Underreported vertebral fractures in an Italian population: comparison of plain radiographs vs quantitative measurements.

PURPOSE: Vertebral fractures (VFs) are the hallmark of osteoporosis and are responsible for almost 70,000 hospital admissions yearly, implying social costs and impaired quality of life for patients. In recent years, several techniques, both qualitative and quantitative, have been proposed for VF diagnosis, but a gold standard is not yet available and the visual semiquantitative (VSQ) assessment proposed by Genant remains the most validated. However, given the lack of a standardised method, in clinical practice, the diagnosis of VF is often missed, and patients are not correctly assessed. The aim of our study was to estimate the percentage of VFs not detected in clinical practice in italian population using the VSQ method and a new morphometric technique. MATERIALS AND METHODS: In 283 postmenopausal women referred to our clinic for osteoporosis screening, we performed a clinical examination, plain spinal radiographs (for VSQ assessment) and digital computerised morphometry (DCM) to assess VFs. Bone density was measured using dual-energy X-ray absorptiometry (DXA). RESULTS: Forty-seven percent of patients had a T score <-2.5 standard deviations (SD), and 35.2% were osteopenic, but no significant correlations between T score and grade or number of fractures were found. DCM identified VFs in 38.5% of patients versus 32.5% using the VSQ method. Overall, 280 VFs were detected by DCM and 236 by VSQ, whereas only 105 were recognised by the reports. CONCLUSIONS: VFs went undetected in 55.5% according to the VSQ method on standard spinal radiographs. Therefore, the morphometric technique may be helpful when performed with the semiquantitative approach to improve recognition of VFs. However, other studies are needed to further validate the utility of this new morphometric technique in clinical practice.

Effects of mud-pack treatment on plasma cytokine and soluble adhesion molecule levels in healthy volunteers.

BACKGROUND: The suggested hypothesis of a direct anti-inflammatory property of mud-pack treatment has led us to speculate that its action on the cytokine network might counteract the heat-stress-related effects on platelet and endothelial cell function often reported following hot-spring baths. Therefore, the present study was designed to investigate the effects of a cycle of 12 daily mud-pack treatments on bio-humoral markers of inflammation, as well as on markers of in vivo platelet and/or endothelial cell activation, in plasma samples obtained from healthy volunteers. METHODS: Blood samples were obtained before (T(0)), at the end of the first treatment (T(1)) and after a cycle of 12 daily mud-pack treatments (T(2)). Plasma cytokines (TNF-alpha IL-1beta, and IL-6) and adhesion molecules (sP-selectin, sE-selectin and sVCAM) levels, as well as hematocrit and complete and differential blood cell counts were determined at every time point. RESULTS: Plasma sP-selectin levels were not modified during treatment, as were not sE-selectin or sVCAM. Similarly, IL-1beta and TNF-alpha levels were unchanged through a 12 daily mud-pack treatment. Conversely, plasma IL-6 levels were significantly lowered at the end of a 20-min 47 degrees C mud-pack treatment (p<0.01). CONCLUSIONS: The lack of effects on in vivo platelet and/or endothelial cell activation suggests that hot mud-pack treatment might be used as a relatively safe procedure in patients with atherothrombotic disorders.