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Gimigliano F, Resmini G, Moretti A, Aulicino M, Gargiulo F, Gimigliano A, Liguori S, Paoletta M, Iolascon G. Epidemiology of Musculoskeletal Injuries in Adult Athletes: A Scoping Review. Medicina (Kaunas) 2021; 57:medicina57101118. [PMID: 34684155 PMCID: PMC8539527 DOI: 10.3390/medicina57101118] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/06/2021] [Accepted: 10/14/2021] [Indexed: 02/05/2023]
Abstract
Background and Objectives: Sport-related musculoskeletal injuries (MSK-Is) are a common health issue in athletes that can lead to reduced performance. The aim of this scoping review was to synthetize available evidence on injury incidence rates (IIRs), types, and sites that affect the musculoskeletal (MSK) system of adult athletes. Materials and Methods: We performed a scoping review on the Pubmed database limiting our search to 33 Olympic sports. Results: We identified a total of 1022 papers, and of these 162 were examined in full for the purpose of this review. Archery was the sport with the highest risk of injuries to the upper extremities, marathons for the lower extremities, and triathlon and weightlifting for the body bust. In the majority of the sports examined, muscle/tendon strain and ligament sprain were the most common MSK-Is diagnoses, while athletics, karate, and football were the sports with the highest IIRs, depending on the methods used for their calculations. Conclusions: Our scoping review highlighted the general lack and dishomogeneity in the collection of data on MSK-Is in athletes.
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Affiliation(s)
- Francesca Gimigliano
- Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, 81100 Naples, Italy;
| | - Giuseppina Resmini
- Centre for the Study of Osteoporosis and Metabolic Bone Disease, Section of Orthopaedic and Traumatology, Treviglio-Caravaggio Hospital, 24047 Bergamo, Italy;
| | - Antimo Moretti
- Department of Medical and Surgical Specialties and Dentistry, University of Campania Luigi Vanvitelli, 81100 Naples, Italy; (M.A.); (F.G.); (S.L.); (M.P.); (G.I.)
- Correspondence: ; Tel.: +39-081-566-5537
| | - Milena Aulicino
- Department of Medical and Surgical Specialties and Dentistry, University of Campania Luigi Vanvitelli, 81100 Naples, Italy; (M.A.); (F.G.); (S.L.); (M.P.); (G.I.)
| | - Fiorinda Gargiulo
- Department of Medical and Surgical Specialties and Dentistry, University of Campania Luigi Vanvitelli, 81100 Naples, Italy; (M.A.); (F.G.); (S.L.); (M.P.); (G.I.)
| | | | - Sara Liguori
- Department of Medical and Surgical Specialties and Dentistry, University of Campania Luigi Vanvitelli, 81100 Naples, Italy; (M.A.); (F.G.); (S.L.); (M.P.); (G.I.)
| | - Marco Paoletta
- Department of Medical and Surgical Specialties and Dentistry, University of Campania Luigi Vanvitelli, 81100 Naples, Italy; (M.A.); (F.G.); (S.L.); (M.P.); (G.I.)
| | - Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania Luigi Vanvitelli, 81100 Naples, Italy; (M.A.); (F.G.); (S.L.); (M.P.); (G.I.)
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Iolascon G, de Sire A, Calafiore D, Benedetti MG, Cisari C, Letizia Mauro G, Migliaccio S, Nuti R, Resmini G, Gonnelli S, Moretti A. Multifactorial Assessment of Risk of Falling in 753 Post-Menopausal Women: A Multicenter Cross-Sectional Study by the Italian Group for the Study of Metabolic Bone Diseases. Clin Interv Aging 2020; 15:1077-1084. [PMID: 32753859 PMCID: PMC7354000 DOI: 10.2147/cia.s257304] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 06/05/2020] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To assess physical performance, number of falls, previous fragility fractures, and ongoing pharmacological therapy in a cohort of post-menopausal women, according to their risk of falling. METHODS In this multicenter cross-sectional study, we recruited in a 3-year period (May 2016 to April 2019), women aged >60 years referred to seven Osteoporosis and Bone Metabolism Outpatient Services of the Italian Group for the Study of Metabolic Bone Diseases. The study population was divided into three groups according to the risk of falling, assessed through the Elderly Fall Screening Test (EFST): low risk (EFST score=0-1); moderate risk (EFST=2-3); high risk (EFST=4-5). Outcome measures were: 4-meter gait speed (4MGS); unipedal stance time (UST); number of falls in the previous year; previous fragility fractures; ongoing pharmacological therapy. RESULTS We analyzed 753 women (mean aged 70.1±9.2 years): 378 (50.2%) at low risk of falling, 247 (32.8%) at moderate risk, and 128 (17.0%) at high risk. 4MGS and UST resulted as pathological in the 93.9% and 99.2%, respectively, of women at high risk. There were significant differences among groups for both outcomes (p<0.001). There was also a significant difference among groups (p<0.001) in terms of previous falls and fragility fractures. Lastly, there were significant differences (p<0.05) among groups in using antihypertensive drugs, antiplatelet agents, anticoagulants, antidepressants, anti-osteoporotic drugs, and vitamin D, and/or calcium supplementation. CONCLUSION Physical performance, prevalence of falls and fragility fractures, and an assessment of pharmacological therapy should be investigated in post-menopausal women because of their significant correlation with risk of falling.
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Affiliation(s)
- Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Alessandro de Sire
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, Italy
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, Novara, Italy
- Rehabilitation Unit, “Mons L. Novarese” Hospital, Vercelli, Moncrivello, Italy
- Correspondence: Alessandro de Sire Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, Viale Piazza D’Armi 1, Novara28100, ItalyTel +3903213734800 Email
| | - Dario Calafiore
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, Italy
- Section of Neuromotor Rehabilitation, Department of Neuroscience, ASST Carlo Poma, Mantova, Italy
| | - Maria Grazia Benedetti
- Physical Medicine and Rehabilitation Unit, IRCCS-Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Carlo Cisari
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, Novara, Italy
- Physical Medicine and Rehabilitation Unit, University Hospital “Maggiore della Carità”, Novara, Italy
| | - Giulia Letizia Mauro
- Department of Surgical and Oncology Sciences, University of Palermo, Palermo, Italy
| | - Silvia Migliaccio
- Department of Movement, Human and Health Sciences, Section of Health Sciences, University of Rome, Foro Italico, Rome, Italy
| | - Ranuccio Nuti
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Giuseppina Resmini
- Section of Orthopaedics and Traumatology, Treviglio-Caravaggio Hospital, Treviglio, Bergamo, Italy
| | - Stefano Gonnelli
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Antimo Moretti
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, Italy
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Migliaccio S, Francomano D, Romagnoli E, Marocco C, Fornari R, Resmini G, Buffa A, Di Pietro G, Corvaglia S, Gimigliano F, Moretti A, de Sire A, Malavolta N, Lenzi A, Greco EA, Iolascon G. Persistence with denosumab therapy in women affected by osteoporosis with fragility fractures: a multicenter observational real practice study in Italy. J Endocrinol Invest 2017; 40:1321-1326. [PMID: 28589380 DOI: 10.1007/s40618-017-0701-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Accepted: 05/26/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Persistence is commonly considered a key factor for the successful management of osteoporosis and fragility fractures. Denosumab is the first biologic agent developed for the treatment of osteoporosis with satisfying data regarding the persistence with this therapy. AIM The purpose of this multicenter observational real practice study was to evaluate the persistence with denosumab treatment in post-menopausal women affected by osteoporosis. MATERIAL/SUBJECTS AND METHODS Women were recruited in four specialized centers for the management of osteoporosis in North, Center and South of Italy. We included women with a diagnosis of post-menopausal osteoporosis, aged >50 years, able to obtain a prescription according to the Italian reimbursement criteria in force during the study period for anti-osteoporotic pharmacological treatment. They initiated a treatment with subcutaneous denosumab (Prolia®) 60 mg/every 6 months between November 2011 and May 2016. Women who had received aromatase inhibitors were excluded. Patients were assessed at baseline and every 6 months for all treatment length. Persistence data were evaluated for a total of 36 months. RESULTS Eight hundred seventy women were enrolled; mean aged 70 years, with a mean body mass index of 24.8 ± 4.1 kg/m2. At the Dual-energy X-ray absorptiometry assessment, the mean lumbar spine T-score was -2.76 ± 1.14 standard deviations (SD) and the mean femoral neck T-score was -2.49 ± 0.80 SD. During the study, the total persistence was 91.4%. Total dropouts were 75 (8.6%), higher within the initial 6-month period of treatment. CONCLUSIONS Persistence to denosumab treatment in our observational real practice study was very high. These results suggest that factors such as frequency of visits, pharmacological schedule, and opportunity to call the doctor might play an important role in the persistence and adherence to treatment to obtain maximum therapeutic effect and avoid further fragility fractures.
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Affiliation(s)
- S Migliaccio
- Section of Health Sciences, Department of Movement, Human and Health Sciences, University "Foro Italico", Piazza Lauro de Bosis, 6, 00135, Rome, Italy.
| | - D Francomano
- Section of Medical Pathophysiology, Endocrinology and Nutrition, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - E Romagnoli
- Section of Medical Pathophysiology, Endocrinology and Nutrition, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - C Marocco
- Section of Medical Pathophysiology, Endocrinology and Nutrition, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - R Fornari
- Section of Medical Pathophysiology, Endocrinology and Nutrition, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - G Resmini
- Section of Orthopaedic and Traumatology, Center of Osteoporosis and Skeletal Metabolic Diseases, ASST-Bergamo Ovest, Treviglio-Caravaggio, Italy
| | - A Buffa
- Departmental Program: Rheumatic, Connective and Bone Metabolic Diseases Management Bologna, Department of Medical and Surgical Sciences, St Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - G Di Pietro
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Via de Crecchio 4, 80138, Naples, Italy
| | - S Corvaglia
- Departmental Program: Rheumatic, Connective and Bone Metabolic Diseases Management Bologna, Department of Medical and Surgical Sciences, St Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - F Gimigliano
- Department of Physical and Mental Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - A Moretti
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Via de Crecchio 4, 80138, Naples, Italy
| | - A de Sire
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Via de Crecchio 4, 80138, Naples, Italy
| | - N Malavolta
- Departmental Program: Rheumatic, Connective and Bone Metabolic Diseases Management Bologna, Department of Medical and Surgical Sciences, St Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - A Lenzi
- Section of Medical Pathophysiology, Endocrinology and Nutrition, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - E A Greco
- Section of Medical Pathophysiology, Endocrinology and Nutrition, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - G Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Via de Crecchio 4, 80138, Naples, Italy.
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Tarantino U, Iolascon G, Cianferotti L, Masi L, Marcucci G, Giusti F, Marini F, Parri S, Feola M, Rao C, Piccirilli E, Zanetti EB, Cittadini N, Alvaro R, Moretti A, Calafiore D, Toro G, Gimigliano F, Resmini G, Brandi ML. Clinical guidelines for the prevention and treatment of osteoporosis: summary statements and recommendations from the Italian Society for Orthopaedics and Traumatology. J Orthop Traumatol 2017; 18:3-36. [PMID: 29058226 PMCID: PMC5688964 DOI: 10.1007/s10195-017-0474-7] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The Italian Society for Orthopaedics and Traumatology conceived this guidance-which is primarily addressed to Italian orthopedic surgeons, but should also prove useful to other bone specialists and to general practitioners-in order to improve the diagnosis, prevention, and treatment of osteoporosis and its consequences. MATERIALS AND METHODS Literature reviews by a multidisciplinary team. RESULTS The following topics are covered: the role of instrumental, metabolic, and genetic evaluations in the diagnosis of osteoporosis; appraisal of the risk of fracture and thresholds for intervention; general strategies for the prevention and treatment of osteoporosis (primary and secondary prevention); the pharmacologic treatment of osteoporosis; the setting and implementation of fracture liaison services for tertiary prevention. Grade A, B, and C recommendations are provided based on the main levels of evidence (1-3). Toolboxes for everyday clinical practice are provided. CONCLUSIONS The first up-to-date Italian guidelines for the primary, secondary, and tertiary prevention of osteoporosis and osteoporotic fractures are presented.
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Affiliation(s)
- Umberto Tarantino
- Policlinico Tor Vergata Foundation, Orthopaedics and Traumatology, University of Rome Tor Vergata, Rome, Italy
| | - Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, Second University of Naples, Naples, Italy
| | - Luisella Cianferotti
- Metabolic Bone Diseases Unit, Department of Surgery and Translational Medicine, University Hospital of Florence, University of Florence, Viale Pieraccini, 6, 50139, Florence, Italy
| | - Laura Masi
- Metabolic Bone Diseases Unit, Department of Surgery and Translational Medicine, University Hospital of Florence, University of Florence, Viale Pieraccini, 6, 50139, Florence, Italy
| | - Gemma Marcucci
- Metabolic Bone Diseases Unit, Department of Surgery and Translational Medicine, University Hospital of Florence, University of Florence, Viale Pieraccini, 6, 50139, Florence, Italy
| | - Francesca Giusti
- Metabolic Bone Diseases Unit, Department of Surgery and Translational Medicine, University Hospital of Florence, University of Florence, Viale Pieraccini, 6, 50139, Florence, Italy
| | - Francesca Marini
- Metabolic Bone Diseases Unit, Department of Surgery and Translational Medicine, University Hospital of Florence, University of Florence, Viale Pieraccini, 6, 50139, Florence, Italy
| | - Simone Parri
- Metabolic Bone Diseases Unit, Department of Surgery and Translational Medicine, University Hospital of Florence, University of Florence, Viale Pieraccini, 6, 50139, Florence, Italy
| | - Maurizio Feola
- Policlinico Tor Vergata Foundation, Orthopaedics and Traumatology, University of Rome Tor Vergata, Rome, Italy
| | - Cecilia Rao
- Policlinico Tor Vergata Foundation, Orthopaedics and Traumatology, University of Rome Tor Vergata, Rome, Italy
| | - Eleonora Piccirilli
- Policlinico Tor Vergata Foundation, Orthopaedics and Traumatology, University of Rome Tor Vergata, Rome, Italy
| | - Emanuela Basilici Zanetti
- Nursing Science, Center of Excellence for Culture and Nursing Research-IPASVI, University of Rome Tor Vergata, Rome, Italy
| | - Noemi Cittadini
- Nursing Science, Center of Excellence for Culture and Nursing Research-IPASVI, University of Rome Tor Vergata, Rome, Italy
| | - Rosaria Alvaro
- Nursing Science, Center of Excellence for Culture and Nursing Research-IPASVI, University of Rome Tor Vergata, Rome, Italy
| | - Antimo Moretti
- Department of Medical and Surgical Specialties and Dentistry, Second University of Naples, Naples, Italy
| | - Dario Calafiore
- Department of Medical and Surgical Specialties and Dentistry, Second University of Naples, Naples, Italy
| | - Giuseppe Toro
- Department of Medical and Surgical Specialties and Dentistry, Second University of Naples, Naples, Italy
| | - Francesca Gimigliano
- Department of Medical and Surgical Specialties and Dentistry, Second University of Naples, Naples, Italy
| | - Giuseppina Resmini
- Section of Orthopaedics and Traumatology, Centre for the Study of Osteoporosis and Metabolic Bone Disease, Treviglio-Caravaggio Hospital, Bergamo, Italy
| | - Maria Luisa Brandi
- Metabolic Bone Diseases Unit, Department of Surgery and Translational Medicine, University Hospital of Florence, University of Florence, Viale Pieraccini, 6, 50139, Florence, Italy.
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Iolascon G, Gimigliano R, Bianco M, De Sire A, Moretti A, Giusti A, Malavolta N, Migliaccio S, Migliore A, Napoli N, Piscitelli P, Resmini G, Tarantino U, Gimigliano F. Are Dietary Supplements and Nutraceuticals Effective for Musculoskeletal Health and Cognitive Function? A Scoping Review. J Nutr Health Aging 2017; 21:527-538. [PMID: 28448083 DOI: 10.1007/s12603-016-0823-x] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The aim of our scoping review was to summarize the state of the art regarding micronutrients in order to identify which of them might effectively improve health status in the areas typically impaired in older people: bone, skeletal muscle, and cognitive function. DESIGN Scoping review. METHODS The Italian Study Group on Healthy Aging by Nutraceuticals and Dietary Supplements (HANDS) performed this scoping review, based on the following steps: doing a list of micronutrients related with musculoskeletal or cognitive functions, included in dietary supplements and nutraceuticals commercialized in Italy; planning a research on PubMed, according to an evidence-based approach, in order to the most relevant positive study for each micronutrient into each of the three areas involved (bone, skeletal muscle and cognitive function); identifying the micronutrients effective in maintaining or achieving an adequate health status in older people, specifying the effective and safe daily doses, according to the selected studies. RESULTS In literature we found 12 relevant positive studies (1 international society guidelines/recommendations, 1 systematic review, 7 randomized controlled trials, and 3 prospective cohort studies). We showed that only 16 micronutrients resulted to have appropriate scientific evidences in terms of improving musculoskeletal health and/or cognitive function in older people: beta-alanine, calcium, creatine, fluorides, leucine, magnesium, omega-3 fatty acids, potassium, vitamin B6, vitamin B9, vitamin B12, vitamin C, vitamin D, vitamin E, vitamin K2, and zinc. CONCLUSION This scoping review showed that selected micronutrients in adequate doses might have an ancillary role in musculoskeletal health and cognitive functions in older people.
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Affiliation(s)
- G Iolascon
- G. Iolascon, Department of Medical and Surgical Specialties and Dentistry, Second University of Naples, Naples, Italy,
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Abstract
Complex Regional Pain Syndrome (CRPS) is a chronic pain condition that occurs after a tissue injury (fractures, sprain, surgery) of the upper or lower extremities. A clear pathophysiological mechanism has not been established yet and different patterns are considered to play a role in the genesis of the disease. The diagnosis is made by different diagnosis criteria and a gold standard has not been established yet. Incidence of CRPS is unclear and large prospective studies on the incidence and prevalence of CRPS are scarce. The aim of this review is to give an overview on the prevalent data regarding this chronic syndrome.
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Affiliation(s)
- Chiara Ratti
- Orthopaedic, Traumatologic Clinic, University Hospital "Ospedali Riuniti", Trieste, Italy
| | - Andrea Nordio
- Orthopaedic, Traumatologic Clinic, University Hospital "Ospedali Riuniti", Trieste, Italy
| | - Giuseppina Resmini
- U.O. Orthopaedics and Traumatology, University Hospital "Ospedale di Treviglio-Caravaggio" (BG), Italy
| | - Luigi Murena
- Orthopaedic, Traumatologic Clinic, University Hospital "Ospedali Riuniti", Trieste, Italy
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Iolascon G, Moretti A, Cannaviello G, Resmini G, Gimigliano F. Proximal femur geometry assessed by hip structural analysis in hip fracture in women. Aging Clin Exp Res 2015; 27 Suppl 1:S17-21. [PMID: 26178633 DOI: 10.1007/s40520-015-0406-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 07/01/2015] [Indexed: 02/08/2023]
Abstract
INTRODUCTION In the pathogenesis of hip fracture, proximal femur geometry plays a key role as well as decreased bone density. The hip structural analysis (HSA) processes dual energy X-ray absorptiometry (DXA) images containing information on the geometry closely related to the strength of the proximal femur. The objective of this study was to investigate bone mineral density (BMD) and mechanical properties of the proximal femur in a group of women with a previous contralateral hip fragility fracture compared to women without history of hip fracture. MATERIALS AND METHODS In a population of postmenopausal women, we evaluated bone density by DXA and bone geometry using the HSA parameters (femoral strength index, cross-sectional moment of inertia, cross-sectional area, section modulus, and buckling ratio) including hip axis length (HAL) and neck shaft angle. RESULTS Of a total of 62 postmenopausal women, twenty-six with a history of hip fracture had a mean femoral neck BMD significantly lower in comparison with 36 women in the control group (0.703 versus 0.768 g/cm(2), p = 0.0347). There was a statistically significant difference between groups also for HAL (106.75 mm in fracture group versus 100.93 mm in control group, p = 0.0015). DISCUSSION AND CONCLUSIONS Our results demonstrated that all the geometrical parameters resulted worst into the group of patients with history of hip fracture, even though only the HAL was significantly lower in control subjects. In our opinion HSA is useful to characterize the risk of hip fracture in postmenopausal women, providing additional data on the spatial distribution of bone mass strongly related to bone strength.
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Affiliation(s)
- Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, Second University of Naples, Naples, Italy.
| | - Antimo Moretti
- Department of Medical and Surgical Specialties and Dentistry, Second University of Naples, Naples, Italy
| | - Giovanni Cannaviello
- Department of Medical and Surgical Specialties and Dentistry, Second University of Naples, Naples, Italy
| | - Giuseppina Resmini
- Centre for the Study of Osteoporosis and Metabolic Bone Disease, Section of Orthopaedic and Traumatology, Treviglio-Caravaggio Hospital, Bergamo, Italy
| | - Francesca Gimigliano
- Department of Mental and Physical Health and Preventive Medicine, Second University of Naples, Naples, Italy
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Abstract
Complex Regional Pain Syndrome (CRPS) is a multifactorial and disabling disorder with complex etiology and pathogenesis. Goals of therapy in CRPS should be pain relief, functional restoration, and psychological stabilization, but early interventions are needed in order to achieve these objectives. Several drugs have been used to reduce pain and to improve functional status in CRPS, despite the lack of scientific evidence supporting their use in this scenario. They include anti-inflammatory drugs, analgesics, anesthetics, anticonvulsants, antidepressants, oral muscle relaxants, corticosteroids, calcitonin, bisphosphonates, calcium channel blockers and topical agents. NSAIDs showed no value in treating CRPS. Glucocorticoids are the only anti-inflammatory drugs for which there is direct clinical trial evidence in early stage of CRPS. Opioids are a reasonable second or third-line treatment option, but tolerance and long term toxicity are unresolved issues. The use of anticonvulsants and tricyclic antidepressants has not been well investigated for pain management in CRPS. During the last years, bisphosphonates have been the mostly studied pharmacologic agents in CRPS treatment and there are good evidence to support their use in this condition. Recently, the efficacy of intravenous (IV) administration of neridronate has been reported in a randomized controlled trial. Significant improvements in VAS score and other indices of pain and quality of life in patients who received four 100 mg IV doses of neridronate versus placebo were reported. These findings were confirmed in the open-extension phase of the study, when patients formerly enrolled in the placebo group received neridronate at the same dosage, and these results were maintained at 1 year follow-up. The current literature concerning sympathetic blocks and sympathectomy techniques lacks evidence of efficacy. Low evidence was recorded for a free radical scavenger, dimethylsulphoxide (DMSO) cream (50%). The same level of efficacy was noted for vitamin C (500 mg per day for 50 days) in prevention of CRPS in patients affected by wrist fracture. In conclusion, the best available therapeutic approach to CRPS is multimodal and is based on the use of several classes of drugs, associated to early physiotherapy. Neridronate at appropriate doses is associated with clinically relevant and persistent benefits in CRPS patients.
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Affiliation(s)
- Giuseppina Resmini
- Centre for the Study of Osteoporosis and Metabolic Bone Disease, Section of Orthopaedic and Traumatology, Treviglio-Caravaggio Hospital, Bergamo, Italy
- Address for correspondence: Giuseppina Resmini, MD, Centre for the Study of Osteoporosis and Metabolic, Bone Disease, Section of Orthopaedic and Traumatology, Treviglio-Caravaggio Hospital, P.le Ospedale 1, 24047 Treviglio (BG), Italy, E-mail:
| | - Chiara Ratti
- Orthopaedic Clinic, University of Trieste, Trieste, Italy
| | | | - Luigi Murena
- Orthopaedic Clinic, University of Trieste, Trieste, Italy
| | - Antimo Moretti
- Department of Medical and Surgical Specialties and Dentistry, Second University of Naples, Naples, Italy
| | - Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, Second University of Naples, Naples, Italy
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Tarantino U, Celi M, Feola M, Liuni FM, Resmini G, Iolascon G. A new antiresorptive approach to the treatment of fragility fractures: long-term efficacy and safety of denosumab. Aging Clin Exp Res 2013; 25 Suppl 1:S65-9. [PMID: 24046047 DOI: 10.1007/s40520-013-0082-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Accepted: 06/24/2013] [Indexed: 01/22/2023]
Abstract
An imbalance of the remodeling process for bone resorption leads to a loss of tissue with consequent microarchitectural damage, evident in conditions such as osteoporosis and related fragility fractures. Currently, pharmacological therapies are able to prevent or slow down bone resorption by inhibiting osteoclast activity. An innovative and targeted anti-resorptive approach is represented by the inhibition of RANK ligand (RANK-L), essential for the proliferation and activity of osteoclastic cells. The human monoclonal antibody against RANK-L (denosumab) has been approved for the treatment of osteoporosis. In clinical trials of patients with osteoporosis, inhibition of RANK-L has reduced bone loss and damage to the microarchitecture and was associated with an increase in mass and resistance at different skeletal sites, with most significant effects than those demonstrated by any other antiresorptive drugs. In addition, after 3 years of treatment, it showed a reduction in vertebral and non-vertebral fracture risk. Denosumab treatment also has not revealed any alteration in the physiological processes of fracture repair, showing no increase in the onset of complications 3 years after the fracture. The data show that denosumab offers an effective alternative therapeutic approach for the treatment of severe osteoporosis, with positive effects on BMD and reduction of fragility fractures risk. So, promising results in terms of therapeutic efficacy and reliability make desirable the wide clinical use of denosumab for the treatment of osteoporotic fractures in the near future.
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Iolascon G, Resmini G, Tarantino U. Effects of denosumab on cortical and trabecular microarchitecture: evidences from clinical studies. Aging Clin Exp Res 2013; 25 Suppl 1:S19-22. [PMID: 24046050 DOI: 10.1007/s40520-013-0086-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 07/03/2013] [Indexed: 01/23/2023]
Abstract
Excess of bone remodeling is still the major pathogenic factor in involutional osteoporosis. This phenomenon is linked to an imbalance between neoformation (by osteoblasts) and resorption (by osteoclasts). Recently, research in drug development is focused on new and more "physiological" approach to balance bone remodeling. The efficacy of denosumab was proved in the prevention of vertebral and non-vertebral fractures and related to the ability of the drug to penetrate in cortical and trabecular bone. Recently, data from several clinical studies confirm that denosumab improves fracture outcomes, also at skeletal sites rich in cortical bone.
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Affiliation(s)
- G Iolascon
- Department of Medical and Surgical Specialties and Dentistry, Second University of Naples, Naples, Italy,
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Resmini G, Tarantino U, Iolascon G. Vitamin D: role and opportunity to prescribe. Aging Clin Exp Res 2013; 25 Suppl 1:S125-7. [PMID: 24046033 DOI: 10.1007/s40520-013-0108-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 07/20/2013] [Indexed: 10/26/2022]
Abstract
The major role of vitamin D in humans is to increase the absorption of calcium and phosphatase for the mineralization of the skeleton. The synthesis of vitamin D3 in the skin under influence of UV light decreases with aging due to insufficient sunlight exposure, and a decreased functional capacity of the skin. Deficiency in vitamin D causes secondary hyperparathyroidism, high bone turnover, bone loss, mineralization defects, proximal myopathy, falls and hip and other fractures. The goal of therapy of hypovitaminosis D is to restore normal serum and deposits of 25 (OH) D. The daily supplementation of vitamin D indicated is about 800-1,000 IU/day but may increase up to a maximum dose of 2,000 IU/day in conditions of severe vitamin D deficiency with a concomitant reduced or no sun exposure, reduced dietary intake and reduced calcium absorption.
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Migliaccio S, Resmini G, Buffa A, Fornari R, Di Pietro G, Cerocchi I, Dormi A, Gimigliano F, Mulè R, Celi M, Frigato M, Lenzi A, Tarantino U, Iolascon G, Malavolta N. Evaluation of persistence and adherence to teriparatide treatment in patients affected by severe osteoporosis (PATT): a multicenter observational real life study. ACTA ACUST UNITED AC 2013; 10:56-60. [PMID: 23858313 DOI: 10.11138/ccmbm/2013.10.1.056] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Osteoporosis is a chronic condition leading to an increased risk of developing fractures, with high morbidity and mortality in aging population. Efficacy of anti-osteoporotic treatment is based on drug potency but also on compliance and persistence to treatment regimen, which is very low, as already described for other diseases. Teriparatide (TPTD) is the first anabolic agent developed for the treatment of osteoporosis. Since it appears that persistence to Teriparatide declines over time, aim of this pilot multicenter observational study was to evaluate persistence and adherence to TPTD (20 μg daily injection regimen for 18 months) treatment (PATT) in patients affected by severe osteoporosis in an every day clinical practice. METHODS Patients affected by severe osteoporosis were selected among those who referred to 5 different specialized centers for osteoporosis in North, Center and South of Italy. A sample of 475 women with severe postmenopausal osteoporosis treated with TPTD in accordance to the Italian osteoporosis guidelines was included. At the beginning of TPTD treatment patients were instructed on the use of the device by the referring specialist of the center, a resident fellow or a nurse. Bone biochemical markers were evaluated the same morning and after 1, 3, 6, 12 and 18 months. Patients were visited at time 0 and after 6, 12 and 18 months for clinical follow up. RESULTS The results included observations of 441/475 patients (98% women) who completed the 18 months treatment; mean age for women was 73±8 and for men 65±9. After 6 months of TPTD treatment persistence was of 89,79%, 87,75% after 12 months and 86,85% after 18 months. Adherence was of 100% at 6,12 and 18 months. Total dropouts were 13,15% (71/441), which was usually higher within the first 6 months of TPTD treatment. Most common adverse events (arthralgies 2,7%, dizziness 1,8%, migraine 1,8%, depression 1,6%, hypertension 1,1%) were reported in 62/441 patients (14%) of patients, but were not reason for stopping treatment. CONCLUSIONS The persistence and adherence to TPTD treatment obtained in this multicenter observational real life study was very high as compared to studies performed by others. These encouraging results suggest that different key factors such quality of information, frequency of visits, motivations given to patients, opportunity to call the doctor might play a pivotal role in the high persistence and adherence to TPTD treatment obtained in our study and need to be carefully considered before prescribing chronic anti-osteoporotic therapy.
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Affiliation(s)
- Silvia Migliaccio
- Department of Experimental Medicine, "Sapienza" University of Roma, Rome, Italy ; Department of Movement, Human, and Health Sciences, "Foro Italico" University, Rome, Italy
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13
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Iolascon G, Gimigliano F, Malavolta N, Tarantino U, Fornari R, Greco E, Di Pietro G, Gimigliano R, Lenzi A, Resmini G, Migliaccio S. Effectiveness of teriparatide treatment on back pain-related functional limitations in individuals affected by severe osteoporosis: a prospective pilot study. Clin Cases Miner Bone Metab 2012; 9:161-165. [PMID: 23289031 PMCID: PMC3535991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Vertebral fractures have been associated with back pain, functional limitations and reduced health-related quality of life (HRQoL). Teriparatide is the first effective anabolic agent that demonstrated to significantly reduce the risk of vertebral fracture by 65%, as compared to placebo. The aims of this study were to evaluate the effectiveness of teriparatide treatment on back pain-related functional limitations and to investigate on patients HRQoL. MATERIALS AND METHODS In this prospective observational pilot study osteoporotic patients, who were prescribed teriparatide therapy and a supplementation of calcium and vitamin D, were asked to answer to two self-administered questionnaires: the Spine Pain Index (SPI) and the SF-12 (at the recruitment, after 6, 12, and 18 months). RESULTS Fifty-two women were evaluated (mean age of 70.58 yrs). The mean SPI score passed from 50.01 at baseline to 32.20 at 18 months. The mean SF-12 PCS score passed from 30.00 at baseline to 36.79 at 18 months, while the mean SF-12 MCS score was already within the normality range at baseline, constantly improving during the 18 months. CONCLUSION In conclusion, 18 months of treatment with teriparatide has to be considered an effective therapeutic option for women with severe osteoporosis and vertebral fractures, in a real-life clinical setting, to improve both back pain related disability and quality of life.
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Affiliation(s)
- Giovanni Iolascon
- Multidisciplinary of Medical, Surgical and Dental Specialties, Second University of Naples, Naples, Italy
| | - Francesca Gimigliano
- Department of Mental and Physical Health and Preventive Medicine Second University of Naples, Naples, Italy
| | | | | | - Rachele Fornari
- Department of Experimental Medicine, “Sapienza” University of Rome, Italy
| | - Emanuela Greco
- Department of Experimental Medicine, “Sapienza” University of Rome, Italy
| | - Gioconda Di Pietro
- Multidisciplinary of Medical, Surgical and Dental Specialties, Second University of Naples, Naples, Italy
| | - Raffaele Gimigliano
- Multidisciplinary of Medical, Surgical and Dental Specialties, Second University of Naples, Naples, Italy
- “Casa di Cura Santa Maria del Pozzo”, Somma Vesuviana (NA), Italy
| | - Andrea Lenzi
- Department of Experimental Medicine, “Sapienza” University of Rome, Italy
| | - Giuseppina Resmini
- Center for the Study of Osteoporosis and Bone Metabolic Diseases, Section of Orthopaedics and Traumatology, Hospital “Treviglio-Caravaggio”, Bergamo, Italy
| | - Silvia Migliaccio
- Department of Experimental Medicine, “Sapienza” University of Rome, Italy
- Department of Health Sciences, University “Foro Italico”, Rome, Italy
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Nardi A, Tarantino U, Ventura L, Armotti P, Resmini G, Cozzi L, Tonini G, Ramazzina E, Rossini M. Domino Effect: mechanic factors role. Clin Cases Miner Bone Metab 2011; 8:38-42. [PMID: 22461815 PMCID: PMC3279072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The rapid onset of the Domino Effect following the first Vertebral Compression Fracture is a direct consequence of the mechanical variations that affect the spine when physiological curves are modified. The degree of kyphosis influences the intensity of the Flexor Moment; this is greater on vertebrae D7, D8 and on vertebrae D12, L1 when the spine flexes. Fractures of D7, D8, D12 and L1 are, by far, the most frequent and also the main cause of the mechanical alterations that can trigger the Domino Effect. For these considerations vertebrae D7, D8, D12 and L1 have to be taken in consideration as "critical". In the case of critical clinical vertebral fractures it is useful to provide an indication for minimally invasive surgical reduction or intrasomatic stabilization. When occurs a fracture of a "critical vertebra", prompt restoration of the heights leads to a reduction in the Kyphosis Index and therefore in the Flexor Moment, not only of the fractured vertebra but also, in turn, of all the other metameres which, even if morphologically still intact, are structurally fragile; so, through the restoration of the mechanical vertebral proprieties, we can reduce the risk of the Domino Effect. At the same time the prompt implementation of osteoinductive therapy is indispensable in order to achieve rapid and intense reconstruction of the trabecular bone, the strength of which increases significantly in a short period of time. Clinical studies are necessary to confirm the reduction of the domino effect following a fragility fracture of "critical vertebrae" with the restoration of the mechanical properties together with anabolic therapy.
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Affiliation(s)
- Alfredo Nardi
- SOS Dept of Osteoarticular Pathology, Rovigo Hospital, Azienda ULSS 18, Rovigo, Italy
| | - Umberto Tarantino
- Dept of Orthopaedics and Traumatology, University of Rome, “Tor Vergata” School of Medicine, Rome, Italy
| | - Lorenzo Ventura
- Internal Medicine, Azienda Ospedaliera Carlo Poma, Mantova, Italy
| | - Pierantonio Armotti
- SOC Orthopaedics and Traumatology, Rovigo Hospital, Azienda ULSS 18, Rovigo, Italy
| | - Giuseppina Resmini
- SOC Orthopaedics and Traumatology, Treviglio-Caravaggio Hospital, Treviglio (BG), Italy
| | - Luisella Cozzi
- SOS Dept of Osteoarticular Pathology, Rovigo Hospital, Azienda ULSS 18, Rovigo, Italy
| | - Greta Tonini
- SOS Dept of Osteoarticular Pathology, Rovigo Hospital, Azienda ULSS 18, Rovigo, Italy
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Adami S, Maugeri D, Toscano V, Topa G, Carminiti M, Brancati A, Massarotti M, Osella G, Malavolta N, Iolascon G, Cagnoni C, Camozzi V, Corradini C, Nardi A, Migliaccio S, Ulivieri FM, Resmini G, Valle D, Tauchmanovà L, Silvestri S. Baseline characteristics of the population enrolled in the Italian Observational Study on Severe Osteoporosis (ISSO). Clin Exp Rheumatol 2011; 29:477-484. [PMID: 21640043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Accepted: 12/20/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVES Baseline characteristics of the population enrolled in the ISSO study, designed to evaluate the incidence of vertebral and non-vertebral fractures in Italian patients with severe osteoporosis treated according to clinical practice over 24 months observation. METHODS Prospective observational study in 783 post-menopausal women and men entering 18-month treatment with teriparatide in a community setting at 57 centres in Italy. Characterisation included demographics, fracture risk factors, bone mineral density, fracture status, Health-Related Quality of Life (HRQoL) measured by the European Quality of Life Questionnaire, EQ-5D, and back pain assessed by VAS. RESULTS Most patients were elderly women (90.5%), mean age±SD was 72.9±8.8 years. Nearly all (91.3%) had experienced ≥ 1 vertebral fracture (mean±SD, 3.6±2.2 per patient), 37.5% had ≥ 1 non-vertebral fracture (mean±SD, 1.4±0.7 per patient). Nearly all patients were suffering from back pain (94.9%), which had significantly restricted their daily activities (51.7%) and had likely or very likely been caused by vertebral fractures (29.2% and 55.8%, respectively). Mean EuroQoL EQ-5D index value was 0.58±0.25 and VAS score 49.2±23.6. Non-vertebral fractures, back pain and multiple vertebral fractures were associated with lower HRQoL (EuroQoL-5D Index both p<0.001, EQ-5D VAS score p=0.025 and p<0.016, respectively). Many patients were physically inactive (81.1%). One third (34.7%) of population had co-morbidities and 60.5% were on chronic concomitant treatments. Few subjects reported a maternal history of osteoporosis (15.5%), regular consumption of alcohol (13.3%) or were current smokers (11.5%). Nearly two-thirds (71.5%) had already been treated for osteoporosis, mainly with bisphosphonates. Calcium and vitamin D supplements were taken by 13% and 15.5% of the total population, respectively. CONCLUSIONS At enrollment, the population of ISSO study mostly consisted in aging women, who had osteoporosis with high fracture risk, poor HRQoL and suffered from significant back pain. Most of them had already been treated by bisphosphonates but without calcium and vitamin D supplements. Back pain, as well as non-vertebral and multiple vertebral fractures, were associated with lower HRQoL.
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Affiliation(s)
- S Adami
- Unità Riabilitazione Reumatologica Osseo-Articolare, Ospedale Maggiore Borgo Trento, Verona, Italy
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Resmini G, Iolascon G. New insights into the role of teriparatide. Aging Clin Exp Res 2011; 23:30-32. [PMID: 21970914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Parathyroid hormone (PTH) is secreted by the parathyroid glands and is an important regulator of blood calcium concentrations. Synthesis and secretion of PTH are stimulated by a decrease in blood calcium. PTH has three actions: 1) to increase the release of calcium from bone, 2) to reduce renal clearance of calcium, and 3) to stimulate the production of 1,25 (OH)2D3. Human parathyroid hormone is a single chain polypeptide with 84 amino acids and a molecular weight of 9425 Da. The N-terminal region, 1-34, is biologically active and sufficient for regulation of mineral ion homeostasis (1). Recombinant teriparatide {human PTH(1-34) [hPTH (1-34)]}, currently the only bone-forming osteoporosis drug available for clinical use, increases bone turnover with a greater stimulation of formation than resorption (2). Bone turnover markers also rise during treatment with teriparatide (TPTD), with markers of bone formation rising early and rapidly, followed by rises in bone resorption markers.
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Affiliation(s)
- Giuseppina Resmini
- Centre for the Study of Osteoporosis and Metabolic Bone Disease, Section of Orthopaedics and Traumatology, Treviglio-Caravaggio Hospital, Bergamo, Italy.
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Iolascon G, Resmini G, Gimigliano F. Severe osteoporosis and its identification. Aging Clin Exp Res 2011; 23:6-7. [PMID: 21970904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The severity of osteoporosis depends not only on densitometric data but implies the occurrence of at least one of the following conditions: increased risk of mortality, worsening of quality of life and significant disability in the performance of activities of daily living, presence of comorbidities that increase the risk of falls, the presence of at least one fragility fracture.
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Affiliation(s)
- Giovanni Iolascon
- Department of Orthopedics and Rehabilitation, Second University of Naples, 80138 Naples, Italy.
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Iolascon G, Resmini G, Tarantino U. Inhibition of RANK ligand: a new option for preventing fragility fractures. Aging Clin Exp Res 2011; 23:28-29. [PMID: 21970913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Cortical and trabecular bone undergo a continuous and balanced remodeling process, consisting of an osteoclast-mediated bone-resorption phase and an osteoblast- mediated bone-formation phase. An imbalance in this process, which favours bone resorption, results in bone loss and in damage to the skeletal microarchitecture. A new targeted anti-resorptive approach is represented by the inhibition of RANK ligand (RANKL), which is one of the primary mediators of osteoclast activity, essential for osteoclast formation, function and survival.
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Affiliation(s)
- Giovanni Iolascon
- Department of Orthopedics and Rehabilitation, Second University of Naples, Italy.
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Resmini G, Migliaccio S, Dalle Carbonare L, Sala U, Brama M, Fornari R, Maggi S, Siviero P, Malavolta N, Iolascon G. Differential characteristics of bone quality and bone turnover biochemical markers in patients with hip fragility fractures and hip osteoarthritis: results of a clinical pilot study. Aging Clin Exp Res 2011; 23:99-105. [PMID: 21743289 DOI: 10.1007/bf03351075] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND AIMS Bone density and quality alterations worsen the ability of osteoporotic bone to support prosthetic implants. The aim of our study was to evaluate potential differences in bone quality and bone turnover markers in aged individuals undergoing surgery for hip fragility fracture or hip osteoarthritis. METHODS Eighteen subjects with hip fragility fractures (Hip Fracture Group), 35 subjects with osteoarthritis of the hip (Hip Osteoarthritis Group) and 19 subjects with normal femoral bone mineral density (Control Group) were evaluated. Serum and urinary bone markers were assayed preoperatively in all surgical patients, and within 48 hours after fracture in the Hip Fracture, Osteoarthritis and Control groups. Histomorphometric analysis was performed on surgical samples. RESULTS A significant alteration in calcium and PTH serum levels with hyperparathyroidism was observed in the Hip Fracture Group compared with Hip Osteoarthritis and Control Groups. C-Terminal telopeptides of type I-collagen (CTx) and tartrate resistant-acid phosphatase (TRAP), markers of bone resorption, were increased in the Hip Fracture Group compared with both Osteoarthritis and Control Groups (CTx: p<0.0007 and p<0.0039 respectively; TRAP: p<0.002 and p<0.0007). All subjects were vitamin D3-deficient, but no differences were found among the different groups. In addition, histomorphometric data showed better maintained connectivity in the Osteoarthritis Group compared with the Hip Fracture Group (p<0.0001). CONCLUSIONS Our data show significant differences in bone turnover markers in patients undergoing hip prosthesis for fragility fractures, compared with patients operated for hip osteoarthritis.
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Resmini G, Iolascon G. 79-year-old post-menopausal woman with humerus fracture during teriparatide treatment. Aging Clin Exp Res 2007; 19:30-31. [PMID: 18182890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The patient, a 79-year-old woman with a history of osteoporosis, presented with acute back pain without trauma, three years ago. Spinal X rays showed a vertebral compression fracture at T7, and DXA indicated a T-score of -2.65 BMD at the total hip. The patient started treatment with alendronate 70 mg once a week, plus calcium and vitamin D supplementation. After two years, she presented new acute back pain, and spinal X-rays revealed new vertebral compression fractures at T8 and T11. In September 2004, she stopped alendronate therapy and began teriparatide 20 microg subcutaneously each day for 18 months, associated with a dose of 1200 mg/day of calcium and 880 IU/day of vitamin D. In July 2005, she fell and sustained a fracture of the left proximal humerus. She was treated with conservative therapy and continued teriparatide therapy. After 25 days of conservative management, left shoulder X-ray showed quick formation of fracture healing. In conclusion, although teriparatide is indicated for the treatment of severe osteoporosis and not to enhance fracture healing, there are many experimental data which indicate that it may be beneficial also in enhancing fracture healing.
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Affiliation(s)
- Giuseppina Resmini
- Centro per lo Studio dell'Osteoporosi e delle Malattie Metaboliche dell'Osso, U.O. di Ortopedia e Traumatologia, A.O. Ospedale di Treviglio-Caravaggio, Bergamo, Italy.
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Iolascon G, Gimigliano F, Resmini G. Teriparatide and orthopedic surgery. Aging Clin Exp Res 2007; 19:22-25. [PMID: 18182888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Teriparatide has an anabolic effect on bone tissue, leading to an increase in bone strength with a reduction in the risk of fragility fractures in osteoporotic women. In the last ten years, many animal studies have been conducted to support the hypothesis that this anabolic effect of teriparatide may benefit fracture healing by reducing the time of callus formation and remodeling. Teriparatide also seems to have an effect in the early post-operative period after osteosynthesis or joint replacement, by stimulating new bone formation, increasing bone-implant contact as early as after 1 week, and enhancing the tensile strength of the bone-cement interface, thereby decreasing the risk of late aseptic loosening. Scientific evidence supports the hypothesis that teriparatide may represent a huge resource for wide applications in orthopedic surgery.
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Affiliation(s)
- Giovanni Iolascon
- Dipartimento di Scienze Ortopediche, Traumatologiche, Riabilitative e Plastico-Ricostruttive, Seconda Università di Napoli, 80138 Napoli, Italy.
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Abstract
Aim of this study was to investigate whether osteoclast activity changes as a consequence of even mild physiological perturbation of plasma calcium as such induced by an oral calcium load. Osteoclast activity was determined indirectly by measuring, in spot urines at two and four hours after oral calcium load, the urinary excretion of hydroxylysylpyridinoline (Pyr), deoxylysylpyridinoline (D-Pyr), hydroxyproline (Hyp) and galactosyl-hydroxylysine (GHyl). The occurrence of the metabolic perturbation of plasma calcium homeostasis was assessed by measuring three indexes: i.e. calcemic response, PTH reduction and calciuric response at times following oral calcium loading. A significant fall of urinary D-Pyr and Pyr followed the perturbation of calcium homeostasis induced by the oral calcium load in two groups of healthy young adult and postmenopausal women. The highest mean percent reduction was observed for D-Pyr and was quantitatively similar in the two groups. Since urinary D-Pyr is the most specific bone resorption marker, it may be inferred that the perturbation of plasma calcium homeostasis induced by an oral calcium load is able to acutely inhibit osteoclast activity. This supports the view that osteoclasts are involved in the short-term error correction of plasma calcium.
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Affiliation(s)
- A Rubinacci
- Unità Metabolica dell'Osso, Istituto Scientifico San Raffaele, Milano, Italy
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Villa I, Banfi G, Daverio R, Resmini G, Rubinacci A. Osteocalcin production in vivo and in vitro after 1,25-dihydroxycholecalciferol stimulation comparison of different assays. Eur J Clin Chem Clin Biochem 1996; 34:771-5. [PMID: 8891532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The study was designed to assess the sensitivity of three commercial assays (which differ in methodology, standard and antibodies) for osteocalcin, used for detecting changes in osteocalcin secretion induced by calcitriol (1,25-dihydroxycholecalciferol) in vivo and in vitro. Osteocalcin levels were determined in serum samples of 10 osteoporotic women after short term calcitriol treatment, and in the culture medium of human osteoblast-like cells (n = 22) after 48 h calcitriol exposure. All assays displayed similar sensitivity in detecting osteocalcin production in vivo after a 1 microgram daily dose of calcitriol. A novel IRMA (CIS), claimed to detect intact osteocalcin, showed higher osteocalcin values than the other assays, and in vitro showed the best sensitivity; it provides an appropriate index of the osteocalcin synthetic activity of cultured human osteoblasts.
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Affiliation(s)
- I Villa
- Laboratorio di Osteologia, Unità Metabolica dell'Osso, Milano, Italia
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Sirtori P, Sosio C, Resmini G, Rubinacci A. Effect of short course of 1,25-dihydroxyvitamin D3 on biochemical markers of bone remodelling in postmenopausal women. Pharmacol Res 1996; 33:353-9. [PMID: 8971958 DOI: 10.1006/phrs.1996.0049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study was designed to test the hypothesis that a short treatment course of 1,25(OH)2D3 elicits a stimulation of osteoblast activity without any action on the osteoclast. To test this, oral daily doses of 0.5 microgram or 1 microgram of 1,25(OH)2D3 were administered for 7 days to two groups (n = 5 and n = 7, respectively) of postmenopausal women with low bone mineral density. Markers of osteoblast activity, i.e. osteocalcin (BGP), total alkaline phosphatase activity (ALP) and bone alkaline phosphatase activity (BALP), and markers of osteoclast activity, i.e. hydroxylysyl-pyridinoline (Pyr), lysyl-pyridinoline (D-Pyr), and galactosyl-hydroxylysine (GHyl) were measured in plasma and in fasting urinary samples, respectively, at sequential times during and after 1,25(OH)2D3 administration. It resulted that short term 1 microgram 1,25(OH)2D3 oral administration induced a significant (P < 0.05) rise of BGP serum level without any associated increase of D-Pyr and GHyl, the latter also expressed as GHyl to GGHyl ratio. Urinary Pyr increased significantly after 1 microgram daily doses of 1,25(OH)2D3. Thus, a short course of 1 microgram daily doses of 1,25(OH)2D3 elicits a stimulation of osteoblast activity without any enhancement of D-Pyr, the most specific marker of osteoclast activity. The enhancement of Pyr after 1 microgram daily doses of 1,25(OH)2D3 might be due to the activation of extraosseous metabolic pathways rather than to the activation of osteoclast.
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Affiliation(s)
- P Sirtori
- Unità Metabolica dell Osso, Istituto Scientifico San Raffaele, Milano, Italia
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Pontiroli AE, Pajetta E, Scaglia L, Rubinacci A, Resmini G, Arrigoni M, Pozza G. Analgesic effect of intranasal and intramuscular salmon calcitonin in post-menopausal osteoporosis: a double-blind, double-placebo study. Aging (Milano) 1994; 6:459-63. [PMID: 7748920 DOI: 10.1007/bf03324278] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Different types of calcitonin (porcine, human, salmon) are used in the management of bone diseases characterized by a high bone turnover, such as post-menopausal osteoporosis and Paget's disease; recently, salmon calcitonin has become clinically available as an intranasal (i.n.) spray. An analgesic effect has also been described for calcitonins, both in experimental animals and humans, but only a few studies in humans were placebo controlled. The aim of this study was to compare the analgesic efficacy of i.n. and intramuscular (i.m.) salmon calcitonin (sCT) and of placebo in women affected by painful post-menopausal osteoporosis, in a double-blind, double-placebo trial. Twenty-eight women were randomly allocated to one of the following treatments: 1) i.n. sCT 200 U/day plus i.m. placebo; 2) i.n. placebo plus i.m. sCT 100 U/day; and 3) i.n. and i.m. placebo. Each treatment lasted four weeks, and the pain score was evaluated weekly by means of a visual analogic scale (VAS). Twenty-four women completed the trial; with i.n. sCT, the pain score decreased significantly by the second week of treatment (p < 0.05); with i.m. sCT and with placebo, the pain score decreased significantly only by the fourth week (p < 0.05), so that the final pain scores obtained with the three treatments were not different. We conclude that i.n. sCT was probably more rapid, but not more effective than i.m. sCT or placebo in decreasing pain in post-menopausal osteoporosis.
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Affiliation(s)
- A E Pontiroli
- Istituto Scientifico San Raffaele, Università di Milano, Italy
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Rubinacci A, Divieti P, Capponi A, Resmini G, Daverio R, Veglia F, Tessari L. [Reduction in parathormone secretion after oral calcium loading in osteoporotic adults]. MINERVA ENDOCRINOL 1992; 17:55-65. [PMID: 1296145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The purpose of this study was to verify if a decreased inhibition of PTH secretion (abnormal suppressibility) in response to physiological increment of plasma calcium is present in patients with osteoporosis. The plasma concentration curve of intact PTH 1-84 following an oral calcium load (Pak) has been calculated in a selected population of 38 osteopenic patients (16 males and 22 females) and in a control group of 9 young healthy adults. All the patients included in this study a) had no past or present diseases and medications of potential influence on calcium homeostasis, b) showed a maximal calcemic response to the oral calcium load equal to that of the control group. PTH suppressibility was significantly smaller in the osteoporotic patients (-42% in males and -32% in females) than in the control group (-76%). This abnormal suppressibility of PTH is independent on sex and, in the females, also on postmenopausal estrogen deficiency. These results support the hypothesis that osteoporosis is associated to an altered secretory response of parathyroid glands maybe due to reduced sensitivity of the parathyroid cells to extracellular calcium.
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Affiliation(s)
- A Rubinacci
- Istituto Scientifico, Ospedale San Raffaele, Milano
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Rubinacci A, Resmini G, Divieti P, Capponi A, Daverio R, Tessari L. [The blood calcium error induced by oral calcium loading: study of the homeostatic compensation mechanism]. MINERVA ENDOCRINOL 1992; 17:47-54. [PMID: 1296144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The oral calcium load test, originally proposed for evaluating the intestinal calcium absorption and the renal calcium leak triggers some endocrine and metabolic responses addressed to correct the "calcemic error" induced by the load. Besides the increased plasma calcium there are: plasma PTH drop, increment in the urinary calcium excretion and in the threshold of tubular phosphate reabsorption. These responses have been measured and reciprocally correlated in 9 young adults at different times after the oral calcium load. The responses can be assessed with high precision in clinical practice and are in agreement with the known physiological models. The oral calcium load test is proposed as a tool for studying in the osteopenic population in the individual's capacity of correcting the calcemic error induced by the load.
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Affiliation(s)
- A Rubinacci
- Istituto Scientifico, Ospedale San Raffaele, Milano
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Pontiroli AE, Pajetta E, Calderara A, Alberetto M, Pozza G, Manganelli V, Resmini G, Tessari L, Maresca V. Intranasal and intramuscular human calcitonin in female osteoporosis and in Paget's disease of bones: a pilot study. J Endocrinol Invest 1991; 14:47-51. [PMID: 1646250 DOI: 10.1007/bf03350260] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
It has been shown that human calcitonin (hCT) is absorbed through the nasal mucosa when administered together with promoters like sodium glycocholate (SGC) or dihydrofusinate. The aim of this study was to compare the clinical and metabolic effect of intranasal (in) and intramuscular (im) hCT in patients with osteoporosis or with Paget's disease of bones. Fifteen women with postmenopausal or with senile osteoporosis entered a randomized six months trial with in hCT (plus SGC) or with im hCT 100 U on alternate days. Six women in each group were treated for 2 months, and only four women in each group continued treatment for an additional 4 months period. In hCT, but not im hCT, reduced subjective pain, while urinary cAMP increased to a similar extent in the 2 groups. Other metabolic indexes and bone mineral content (BMC) were unchanged, no new fractures took place, and side effects were fewer with in than with im hCT. To confirm the analgesic effect of in hCT, twelve patients with Paget's disease of bone were randomly treated for 20 days with in or im hCT 100 U/day: during the short period of treatment, pain was reduced by in, not by im hCT, and urinary cAMP excretion similarly increased in the two groups of patients.
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Rubinacci A, Moro GE, Resmini G, Fulconis F, Tessari L, Minoli I, Räihä NC. Sex-related differences of bone mineral content in low birthweight infants fed cow's milk formula. Acta Paediatr Scand 1990; 79:866-8. [PMID: 2239288 DOI: 10.1111/j.1651-2227.1990.tb11570.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- A Rubinacci
- Clinica Ortopedica, Istituto Scientifico San Raffaele, Milano, Italy
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