Eleonora Piccirilli

Sarcopenia and fragility fractures: molecular and clinical evidence of the bone-muscle interaction

➤ Bone and muscle tissues are in close relationship, and the aging process is a factor involved in the loss of the functionality of both bones and muscles.➤ Sarcopenia and osteoporosis are linked from a biological and functional perspective and are related to an increased fracture risk in the elderly.➤ The increased fracture risk in sarcopenic and osteoporotic subjects is due to the decline of muscle mass and strength, the decrease in bone mineral density, and limited mobility.

Hormones and tendinopathies: the current evidence

BACKGROUNDnTendinopathies negatively affect the quality of life of millions of people, but we still do not know the factors involved in the development of tendon conditions.nnnSOURCES OF DATAnPublished articles in English in PubMed and Google Scholar up to June 2015 about hormonal influence on tendinopathies onset. One hundred and two papers were included following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.nnnAREAS OF AGREEMENTnIn vitro and in vivo, tenocytes showed changes in their morphology and in their functional properties according to hormonal imbalances.nnnAREAS OF CONTROVERSYnGenetic pattern, sex, age and comorbidities can influence the hormonal effect on tendons.nnnGROWING POINTSnThe increasing prevalence of metabolic disorders prompts to investigate the possible connection between metabolic problems and musculoskeletal diseases.nnnAREAS TIMELY FOR DEVELOPING RESEARCHnThe influence of hormones on tendon structure and metabolism needs to be further investigated. If found to be significant, multidisciplinary preventive and therapeutic strategies should then be developed.

I.S.Mu.L.T - Rotator cuff tears guidelines

Despite the high level achieved in the field of shoulder surgery, a global consensus on rotator cuff tears management is lacking. This work is divided into two main sessions: in the first, we set questions about hot topics involved in the rotator cuff tears, from the etiopathogenesis to the surgical treatment. In the second, we answered these questions by mentioning Evidence Based Medicine. The aim of the present work is to provide easily accessible guidelines: they could be considered as recommendations for a good clinical practice developed through a process of systematic review of the literature and expert opinion, in order to improve the quality of care and rationalize the use of resources.

Obstructive sleep apnoea as a risk factor for osteopenia and osteoporosis in the male population.

Obstructive sleep apnoea (OSA) is a sleep disorder characterised by recurrent apnoea events leading to hypoxia, hypercapnia and sleep disruption [1]. OSA represents a growing health problem mainly affecting men; in fact, its prevalence in the adult male population is between 4% and 24% [1–3]. This report proposes the clinical potential of monitoring bone mineral density in male OSA patients http://ow.ly/Voe47

Satellite Cells CD44 Positive Drive Muscle Regeneration in Osteoarthritis Patients

Age-related bone diseases, such as osteoarthritis and osteoporosis, are strongly associated with sarcopenia and muscle fiber atrophy. In this study, we analyzed muscle biopsies in order to demonstrate that, in osteoarthritis patients, both osteophytes formation and regenerative properties of muscle stem cells are related to the same factors. In particular, thanks to immunohistochemistry, transmission electron microscopy, and immunogold labeling we investigated the role of BMP-2 in muscle stem cells activity. In patients with osteoarthritis both immunohistochemistry and transmission electron microscopy allowed us to note a higher number of CD44 positive satellite muscle cells forming syncytium. Moreover, the perinuclear and cytoplasmic expression of BMP-2 assessed by in situ molecular characterization of satellite cells syncytia suggest a very strict correlation between BMP-2 expression and muscle regeneration capability. Summing up, the higher BMP-2 expression in osteoarthritic patients could explain the increased bone mineral density as well as decreased muscle atrophy in osteoarthrosic patients. In conclusion, our results suggest that the control of physiological BMP-2 balance between bone and muscle tissues may be considered as a potential pharmacological target in bone-muscle related pathology.

Bone Morphogenetic Proteins and myostatin pathways: key mediator of human sarcopenia

BackgroundSarcopenia, osteoporosis and osteoarthritis are the most frequent musculoskeletal disorders affecting older people. The main aim of this study was to test the hypothesis that the balance between BMPs and myostatin pathways regulates the age-related muscle degeneration in OP and OA patients. To this end, we investigated the relationship among the expression of BMP-2/4-7, myostatin and phosphorylated Smads1-5-8 and the muscle quality, evaluated in term of fibers atrophy and satellite cells activity.MethodsIn this retrospective study, we collected 123 biopsies of vastus lateralis: 48 biopsies from patients who underwent hip arthroplasty for subcapital fractures of the femur (OP), 55 biopsies from patients who underwent hip arthroplasty for osteoarthritis (OA) and 20 biopsies from patients who underwent hip arthroplasty for high-energy hip fractures (CTRL). Muscle biopsies were fixed in 4% paraformaldehyde and paraffin embedded. Serial sections were used for morphometrical and immunohistochemical analysis (BMP/2/4-7, myostatin, Smads1-5-8, Pax7 and myogenin). In addition, 1xa0mm3 of muscle tissue of each patient was embedded in epon for ultrastructural study.ResultsMorphometric data indicated an increase of the number of atrophic fibers in OP patients compare to OA. In line with these data, we found an high regenerative potential in muscle tissues of OA patients due to the significant amount of both Pax7 and myogenin positive satellite cells detected in OA group. In addition, our data showed the decrease of BMP2/4 and -7 expression in OP patients compared to both OA group and CTRL. Conversely, OP patients were characterized by high levels of myostatin expression. A different expression profile was also found for phosphorylated Smad1-5-8 between OP and OA patients. In particular, OP patients showed a low number of positive phosphorylated Smad1-5-8 nuclei.ConclusionThe identification of molecular pathways involved in the pathogenesis of sarcopenia open new prospective for the development of drugs able to prevent/treat the muscle impairment that occur in elderly. Results here reported, highlighting the role of BMPs and myostatin pathways in physio-pathogenesis of human sarcopenia, allow us to propose human recombinant BMP-2/7 and anti-myostatin antibodies as a possible therapeutic option for the sarcopenia.

Sarcopenia: a histological and immunohistochemical study on age-related muscle impairment

BackgroundSarcopenia and osteoporosis increase the risk of bone fracture in the elderly due to the loss of muscle mass and the decrease in bone mineral density. Myostatin and Bone Morphogenetic Proteins (BMPs) are important molecules involved in muscle mass homeostasis.AimIn this study, we investigated the role of BMP4 and myostatin in the pathophysiogenesis of sarcopenia related to osteoporosis and osteoarthritis.MethodsMuscle atrophy, BMP4 and myostatin expression were evaluated in 27 biopsies of osteoarthritic (OA) women and 27 biopsies from osteoporotic (OP) group by immunohistochemical reaction. Muscle stem cell niches were investigated by transmission electron microscopy analysis.ResultsMyostatin and BMP4 expression was evaluated by counting the number of positive fibers on 25 high-power field. We found that OA muscle biopsies showed a significantly higher number of BMP4-positive fibers (37.35xa0±xa05.63) as compared with muscle of OP patients (9.60xa0±xa01.57). Unlike BMP4 expression, the number of myostatin-positive fibers in OP patients (33.95xa0±xa04.10) was significantly higher compared to OA group (13.86xa0±xa01.68). The ultrastructural analysis of BMP4-positive tissues displayed the presence of a high rate of satellite cells both single or as syncytium giving proof of muscle regeneration capability.DiscussionOur results indicated that sarcopenia and osteoporosis shared an impairment of metabolic activity. Conversely, the molecular mechanisms of OA seem to inhibit the onset of an age-related sarcopenia.ConclusionThe characterization of molecular mechanisms underlying the bone–muscle crosstalk could open new therapeutic perspectives in elderly diseases.

I.S.Mu.L.T. First-time patellar dislocation guidelines

Primary traumatic patellar dislocation is common, particularly in young active individuals. A consensus on its management is still lacking. The present work provides easily accessible guidelines to be considered as recommendations for a good clinical practice developed through a process of systematic review of the literature and expert opinion, to improve the quality of care and rationalize the use of resources.nnnLEVEL OF EVIDENCEnIa.

Clinical guidelines for the prevention and treatment of osteoporosis: summary statements and recommendations from the Italian Society for Orthopaedics and Traumatology

AbstractBackgroundnThe Italian Society for Orthopaedics and Traumatology conceived this guidance—which is primarily addressed to Italian orthopedic surgeons, but should also prove useful to other bone specialists and to general practitioners—in order to improve the diagnosis, prevention, and treatment of osteoporosis and its consequences.Materials and methodsLiterature reviews by a multidisciplinary team.ResultsThe following topics are covered: the role of instrumental, metabolic, and genetic evaluations in the diagnosis of osteoporosis; appraisal of the risk of fracture and thresholds for intervention; general strategies for the prevention and treatment of osteoporosis (primary and secondary prevention); the pharmacologic treatment of osteoporosis; the setting and implementation of fracture liaison services for tertiary prevention. Grade A, B, and C recommendations are provided based on the main levels of evidence (1–3). Toolboxes for everyday clinical practice are provided.ConclusionsThe first up-to-date Italian guidelines for the primary, secondary, and tertiary prevention of osteoporosis and osteoporotic fractures are presented.

Viscosupplementation with intra-articular hyaluronic acid for hip disorders: a systematic review and meta-analysis

BACKGROUNDnHip joint diseases are common in adult population and their prevalence increases with age. Osteoarthritis, rheumatoid arthritis and femoroacetabular impingement are the most common chronic diseases in the hip joint. Viscosupplementation with exogenous hyaluronic acid (HA) is one of the most widely used conservative treatment aiming to improve synovial fluid properties and to decrease pain. There is no global consensus on the type of HA, method of injection and frequency, or on its efficacy in hip joint.nnnMETHODSnWe selected published data in English in the PubMed and Google Scholar electronic databases up to March 2016 about hyaluronic acid injections in hip disorders.nnnRESULTSn26 articles were included following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.nnnCONCLUSIONnThere is a lack of standardization of HA injections for hip conditions. Our results suggest that this is the best conservative therapy before surgery and it can act on pain relief and function however there is no evidence to prove its ability to modify the morphological structure of the pathological hip and the natural history of the disease. There are few data about the use of HA in other hip disorders rather than osteoarthritis. The most relevant evidence seems to show the utility of HA injections in improving synovial inflammation, but only a few studies have been conducted.nnnLEVEL OF EVIDENCEnI.