties in walking and climbing stairs were found. Lower PAF levels were associated with higher-probability risks of having a negative SPH and difficulties in walking and climbing stairs. Conclusions: Physical inactivity emerged as an important risk factor for worse SPH and functional mobility. These associations underline the importance that PA programmes can play in the improvement of health and functional mobility, as well as in other aspects, in people with pain.

Prescribing exercise therapy for the management of musculoskeletal pain: new-graduate physiotherapists' perceptions and perceived training needs

BACKGROUND

Pain management is a challenging area of practice for new-graduate physiotherapists during the transition from student to clinician. The attitudes and beliefs of new-graduate physiotherapists toward the use of exercise therapy as part of the management of musculoskeletal pain remain relatively unknown.

PURPOSE

The aim of the study was to investigate the perspectives of new-graduate physiotherapists toward prescribing exercise therapy in musculoskeletal pain management, and their perceptions of training and support needs in this area of practice.

METHODS

A qualitative study with a general inductive approach was used to investigate new-graduate physiotherapists' perspectives. Semi-structured interviews were conducted with 16 participants. Interview data was subjected to thematic analysis.

RESULTS

Four themes were generated following analysis: 1) Balancing the value of exercise with practical challenges; 2) Communication and education are inherent in exercise; 3) Influence of support and training; and 4) The benefits of direct experience.

CONCLUSION

New-graduate physiotherapists acknowledge the pivotal role of exercise in managing musculoskeletal pain. Direct learning experiences in pre-professional training that develop knowledge and skills required for delivering exercise therapy were highly valued. New-graduates recognize pain management as a skill that requires further development and identify the importance of opportunities for professional development in exercise therapy.

Risk Factors for Musculoskeletal Health: A Review of the Literature and Clinical Application

Context

Musculoskeletal disorders (MSKD) are currently the leading contributor to disability worldwide. Unlike other prevalent and disabling healthcare conditions such as CVD, risk factors associated with MSKD are not commonly discussed or integrated into current medical practice, rehabilitation practice or wellness programs. The primary purpose of this review is to describe the known risk factors most closely associated with MSKD. The secondary purpose is to propose a clinical model to manage MSK health aimed at maximizing the healthy pursuit of a physically active and healthy lifestyle.

Evidence acquisition

In this review the most common MSKD risk factors, with a focus on those that can be easily screened in clinical practice are presented. The importance of understanding the magnitude and number of risk factors present as well as the multidimensional nature of MSKD risk is discussed.

Results

A total of 11 MSKD risk factors were identified. Most of the risk factors are modifiable, and the evidence associated with modifiability for the most prominent risk factors is reviewed.Researchers have found that often patients are discharged from care with several known MSKD risk factors. In such instances, local pain and dysfunction are managed well, but expanding our rehabilitation care to include comprehensive risk factor management would ultimately benefit the patient and reduce healthcare costs.

Conclusion

The most common MSKD risk factors are discussed and a clinical framework to individualize intervention is proposed. Addressing key risk factors within rehabilitation may be an important step to reduce the enormous and growing burden these disorders are having on society.

Level of Evidence

5.

Self-Monitoring Practices and Use of Self-Monitoring Technologies by People with Rheumatic and Musculoskeletal Diseases: An International Survey Study

BACKGROUND/OBJECTIVES

Digital health applications (DHAs) promise to improve disease self-management, but adherence remains suboptimal. We aimed to explore self-monitoring practices of rheumatic and musculoskeletal diseases (RMD) patients. A web-survey was conducted over 7 months including RMD patients to study their self-monitoring practices and the potential of DHAs.

METHODS

Health, sociodemographic, and technology adherence indicators were retrieved for comparison. Regression analyses and unsupervised profiling were performed to investigate multiple patient profiles.

RESULTS

From 228 responses gathered, most reported willingness to use DHAs to monitor their condition (78% agreement), although the majority rarely/never tracked symptoms (64%), often due to stable condition or no perceived value (62%). Of those tracking regularly, 52% used non-digital means. Participants with regular self-monitoring practices were more open to use a self-monitoring app (OR = 0.8 [0.6, 0.9]; p = 0.008) and be embedded in multidisciplinary care (OR = 1.4 [1.1, 1.6]; p < 0.001), but showed worse health status (g = 0.4; p = 0.006). Cluster analyses revealed three distinct groups of reasons for not tracking regularly (χ2 = 174.4; p < 0.001), two characterised by perceived low disease activity.

CONCLUSIONS

Effective use of DHAs remains limited and non-digital means prevail in symptom monitoring. Findings suggest that better patient engagement strategies and passive monitoring should be adopted in early development stages of DHAs for better long-term disease self-care.

Prevalence of rheumatic and musculoskeletal diseases (RMDs) in nursing home residents: a systematic literature review

PURPOSE

The objective of this systematic literature review was to: (1) estimate the prevalence of (symptoms of) rheumatic and musculoskeletal diseases (RMDs) and (2) explore how (symptoms of) RMDs are identified and documented in studies among nursing home residents.

METHODS

Prevalence data of (symptoms of) RMDs in permanently admitted nursing home residents ≥ 60 years were included. Data extraction, data synthesis and risk of bias assessment were performed by two reviewers independently. Included studies were categorized based on case ascertainment and case definition comprising: (location of) musculoskeletal pain, general terms for RMDs or a specific type of RMD. Results were summarized descriptively.

RESULTS

Out of 6900 records, 53 studies were included. Case ascertainment comprised databases (n = 5), physical examination (n = 1), self-report questionnaires (n = 14), review of medical charts (n = 23) and self-report questionnaires combined with review of medical charts (n = 10). Prevalence ranged between 0.9 and 77.0% for (localized) musculoskeletal pain (n = 19) and between 0.6 and 67.5% for RMDs in general (n = 39). Prevalence rates of specific type of RMDs ranged between 0.7 and 47.5% for gout, between 3.3 and 11.0% for rheumatoid arthritis and between 2.8 and 75.4% for osteo-arthritis (n = 14). Heterogeneity with regard to documentation of (symptoms of) RMDs in medical data of nursing home residents was high.

CONCLUSION

The overall prevalence of (symptoms of) RMDs varied to a great extent. This was mainly due to large heterogeneity in documentation of (symptoms of) RMDs. Establishing agreement on a useful and practical classification may ultimately increase identification of RMDs in the nursing home setting.

Investigating the Use of Telemedicine by Health Care Providers to Diagnose and Manage Patients With Musculoskeletal Disorders: Systematic Review and Meta-Analysis

BACKGROUND

Access to care is a major challenge for patients with musculoskeletal disorders (MSKDs). Telemedicine is one of the solutions to improve access to care. However, initial remote diagnosis of MSKDs involves some challenges, such as the impossibility of touching the patient during the physical examination, which makes it more complex to obtain a valid diagnosis. No meta-analysis has been performed to date to synthesize evidence regarding the initial assessment including a physical evaluation using telemedicine to diagnose patients with MSKDs.

OBJECTIVE

This study aims to appraise the evidence on diagnostic and treatment plan concordance between remote assessment using synchronous or asynchronous forms of telemedicine and usual in-person assessment for the initial evaluation of various MSKDs.

METHODS

An electronic search was conducted up to August 2023 using terms related to telemedicine and assessment of MSKDs. Methodological quality of studies was assessed with the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Random-effect model meta-analyses were performed. The Grading of Recommendations, Assessment, Development, and Evaluations framework was used to synthesize the quality and certainty of the evidence.

RESULTS

A total of 23 concordance studies were eligible and included adult participants (N=1493) with various MSKDs. On the basis of high certainty, pooled κ and prevalence-adjusted and bias-adjusted κ for the diagnostic concordance between remote and in-person assessments of MSKDs were 0.80 (95% CI 0.72-0.89; 7 studies, 353 patients) and 0.83 (95% CI 0.76-0.89; 6 studies, 306 patients). On the basis of moderate certainty, pooled Gwet AC1 for treatment plan concordance between remote and in-person assessments of MSKDs was 0.90 (95% CI 0.80-0.99; 2 studies, 142 patients).

CONCLUSIONS

The diagnostic concordance for MSKDs is good to very good. Treatment plan concordance is probably good to excellent. Studies evaluating the accuracy to detect red and yellow flags as well as the potential increase in associated health care resources use, such as imaging tests, are needed.

Gene co-expression networks reveal sex-biased differences in musculoskeletal ageing

Aging is a universal and progressive process involving the deterioration of physiological functions and the accumulation of cellular damage. Gene regulation programs influence how phenotypes respond to environmental and intrinsic changes during aging. Although several factors, including sex, are known to impact this process, the underlying mechanisms remain incompletely understood. Here, we investigate the functional organization patterns of skeletal muscle genes across different sexes and ages using gene co-expression networks (GCNs) to explore their influence on aging. We constructed GCNs for three different age groups for male and female samples, analyzed topological similarities and differences, inferred significant associated processes for each network, and constructed null models to provide statistically robust results. We found that each network is topologically and functionally distinct, with young women having the most associated processes, likely due to reproductive tasks. The functional organization and modularity of genes decline with age, starting from middle age, potentially leading to age-related deterioration. Women maintain better gene functional organization throughout life compared to men, especially in processes like macroautophagy and sarcomere organization. The study suggests that the loss of gene co-expression could be a universal aging marker. This research offers insights into how gene organization changes with age and sex, providing a complementary method to analyze aging.

Evidence for telemedicine heterogeneity in rheumatic and musculoskeletal diseases care: a scoping review

Telemedicine and digital health represent alternative approaches for clinical practice; indeed, its potential in healthcare services for prevention, diagnosis, treatment, rehabilitation, and disease monitoring is widely acknowledged. These are all crucial issues to consider when dealing with chronic Rheumatic and Musculoskeletal Diseases (RMDs). The aim was to determine the current state of telemedicine in the field of rheumatology, considering the tools and devices in use as well as the Patient Reported Outcomes. A scoping review was performed following the PRISMA-ScR, retrieving articles through five databases from 1990 to 2022. Inclusion criteria were as follows: (I) adult patients with RMDs, (II) original research papers in the English language with available abstracts, and (III) telehealth and telemedicine are provided as healthcare services. Within the 62 included studies, multiple tools of telemedicine were used: 21/62 websites/online platforms, 18/62 mobile applications, 16/62 telephone contacts, 5/62 video-consultations, and 1/62 wearable devices. Outcomes were classified based on the economic, clinical, and humanistic framework. Clinical outcomes assessed through digital tools were pain, disease activity, and serum uric acid levels. Humanistic outcomes have been grouped according to four categories (e.g., mental and physical function, health management, and health perception). The heterogeneity of digital tools in the field of rheumatology highlights the challenge of implementing reliable research into clinical practice. Effective telerehabilitation models have been presented, and the use of a tight control strategy has also been mentioned. Future research should focus on establishing studies on other RMDs as well as summarizing and formulating clinical guidelines for RMDs. Key Points • Evidence for the usefulness of telemedicine and digital health for managing and monitoring rheumatic and musculoskeletal diseases is progressively increasing. • Several digital tools effectively measure clinical and humanistic and patient reported outcomes in rheumatic and musculoskeletal diseases. • Integrating diverse digital tools in rheumatology is challenging yet promising. • Future research should focus on developing standardized recommendations for practical use of telemedicine in daily practice.

Adoption of a Societal Perspective in Economic Evaluations of Musculoskeletal Disorders: A Conceptual Paper

Economic evaluations are used to compare the costs and consequences of healthcare interventions, including those for musculoskeletal (MSK) disorders, which are very common and a major source of morbidity and absence from work. Reimbursement decisions for interventions for MSK disorders by decision-makers rely on the findings of economic evaluations, the design and results of which depend largely on the perspective adopted. Despite methodological advancements in economic evaluations, there are no clear guidelines on the perspective to adopt. This paper explores the adoption of a societal perspective in economic evaluations of MSK disorders. Within health economics evaluations, the most commonly used perspectives include the payer perspective, the healthcare perspective, and the societal perspective. To facilitate optimal resource allocation decisions in order to reduce the significant economic burden of MSK disorders and improve the health outcomes of individuals with these disorders, all costs and benefits associated with interventions for them should be included. Thus, the societal perspective is arguably a preferable option to the others for economic evaluations of interventions for MSK disorders.

The inequity of global healthcare in pediatric rheumatology

In pediatric rheumatology, global health inequity relates to the uneven distribution of healthcare resources, accessibility, and health outcomes among children with rheumatic conditions across various countries, regions, and socioeconomic groups. This inequity can manifest in various ways. This review article provides an overview of common rheumatic diseases, such as juvenile idiopathic arthritis and systemic lupus erythematosus, which significantly contribute to and are affected by disparities in global healthcare. Subsequently, we delve into the inequalities in accessing patient care, encompassing issues related to diagnosis and treatment. Additionally, we address challenges in educational advancement and identify research gaps within the field of pediatric rheumatology. We also reveal successful global collaborations, such as a Global Task Force for Pediatric Musculoskeletal Health and special working groups among international organizations, aimed at bridging the disparities gap. Through these efforts, we try to enhance understanding, cooperation, and resource allocation to ensure equal access to quality care worldwide for children with rheumatic conditions. Futhermore, we present a case study from Thailand, highlighting their successful initiatives in developing pediatric rheumatology within their healthcare system.

Melatonin Alleviates Osteoarthritis by Regulating NADPH Oxidase 4-Induced Ferroptosis and Mitigating Mitochondrial Dysfunction

Recent evidence indicates that the damaged regions in osteoarthritis are accompanied by the accumulation of iron ions. Ferroptosis, as an iron-dependent form of cell death, holds significant implications in osteoarthritis. Melatonin, a natural product with strong scavenging abilities against reactive oxygen species and lipid peroxidation, plays a crucial role in the treatment of osteoarthritis. This study aims to demonstrate the existence of ferroptosis in osteoarthritis and explore the specific mechanism of melatonin in suppressing ferroptosis and alleviating osteoarthritis. Our findings reveal that melatonin reverses inflammation-induced oxidative stress and lipid peroxidation while promoting the expression of extracellular matrix components in chondrocytes, safeguarding the cells. Our research has revealed that NADPH oxidase 4 (NOX4) serves as a crucial molecule in the ferroptosis process of osteoarthritis. Specifically, NOX4 is located on mitochondria in chondrocytes, which can induce disorders in mitochondrial energy metabolism and dysfunction, thereby intensifying oxidative stress and lipid peroxidation. LC-MS analysis further uncovered that GRP78 is a downstream binding protein of NOX4. NOX4 induces ferroptosis by weakening GRP78's protective effect on GPX4 and reducing its expression. Melatonin can inhibit the upregulation of NOX4 on mitochondria and mitigate mitochondrial dysfunction, effectively suppressing ferroptosis and alleviating osteoarthritis. This suggests that melatonin therapy represents a promising new approach for the treatment of osteoarthritis.