G. Trovas

A Randomized Trial of Nasal Spray Salmon Calcitonin in Men With Idiopathic Osteoporosis: Effects on Bone Mineral Density and Bone Markers

In a 12‐month randomized, double‐blind, placebo‐controlled trial, we have studied the effects of intranasal salmon calcitonin (SCT) on bone mineral density (BMD) and biochemical markers of bone turnover. Twenty‐eight men with idiopathic osteoporosis aged 27‐74 years (mean, 52.4 years) were randomized to receive either nasal SCT (200 IU) or a nasal placebo daily for a period of 1 year. All the men received a daily supplement of 0.5 g of calcium. The men who received SCT had a mean (±SEM) increase in BMD of 7.1 ± 1.7% at the lumbar spine. In contrast, the men who received the placebo had an increase of 2.4 ± 1.5% (p > 0.05) for the comparison with baseline. The increase in lumbar BMD in the calcitonin group was significantly greater than that in the placebo group (p < 0.05). There were no significant changes in the femoral neck, trochanter, or Wards triangle relative to both baseline and placebo after 12 months. Treatment with nasal SCT resulted in a significantly pronounced suppression of bone resorption markers (urinary deoxypyridinoline [DPD], type I cross‐linked N‐telopeptide [NTX], and type I cross‐linked C‐telopeptide [CTX]) and to a lesser extent in bone formation markers (serum bone‐specific alkaline phosphatase [BALP], osteocalcin [OC], serum C‐terminal procollagen type I extension peptides [PICP], and serum N‐terminal procollagen type I extension peptides [PINP]), whereas the placebo did not. Therapy was tolerated well and there were no treatment‐related adverse events. We conclude that intranasal SCT (200 IU daily) is safe and effective in increasing lumbar BMD and reducing bone turnover in men with idiopathic osteoporosis.

Association of physical exercise and calcium intake with bone mass measured by quantitative ultrasound

BackgroundInterventions other than medications in the management of osteoporosis are often overlooked. The purpose of this study was to investigate the association of physical activity and calcium intake with bone parameters.MethodsWe measured the heel T-score and stiffness index (SI) in 1890 pre- and postmenopausal women by quantitative ultrasound (QUS) and assessed physical activity and dietary calcium intake by questionnaire. Participants were divided according to their weekly physical activity (sedentary, moderately active, systematically active) and daily calcium consumption (greater than or less than 800 mg/day).ResultsSI values were significantly different among premenopausal groups (p = 0.016) and between sedentary and systematically active postmenopausal women (p = 0.039). QUS T-scores in systematically active premenopausal women with daily calcium intake > 800 mg/day were significantly higher than those in all other activity groups (p < 0.05) independent of calcium consumption.ConclusionsSystematic physical activity and adequate dietary calcium intake are indicated for women as a means to maximize bone status benefits.

Impact on bone and muscle area after spinal cord injury

Spinal cord injury (SCI) causes inactivation and consequent unloading of affected skeletal muscle and bone. This cross-sectional study investigated correlations of muscle and bone in spinal cord-injured subjects compared with able-bodied subjects. Thirty-one complete SCI paraplegics were divided according to the neurological level of injury (NLoI) into group A (n=16, above thoracic 7 NLoI, age: 33±16 years, duration of paralysis (DoP): 6±6 years) and group B (n=15, thoracic 8-12, age: 39±14 years, DoP: 5.6±6 years), compared with 33 controls (group C). All were examined with peripheral quantitative computed tomography at 66% of tibia length (bone and muscle area, bone/muscle area ratio). In able-bodied subjects, muscle area was correlated with bone area (P<0.001, r=0.88). Groups A and B differed significantly from the control group in terms of bone and muscle area (P<0.001). In paraplegics, less muscle per unit of bone area (bone/muscle area ratio) was found compared with controls (P<0.001). Bone area was negatively correlated with the DoP in the total paraplegic group (r=-0.66, P<0.001) and groups A and B (r=-0.77, P=0.001 vs r=-0.52, P=0.12, respectively). Muscle area and bone/muscle ratio area correlations in paraplegic groups with DoP were weak. Paraplegic subjects who performed standing and therapeutic walking had significantly higher bone area (P=0.02 and P=0.013, respectively). The relationship between bone and muscle was consistent in able-bodied subjects and it was predictably altered in those with SCI, a clinical disease affecting bone and muscle.

Assessment of musculoskeletal system in women with jumping mechanography

The purpose of this study was to investigate and add reference data about the musculoskeletal system in women. The mechanography system of the Leonardo™ platform (Novotec, Germany) was used to measure parameters of movement (velocity, force, power) in 176 healthy Greek women aged 20–79 years, separated according to age decade in six groups: group 1 (n = 12), 20–29 years; group 2 (n = 14), 30–39 years; group 3 (n = 33), 40–49 years; group 4 (n = 59), 50–59 years including 21 postmenopausal; group 5 (n = 31), 60–69 years including 12 postmenopausal; and group 6 (n = 27), 70–79 years all postmenopausal. This system measures forces applied to the plate over time, calculates through acceleration the vertical velocity of center of gravity and using force and velocity it calculates power of vertical movements. All women performed a counter-movement jump (brief squat before the jump) with freely moving arms. Weight was recorded on the platform before the jump and height was measured with a wall-mounted ruler. Body weight and body mass index were gradually increased; on the contrary height and all movement parameters except force (velocity, power) were statistically decreased during aging and after menopause.

Prospective study of spinal orthoses in women

Background: There are not many clinical trials investigating the efficiency and compliance of using spinal orthoses in the management of osteoporosis. Objectives: The purpose of this study was to investigate the effect of long-term use and the compliance of spinal orthoses in postmenopausal women with vertebral fractures. Study design: Clinical trial of spinal orthoses in postmenopausal women. Methods: Women were separated into groups wearing different types of orthoses (Spinomed, Osteomed, Spinomed active, and Spine-X). Isometric maximum strength of trunk muscles (F/Wabdominals–extensors) was calculated and back pain was assessed in all women. In addition, women completed a compliance questionnaire about the use of the orthoses. Results: Spinomed decreased pain (p = 0.001) and increased trunk muscle strength (F/Wabdominals, p = 0.005 and F/Wextensors, p = 0.003, respectively). The compliance of wearing an orthosis for 6 months was 66%. Conclusion: The results suggest that orthoses could be an effective intervention for back pain and muscle strengthening in osteoporotic women. Clinical relevance In women with established osteoporosis, wearing Spinomed orthosis for at least 2 h/day for 6 months decreased back pain significantly and increased personal isometric trunk muscle strength. All spinal orthoses could be valuable instruments to help all requested rehabilitation programs like spine muscles’ strengthening and postural correct behavior, but only when used properly.

Bone And Soft Tissue Changes In Patients With Spinal Cord Injury And Multiple Sclerosis.

Abstract In patients with spinal cord injury and multiple sclerosis, deterioration of body composition (changes in bone, fat and muscle mass) is associated with increased risk for diseases such as coronary artery heart disease, non-insulin dependent diabetes mellitus, lipid metabolism abnormalities, and osteoporotic fractures in these patients. Immobility leads to a changing pattern of loading in the paralyzed areas, and secondary alteration in structure. However, bone and soft tissue changes in these patients are usually neglected. The purpose of this article is to update on the pathophysiological mechanisms leading to bone and soft tissue changes, and to increase the awareness of the treating physicians with respect to bone, muscle and fat loss and their consequences aiming to obtain measures to prevent bone and soft tissue loss in these patients.

Response to: A role for thiazide diuretic therapy in preventing bone loss, fracture and nephrolithiasis in individuals with thalassemia and hypercalciuria?

Dear Editor, We would like to thank AdamMorton for his interesting comments on the possible value of thiazide diuretics in the management of bone loss, fractures, and nephrolithiasis in patients with thalassemia and calciuria [1, 2]. We agree with the comments, however, to our knowledge, there are no studies evaluating the effects of thiazide diuretics on these outcomes in patients with thalassemia. Thiazides have documented protective effect on nephrolithiasis [3] and indeed have been associated with positive effects on bone mineral density [4, 5] even though the effects are small and not invariably demonstrated [6]. Fracture data are based only on observational studies and are inconclusive showing potential beneficial [7] or negative effects [8], possibly depending on age. Recently, a Cochrane review has shown an overall reduction in the risk of hip fractures [9]. Due to the complex pathophysiology of thalassemia, welldesigned studies evaluating the effects of thiazide diuretics on calciuria, nephrolithiasis, and bone mineral density and aiming to identify subsets of patients who might benefit from such an intervention would be valuable.

Sarcopenia: From definition to treatment

1Physical Medicine & Rehabilitation Department, European Interbalkan Medical Center, Thessaloniki, Greece; 2Medical School of Patras, Rio, Patras, Greece; 3Medical School of Thessaly, Larissa, Greece; 4Department of Medical Laboratories, Technological Educational Institute of Athens, Athens, Greece; 5Department of Kinesitherapy, Faculty of Public Health, Medical University of Sofia, Bulgaria; 62nd Orthopaedic Department, Athens University; Konstantopoulio General Hospital; Athens, Greece; 7Endocrinology Department, General Hospital Asklepieio Voulas, Voula, Greece; 8Laboratory for Research of the Musculoskeletal System, University of Athens, Kifissia, Greece Commentary HORMONES 2017, 16(4):429-439