Dilsad Sindel

Awareness of osteoporotic patients

Osteoporosis has recently been recognized as a major public health problem by some governments and health care providers. Despite significant progress in knowledge about osteoporosis, public awareness is required for effective management if precautions are to be taken. The aim of this study was to evaluate the educational status of osteoporotic individuals, and their awareness about the disease and sources of information. We also aimed to compare the variables between the geographical regions of the country, since significant differences exist in socioeconomic status and lifestyle within the same cultural context. This multicenter study was carried out in eight cities located in six different geographical regions between September 2001 and January 2002. To our knowledge, this is the first multicenter study in Turkey evaluating the relationship between awareness of osteoporotic patients and other variables such as educational level and economic factors. Ten centers took part in this study and consecutive patients with either femoral or lumbar T-scores below −2.5 SD were enrolled into the study group. Bone mineral density was measured using dual energy X-ray absorptiometry (DXA). Patients were interviewed using a questionnaire on past medical history, education, awareness about their disease and risk factors for osteoporosis. A total of 540 women (93.8%) and 36 men (6.3%) were included in the study. Fifty-four percent of patients declared that they were aware of osteoporosis. With regard to sources of information, 56.8% of patients reported physicians as the main source of information. Awareness of the patients was negatively correlated with age (P=0.025, r=−0,94) but positively correlated with education (P=0.0001, r=0.327), level of physical activity (P=0.001, r=143), calcium intake (P=0.005, r=119) and modern clothing style (P=0.0001, r=309). Educational status of the patients was negatively correlated with BMI (P=0.0001, r=−283) and positively correlated with physical activity (P=0.0001, r=268), modern clothing style (P=0.0001, r=600) and smoking (P=0.0001, r=273). Regional comparison of female patients demonstrated that significant differences exist in terms of educational status, clothing style, smoking, level of physical activity, calcium intake, and knowledge about osteoporosis. As a result, education has profound effects on awareness about osteoporosis and many aspects of human behavior, such as calcium intake, physical activity, clothing style and smoking. Significant disparities may be observed between the geographical regions of the same country.

Differences between the right and the left foot in calcaneal quantitative ultrasound measurements

A total of 621 women, aged 30–80 years, who were grouped according to having single (group 1) or duplicate measurements of their both calcanei with quantitative ultrasound (QUS) on the same day (group 2) or on a different day than the first measurement (group 3) were evaluated for differences between the right and left foot. Despite similar mean values of QUS indices on both sides, individual percentage differences were found varying from 7.3 to 9.5% in the quantitative ultrasound index (QUI), from 11.1 to 12.5% in broadband ultrasound attenuation (BUA), from 0.62 to 0.86% in speed of sound (SOS) and from 8.9 to 10.9% in estimated heel bone mineral density as measured using the Sahara Clinical Bone Sonometer in three groups of subjects. The percentage of subjects with a proportional difference exceeding the coefficient of variation of duplicate measurements of the same heel was the highest for BUA, varying from 63 to 76.7%, and ranged between 43.1 and 76.7% in other QUS indices. We conclude that there is a real inter-individual difference between the right and left foot in QUS parameters, whether measured once or twice or on different occasions. We recommend measuring both sides when using QUS to avoid misleading implications regarding a subject’s bone status.

Radial Extracorporeal Shock Wave Therapy Is Not More Effective Than Placebo in the Management of Lateral Epicondylitis: A Double-Blind, Randomized, Placebo-Controlled Trial.

ObjectivesThe aim of this study was to investigate the effects of radial extracorporeal shock wave therapy (rESWT) on pain, function, and grip strength in the treatment of patients with lateral epicondylitis unresponsive to previous treatments. DesignA double-blind, randomized, placebo-controlled trial was conducted in outpatient clinics in a medical faculty hospital. Fifty-six patients with lateral epicondylitis were randomized to rESWT (n = 28) or sham rESWT (n = 28) groups. Both the patients and the outcome assessing investigator were blinded to group assignment. The rESWT was administered to the painful epicondyle at the elbow with a total of 2000 pulses of 10 Hz frequency at a 1.8 bar of air pressure at each session at three once weekly sessions. Sham rESWT was applied without the contact of the applicator at the same area. Study patients were assessed at baseline and at 1 and 3 mos after treatment using a visual analog scale for pain and Roles and Maudsley scale and Patient-Rated Tennis Elbow Evaluation for pain and function. Grip strength of the affected extremity was also measured using a hand dynamometer. ResultsBoth rESWT and sham rESWT groups showed a significant improvement in all outcome measures at posttreatment follow-up points. Favorable absolute and percentage changes in assessments at 1- and 3-mo posttreatment did not show any significant difference between groups. ConclusionsThe rESWT does not seem to be more effective either in reducing pain or improving function or grip strength in patients with lateral epicondylitis at least at 3 mos after treatment when compared with sham rESWT.

Relationship between insulin-like growth factor 1 and bone mineral density in men aged over 65 years.

Objective: To determine the association between insulin growth factor 1 (IGF-1) and bone mineral density (BMD) in men over 65 years of age. Subjects and Methods: Forty-one male patients aged 65–88 years without a history of drug use or illness which is known to affect BMD were enrolled in the study. The control group consisted of 20 healthy men (19–62 years old). An immunoradiometric assay was used to measure IGF-1 levels. Dual-energy X-ray absorptiometry was used to determine BMD at the proximal femur and lumbar spine. A detailed questionnaire was used to assess the epidemiological findings. Results: The men over 65 years of age had a lower mean IGF-1 level (102.04 ± 36.65 vs. 196.62 ± 84.86 ng/ml) and a lower mean BMD at the femoral neck, trochanter and intertrochanteric zones, Ward’s triangle and total hip than the controls. No statistically significant association was observed in the BMD of the lumbar vertebrae between the patients and controls. IGF-1 levels were strongly and negatively correlated with age (p < 0.0001, r = –0.82). Logistic regression analysis showed that low IGF-1 levels were strongly associated with osteopenia of the total hip, femoral neck, trochanter and intertrochanteric zone. Conclusion: The finding shows that low serum IGF-1 levels were associated with an increased risk of hip osteopenia and, hence, at least partly responsible for the osteopenia observed in men aged 65 years or over.

Effect of nasal calcitonin on pain in osteoporotic patients with vertebral fractures

THE INCREASE IN VERTEBRAL BONE MASS INDUCED IN INTACT RATS BY LONG-TERM ADMINISTRATION OF THE STRONTIUM SALT S-12911 IS DIRECTLY CORRELATED WITH VERTEBRAL BONE STRENGTH, p. Ammann, R. Rizzoli, P. Deloffre, Y. Tsouderos, J.M. Meyer and J.P. Bonjour. Die. of Clinical Pathophysiology, Dept. of Internal Medicine, and School of Dentistry, University Hospital, Geneva, Switzerland, and IRI Servier, Courbevoie, France. Strontium salt (S-12911) has been shown to increase bone mass in ovariectomizad rats by inhibition of bone resorption and stimulation of bone formation. Similar effects were demonstrated in osteoporotic postmenopausal women after one year of treatment. However, long-term effects of S-1291t on bone mass and bone mechanical properties in rat were unknown. Seven-week old intact male and female rats were fed ad libitum a diet containing S-12911 (625 mg/kg day) for two years. Ex vivo vertebral body L4 bone mineral density (BMD) was measured using Hologic QDR 1000. BMD was corrected for Strontium content measured in ashed bone. Ultimate strength, stitfnass and energy were evaluated using a compression test of the intact vertebral body L4. External volume of the vertebral body was evaluated using Archimedes law. In male, S-12911 significantly increased vertebral body BMD (0.2116+0.0053, x• n=19, vs 0.1917+_0.0169 g/cm2, n=22, p=0.003), without modification of vertebral body volume (0.107+-0.002 vs 0.105:L-0.002 cm3). S-12911 also increased ultimate strength (391+-20 vs 332+-13 N, p=0.018) and energy (80.1+_7.0 vs 57.5+_4.3 N*mm, p=0.009) but not stiffness (1256+_81 vs 1161+_49 N/mm). Ultimate strength and energy were significantly correlated to BMD (r=0.720, p=0.0001, and r=0.597, p=0.0001, raspectively). In female, S-12911 increased vertebral body BMD (0.2031• n=14, vs 0.1853i-0.0030 g/cm2, n=22, p=0.02). Vertebral body volume was not significantly affected (0.073_+0.002 vs 0.069+-0.002 cm3). Increments of ultimate strength (310-• vs 273+_15 N) and energy (64.6+_7.3 vs 51.2~:3.5 N*mm) did not reach a level of statistical significance but these values were significantly correlated to BMD (r=0.519, p=0.O05, and r=0.481, p=0.009, respectively). In conclusion, Iong-tarr~ administration of S-12911 for 2 years in intact rats increased vertebral bone mass and bone strength. This positive relationship between bone strength and BMD could further support the use of S-12gll in the treatment of ostaoporosis and bone fragility. 9 TUESDAY MAY 21, 1996

2017 update of the Turkish League Against Rheumatism (TLAR) evidence-based recommendations for the management of knee osteoarthritis

In a Turkish League Against Rheumatism (TLAR) project, evidence-based recommendations for the management of knee osteoarthritis (OA) was developed for the first time in our country in 2012 (TLAR-2012). In accordance with developing medical knowledge and scientific evidence, recommendations were updated. The committee was composed of 22 physical medicine and rehabilitation specialists (4 have rheumatology subspeciality also) and an orthopaedic surgeon. Systematic literature search were applied on Pubmed, Embase, Cochrane and Turkish Medical Index for the dates between January the 1st 2012 and January the 29th of 2015. The articles were assessed for quality and classified according to hierarchy for the level of evidence, and the selected ones sent to committee members electronically. They were asked to develop new recommendations. In the meeting in 2015, the format of the recommendations was decided to be patient-based and considering the grade and the severity of the disease. By the discussion of the each item under the light of new evidences, the final recommendations were developed. Each item was voted electronically on a 10-cm visual analogue scale (VAS) and the strength of recommendation (SoR) was calculated. In the light of evidences, totally 11 titles of recommendations were developed; the first 7 were applicable to each patient in every stages of the disease, remaining were for defined specific clinical situations. The mean SoR value of the recommendations was between 7.44 and 9.93. TLAR-2012 recommendations were updated in a new format. We think that, present recommendations will be beneficial for the physicians who manage, as well as the patients who suffer from the disease.

The utility of dual-energy X-ray absorptiometry, calcaneal quantitative ultrasound, and fracture risk indices (FRAX® and Osteoporosis Risk Assessment Instrument) for the identification of women with distal forearm or hip fractures: A pilot study.

ABSTRACT Purpose: Dual-energy X-ray absorptiometry (DXA) is considered the “gold standard” in predicting osteoporotic fractures. Calcaneal quantitative ultrasound (QUS) variables are also known to predict fractures. Fracture risk assessment tools may also guide us for the detection of individuals at high risk for fractures. The aim of this case–control study was to evaluate the utility of DXA bone mineral density (BMD), calcaneal QUS parameters, FRAX® (Fracture Risk Assessment Tool), and Osteoporosis Risk Assessment Instrument (ORAI) for the discrimination of women with distal forearm or hip fractures. Materials and methods: This case–control study included 20 women with a distal forearm fracture and 18 women with a hip fracture as cases and 76 age-matched women served as controls. BMD at the spine, proximal femur, and radius was measured using DXA and acoustic parameters of bone were obtained using a calcaneal QUS device. FRAX® 10-year probability of fracture and ORAI scores were also calculated in all participants. Receiver operating characteristic (ROC) analysis was used to assess fracture discriminatory power of all the tools. Results: While all DXA BMD, and QUS variables and FRAX® fracture probabilities demonstrated significant areas under the ROC curves for the discrimination of hip-fractured women and those without, only 33% radius BMD, broadband ultrasound attenuation (BUA), and FRAX® major osteoporotic fracture probability calculated without BMD showed significant discriminatory power for distal forearm fractures. Conclusions: It can be concluded that QUS variables, particularly BUA, and FRAX® major osteoporotic fracture probability without BMD are good candidates for the identification of both hip and distal forearm fractures.

AB0667 The effectiveness of therapeutic ultrasound in non-specific mechanical cervical pain and comparison of different application methods for clinical practice

Objectives The aim of this study was to investigate the effectiveness of therapeutic ultrasound (US) in non-specific mechanical neck pain, and to compare the effects of intermittent and continuous US applications on pain severity and functional disability. Methods Seventy-one patients, aged between 18 and 65, with non-spesific mechanical neck pain suffering from less than three months were included the study. After the baseline measurements, patients were randomized to three physical treatment groups. US was applied at 1.5 Watt/cm2 power, 100 Hz, 1 MHz frequency with 50% duty cycle intermittently in the first group and 1.5 Watt/cm2 power, 100 Hz, 1 MHz frequency continuously in the second group while the third group received sham US application during 10 sessions. Three groups were also treated with transcutaneous electrical nerve stimulation. Patients were evaluated by visual analog scale and algometer for pain severity and sensitivity level of painful point on cervical region, also neck disability index was used for assessment of functional disability. Active cervical range of motion was measured by using goniometer. Control measurements were done after physical therapy and three months later after therapy. Results Fifty-three patients completed the study. Seventeen (32.1%) of them were in intermittent US group, 19 (35.8%) of them were in continuous US group and 17 (32.1%) of them were in placebo US group. The groups were homogeneous regarding to age, gender, body mass index and baseline measurements. Pain severity was improved statistically significant in three groups after the treatment and three months later after therapy (p<0.001). Pain pressure threshold (PPT) was increased statistically significant in the first and second group after the treatment (p<0.05), while PPT was decreased in control group. Three months later after therapy PPT was increased statistically significant in all of three groups (p<0.05). There were no statistically significant differences between three groups regarding to pain severity and PPT improvements (p>0.05). There were no statistically significant changes in cervical range of motion after intermittent US application (p>0.05). Cervical range of motion was statistically significant increased at three planes after continuous US application but, there were no significant differences between continuous and placebo applications (p>0.05). Continuous US was observed more effective than intermittent application in cervical rotation range when the groups were compared after the physical therapy sessions. Statistically significant improvement was observed in functional disability for all of three groups after physical therapy sessions and three months later after therapy (p>0.05). Continuous application was observed more effective when the group were compared in terms of functional recovery. Conclusions Therapeutic US applications are effective in reducing the severity of pain and sensitivity level of painful point on cervical region by increasing PPT, furthermore it affects the functional status positively by increasing cervical range of motion. Disclosure of Interest None Declared

Prevalence of Rheumatoid Arthritis and Spondyloarthritis in Turkey: A Nationwide Study

Objectives This study aims to estimate the prevalence of rheumatoid arthritis (RA) and spondyloarthritis (SpA) in Turkey using the same telephone questionnaire developed for screening RA and SpA in France and used in Serbia and Lithuania. Material and methods The study was performed in two steps. In step I, the French questionnaire was translated into Turkish and validated through a group of 200 patients (80 males, 120 females; mean age 44.0±13.1 years; range 19 to 75 years) followed up at the rheumatology departments of University Hospitals in Antalya and Ankara. In step II, the validated Turkish questionnaire was administered face-to-face to randomly selected 4,012 subjects (1,670 males, 2,342 females; mean age 41.5±16.8 years; range 16 to 97 years) by trained general practitioners across the country, in 25 prov- inces for case detection. The subjects who were suspected of having RA or SpA in accordance with the questionnaire were invited to the nearest university hospital for rheumatologic examination in order to confirm the diagnosis. Results In step II, a total of 25 subjects (2 males, 23 females) were diagnosed as RA. The standardized RA prevalence for the general population of Turkey was calculated as 0.56% (95% confidence interval [CI]; 0.33-0.79), 0.10% (95% CI; -0.05-0.25) for males and 0.89% (95% CI; 0.51-1.27) for females. A total of 18 subjects (3 males, 15 females) were diagnosed as SpA. The standardized SpA prevalence for the general population of Turkey was 0.46% (95% CI; 0.25-0.67), 0.17% (95% CI; -0.03-0.37) for males and 0.65% (95% CI; 0.32-0.98) for females. The prevalence of RA was highest in the Northern region (2.00%) and the prevalence of SpA was highest in the Central region (1.49%). Conclusion The prevalences of RA and SpA in Turkey are close to each other and there are significant inter-regional variations in prevalences of both RA and SpA.

THU0375 Can Radial Speed of Sound Measurements Identify Osteoporosis at the Radius as Measured by DXA

Background One-third radius (33% radius) bone mineral density (BMD) measurements of the non-dominant forearm using dual-energy X-ray absorptiometry (DXA) may be used for the diagnosis of osteoporosis in certain circumstances. Objectives The aim of this study was to investigate the ability of radial speed of sound (SOS) measurements for identifying osteoporosis at the radius as measured by DXA. Methods Both 1/3 radius BMD and SOS of the non-dominant forearm were measured in 128 women aged between 21 and 79 years using DXA (Hologic QDR® 4000) and a multi-site quantitative ultrasound (QUS) device (Sunlight Omnisense™ 8000), respectively. Osteoporosis at the radius was defined according to the WHO criteria (a T-score ≤-2.5) in postmenopausal women in the sample studied. In premenopausal women, Z-scores of ≤-2.0 were used for defining osteoporosis or BMD below the expected range for age. Results Pearson correlation coefficients revealed statistically significant correlations between DXA 1/3 radius BMD and radial SOS measurements (r=0.496; p<0.001) as well as 1/3 radius and radial SOS T-scores (r=0.495; p<0.001). The areas under the receiver operating characteristic curves (AUCs) for radial SOS and its T-score for predicting osteoporosis or BMD below the expected range were 0.762 (p<0.001) and 0.760 (p<0.001), respectively. Conclusions Significant correlations between radial BMD measurements and QUS parameters and fair AUCs for QUS parameters for identifying osteoporosis or BMD below the expected range found in this small sample of women may have implications that radial SOS measurements may provide valuable information for treatment decisions when DXA cannot be done in any region of interest. Disclosure of Interest None Declared