Alessandro de Sire

Can vitamin D deficiency influence muscle performance in post-menopausal women? A multicenter retrospective study.

BACKGROUND The presence of the vitamin D receptor (VDR) has been recently demonstrated in human muscle supporting the theory of a role of vitamin D in the proliferation and differentiation of muscle cells. So far only few studies investigated the association between vitamin D and muscle performance in postmenopausal women. AIM To define the functional impact of vitamin D deficiency. DESIGN Multicenter retrospective study. SETTING Five Italian outpatient services of Physical and Rehabilitation Medicine (PRM). POPULATION Postmenopausal women. METHODS We divided the population in two groups based on the threshold of 30 ng/mL as cut-off to define sufficient and insufficient serum levels of 25-hydroxyvitamin D3 [25(OH)D3]. Outcome measures were: appendicular lean mass (ALM); ALM-to-BMI ratio (ALMBMI); total fat mass (FM); visceral adipose tissue (VAT); Hand Grip Strength (HGS); Knee Isometric Extension Strength (KES); Short Physical Performance Battery (SPPB); 4-meter gait speed (4MGS). RESULTS We analyzed the data records of 401 postmenopausal women (mean age 66.93±8.47 years): 203 with hypovitaminosis D (mean age 66.81±8.11 years) and 198 with normal levels of 25(OH)D3 (mean age 67.04±8.84 years). The analysis showed a significant difference between the two groups in terms of: ALMBMI (0.002), FM (P<0.001), VAT mass (0.010), VAT volume (P=0.006), HGS (P<0.001), KES (P<0.001), SPPB score (P<0.001), percentage of people with a 4MGS≤0.8 m/s (P<0.001). Furthermore, there were significant correlations (P<0.001) between serum levels of 25(OH)D3 and HGS (r=0.323), KES (r=0.510), and SPPB sit to stand (r=-0.362) and walking sub-scores (r=-0.312). CONCLUSIONS This multicenter study demonstrated that postmenopausal women with vitamin D deficiency had a significant reduction of appendicular muscle strength and physical performance. CLINICAL REHABILITATION IMPACT This study reported the frequency of hypovitaminosis D in postmenopausal women and its influence on the reduction of muscle mass, strength, and physical performance in a typical population referring to the physiatrist for musculoskeletal disorders.

Functional Evaluation of the Subjects with Skeletal Alterations

The appropriate management of osteoporotic patients, with or without fragility fracture, should include a comprehensive functional evaluation in order to define the alterations in functioning of the various organs and systems involved in the pathological process and its complications. The functional evaluation has to follow to an accurate anamnesis and inspection of the patient and should collect information on the range of motion of the joints, on muscle mass, strength, and power, and on balance, disability, and pain. An assessment of the Health Related Quality of Life is also mandatory as its improvement should be the major goal of any treatment.

Rehabilitation Therapy After Surgery in Osteoporotic Patients

Osteoporosis is a skeletal disorder characterized by compromised bone strength predisposing to an increased risk of fragility fractures that could induce long-term morbidity, functional limitation, decreased quality of life, and increase mortality. The most frequent sites of fragility fractures are the vertebrae, hip, wrist, proximal humerus, and ankle. In several cases, a surgical approach with subsequent rehabilitative treatment is required. The main aims of rehabilitation are restoring pre-fracture functioning and improving patients’ activities, participation level, and quality of life.

Safety Profile of High-Dose Botulinum Toxin Type A in Post-Stroke Spasticity Treatment

Botulinum toxin type A (BoNT-A) is considered the gold standard for the treatment of focal post-stroke spasticity (PSS). However, a recently published study estimated that a significant percentage of patients affected by PSS could benefit from higher doses of BoNT-A than those permitted by current directives in the countries studied. Several studies have reported the use of high doses of BoNT-A in the management of patients affected by severe PSS; however, the most important adverse effect of this drug might be systemic diffusion of the toxin, which could potentially be related to its dose. Even if systemic toxicity is a rare event, fear of systemic toxicity is still the most relevant concern regarding use of high doses. The aim of our narrative review was to show the state of the art on the use of high doses of BoNT-A in patients affected by PSS in order to define the safety profile, focusing on both clinical and instrumental assessment of systemic effects. Current evidence from the literature suggests that higher doses of BoNT-A are effective in reducing spasticity of upper and lower limbs after stroke, with rare occurrence of mild adverse effects. The use of high doses seems to be an effective and safe therapeutic option to reduce multifocal or generalized PSS in selected patients. In particular, the potential role of higher doses in order to improve the functional outcome of these patients should be noted.

No. 351 Influence of Sarcopenic Obesity on Osteoporosis and Vertebral Fragility Fractures in Post-Menopausal Women

Introduction Recent evidences suggest that osteoporosis, sarcopenia and obesity share physiopathological features.1 Since 1996, the involuntary loss of skeletal muscle mass coexisting with excess body fat has been defined as sarcopenic obesity.2 Recently, this condition has been identified as a key risk factor for fractures in obese postmenopausal women.3 In fact, in obese subjects, there is an increased risk of all osteoporotic fractures after adjusting for BMD data, suggesting an independent effect of obesity on fracture risk.4 The hypothesis is that obesity increases the percentage of intramuscular fat mass infiltration, lowering muscle quality and physical performance, with increased risk of falls and fractures.1,5 The recommended method for the quantification of muscle mass is Dual energy X-ray Absorptiometry (DXA),6 based on assessment of total fat mass and appendicular lean mass.7 The aim of our study is to evaluate the influence of sarcopenic obesity on osteoporosis and vertebral fragility fractures in post-menopausal women. Influence of sarcopenic obesity on osteoporosis and vertebral fragility fractures in post-menopausal women