Radon balneotherapy and physical activity for osteoporosis prevention: a randomized, placebo-controlled intervention study

Osteo-immunological impact of radon spa treatment: due to radon or spa alone? Results from the prospective, thermal bath placebo-controlled RAD-ON02 trial

Musculoskeletal disorders (MSDs) are associated with pain and lead to reduced mobility and quality of life for patients. Radon therapy is used as alternative or complementary to pharmaceutical treatments. According to previous reports, radon spa leads to analgesic and anti-inflammatory effects, but the cellular and molecular mechanisms are widely unknown. A previous study (RAD-ON01) revealed, that bone erosion markers like collagen fragments (C-terminal telopeptide, CTX) are reduced after radon spa treatment in serum of patients with degenerative MSDs. Within the scope of the prospective, placebo-controlled RAD-ON02 trial presented here, we analyzed the influence of radon and thermal spa treatment on osteoclastogenesis. From patient blood, we isolate monocytes, seeded them on bone slices and differentiated them in the presence of growth factors into mature osteoclasts (mOCs). Subsequent analysis showed a smaller fraction of mOCs after both treatments, which was even smaller after radon spa treatment. A significantly reduced resorbed area on bone slices reflects this result. Only after radon spa treatment, we detected in the serum of patients a significant decrease of receptor activator of NF-κB ligand (RANKL), which indicates reduced differentiation of OCs. However, other markers for bone resorption (CTX) and bone formation (OPG, OCN) were not altered after both treatments. Adipokines, such as visfatin and leptin that play a role in some MSD-types by affecting osteoclastogenesis, were not changed after both treatments. Further, also immune cells have an influence on osteoclastogenesis, by inhibiting and promoting terminal differentiation and activation of OCs, respectively. After radon treatment, the fraction of Treg cells was significantly increased, whereas Th17 cells were not altered. Overall, we observed that both treatments had an influence on osteoclastogenesis and bone resorption. Moreover, radon spa treatment affected the Treg cell population as well as the Th17/Treg ratio were affected, pointing toward a contribution of the immune system after radon spa. These data obtained from patients enrolled in the RAD-ON02 trial indicate that radon is not alone responsible for the effects on bone metabolism, even though they are more pronounced after radon compared to thermal spa treatment.

Improvement of Pain Symptoms in Musculoskeletal Diseases After Multimodal Spa Therapy in the Austrian Gastein Valley-A Study Based on Longitudinal Registry Data

Objective: The study aim was to investigate the course of pain in rest and motion in seven different rheumatic diseases (RMD), prior and after multimodal spa therapy including low-dose radon treatment and at 3-, 6-; and 9-month follow up. Methods: Complete data from the radon indication registry including information on 561 subjects with RMD were analysed to explore the association of timepoint of measurement with pain in rest and motion. For this purpose, linear regression models adjusted for RMD-type, age, sex and body mass index (BMI) were applied. Results: The mean age of the sample was 55 years, the average body mass index was 26.8, and 275 subjects were women. Pain scores were significantly improved at all-time points compared to baseline. Pain courses were different for each RMD with the largest improvement seen in fibromyalgia. Conclusion: Timing spa facility visits according to RMD-specific pain courses may result in sustained pain reduction.

Balneotherapy and Health-related Quality of Life in Adults with Knee Osteoarthritis: a Prospective Observational Study Into a Real Clinical Practice Condition

Aim: To analyze the influence of balneotherapy applied in conditions of real clinical practice in Fitero’s Thermal Station (Spain) on HRQoL in adults with KOA. Materials and Methods: This was a prospective observational study conducted under conditions of real clinical practice with a 9-month follow-up. The individuals were beneficiaries of the Spanish social thermalism programme. A total of 10 sessions were prescribed, individually, considering the clinical situation and preferences of each participant. In all cases, 10 bath sessions were administered, along with other techniques. The clinical assessments were conducted before initiating the balneotherapy and 1, 3, 6 and 9 months after. The main variable was HRQoL (Euroqol 5D-5L; WOMAC). The statistical analysis was performed by intention to treat. Results: The study included 71 users. At 6 months, improvements were found in the following dimensions of the WOMAC questionnaire: pain (24.47%), stiffness (30.75%) and functional capacity (26.66%) (p<0.05). Pain and anxiety/depression showed statistically significant differences in the EQ 5D-5L throughout the study. Conclusions: HRQoL in KOA would improve with the Balneotherapy, prevailing the effects for up to 6 months. The absence of adverse effects and the ease of completing the treatment provided by the Spanish social thermalism system make this treatment feasible.

Resistance circuit training combined with hypoxia stimulates bone system of older adults: A randomized trial

PURPOSE

Aging leads to gradual irreversible decline in bone mass. As adherence to pharmacological treatment is poor, hypoxia combined with strength training has been suggested for therapeutic benefit for clinical populations. The present study investigated the effects of normobaric cyclic hypoxic exposure combined with resistance circuit training on bone of older adults.

METHODS

Healthy older adults (n = 50) were randomly assigned to a (1) control group (CON; n = 20), who were instructed to continue with their normal daily activities, (2) a group that performed resistance training in normoxia (RTN; n = 17) and (3) a group that performed resistance training in hypoxia (RTH; n = 13). During 24 weeks, RTH group performed resistance training with elastic bands under normobaric hypoxic conditions (16.1 % FiO2). A session of both exercise groups included nine exercises of several body areas with a structure of 3 sets × 12-15 repetitions per exercise, with a 1-minute rest between sets. Bone mineral density (g·cm-2) was measured using dual-energy X-ray absorptiometry. Bone turnover markers of formation (N-terminal propeptide of type I procollagen; PINP) and resorption (C-terminal telopeptide of type I collagen; bCTX) were analysed with enzyme-linked immunosorbent assay (ELISA) microplate reader.

RESULTS

Values of bCTX and bCTX/PINP significant decreased in RTN (bCTX: 47.79 %; p = 0.002; bCTX/PINP: 61.43 %; p = 0.007) and RTH (bCTX: 59.09 %; p = 0.001; bCTX/PINP: 62.61 %; p = 0.003) groups compared with CON group. Change in bone mineral density was not significantly different between groups. Based on clinically significant change, 23 % of the participants in the RTH group reached this value for femoral neck and trochanter bone mineral density (vs 0 % and 6 % of the RTN group, respectively).

CONCLUSIONS

24-Weeks of normobaric cyclic hypoxic exposure combined with resistance circuit training has potential to generate positive effects on bone in older adults.

TRIAL REGISTRATION NUMBER

NCT04281264 (date of registration: February 24, 2020).

[Dental care in health resort institutions]

Over the past decades, a small yet convincing evidence base has accumulated that demonstrates the effectiveness of dental care for patients in health-resort (HR) settings. In addition to a positive local effect, complex HR care increases nonspecific resistance and promotes desensitization.

OBJECTIVE OF THE REVIEW

Addressing the HR rehabilitation in patients with various maxillofacial diseases for further consideration of the possibility of the increased use of HR care in dental practice.

MATERIAL AND METHODS

Russian and English-language publications were analyzed without specifying the search timeframe. The search keywords were the following: «health-resort care», «balneotherapy», «peloid therapy», «physiotherapy», «magnet therapy», «laser therapy» in combination with «dental diseases», «maxillofacial diseases», «periodontal diseases», «temporomandibular joint diseases», «postoperative rehabilitation» «balneotherapy», «mud therapy», «peloid therapy», «spa therapy», «physiotherapy». A total of 21 articles were analyzed, including 10 related to periodontal disease, 5 to temporomandibular joint pathology, and 6 to rehabilitation in the postoperative period. Seventeen original studies (3855 patients) were selected, including 47.62% with evidence level C, due to lack of information on comparison group or randomization.

RESULTS AND DISCUSSION

Available data from clinical studies suggest the effectiveness of natural and physiotherapeutic factors in the medical rehabilitation of patients with various dental diseases. Further randomized clinical trials and the development of clinical guidelines for various techniques in dental diseases are warranted.

The effectiveness of balneotherapy and aquatic exercise on bone metabolism: A systematic review and meta-analysis

OBJECTIVE

To systematically evaluate the effectiveness of balneotherapy and/or aquatic exercise on bone metabolism.

DESIGN

A systematic literature search was conducted from inception to January 4, 2021. Standardized mean differences (SMDs) and 95% confidence intervals (CIs) were calculated using a fixed-effect model according to study heterogeneity.

RESULTS

Seven articles involving 467 participants were selected. Three balneotherapy studies were qualitatively integrated. The results showed that bone resorption slowed down with or without stimulation of bone formation. A pooled meta-analysis of four studies on aquatic exercise showed significant evidence for a reduction in parathyroid hormone (PTH; SMD = -0.71; 95% CI, -1.04 to -0.38; P < 0.001), and a significant increase in osteocalcin (OC; SMD = 0.60; 95% CI, 0.16 to 1.03; P = 0.007) after aquatic exercise.

CONCLUSION

Balneotherapy and aquatic exercise had significant effects on bone metabolism, reducing bone resorption and/or increasing bone formation. This study highlights the importance of balneotherapy and aquatic exercise for bone health.

Radon Exposure-Therapeutic Effect and Cancer Risk

Largely unnoticed, all life on earth is constantly exposed to low levels of ionizing radiation. Radon, an imperceptible natural occurring radioactive noble gas, contributes as the largest single fraction to radiation exposure from natural sources. For that reason, radon represents a major issue for radiation protection. Nevertheless, radon is also applied for the therapy of inflammatory and degenerative diseases in galleries and spas to many thousand patients a year. In either case, chronic environmental exposure or therapy, the effect of radon on the organism exposed is still under investigation at all levels of interaction. This includes the physical stage of diffusion and energy deposition by radioactive decay of radon and its progeny and the biological stage of initiating and propagating a physiologic response or inducing cancer after chronic exposure. The purpose of this manuscript is to comprehensively review the current knowledge of radon and its progeny on physical background, associated cancer risk and potential therapeutic effects.

Rheumatology in Ukraine

Rheumatology in Ukraine is based on established research and clinical infrastructure that enable the integration with regional and global societies. This article overviews current state of Ukrainian rheumatology, important steps toward expanding clinical settings, and opportunities for strengthening cooperation of local rheumatologists and patients with rheumatic diseases with related international societies. The main achievements and some challenges encountered by the Association of Rheumatologists of Ukraine are outlined. The Association supports continuing medical education of local specialists and explores options for advancing research and publishing in rheumatology. One of the main challenges still remains the creation of registries of patients with rheumatic diseases and expansion of activities of public societies with interest in combating rheumatic diseases. The issue of inadequate access to immunobiological therapies is also highlighted.

Association between lifestyle and pathologic fractures in patients admitted to surgery departments of selected hospitals affiliated to Alborz University of Medical Sciences in 2014-2015

Background and Purpose:

Health professions that previously focused on treatment of patients are now focusing on prevention and health provision by improving lifestyle and eliminating factors that somehow have a negative impact on human health. Some people have strong skeleton genetically, but others do not. So far, medical science has not been able to change the genetic characteristics of individuals; however, lifestyles can be changed to reach the maximum bone mass. The aim of this study was to investigate the association between lifestyle and pathologic fractures in patients admitted to surgery departments of selected Hospitals in 2014–2015.

Materials and Methods:

In this descriptive (correlational) study, using the Cochran sampling formula, 350 patients with fractures were selected by stratified sampling in surgery departments of selected hospitals affiliated to Alborz University of Medical Sciences. Data were collected using the standard lifestyle questionnaire, which was validated through the test–retest method. The qualitative data of this project were analyzed using SPSS 20 software at a significance level of 0.05.

Results:

Most of the subjects were in the age group of 72–85 years which included 103 (26.8%) people. In all, 187 (48.6%) subjects were male and 198 (51.4%) subjects were female. A total of 83 (21.6%) participants were in the healthy group, 123 (32.0%) subjects were in the osteoporosis group, 113 (29.3%) subjects were in the bone infection group, and 66 (17.1%) individuals were in the general bone disease group.

Conclusion:

All studied components including smoking, physical activity, and nutrition directly affect pathologic fractures.

Effects of Whole-Body Vibration Training Combined With Cyclic Hypoxia on Bone Mineral Density in Elderly People

Prevention and treatment of osteoporosis are an issue of great concern in public health so that the increase/maintenance of whole-body bone mineral density (BMD) is clinically relevant and could reduce the financial burden. Whole-body vibration (WBV) has been recently proposed as a potential alternative to bone stimulation, which combined with therapies, could provide a new treatment for osteoporosis prevention. In this sense, moderate cyclic hypoxia protocols may help to restrain osteoclastic activity and/or stimulate osteoblastic activity, enhance the effects of whole-body vibration alone. So, the present study investigated the effects of cyclic hypoxic exposure combined with WBV training on BMD of the elderly. Healthy elderly persons (n = 30) were randomly assigned to a (1) Hypoxia-Whole Body Vibration group (HWBV; n = 10), (2) Normoxic-Whole Body Vibration group (NWBV; n = 10) or (3) Control group (CON; n = 10). During 18 weeks, HWBV performed WBV treatment under normobaric hypoxic conditions (16.1% FiO₂). A vibration session included 4 bouts of 30 s (12.6 Hz–4 mm) with 1 min rest between bouts. NWBV performed the same vibration treatment as HWBV but under normoxic conditions. Whole-body and proximal femur BMD (g⋅cm⁻²) were measured using dual-energy X-ray absorptiometry. Two-way ANOVA indicated a borderline significant (p = 0.07) time x group interaction for total BMD; post hoc analysis revealed a slight but significant (p = 0.021) increase of BMD after treatment in the HWBV group. In conclusion, 18-week WBV training with hypoxic stimuli has shown positive effects for the participants of the current study. As changes did not differ significantly between groups, future large-scale studies will be necessary to confirm these findings.

Temporarily increased TGFβ following radon spa correlates with reduced pain while serum IL-18 is a general predictive marker for pain sensitivity

Sustained pain relief following radon spa therapy in patients suffering from chronic painful diseases has been well described. But still, the underlying mechanisms are not fully understood. We conducted the prospective and explorative RAD-ON01 study which included 103 patients who suffered from chronic painful musculoskeletal disorders of the spine and/or joints and present here the data of the examination of pro- and anti-inflammatory cytokines in the serum of the patients before and at weeks 6, 12 and 30 after therapy. While TNFα, IL-1β, IFNγ, IL-1Ra and IL-10 were not altered, TGFβ was temporarily significantly (p = 0.013) elevated 6 weeks after therapy. Importantly, this elevation positively correlated with lowered pain sensitivity (r = 0.41). Further, the amount of IL-18 in the serum positively correlated with lowered pain sensitivity. Therefore, IL-18 can be considered as predictive marker for pain sensitivity of radon spa patients. We conclude that alterations in TGFβ and general IL-18 levels in serum have prognostic and predictive value in situations of lowered pain by exposure of patients to very low-doses of radiation as it is the case in radon spa.

[Balneotherapy and modification of risk factors in cardiovascular disease prevention programs]

Cardiovascular disease (CVD) is the leading cause of death in the Russian Federation, as in many other countries. Taking into consideration the observed increase in the spread of risk factors, modern demographic trends (an increase in the proportion of elderly people), and a high economic burden of circulatory system diseases, the search for new forms and effective strategies of prevention is becoming relevant. OBJECTIVE: To provide the data available in the scientific literature on the effectiveness of the measures to modify risk factors and lifestyle, which are implemented during balneotherapy under both resort and in non-resort conditions, and to define areas for further investigators in this field. Investigations evaluating the effectiveness of these measures were sought in the Embase, PubMed, PEDro, Web of Science, eLIBRARY databases in January 2012 to August 2018. The analysis included seven trials that showed an improvement of estimated endpoints (blood pressure, body mass index, lipid profile, physical activity, and morbidity and mortality rates). The generalization of results of the analyzed trials was limited by the high heterogeneity of their protocols and methodological quality, which does not allow for a final conclusion on the effectiveness of preventive measures implemented during balneotherapy. Future research should provide more evidence of the benefits of this approach. The analysis will be able to take into account the existing experience and to develop a strategy to enhance the effectiveness of cardiovascular disease prevention programs based on high-quality randomized clinical trials.

The role of mineral elements and other chemical compounds used in balneology: data from double-blind randomized clinical trials

The aims of this study were to conduct a systematic literature review on balneotherapy about the specific therapeutic role of mineral elements and other chemical compounds of mineral waters and derivate peloids/muds and to discuss the study methods used to evaluate it (in musculoskeletal conditions). We searched Medline by PubMed using the following key words: "spa therapy" "balneotherapy" "mud" "peloid" "mud pack Therapy" in combination with "randomized controlled trial" "double blind trial." We also reviewed the reference list of articles retrieved by the Medline search. We selected the double-blind randomized clinical trials that assessed the effects of mineral water or mud treatments compared to tap water, attenuated peloid/mud therapy or similar treatments without the specific minerals or chemical compounds of the treatment group ("non-mineral"). We evaluated the internal validity and the quality of the statistical analysis of these trials. The final selection comprised 27 double-blind randomized clinical trials, 20 related to rheumatology. A total of 1118 patients with rheumatological and other musculoskeletal diseases were evaluated in these studies: 552 of knee osteoarthritis, 47 of hand osteoarthritis, 147 chronic low back pain, 308 of reumathoid arthritis, and 64 of osteoporosis; 293 of these participants were assigned to the experimental groups of knee osteoarthritis, 24 in hand osteoarthritis, 82 of low back pain, 152 with reumathoid arthritis, and 32 with osteoporosis. They were treated with mineral water baths and/or mud/peloid (with or without other forms of treatment, like physical therapy, exercise…). The rest were allocated to the control groups; they received mainly tap water and/or "non-mineral" mud/peloid treatments. Mineral water or mud treatments had better and longer improvements in pain, function, quality of life, clinical parameters, and others in some rheumatologic diseases (knee and hand osteoarthritis, chronic low back pain, rheumatoid arthritis, and osteoporosis) compared to baseline and non-mineral similar treatments. Internal validity and other limitations of the study's methodology impede causal relation of spa therapy on these improvements. Randomized clinical trials are very heterogeneous. Double-blind randomized clinical trials seem to be the key for studying the role of mineral elements and other chemical compounds, observing enough consistency to demonstrate better and longer improvements for mineral waters or derivate compared to tap water; but due to heterogeneity and gaps on study protocol and methodology, existing research is not sufficiently strong to draw firm conclusions. Well-designed studies in larger patients' population are needed to establish the role of minerals and other chemical compounds in spa therapy.

Decrease of Markers Related to Bone Erosion in Serum of Patients with Musculoskeletal Disorders after Serial Low-Dose Radon Spa Therapy

Musculoskeletal disorders (MSDs) are the most frequent cause of disability in Europe. Reduced mobility and quality of life of the patients are often associated with pain due to chronic inflammation. The inflammatory process, accompanied by a destruction of the cartilage and bone tissue, is discussed as a result of (A) the infiltration of immune cells into the joints, (B) an altered homeostasis of the joint cavity (synovium) with a critical role of bone remodeling cells, and (C) release of inflammatory factors including adipokines in the arthritic joint. In addition to the classical medication, low-dose radiation therapy using photons or radon spa treatments has shown to reduce pain and improve the mobility of the patients. However, the cellular and molecular mechanisms of anti-inflammatory effects of radon are yet poorly understood. We analyzed blood and serum samples from 32 patients, suffering from MSDs, who had been treated in the radon spa in Bad Steben (Germany). Before and after therapy, we measured the levels of markers related to bone metabolism (collagen fragments type-1, cartilage oligomeric matrix protein, receptor activator of NFκB ligand, and osteoprotegerin) in the serum of patients. In addition, adipokines related to inflammation (visfatin, leptin, resistin, and adiponectin) were analyzed. Some of these factors are known to correlate with disease activity. Since T cells play an important role in the progression of the disease, we further analyzed in blood samples the frequency of pro- and anti-inflammatory T cell subpopulations (CD4⁺IL17⁺ T cells and CD4⁺FoxP3⁺ regulatory T cells). Overall, we found a decrease of collagen fragments (CTX-I), indicating decreased bone resorption, presumably by osteoclasts, in the serum of MSD patients. We also observed reduced levels of visfatin and a consistent trend toward an increase of regulatory T cells in the peripheral blood, both indicating attenuation of inflammation. However, key proteins of bone metabolism were unchanged on a systemic level, suggesting that these factors act locally after radon spa therapy of patients with MSDs.

Effect of resistance ladder training on sparc expression in skeletal muscle of hindlimb immobilized rats

INTRODUCTION

Secreted protein acidic and rich in cysteine (SPARC) is associated with skeletal muscle atrophy. Here we examined possibility that resistance training could regulate SPARC expression in muscle atrophy in an immobilized hindlimb model.

METHODS

Sprague-Dawley rats underwent resistance ladder training and hindlimb immobilization. Cross sectional area and grip strength were measured. SPARC protein levels in the plantaris and soleus, and serum after exercise and immobilization were then analyzed.

RESULTS

Resistance training decreased body weight (P < 0.001) and increased muscle quality (P < 0.001). In the plantaris, muscle atrophy (31.82%) and up-regulated SPARC expression (P < 0.05) after immobilization were alleviated by resistance training.

CONCLUSIONS

Resistance training led to suppression of SPARC expression in the plantaris and showed a pretraining effect in atrophied rat muscle. Thus, SPARC may play a pivotal role in muscle homeostasis. Muscle Nerve 53: 951-957, 2016.