Ladislav Krapac

Muscle strength and bone density in patients with different rheumatic conditions: cross-sectional study

Aim To explore the relationship between muscle strength and bone density in patients with different rheumatic diseases and to examine whether inflammatory arthritis was more harmful for muscle strength and bone loss than degenerative joint diseases. Methods The study included 361 men and women with a mean ± standard deviation age of 60.5 ± 11.4 years and different rheumatic conditions: regional syndromes, osteoarthritis of the hands, shoulders, knees, and hips, and inflammatory arthritis. Maximum voluntary back strength was measured by isometric dynamometry. Bone mineral density (BMD; g/cm2) of the lumbar spine, femoral neck, and distal radius was measured by dual-energy x-ray absorptiometry. Anthropometry and lifestyle characteristics were also assessed. Results Back strength was lowest in patients with hand and shoulder osteoarthritis (20.0 ± 17.9 kg), followed by patients with inflammatory arthritis (24.8 ± 19.2 kg). Patients with inflammatory arthritis had the lowest BMD at the mid-radius (0.650 ± 0.115 g/cm2) and femoral neck (0.873 ± 0.137 g/cm2), while patients with hand and shoulder osteoarthritis had the lowest BMD at the mid-radius (0.660 ± 0.101). In both sexes, muscle strength was significantly lower in patients who had lower BMD (T score<-1.0). Multiple regression analysis identified significant predictors of back strength to be spine BMD (P = 0.024) and body mass index (P = 0.004) in men and femoral neck BMD in women (P = 0.004). Conclusion Muscle strength decline may be connected to bone loss in patients with rheumatic conditions, especially those with inflammatory joint diseases.

Relationship Between Osteonecrosis of the Jaw and Bisphosphonate Treatment

Povezanost osteonekroze čeljusti i terapije bisfosfonatima Terapija bisfosfonatima i njezina etiopatogenetska povezanost s aseptičkom osteonekrozom čeljusti važan je javnozdravstveni problem današnjice. Svrha je rada pregledom suvremene znanstvene literature utvrditi posljedice višestrukog djelovanja bisfosfonata (antiosteoklastična aktivnost, citotoksičnost na meka i koštana tkiva, antiangiogeneza, genski čimbenici, poremećena ravnoteža između osteoklasta i osteoblasta). Terapija bisfosfonatima jedan je od najčešćih uzroka razvoja osteonekroze čeljusti. Epidemiološki podaci pokazuju da se javlja u bolesnika koji su uzimali jedan ili kombinanciju nitrogenih bisfosfonata. Najvažniji čimbenici rizika za ovu nuspojavu su vrsta bisfosfonata (napose visokopotentni pamidronat i zoledronat koji se daju intravenski), njihova doza i duljina medikacije te vrsta bolesti zbog koje se propisuje terapija. Pojava osteonekroze čeljusti zabilježena je uglavnom u onkoloških bolesnika i u samo 5 % bolesnika s osteoporozom koji su liječeni bisfosfonatima. U patogenezi osteonekroze povezane s bisfosfonatima važno je, sa stajališta dentalnomedicinske prakse, dobro opće oralno zdravlje jer se osteonekroza javlja napose nakon prethodnoga parodontološkog i oralnokirurškog zahvata. Relationship Between Osteonecrosis of the Jaw and Bisphosphonate Treatment Bisphosphonate treatment and its aetiopathogenic association with aseptic osteonecrosis of the jaw is one of the more prominent public health issues today. The aim of this review is to see into the mechanisms of bisphosphonate effects on bones described in literature (anti-osteoclastic activity, cytotoxicity, antiangiogenesis, genetic factors, and imbalance between osteoclasts and osteoblasts). Bisphosphonate treatment is the dominant cause of jaw necrosis. Epidemiological data show an exclusive incidence of osteonecrosis of the jaw in patients who took one or a combination of nitrogen-containing bisphosphonates. Risk factors vary by the bisphosphonate potency (particularly risky are the highly potent pamidronate and zoledronate, which are given intravenously), dosage, duration of treatment, and the illness. Jaw necrosis is most common in oncology patients, and only 5 % in patients with osteoporosis. From a dental-medical point of view, a good oral health is important because osteonecrosis often appears after a periodontal or oral surgical procedure.

S247 PHYSICAL TREATMENT OF TEMPOROMANDIBULAR JOINT PAIN IN PATIENTS WITH VARIOUS BONE MINERAL STATUSES

Background and aims. The bone mineral density (BMD) of patients with temporomandibular joint (TMJ) disorder was analyzed. Methods. Clinical examination and magnetic resonance imaging as a gold standard was used in the TMJ diagnostics. 35 female patients (mean age 59 years, range 28 – 78) with TMJ disorder (disc displacement, osteoarthritis) underwent physical therapy. Clinical symptomatology included pathological sounds (clicking, crepitation) and/or pain in the TMJs (measured by visual-analogue scale (VAS) 0-10) with one-year follow-up after the beginning of treatment. Apart from the body mass index (BMI in kg/m2), due to medical indications, BMD (in g/cm2) was measured in the lumbar and femoral area by means of dual-energy x-ray absorptiometry. Results. From the total number of patients, 9 of them (25.7%) had normal BMD, 18 (51.4%) had osteopenia and 8 (22.9%) had osteoporosis. Physical therapy significantly reduced pain intensity (p 0.05). Conclusions. Densitometry is not a standard examination procedure within TMJ diagnostics and therefore the sample is rather small. Physical therapy can significantly reduce pain but it does not depend on patients’ BMI.