The role of bone anabolic drugs in the management of periodontitis: a scoping review.

The aim of this scoping review was to summarise current knowledge about the effects of bone anabolic drugs on periodontitis, in order to identify new therapeutic strategies for preventing disease progression and reducing tooth loss. A technical expert panel (TEP) was established of 11 medical specialists, including periodontists and bone specialists that followed the PRISMA-ScR model to perform the scoping review and considered for eligibility both pre-clinical and clinical studies published in the English language up to September 2020. 716 items were initially found. After duplicate removal and screening of articles for eligibility criteria, 25 articles published between 2001 and 2019 were selected. Only studies concerning teriparatide, strontium ranelate, sclerostin antibodies and DKK1 antibodies met the eligibility criteria. In particular, only for teriparatide were there both clinical studies and experimental studies available, while for other bone anabolic drugs only animal studies were found. Available evidence about the use of bone anabolic drugs in periodontology demonstrates beneficial effects of these agents on biological pathways and histological parameters involved in periodontal tissue regeneration that suggest relevant clinical implications for the management of periodontitis.

Persistence with denosumab therapy in women affected by osteoporosis with fragility fractures: a multicenter observational real practice study in Italy.

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.

Whole body vibration in sport: a critical review.

Whole body vibration training is a recent area of study in athletic conditioning, health and rehabilitation. This paper provides a review of the effectiveness of this type of training in sport. A search was conducted across several electronic databases and studies on effects of whole body vibration training on sport performance were reviewed. Thirteen articles were included in the final analysis. The following variables were considered: participants investigated (sex and age), characteristics of the vibration (frequency and amplitude), training (type of sport, exposure time and intensity, tests used, type of study, effects examined and results obtained). This review considers proposed neural mechanisms and identifies studies that have demonstrated the effectiveness of WBV in sports. It considers where WBV might act and suggests that vibration can be an effective training stimulus. Future studies should focus on evaluating the long-term effects of vibration training and identify optimum frequency and amplitude, improve strength and muscular performance.

Risk of pelvic floor dysfunctions in young athletes.

PURPOSE OF INVESTIGATION: Numerous epidemiological studies have shown a correlation between sport and the development of pelvic floor dysfunction. Therefore, the aim of the present study was to evaluate the prevalence of urinary incontinence in female young athletes. MATERIALS AND METHODS: The epidemiological study was conducted on 105 female volleyball players, who were given a questionnaire, self-compiled, consisting of four main domains (personal data and medical history, urinary incontinence, urinary disorders, and judgment on the questionnaire). RESULTS: In a total of 105 athletes, the present authors observed that 65.7% had reported at least one symptom of stress urinary incontinence (SUI) and/or urgency, during sport or in daily life situations. In particular, the 49.52% reported urge urinary incontinence, 20% urine loss for urgency, and 29.52% SUI. In addition, the present authors observed that nocturia was reported in 70.48% of cases, incomplete bladder emptying in 55.24%, urinary hesitancy in the 36.19%, and pelvic pain in 52.38%. In all cases, the symptoms were occasional and low. In relation to the coexistence of symptoms, the present authors observed that 22.85% of athletes had only symptoms of urge urinary incontinence, 6.66% mixed incontinence, and 6.66% symptoms of urge urinary incontinence associated to urine loss for SUI. CONCLUSION: The present authors observed a relationship between the sport and the pelvic floor dysfunction, in particular urinary incontinence.

NSAIDs and opioids in management of fragility fractures.

Fragility fractures and their care are a major burden on individuals, health systems, and social care systems in industrialized countries. Fragility fracture can lead to long lasting painful and disabling condition. The level of pain is a major determinant for the outcome of any treatment of these fractures regardless of its location. The treatment of pain in patient with fragility fracture is rarely considered a priority in the care pathway.

Rehabilitative approach in patients with vertebral fragility fracture.

Osteoporosis is a skeleton disease characterized by low bone mineral density and deterioration of bone tissue, resulting in an increased risk of fragility fracture. Osteoporotic vertebral fractures are recognized as a significant health problem particularly in older people with an impact on the quality of life, mobility and mortality. A well-timed diagnosis and treatment is necessary in preventing further vertebral fracture and their consequences. Exercise alone or as part of physical therapy management is often recommended as a non-pharmacological intervention. The exercise protocols, designed specifically for individuals with vertebral fracture, should include postural correction, trunk and lower extremity muscle strengthening, balance exercises and falls prevention program. The aim of this short communication is to examine the rationale of a rehabilitation protocol after a vertebral fracture.

Characteristics and circumstances of falls in hip fractures.

Osteoporosis is a chronic disease characterized by a loss of bone mass and deterioration of bone microstructure that lead to a greater risk of fragility fractures. Fall is generally the main cause of fractures. Hip fractures are the most common ones and are usually correlated to a greater morbidity and mortality. The aim of our observational study was to evaluate, among patients with hip fragility fracture, characteristics and circumstances of falls. We conducted a national epidemiological survey, involving 80 physiatrists. They were asked to collect data on patients over 55 years of age who underwent a fragility fracture in the 12 months prior to recruitment. For each patient they had to fill a form including questions on different aspects of patients' medical history: age, gender, reason for the visit, type of fracture, number of falls in the last year and the year before the fall. Among 419 patients who sustained hip fracture, 70 had experienced a fall, while 119 were incurred in more falls in the 12 months before the fracture. In most people of our cohort, hip fracture was caused by a fall that occurred on the side during the morning.

Post-surgical rehabilitative approach to fragility fractures.

Osteoporosis is a skeletal disorder characterized by compromised bone strength predisposing to an increased risk of fracture. The most frequent sites of fragility fractures are the hip, the distal radius, the spine, the proximal humerus, and the ankle. In most cases, a surgical approach with subsequent rehabilitative treatment is required. The general aims of rehabilitation are to increase functioning and improve patients' activities, participation level, and quality of life.

Sarcopenia in women with vertebral fragility fractures.

We performed a pilot study with the purpose to evaluate the prevalence of sarcopenia in osteoporotic women with vertebral fractures. Dual-energy X-ray absorptiometry (DXA) was used to measure the whole and regional body composition. Appendicular lean mass (aLM) was calculated as the sum of lean mass in arms and legs. We calculated the skeletal muscle mass index (aLM/h(2)), and we measured bone mineral density and T scores by DXA scan at total-body and at femoral neck. Participants were divided according to the number of vertebral fractures (single or multiple fractures). A total of 67 women were included. Thirty-five women (52.23%) had a vertebral fracture, of them 8 (22.85%) were sarcopenic and 32 women (47.76%) had multiple vertebral fractures, of them 14 (43.75%) were sarcopenic. Our results suggest that sarcopenia is common among osteoporotic women increasing along with the number of vertebral fragility fractures.

Hip fractures in Italy: 2000-2005 extension study.

SUMMARY: A total of 507,671 people > or =65 experienced hip fractures between 2000 and 2005. In 2005, 94,471 people > or =65 were hospitalized due to hip fractures, corresponding to a 28.5% increase over 6 years. Most fractures occurred in patients > or =75 (82.9%; n = 420,890; +16% across 6 years), particularly in women (78.2%; n = 396,967). INTRODUCTION: We aimed to analyze incidence and costs of hip fractures in Italy over the last 6 years. METHODS: We analyzed the national hospitalization and DRG databases concerning fractures occurred in people > or =65 between 2000 and 2005. RESULTS: A total of 507,671 people > or =65 experienced hip fractures across 6 years, resulting in about 120,000 deaths. In year 2005 94,471 people aged > or =65 were hospitalized due to hip fractures, corresponding to a 28.5% increase over 6 years. The majority of hip fractures occurred in patients > or =75 (82.9%; n = 420,890; +16% across 6 years) and particularly in women (78.2%; n = 396,967). Among women, 84.2% of fractures (n = 334,223; +28.0% over 6 years) were experienced by patients > or =75, which is known to be the age group with the highest prevalence of osteoporosis, accounting for 68.6% of the overall observed increase in the total number of fractures. Hip fractures in men > or =75 increased by 33.1% (up to 16,540). Hospitalization costs increased across the six examined years (+36.1%) reaching 467 million euros in 2005, while rehabilitation costs rose up to 531 million in the same year. CONCLUSIONS: Hip fractures of the elderly are increasing and represent a major health problem in industrialized countries such as Italy.

Three-dimensional laser scanning as a reliable and reproducible diagnostic tool in breast cancer related lymphedema rehabilitation: a proof-of-principle study.

OBJECTIVE: In this study, we aimed to assess the reproducibility and reliability of a three-dimensional laser scanner (3DLS) in measuring the upper limb volume of BRCL women undergoing a 2-week complete decongestive therapy (CDT). PATIENTS AND METHODS: 3DLS and CM were used to measure the upper limb volume in a cohort of BCRL women before (T0) and after (T1) a 2-week CDT. We evaluated: a) correlation between 3DLS and CM at both time points; b) level of agreement and the consistency of the different measurements at both time points; c) correlation between the inter-rater operator analysis in terms of total limb volume differences before and after rehabilitative treatment of both circumferential method and laser scanning 3D in breast cancer related lymphedema patients. RESULTS: Taken together, 43 BCRL women (age 51.1 ± 5.4 years) were included. Both 3DLS and CM showed a significant inter and intra-operator correlation in the arm volume measurement at both time-points (T0: r2=0.99, p<0.0001; T1: r2=0.99, p<0.0001). 3DLS showed a strong correlation with CM (r2=0.99, p<0.0001) in terms of volume measurement and provided greater intra-operator correlation (r2=0.92 vs. 0.62) in detecting volume variations after the treatment (T1-T0). CONCLUSIONS: 3DLS confirmed to be highly sensitive, cheap and easy-to-use in the evaluation of the upper limb volume in BCRL women before and after a rehabilitative treatment. These findings suggest that augmented reality technologies might be very useful in oncological rehabilitation.

Vitamin D supplementation in fractured patient: how, when and why.

Vitamin D, through its action on calcium metabolism, is essential for bone physiology. It's also required in a wide range of biological systems to act modulating the proliferation and inducing terminal differentiation of a variety of normal cells. Actually vitamin D deficiency can impact muscle function and increases fall risk in elderly, while severe vitamin D deficiency (< 30 nmol/L) is common in patients with fragility fractures. Vitamin D and calcium supplementation, in addition to antiosteoporosis treatment after surgery or conservative treatment, can ensure optimal recovery and survival, especially in hip fractured patients.

The role of 3D imaging in the follow-up of patients with repaired tetralogy of Fallot.

OBJECTIVE: The patients with repaired Tetralogy of Fallot (rToF) are a growing population due to the improvement of surgical management in neonatal age. However, the significant pulmonary regurgitation, consequent to the repair, is the most frequent sequelae and leads to a progressive right ventricle dilation over time. The latter, in turn, is responsible for the possible dysfunction of right and/or left ventricle and an increased risk of dangerous ventricular arrhythmias. Therefore, right ventricle monitoring is necessary for rToF patients and a 3D method is required due to its three anatomical and functional subunits. Magnetic resonance imaging (MRI) has become the 3D modality of choice in the evaluation of both cardiac anatomy and ventricular volumes in rToF patients since it is able to evaluate both the pathophysiology and anatomy, it is free of radiation and, when strictly necessary, it uses a non-iodinated contrast agent. Cardiac CT should be considered in the evaluation of the sequelae in rToF only in selected cases, given that it implies a radiation dose and iodinated contrast, in addition to not evaluating the pathophysiology as MRI.

Are Dietary Supplements and Nutraceuticals Effective for Musculoskeletal Health and Cognitive Function? A Scoping Review.

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.

Sports Eligibility After Risk Assessment and Treatment in Children with Asymptomatic Ventricular Pre-excitation.

BACKGROUND AND OBJECTIVE: Many studies concern the management of young patients with symptomatic Wolff-Parkinson-White (WPW) syndrome, but little information exists on the significance and prognosis of ventricular pre-excitation (VPE) in asymptomatic children. The aim of the study was to evaluate the risk of sudden death in young athletes with asymptomatic VPE by transesophageal electrophysiological study (TEEPS) and their sports eligibility after the risk assessment and/or ablative treatment. METHODS: Ninety-one asymptomatic children and adolescents underwent TEEPS both at rest and during adrenergic stress (exercise testing or isoproterenol infusion). After electrophysiological testing, patients were assessed in the 36 months of follow-up. RESULTS: Thirty-three patients (36.3 %) had a benign form of VPE and were allowed to participate in competitions. Ten patients (11 %) were at borderline risk; thus, sport eligibility was evaluated individually. Forty-eight patients (52.7 %) showed inducible sustained atrioventricular reentrant tachycardia and/or atrial fibrillation (AF), 11 of whom (12.1 % of total population) had a potential risk of sudden cardiac death due to AF inducibility during physical stress. Forty-five young athletes underwent transcatheter ablation (TCA). TCA was interrupted in 12 patients (26.7 %) because of the high procedural risk linked to septal accessory pathway (AP) location. There were no TCA-related complications, and all patients remained asymptomatic during follow-up. CONCLUSION: Most of the young athletes with asymptomatic VPE may be allowed to participate in competitive sports after an adequate risk assessment and/or ablative treatment. However, in our opinion, special care should be taken to avoid procedural complications, which are unacceptable in asymptomatic patients.

Conservative treatment of traumatic shoulder instability: a case series study.

PURPOSE: The aim of this case series study was to evaluate the efficacy of a rehabilitative approach to restoring stability, range of motion, and function of shoulder joint in non-operated adults presenting a first episode of traumatic anterior shoulder dislocation. METHODS: In this case series study, we evaluated patients aged from 20 to 44 years, with diagnosis of first episode of traumatic anterior shoulder dislocation. All participants underwent a conservative treatment protocol, lasting 3 months. The primary outcome measure was the Rowe score for instability. Follow-up evaluations were done at 3, 6, 12, and 24 months. RESULTS: We evaluated 32 participants mean aged 27.94 ± 2.23 years. At the baseline (T 0), the participants had a mean Rowe score of instability of 44.53 ± 7.00 SD, where 81.25% had a poor score and 18.75% had a fair score. At 24 months (T 4), the Rowe score for instability was 79.84 ± 6.66 SD. 21.88% of patients had a fair score, 71.87% had a good score, and 6.25% had an excellent score. CONCLUSIONS: We showed that our rehabilitative approach seems to be effective in the conservative management of shoulder instability in adults with first episode of traumatic anterior shoulder dislocation, not involved in sport activity, and not overhead workers.

Classification of functioning and assessment of fracture risk of a large Italian osteoporotic population. The Physiatric Approach To Osteoporosis project.

BACKGROUND: Osteoporosis is a skeletal disorder characterized by compromised bone strength predisposing to an increased risk of fracture. Osteoporotic fractures cause significant morbidity, disability, and decrease in quality of life. AIM: The aims of the Physiatric Approach To Osteoporosis (PATO) project were to classify osteoporotic patients with or without fragility fractures, using the Brief ICF (International Classification of Functioning, Disability and Health) Core Set for Osteoporosis and to calculate the fracture risk with the WHO FRAX® (World Health Organization Fracture Risk Assessment Tool) algorithm. DESIGN: Cross-sectional survey. SETTING: Seventy-nine Italian Rehabilitation Services distributed throughout Italy. POPULATION: Osteoporotic patients. METHODS: Each physiatrist involved in the survey was asked systematically to record demographic data, presence of fragility fractures, anamnestic risk factors included in the FRAX® Assessment Tool, ICF categories as they are listed in the Brief ICF Core Set for Osteoporosis, and treatment data of 100 osteoporotic patients (50 with at least a clinical fragility fracture and 50 without). RESULTS: In accordance with the FRAX® algorithm, the 35.22% of the interviewed osteoporotic patients had a FRAX® MAJ≥20.00 and the 70.32% had a FRAX® HIP≥3.00. The most commonly impaired ICF categories were the sensation of pain for the body functions, the structure of the trunk for body structures, lifting and carrying objects for the domain of activities and participation, and products or substances for personal consumption for the environmental factors. CONCLUSION: The FRAX® Assessment tool has been recognized as useful to identify people at high risk of fracture and the Brief ICF Core Set seems to be an important framework to be followed when dealing with osteoporotic patients in an outpatient setting or for clinical studies. CLINICAL REHABILITATION IMPACT: Osteoporosis is well recognized as a disabling disease, posing a significant challenge for the society, therefore physiatrists should always be involved, from prevention to treatment.

Effects of focal muscle vibration on physical functioning in patients with knee osteoarthritis: a randomized controlled trial.

BACKGROUND: Knee osteoarthritis (OA) is a chronic condition characterized by pain, stiffness and functional limitations. According to the OsteoArthritis Research Society International (OARSI) recommendations, patients with knee OA should undertake regular quadriceps muscle strengthening exercises. Whole body vibration (WBV) proved its effectiveness in strengthening of the quadriceps muscles and improving balance in chronic knee OA patients. To date, there are no published studies that investigated the effects of focal muscle vibration (FMV) in these patients. AIM: The aim of the present study was to evaluate the effects of FMV on physical functioning in patients with symptomatic knee OA. DESIGN: Randomized controlled trial. SETTING: Outpatient clinic, University Hospital. POPULATION: Men and women aged 60 years or older with radiographic diagnosis of mild to moderate monolateral knee OA (Kellgren-Lawrence grade II or III) and chronic knee pain. METHODS: Patients were randomized in two groups (treatment group and placebo control group). The treatment group received FMV treatment, according to the "repeated muscle vibration" protocol. The control group received a sham treatment. The primary outcome measure was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Secondary outcome measures were the Short Physical Performance Battery (SPPB) and the Performance-Oriented Mobility Assessment (POMA). Follow up evaluations were done at 3 and 6 months. RESULTS: Fifty patients were recruited and randomly assigned to either the study or control group. There was a statistical significant difference between the two groups both for primary (WOMAC) and secondary (SPPB and POMA) outcomes. CONCLUSIONS: In this study, FMV therapy has proven to be effective and safe in improving functioning of patients affected by mild to moderate chronic knee OA. CLINICAL REHABILITATION IMPACT: The use of FMV therapy might be an additional and safe tool in the conservative management of knee OA.

Pulsed Doppler echocardiographic analysis of mitral regurgitation after myocardial infarction.

In 72 patients with previous myocardial infarction (MI), mitral regurgitation (MR) was assessed by pulsed-wave Doppler echocardiography and compared with physical and 2-dimensional echocardiographic findings. MR was found by Doppler in 29 of 42 patients (62%) with anterior MI, 11 of 30 (37%) with inferior MI (p less than 0.01) and in none of 20 normal control subjects. MR was more frequent in patients who underwent Doppler study 3 months after MI than in those who underwent Doppler at discharge (anterior MI = 83% vs 50%, p less than 0.01; inferior MI = 47% vs 27%, p = not significant). Of 15 patients who underwent Doppler studies both times, 3 (all with anterior MI) had MR only on the second study. Of the patients with Doppler MR, 12 of 27 (44%) with a left ventricular (LV) ejection fraction (EF) greater than 30% and 1 of 13 (8%) with an EF of 30% or less (p less than 0.01) had an MR systolic murmur. Mitral prolapse or eversion and papillary muscle fibrosis were infrequent in MI patients, whether or not Doppler MR was present. The degree of Doppler MR correlated with EF (r = -0.61), LV systolic volume (r = 0.47), and systolic and diastolic mitral anulus circumference (r = 0.52 and 0.51, respectively). Doppler MR was present in 24 of 28 patients (86%) with an EF of 40% or less and in 16 of 44 (36%) with EF more than 40% (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Long-term outcomes of perineal rehabilitation.

AIM: Pelvic floor muscle training (PFMT) is classified with a level 1 evidence and a grade A recommendation, but long term effects have not been studied thoroughly. This study aims at assessing the long-term effectiveness of perineal rehabilitation on patients with mild prolapse and pure stress urinary incontinence (IUS) symptoms. METHODS: Retrospective observational study on 49 patients examined at the beginning of the observation and 60 months after receiving biofeedback assisted PFMT. We created two groups. Group A: 27 women with mild symptoms of prolapse and pure mild IUS; Group B: 22 symptomatic patients postsurgery. We considered as therapeutic success a 50% general reduction of the symptoms experienced by the patients in terms of reduction of leakage episodes, number of pads used, strength and endurance of the pubococcygeus muscle and initial prolapse signs/symptoms. RESULTS: Group A (follow-up 60 months): Reduction of prolapse symptoms: cured/much improved: 65% (17 patients); worsened: 22.4% (6 patients); unchanged: 18.5% (5 patients); reduction of urinary symptoms: cured/much improved: 59.3% (16 patients); surgery: 40.7% (11 patients); group B (follow-up 60 months); cured: 55.5% (12 patients); much improved: 44% (10 patients). CONCLUSION: In conclusion, as for the treatment of menopausal patients with symptoms of mild disorders of the urinary/genital system, excellent results were reported in women underwent rehabilitation, as a first approach or after failed TVT-O.