Coşkun Zateri

Risk of falls in patients with ankylosing spondylitis.

BackgroundRisk of vertebral fractures is increased in patients with ankylosing spondylitis (AS). The underlying mechanisms for the elevated fracture risk might be associated with bone and fall-related risks. The aims of this study were to evaluate the risk of falls and to determine the factors that increase the risk of falls in AS patients. MethodsEighty-nine women, 217 men, a total of 306 AS patients with a mean age of 40.1 ± 11.5 years from 9 different centers in Turkey were included in the study. Patients were questioned regarding history of falls within the last 1 year. Their demographics, disease characteristics including Bath AS Disease Activity Index, Bath AS Metrology Index (BASMI), Bath AS Functional Index (BASFI), and risk factors for falls were recorded. The Short Physical Performance Battery (SPPB) test was used for evaluation of static and dynamic balance. Erythrocyte sedimentation rate, C-reactive protein, and 25-hydroxyvitamin D levels were measured. ResultsForty of 306 patients reported at least 1 fall in the recent 1 year. The patients with history of falls had higher mean age and longer disease duration than did nonfallers (P = 0.001). In addition, these patients’ BASMI and BASFI values were higher than those of nonfallers (P = 0.002; P = 0.000, respectively). We found that the patients with history of falls had lower SPPB scores (P = 0.000). We also found that the number of falls increased with longer disease duration and older age (R = 0.117 [P = 0.041] and R = 0.160 [P = 0.005]). Our results show that decreased SPPB scores were associated with increased number of falls (R = 0.183, P = 0.006). Statistically significant correlations were found between number of falls and AS-related lost job (R = 0.140, P = 0.014), fear of falling (R = 0.316, P = 0.000), hip involvement (R = 0.112, P = 0.05), BASMI (R =0.234, P = 0.000), and BASFI (R = 0.244, P = 0.000). ConclusionsAssessment of pain, stiffness, fatigue, and lower-extremity involvement as well as asking for a history of falls will highlight those at high risk for further falls. In addition to the general exercise program adopted for all patients, we suggest that a balance rehabilitation program should be valuable for the patients with risk factors for fall. Exercise may improve fear of falling and BASFI and BASMI scores. However, further study is needed to investigate these hypotheses. We believe that clinicians should train and support the patients via reducing fear of falls and maintaining good posture and functional capacity.

Arm span-height difference is not an indicator of osteoporosis or associated vertebral deformity in postmenopausal women.

We studied ninety postmenopausal women who were suspected of having osteoporosis and aimed to investigate if ’arm span‐height difference’ value can help to estimate osteoporosis or related vertebral fractures. Osteoporosis was found in 51 of the patients. There was no statistical difference between osteoporotic and nonosteoporotic patients for ’arm span‐height’ value (p is less than 0.05). No statistical difference was determined between total Kleerekoper score and ’arm span‐height difference’ value (p is less than 0.05). It did not seem convenient to estimate the presence of osteoporosis and related fractures by the help of ’arm span‐height difference’ value.

The relation between chondromalacia patella and meniscal tear and the sulcus angle/ trochlear depth ratio as a powerful predictor.

PURPOSE To investigate the relation between chondromalacia patella and the sulcus angle/trochlear depth ratio as a marker of trochlear morphology. In addition, we also planned to show the relationship between meniscus damage, subcutaneous adipose tissue thickness as a marker of obesity, patellar tilt angle and chondromalacia patella. METHODS Patients with trauma, rheumatologic disease, a history of knee surgery and patellar variations such as patella alba and patella baja were excluded. Magnetic resonance images of the knees of 200 patients were evaluated. Trochlear morphology from standardized levels, patellar tilt angle, lateral/medial facet ratio, subcutaneous adipose tissue thickness from 3 locations and meniscus injury were assessed by two specialist radiologists. RESULTS Retropatellar cartilage was normal in 108 patients (54%) at radiological evaluation, while chondromalacia patella was determined in 92 (46%) cases. Trochlear sulcus angle and prepatellar subcutaneous adipose tissue thickness were significantly high in patients with chondromalacia patella, while trochlear depth and lateral patellar tilt angle were low. The trochlear sulcus angle/trochlear depth ratio was also high in chondromalacia patella and was identified as an independent risk factor at regression analysis. Additionally, medial meniscal tear was observed in 35 patients (38%) in the chondromalacia patella group and in 27 patients (25%) in the normal group, the difference being statistically significant (P = 0.033). CONCLUSIONS An increased trochlear sulcus angle/trochlear depth ratio is a significant predictor of chondromalacia patella. Medial meniscus injury is more prevalent in patients with chondromalacia patella in association with impairment in knee biomechanics and the degenerative process.

Pain, Body Mass Index, and Bone Mineral Density in Patients with Postmenopausal and Senile Osteoporosis

Objective: Osteoporosis [OP] itself does not cause pain and usually has no signs or symptoms. However, pain occurs when there is a fracture or a posture change due to OP. The purpose of this retrospective study was to explore the pain condition in patients with postmenopausal and senile OP. Methods: We studied symptoms of pain in 909 postmenopausal women between the ages of 33 and 89 years. The patients were retrospectively assessed in our outpatient service. Menopause age, duration of menopause, bone mineral density [BMD] values [gr/cm2], their reports of pain, duration of the pain experienced, and body mass index [BMI] were recorded. Results: We found 695 patients [76.45 percent] reported experiencing pain and 214 patients [23.54 percent] reported no pain. The duration of pain was 8.7 ± 5.27 [minimum: 1, maximum: 26] years. We detected 82 cervical [11.79 percent], 77 dorsal [11.07 percent], 175 lumbar [25.17 percent], 183 knee [26.33 percent], and 177 general [25.46 percent] cases of pain. There was no significant difference in BMD between patients with and without pain [P > 0.05]. The mean BMI of patients with pain were significantly higher than the mean BMIs of patients without pain. Among the patients who reported experiencing pain, the highest BMI values were in the knee pain group. Mean BMIs of the knee pain and dorsal pain groups were significantly higher than the mean BMIs of the painless group. Conclusion: OP commonly affects the spine and may cause debilitating pain. Pain can be either a warning sign of weakened bones and potential injury for women or a symptom of a spinal fracture. However, we did not find a significant association between a change in BMD and pain in postmenopausal and senile women. We detected a relationship between pain and BMI in the patients with knee, dorsal, and general pain.

Evaluation of the efficacy of therapeutic ultrasound on bone mineral density in postmenopausal period

Therapeutic ultrasound is a frequently used modality in the practice of physical therapy. However, its effects on osteoporosis (OP) are not clear. We investigate the effect of therapeutic ultrasound on bone mineral density (BMD). We examined retrospectively 1,610 postmenopausal patients’ data and we created two groups. The treatment group consisted of 36 patients who have been applied only the ultrasound treatment and the control group consisted of 38 patients who have never received any kind of physical treatment. Both of two groups have never received OP treatment. The mean values of BMD showed no significant difference between the treatment and control groups. Patients’ BMD values, within the treatment group, were compared according to the treatment application region. There was no significant difference among groups. We determined that the ultrasound application has no effect on BMD. However, we consider that therapeutic ultrasound will help to decrease the skeletal system related complaints of the patients, improve their exercise capacity, and decrease the risk of osteoporosis.