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Fassio A, Andreola S, Gatti D, Pollastri F, Gatti M, Fabbrini P, Gambaro G, Ferraro PM, Caletti C, Rossini M, Viapiana O, Bixio R, Adami G. Long-Term Bone Mineral Density Changes in Kidney Transplant Recipients Treated with Denosumab: A Retrospective Study with Nonequivalent Control Group. Calcif Tissue Int 2024:10.1007/s00223-024-01218-z. [PMID: 38730099 DOI: 10.1007/s00223-024-01218-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/16/2024] [Indexed: 05/12/2024]
Abstract
Data on the effectiveness of denosumab on osteoporosis after kidney transplantation are limited. We investigated the long-term bone mineral density (BMD) changes in kidney transplant recipients (KTRs) treated with denosumab compared to untreated KTRs. We enrolled KTRs treated with denosumab 60 mg/6 months for 4 years. An untreated group of sex and age-matched KTRs with a 1:1 ratio was included. The primary outcome was BMD changes assessed by Dual-energy X-ray Absorptiometry over 4 years. Data on serum creatinine, alkaline phosphatase (ALP), parathyroid hormone, and 25-hydroxyvitamin D were collected. All patients received oral cholecalciferol and calcium supplementation. 23 denosumab-treated KTRs were enrolled, and 23 untreated KTRs. The median time from transplant to the start of denosumab was 4 years (range 0:24). The denosumab group showed a significant increase from baseline in BMD at the lumbar spine (LS) (9.0 ± 10.7%, p < 0.001), and total hip (TH) (3.8 ± 7.9%, p = 0.041). The untreated group showed a significant decrease at all sites (- 3.0 ± 7%, p = 0.041 at the LS; - 6.3 ± 9.2%, p = 0.003 at the TH; - 6.7 ± 9.3%, p = 0.003 at the FN). The between-group differences in percent BMD changes were statistically significant at all sites. Similar results were found for the respective Z-scores. The ALP serum levels significantly decreased from baseline only in the denosumab group, with a significant between-group difference (p = 0.032). No significant differences in serum creatinine, hypocalcaemic events or acute graft rejection rates were observed. Four years of denosumab therapy were associated with increased BMD in KTRs, while untreated KTRs showed significant BMD losses at all sites.
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Affiliation(s)
- Angelo Fassio
- Rheumatology Unit, University of Verona, Verona, Italy.
- Rheumatology Unit, Policlinico GB Rossi, 37134, Verona, Italy.
| | | | - Davide Gatti
- Rheumatology Unit, University of Verona, Verona, Italy
| | | | - Matteo Gatti
- Rheumatology Unit, University of Verona, Verona, Italy
- Department of Nephrology and Dialysis, Ospedale Bassini, ASST Nord Milano-Cinisello Balsamo, Milan, Italy
| | - Paolo Fabbrini
- Department of Nephrology and Dialysis, Ospedale Bassini, ASST Nord Milano-Cinisello Balsamo, Milan, Italy
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Adami G, Fassio A, Rossini M, Montanari F, Manfrè S, Bonasera G, Bertelle D, Benini C, Viapiana O, Braga V, Gatti D. Long-term effectiveness and predictors of bisphosphonate treatment in type I complex regional pain syndrome. Clin Exp Rheumatol 2024; 42:961-966. [PMID: 38079346 DOI: 10.55563/clinexprheumatol/sdv5qt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 10/11/2023] [Indexed: 05/15/2024]
Abstract
OBJECTIVES Complex regional pain syndrome (CRPS) is a painful disease that leads to chronic pain and disability. Bisphosphonates are largely used in the real-life for the treatment of CRPS, but data on long-term effectiveness and its predictors are lacking. METHODS We conducted a longitudinal observational study on patients with type I CRPS treated with IV neridronate (100 mg on 4 occasions). Clinical and demographic characteristics were collected at baseline, after 3 months (M3) and after 12 months (M12). Multivariable logistic regression was employed to determine the factors associated with long-term response to treatment. RESULTS 103 patients with type I CRPS treated with IV neridronate were included in the study. Mean VAS pain at baseline was 79.1 mm and decreased significantly at M3 (-45.9 mm, 95% CI 40.1 to 51.8) and M12 (-61.6 mm, 95% CI 55.3 to 67.9). Hyperalgesia and allodynia resolved in 84.3% and 88.1% of patients at M12. Loss of motion resolved in 53.5% of patients. The predictors of excellent response were gender (male better), predisposing event to CRPS (no event being better than any predisposing event), site of CRPS (lower limb being better), and early response at M3 on VAS pain (2.5 times the chance of being excellent responder every 10 mm decrease). CONCLUSIONS In this real-life study neridronate was associated with rapid and progressive improvement of symptoms of CRPS which was maintained up to 3 years of follow-up. The predictors of excellent response were early response, lower limb localisation, absence of predisposing events and male gender.
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Affiliation(s)
| | | | | | | | - Silvia Manfrè
- Pharmacy Service, University of Verona Hospital Trust, Verona, Italy
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Fassio A, Gatti D, Biffi A, Ronco R, Porcu G, Adami G, Alvaro R, Bogini R, Caputi AP, Cianferotti L, Frediani B, Gonnelli S, Iolascon G, Lenzi A, Leone S, Michieli R, Migliaccio S, Nicoletti T, Paoletta M, Pennini A, Piccirilli E, Rossini M, Brandi ML, Corrao G, Tarantino U. The sequential antifracturative treatment: a meta-analysis of randomized clinical trials. Ther Adv Musculoskelet Dis 2024; 16:1759720X241234584. [PMID: 38654732 PMCID: PMC11036926 DOI: 10.1177/1759720x241234584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 02/02/2024] [Indexed: 04/26/2024] Open
Abstract
Background Subjects with a fragility fracture have an increased risk of a new fracture and should receive effective strategies to prevent new events. The medium-term to long-term strategy should be scheduled by considering the mechanisms of action in therapy and the estimated fracture risk. Objective A systematic review was conducted to evaluate the sequential strategy in patients with or at risk of a fragility fracture in the context of the development of the Italian Guidelines. Design Systematic review and meta-analysis. Data sources and methods PubMed, Embase, and the Cochrane Library were investigated up to February 2021 to update the search of a recent systematic review. Randomized clinical trials (RCTs) that analyzed the sequential therapy of antiresorptive, anabolic treatment, or placebo in patients with or at risk of a fragility fracture were eligible. Three authors independently extracted data and appraised the risk of bias in the included studies. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation methodology. Effect sizes were pooled in a meta-analysis using fixed-effects models. The primary outcome was the risk of refracture, while the secondary outcome was the bone mineral density (BMD) change. Results In all, 17 RCTs, ranging from low to high quality, met our inclusion criteria. A significantly reduced risk of fracture was detected at (i) 12 or 24 months after the switch from romosozumab to denosumab versus placebo to denosumab; (ii) 30 months from teriparatide to bisphosphonates versus placebo to bisphosphonates; and (iii) 12 months from romosozumab to alendronate versus the only alendronate therapy (specifically for vertebral fractures). In general, at 2 years after the switch from anabolic to antiresorptive drugs, a weighted BMD was increased at the lumbar spine, total hip, and femoral neck site. Conclusion The Task Force formulated recommendations on sequential therapy, which is the first treatment with anabolic drugs or 'bone builders' in patients with very high or imminent risk of fracture.
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Affiliation(s)
- Angelo Fassio
- Rheumatology Unit, University of Verona, Piazzale A Scuro, Policlinico GB Rossi, Verona 37134, Italy
| | - Davide Gatti
- Rheumatology Unit, University of Verona, Verona, Italy
| | - Annalisa Biffi
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano–Bicocca, Milan, Italy
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano–Bicocca, Milan, Italy
| | - Raffaella Ronco
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano–Bicocca, Milan, Italy
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano–Bicocca, Milan, Italy
| | - Gloria Porcu
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano–Bicocca, Milan, Italy
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano–Bicocca, Milan, Italy
| | | | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome ‘Tor Vergata’, Rome, Italy
| | | | - Achille P. Caputi
- Department of Pharmacology, School of Medicine, University of Messina, Messina, Italy
| | | | - Bruno Frediani
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, Azienda Ospedaliero-Universitaria Senese, University of Siena, Siena, Italy
| | - Stefano Gonnelli
- Department of Medicine, Surgery and Neuroscience, Policlinico Le Scotte, University of Siena, Siena, Italy
| | - Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Andrea Lenzi
- Department of Experimental Medicine, Sapienza University of Rome, Viale del Policlinico, Rome, Italy
| | - Salvatore Leone
- AMICI Onlus, Associazione Nazionale per le Malattie Infiammatorie Croniche dell’Intestino, Milan, Italy
| | | | - Silvia Migliaccio
- Department of Movement, Human and Health Sciences, Foro Italico University, Rome, Italy
| | - Tiziana Nicoletti
- Coordinamento Nazionale delle Associazioni dei Malati Cronici e rari di Cittadinanzattiva, Rome, Italy
| | - Marco Paoletta
- Department of Medical and Surgical Specialties and Dentistry, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Annalisa Pennini
- Department of Biomedicine and Prevention, University of Rome ‘Tor Vergata’, Rome, Italy
| | - Eleonora Piccirilli
- Department of Clinical Sciences and Translational Medicine, University of Rome ‘Tor Vergata’, Rome, Italy
- Department of Orthopedics and Traumatology, ‘Policlinico Tor Vergata’ Foundation, Rome, Italy
| | | | | | - Giovanni Corrao
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano–Bicocca, Milan, Italy
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano–Bicocca, Milan, Italy
| | - Umberto Tarantino
- Department of Clinical Sciences and Translational Medicine, University of Rome ‘Tor Vergata’, Rome, Italy
- Department of Orthopedics and Traumatology, ‘Policlinico Tor Vergata’ Foundation, Rome, Italy
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Porcu G, Biffi A, Ronco R, Adami G, Alvaro R, Bogini R, Caputi AP, Frediani B, Gatti D, Gonnelli S, Iolascon G, Lenzi A, Leone S, Michieli R, Migliaccio S, Nicoletti T, Paoletta M, Pennini A, Piccirilli E, Rossini M, Tarantino U, Cianferotti L, Brandi ML, Corrao G. Refracture following vertebral fragility fracture when bone fragility is not recognized: summarizing findings from comparator arms of randomized clinical trials. J Endocrinol Invest 2024; 47:795-818. [PMID: 37921990 DOI: 10.1007/s40618-023-02222-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 10/10/2023] [Indexed: 11/05/2023]
Abstract
PURPOSE Since vertebral fragility fractures (VFFs) might increase the risk of subsequent fractures, we evaluated the incidence rate and the refracture risk of subsequent vertebral and non-vertebral fragility fractures (nVFFs) in untreated patients with a previous VFF. METHODS We systematically searched PubMed, Embase, and Cochrane Library up to February 2022 for randomized clinical trials (RCTs) that analyzed the occurrence of subsequent fractures in untreated patients with prior VFFs. Two authors independently extracted data and appraised the risk of bias in the selected studies. Primary outcomes were subsequent VFFs, while secondary outcomes were further nVFFs. The outcome of refracture within ≥ 2 years after the index fracture was measured as (i) rate, expressed per 100 person-years (PYs), and (ii) risk, expressed in percentage. RESULTS Forty RCTs met our inclusion criteria, ranging from medium to high quality. Among untreated patients with prior VFFs, the rate of subsequent VFFs and nVFFs was 12 [95% confidence interval (CI) 9-16] and 6 (95% CI 5-8%) per 100 PYs, respectively. The higher the number of previous VFFs, the higher the incidence. Moreover, the risk of VFFs and nVFFs increased within 2 (16.6% and 8%) and 4 years (35.1% and 17.4%) based on the index VFF. CONCLUSION The highest risk of subsequent VFFs or nVFFs was already detected within 2 years following the initial VFF. Thus, prompt interventions should be designed to improve the detection and treatment of VFFs, aiming to reduce the risk of future FFs and properly implement secondary preventive measures.
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Affiliation(s)
- G Porcu
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy.
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy.
| | - A Biffi
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - R Ronco
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - G Adami
- Rheumatology Unit, University of Verona, Verona, Italy
| | - R Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - R Bogini
- Local Health Unit (USL) Umbria, Perugia, Italy
| | - A P Caputi
- Department of Pharmacology, School of Medicine, University of Messina, Messina, Italy
| | - B Frediani
- Department of Medicine, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - D Gatti
- Rheumatology Unit, University of Verona, Verona, Italy
| | - S Gonnelli
- Department of Medicine, Surgery, and Neuroscience, Policlinico Le Scotte, University of Siena, Siena, Italy
| | - G Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - A Lenzi
- Department of Experimental Medicine, Sapienza University of Rome, Viale del Policlinico, Rome, Italy
| | - S Leone
- AMICI Onlus, Associazione nazionale per le Malattie Infiammatorie Croniche dell'Intestino, Milan, Italy
| | - R Michieli
- Italian Society of General Medicine and Primary Care (SIMG), Florence, Italy
| | - S Migliaccio
- Department of Movement, Human and Health Sciences, Foro Italico University, Rome, Italy
| | - T Nicoletti
- CnAMC, Coordinamento nazionale delle Associazioni dei Malati Cronici e rari di Cittadinanzattiva, Rome, Italy
| | - M Paoletta
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - A Pennini
- Rheumatology Unit, University of Verona, Verona, Italy
| | - E Piccirilli
- Department of Clinical Sciences and Translational Medicine, University of Rome "Tor Vergata", Rome, Italy
- Department of Orthopedics and Traumatology, "Policlinico Tor Vergata" Foundation, Rome, Italy
| | - M Rossini
- Rheumatology Unit, University of Verona, Verona, Italy
| | - U Tarantino
- Department of Clinical Sciences and Translational Medicine, University of Rome "Tor Vergata", Rome, Italy
- Department of Orthopedics and Traumatology, "Policlinico Tor Vergata" Foundation, Rome, Italy
| | - L Cianferotti
- Italian Foundation for Research on Bone Diseases (FIRMO), Florence, Italy
| | - M L Brandi
- Italian Foundation for Research on Bone Diseases (FIRMO), Florence, Italy
| | - G Corrao
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
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Moretti L, Walsh M, Abualsaud N, Gatti D, Lamperti M, Genest J, Farooq A, Marangoni M. Fast rate dual-comb spectrometer in the water-transparent 7.5-11.5 µm region. Opt Lett 2024; 49:1844-1847. [PMID: 38560879 DOI: 10.1364/ol.515199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 02/23/2024] [Indexed: 04/04/2024]
Abstract
We introduce a dual-comb spectrometer based on erbium fiber oscillators at 250 MHz that operates in the 7.5-11.5 µm spectral range over optical bandwidths up to 9 THz with a multi-kHz acquisition rate. Over an observation bandwidth of 0.8 THz, the signal-to-noise ratio per spectral point reaches 168 Hz0.5 at an acquisition rate of 26 kHz, which allows the investigation of transient processes in the gas phase at high temporal resolution. The system also represents an attractive solution for multi-species atmospheric gas detection in open paths due to the water transparency of the spectral window, the use of thermo-electrically cooled detectors, and the out-of-loop phase correction of the interferograms.
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Fassio A, Porciello G, Carioli G, Palumbo E, Vitale S, Luongo A, Montagnese C, Prete M, Grimaldi M, Pica R, Rotondo E, Falzone L, Calabrese I, Minopoli A, Grilli B, Cuomo M, Fiorillo PC, Evangelista C, Cavalcanti E, De Laurentiis M, Cianniello D, Pacilio C, Pinto M, Thomas G, Rinaldo M, D'Aiuto M, Serraino D, Massarut S, Steffan A, Ferraù F, Rossello R, Messina F, Catalano F, Adami G, Bertoldo F, Libra M, Crispo A, Celentano E, La Vecchia C, Augustin LSA, Gatti D. Post-diagnosis serum 25-hydroxyvitamin D concentrations in women treated for breast cancer participating in a lifestyle trial in Italy. Reumatismo 2024; 76. [PMID: 38523582 DOI: 10.4081/reumatismo.2024.1632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 10/30/2023] [Indexed: 03/26/2024] Open
Abstract
OBJECTIVE To report cross-sectionally serum levels of 25-hydroxyvitamin D [25(OH)D] in women living in Italy within 12 months from breast cancer (BC) diagnosis. METHODS Baseline data were obtained from 394 women diagnosed with primary BC, enrolled from 2016 to 2019 in a lifestyle trial conducted in Italy. Subjects' characteristics were compared between two 25(OH)D concentrations (hypovitaminosis D<20 and ≥20 ng/mL) with the Chi-squared test or Fisher's exact test for small-expected counts. Using multiple logistic regression-adjusted models, we estimated odds ratios (ORs) of hypovitaminosis D with 95% confidence intervals (CIs) in the total sample and in the unsupplemented subgroup. RESULTS Hypovitaminosis D was found in 39% of all subjects, 60% in unsupplemented subjects, and 10% in supplemented subjects. Increasing ORs of hypovitaminosis D were found with increasing body mass index, 25-30, >30, and ≥35 versus <25 kg/m2 (ORs: 2.50, 4.64, and 5.81, respectively, in the total cohort and ORs: 2.68, 5.38, and 7.08 in the unsupplemented); living in the most southern Italian region (OR 2.50, 95%CI 1.22-5.13); and with hypertriglyceridemia (OR 2.46; 95%CI 1.16-5.22), chemotherapy history (OR 1.86, 95%CI 1.03-3.38), and inversely with anti-estrogenic therapy (OR 0.43, 95%CI 0.24-0.75) in the total sample. CONCLUSIONS Hypovitaminosis D in women recently diagnosed with BC and participating in a lifestyle trial in Italy was widespread and highest with obesity, hypertriglyceridemia, and chemotherapy use. Considering that hypovitaminosis D is a risk factor for lower efficacy of bone density treatments and possibly BC mortality, our results suggest the need to promptly address and treat vitamin D deficiency.
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Affiliation(s)
- A Fassio
- Rheumatology Unit, University of Verona.
| | - G Porciello
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Napoli.
| | - G Carioli
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano.
| | - E Palumbo
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Napoli.
| | - S Vitale
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Napoli.
| | - A Luongo
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Napoli.
| | | | - M Prete
- Division of Radiotherapy, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Napoli.
| | - M Grimaldi
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Napoli.
| | - R Pica
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Napoli.
| | - E Rotondo
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Napoli.
| | - L Falzone
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Napoli.
| | - I Calabrese
- Healthcare Direction, "A. Cardarelli" Hospital, Napoli.
| | - A Minopoli
- aboratory Medicine Unit, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Napoli.
| | - B Grilli
- Virology and Microbiology Unit, Università degli Studi di Napoli "Luigi Vanvitelli", Napoli.
| | - M Cuomo
- Laboratory Medicine Unit, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Napoli.
| | - P C Fiorillo
- Laboratory of Chemical, Clinical and Microbiological Analysis, Department of "Strutturale dei Servizi", Ospedale S. Giacomo, Novi Ligure.
| | - C Evangelista
- Immunopathology and Cancer Biomarkers Unit, Centro di Riferimento Oncologico (CRO) IRCCS, Aviano.
| | - E Cavalcanti
- Laboratory Medicine Unit, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Napoli.
| | - M De Laurentiis
- Division of Breast Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Napoli.
| | - D Cianniello
- Division of Breast Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Napoli.
| | - C Pacilio
- Division of Breast Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Napoli.
| | - M Pinto
- Rehabilitation Medicine Unit, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Napoli.
| | | | - M Rinaldo
- Breast Unit, Clinica Villa Fiorita, Aversa.
| | - M D'Aiuto
- Breast Unit, Clinica Villa Fiorita, Aversa.
| | - D Serraino
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano (CRO) IRCSS, Aviano.
| | - S Massarut
- Department of Surgery, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano.
| | - A Steffan
- Immunopathology and Cancer Biomarkers Unit, Centro di Riferimento Oncologico (CRO) IRCCS, Aviano.
| | - F Ferraù
- Division of Medical Oncology, Ospedale San Vincenzo, Taormina.
| | - R Rossello
- Division of Medical Oncology, Ospedale San Vincenzo, Taormina.
| | - F Messina
- Ospedale Evangelico Betania, Napoli.
| | | | - G Adami
- Rheumatology Unit, University of Verona.
| | - F Bertoldo
- Department of Medicine, University of Verona.
| | - M Libra
- Oncologic, Clinical and General Pathology Section, Department of Biomedical and Biotechnological Sciences, University of Catania.
| | - A Crispo
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Napoli.
| | - E Celentano
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Napoli.
| | - C La Vecchia
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano.
| | - L S A Augustin
- pidemiology and Biostatistics Unit, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Napoli.
| | - D Gatti
- Rheumatology Unit, University of Verona.
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Adami G, Rossini M, Gatti D, Serpi P, Fabrizio C, Lovato R. New point-of-care calcaneal ultrasound densitometer (Osteosys BeeTLE) compared to standard dual-energy X-ray absorptiometry (DXA). Sci Rep 2024; 14:6898. [PMID: 38519548 PMCID: PMC10959987 DOI: 10.1038/s41598-024-56787-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 03/11/2024] [Indexed: 03/25/2024] Open
Abstract
Dual-energy X-ray absorptiometry (DXA) represents the gold standard for measuring bone mineral density (BMD). However, its size and bulkiness limit its use in mass screening. Portable and easily accessible instruments are more suitable for this purpose. We conducted a study to assess the repeatability, sensitivity, accuracy, and validation of a new ultrasound densitometer for the calcaneus (OsteoSys BeeTLe) compared to standard DXA. BMD (g/cm2) was measured at the femoral and lumbar spine levels using DXA (Discovery Acclaim (Hologic, Waltham, MA, USA) or Lunar Prodigy (GE Healthcare, Madison, WI, USA) devices). Bone Quality Index (BQI, a dimensionless measure of bone quality derived from measures of SOS [Speed Of Sound] and BUA [broadband ultrasound attenuation]) was measured with OsteoSys BeeTLe. The Bland-Altman test and simple linear regression were used to evaluate the association between values measured with the two instruments. Additionally, the ability of the T-score calculated with BeeTLe to identify patients with previous osteoporotic fractures was tested using ROC curves. A total of 201 patients (94.5% females) with a mean age of 62.1 ± 10.2 were included in the study. The BeeTLe instrument showed a coefficient of variation (CV, in 75 repeated measurements) of 1.21%, which was not statistically different from the CV of DXA (1.20%). We found a significant association between BQI and BMD at the femoral neck (r2 = 0.500, p < 0.0001), total femur (r2 = 0.545, p < 0.0001), and lumbar spine (r2 = 0.455, p < 0.0001). T-scores bias were 0.215 (SD 0.876), 0.021 (SD 0.889) and 0.523 (SD 0.092), for femoral neck, total hip and lumbar spine respectively. AUC for discriminating fracture and non-fractured patients were not significantly different with OsteoSys BeeTLe and standard DXA. In this preliminary study, BeeTLe, a new point-of-care ultrasound densitometer, demonstrated good repeatability and performance similar to DXA. Therefore, its use can be proposed in screening for osteoporosis.
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Affiliation(s)
- Giovanni Adami
- Rheumatology Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Pz Scuro 10, 37134, Verona, Italy.
| | - Maurizio Rossini
- Rheumatology Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Pz Scuro 10, 37134, Verona, Italy
| | - Davide Gatti
- Rheumatology Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Pz Scuro 10, 37134, Verona, Italy
| | | | | | - Roberto Lovato
- Bone Specialist Unit, Ospedale Casa di Cura Villa Berica, Vicenza, Italy
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Adami G, Gatti D, Rossini M, Giollo A, Gatti M, Bertoldo F, Bertoldo E, Mudano AS, Saag KG, Viapiana O, Fassio A. Risk of fracture in women with glucocorticoid requiring diseases is independent from glucocorticoid use: An analysis on a nation-wide database. Bone 2024; 179:116958. [PMID: 37949390 DOI: 10.1016/j.bone.2023.116958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 10/31/2023] [Accepted: 11/07/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE Glucocorticoid-induced osteoporosis (GIOP) is a common cause of secondary osteoporosis. However, glucocorticoid requiring diseases pose a risk themselves for fracture. The aim of the present study was to determine the risk of fracture associated with variety of glucocorticoid requiring diseases independently from glucocorticoid use and other risk factors for osteoporosis. METHODS We conducted a retrospective cross-sectional analysis of a nation-wide cohort (DeFRACalc79 database). We used multivariable regression analysis adjusting for several risk factors for fracture and glucocorticoid intake to estimate the independent role of glucocorticoid requiring illnesses on fracture risk. RESULTS We found that patients with rheumatoid arthritis, connective tissue diseases, chronic obstructive pulmonary disease (COPD) and neurological diseases were at greater risk of vertebral or hip fracture (crude ORs 1.31, 1.20, 1.92 and 2.97 respectively). After adjusting for potential confounders COPD and neurological diseases remained significantly associated with an increased risk of vertebral or hip fractures (aORs 1.33, 95 % CI 1.18-1.49 and 2.43, 95 % CI 2.17-2.74). Rheumatoid arthritis, COPD, IBD and neurological diseases also significantly increased the risk of non-vertebral, non-hip fractures (aORs 1.23, 1.42, 1.52 and 1.94 respectively). CONCLUSION Some glucocorticoid requiring diseases were independently associated with an increased risk of fractures. COPD and neurological diseases with both vertebral and non-vertebral fracture risk while RA and IBD were independently associated only with non-vertebral, non-hip fractures.
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Affiliation(s)
| | - Davide Gatti
- Rheumatology Unit, University of Verona, Verona, Italy.
| | | | | | - Matteo Gatti
- Rheumatology Unit, University of Verona, Verona, Italy
| | - Francesco Bertoldo
- Bone Metabolism and Osteoncology Unit, University of Verona, Verona, Italy.
| | | | - Amy S Mudano
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Kenneth G Saag
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA.
| | | | - Angelo Fassio
- Rheumatology Unit, University of Verona, Verona, Italy
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9
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Adami G, Ruzzon F, Fassio A, Gatti D, Gatti M, Rossini M. Clinical Images: Erosive tophaceous gout and uric acid nephrolithiasis: microscopic and three-dimensional high-resolution peripheral quantitative computed tomography findings. Arthritis Rheumatol 2024. [PMID: 38272830 DOI: 10.1002/art.42814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 01/12/2024] [Accepted: 01/14/2024] [Indexed: 01/27/2024]
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Bernasconi R, Invernizzi GP, Gallo Stampino E, Gotti R, Gatti D, Magagnin L. Printing MEMS: Application of Inkjet Techniques to the Manufacturing of Inertial Accelerometers. Micromachines (Basel) 2023; 14:2082. [PMID: 38004939 PMCID: PMC10672808 DOI: 10.3390/mi14112082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 11/05/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023]
Abstract
In the last few years, the manufacturing of microelectromechanical systems (MEMS) by means of innovative tridimensional and bidimensional printing technologies has significantly catalyzed the attention of researchers. Inkjet material deposition, in particular, can become a key enabling technology for the production of polymer-based inertial sensors characterized by low cost, high manufacturing scalability and superior sensitivity. In this paper, a fully inkjet-printed polymeric accelerometer is proposed, and its manufacturing steps are described. The manufacturing challenges connected with the inkjet deposition of SU-8 as a structural material are identified and addressed, resulting in the production of a functional spring-mass sensor. A step-crosslinking process allows optimization of the final shape of the device and limits defects typical of inkjet printing. The resulting device is characterized from a morphological point of view, and its functionality is assessed in performing optical readout. The acceleration range of the optimized device is 0-0.7 g, its resolution is 2 × 10-3 g and its sensitivity is 6745 nm/g. In general, the work demonstrates the feasibility of polymeric accelerometer production via inkjet printing, and these characteristic parameters demonstrate their potential applicability in a broad range of uses requiring highly accurate acceleration measurements over small displacements.
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Affiliation(s)
- Roberto Bernasconi
- Dipartimento di Chimica, Materiali e Ingegneria Chimica “Giulio Natta”, Politecnico di Milano, Via L. Mancinelli 7, 20131 Milano, Italy; (G.P.I.); (E.G.S.); (L.M.)
| | - Gabriele Pietro Invernizzi
- Dipartimento di Chimica, Materiali e Ingegneria Chimica “Giulio Natta”, Politecnico di Milano, Via L. Mancinelli 7, 20131 Milano, Italy; (G.P.I.); (E.G.S.); (L.M.)
| | - Elisa Gallo Stampino
- Dipartimento di Chimica, Materiali e Ingegneria Chimica “Giulio Natta”, Politecnico di Milano, Via L. Mancinelli 7, 20131 Milano, Italy; (G.P.I.); (E.G.S.); (L.M.)
| | - Riccardo Gotti
- Dipartimento di Fisica, Politecnico di Milano e IFN-CNR, Via G. Previati 1/C, 23900 Lecco, Italy; (R.G.); (D.G.)
| | - Davide Gatti
- Dipartimento di Fisica, Politecnico di Milano e IFN-CNR, Via G. Previati 1/C, 23900 Lecco, Italy; (R.G.); (D.G.)
| | - Luca Magagnin
- Dipartimento di Chimica, Materiali e Ingegneria Chimica “Giulio Natta”, Politecnico di Milano, Via L. Mancinelli 7, 20131 Milano, Italy; (G.P.I.); (E.G.S.); (L.M.)
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11
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Adami G, Fassio A, Rossini M, Benini C, Bixio R, Rotta D, Viapiana O, Gatti D. Machine learning to characterize bone biomarkers profile in rheumatoid arthritis. Front Immunol 2023; 14:1291727. [PMID: 38022514 PMCID: PMC10665911 DOI: 10.3389/fimmu.2023.1291727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
Background Bone metabolism is disrupted in rheumatoid arthritis (RA); however, the bone metabolic signature of RA is poorly known. The objective of the study is to further characterize the bone metabolic profile of RA and compare it to psoriatic arthritis (PsA), systemic sclerosis (SSc) and healthy controls. Methods We did a cross-sectional case-control study on consecutively enrolled patients and age-matched controls. We collected clinical characteristics, serum biomarkers related to bone metabolism and Bone Mineral Density (BMD). A multiple correlation analysis using Spearman's rank correlation coefficient was conducted within the RA patient group to investigate associations between biomarker levels and clinical variables. Machine learning (ML) models and Principal Component Analysis (PCA) was performed to evaluate the ability of bone biomarker profiles to differentiate RA patients from controls. Results We found significantly lower BMD in RA patients compared to PsA, and Systemic Sclerosis SSc groups. RA patients exhibited higher Dkk1, sclerostin and lower P1nP and B-ALP levels compared to controls. No significant differences in CTX levels were noted. Correlation analysis revealed associations between bone biomarkers and clinical variables. PCA and ML highlighted distinct biomarker patterns in RA which can effectively discriminated bone biomarkers profile in RA from controls. Conclusion Our study helped uncover the distinct bone profile in RA, including changes in bone density and unique biomarker patterns. These findings enhance our comprehension of the intricate links between inflammation, bone dynamics, and RA activity, offering potential insights for diagnostic and therapeutic advancements in managing bone involvement in this challenging condition.
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12
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Adami G, Biffi A, Porcu G, Ronco R, Alvaro R, Bogini R, Caputi AP, Cianferotti L, Frediani B, Gatti D, Gonnelli S, Iolascon G, Lenzi A, Leone S, Migliaccio S, Nicoletti T, Paoletta M, Pennini A, Piccirilli E, Tarantino U, Brandi ML, Corrao G, Rossini M, Michieli R. A systematic review on the performance of fracture risk assessment tools: FRAX, DeFRA, FRA-HS. J Endocrinol Invest 2023; 46:2287-2297. [PMID: 37031450 PMCID: PMC10558377 DOI: 10.1007/s40618-023-02082-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 03/27/2023] [Indexed: 04/10/2023]
Abstract
PURPOSE Preventing fragility fractures by treating osteoporosis may reduce disability and mortality worldwide. Algorithms combining clinical risk factors with bone mineral density have been developed to better estimate fracture risk and possible treatment thresholds. This systematic review supported panel members of the Italian Fragility Fracture Guidelines in recommending the use of best-performant tool. The clinical performance of the three most used fracture risk assessment tools (DeFRA, FRAX, and FRA-HS) was assessed in at-risk patients. METHODS PubMed, Embase, and Cochrane Library were searched till December 2020 for studies investigating risk assessment tools for predicting major osteoporotic or hip fractures in patients with osteoporosis or fragility fractures. Sensitivity (Sn), specificity (Sp), and areas under the curve (AUCs) were evaluated for all tools at different thresholds. Quality assessment was performed using the Quality Assessment of Diagnostic Accuracy Studies-2; certainty of evidence (CoE) was evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS Forty-three articles were considered (40, 1, and 2 for FRAX, FRA-HS, and DeFRA, respectively), with the CoE ranging from very low to high quality. A reduction of Sn and increase of Sp for major osteoporotic fractures were observed among women and the entire population with cut-off augmentation. No significant differences were found on comparing FRAX to DeFRA in women (AUC 59-88% vs. 74%) and diabetics (AUC 73% vs. 89%). FRAX demonstrated non-significantly better discriminatory power than FRA-HS among men. CONCLUSION The task force formulated appropriate recommendations on the use of any fracture risk assessment tools in patients with or at risk of fragility fractures, since no statistically significant differences emerged across different prediction tools.
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Affiliation(s)
- G Adami
- Rheumatology Unit, University of Verona, Verona, Italy
| | - A Biffi
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - G Porcu
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - R Ronco
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - R Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - R Bogini
- Local Health Unit (USL) Umbria, Perugia, Italy
| | - A P Caputi
- Department of Pharmacology, School of Medicine, University of Messina, Messina, Italy
| | - L Cianferotti
- Italian Bone Disease Research Foundation (FIRMO), Florence, Italy
| | - B Frediani
- Department of Medicine, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - D Gatti
- Rheumatology Unit, University of Verona, Verona, Italy.
| | - S Gonnelli
- Department of Medicine, Surgery and Neuroscience, Policlinico Le Scotte, University of Siena, Siena, Italy
| | - G Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - A Lenzi
- Department of Experimental Medicine, Sapienza University of Rome, Viale del Policlinico, Rome, Italy
| | - S Leone
- AMICI Onlus, Associazione Nazionale per le Malattie Infiammatorie Croniche dell'Intestino, Milan, Italy
| | - S Migliaccio
- Department of Movement, Human and Health Sciences, Foro Italico University, Rome, Italy
| | - T Nicoletti
- Coordinamento Nazionale delle Associazioni dei Malati Cronici e rari di Cittadinanzattiva, CnAMC, Rome, Italy
| | - M Paoletta
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - A Pennini
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - E Piccirilli
- Department of Clinical Sciences and Translational Medicine, University of Rome "Tor Vergata", Rome, Italy
- Department of Orthopedics and Traumatology, "Policlinico Tor Vergata" Foundation, Rome, Italy
| | - U Tarantino
- Department of Clinical Sciences and Translational Medicine, University of Rome "Tor Vergata", Rome, Italy
- Department of Orthopedics and Traumatology, "Policlinico Tor Vergata" Foundation, Rome, Italy
| | - M L Brandi
- Italian Bone Disease Research Foundation (FIRMO), Florence, Italy
| | - G Corrao
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - M Rossini
- Rheumatology Unit, University of Verona, Verona, Italy
| | - R Michieli
- Italian Society of General Medicine and Primary Care (SIMG), Florence, Italy
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Adami G, Orsolini G, Rossini M, Pedrollo E, Fratucello A, Fassio A, Viapiana O, Milleri S, Fracassi E, Bixio R, Gatti D. Changes in bone turnover markers and bone modulators during abatacept treatment. Sci Rep 2023; 13:17183. [PMID: 37821541 PMCID: PMC10567677 DOI: 10.1038/s41598-023-44374-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 10/07/2023] [Indexed: 10/13/2023] Open
Abstract
Rheumatoid arthritis (RA) causes bone loss, only partly related to inflammation. The impact of RA treatments on bone metabolism and their ability to mitigate bone loss remains uncertain. The primary goal of our study was to examine the influence of abatacept on serum levels of markers and regulators involved in bone turnover. Secondary objectives included evaluating changes in bone mineral density (BMD), bone health parameters, erosions, and exploring potential correlations among these parameters. We conducted a prospective observational study on patients with active seropositive RA failure to biological disease modifying anti-rheumatic drugs initiating treatment with abatacept. We measured at baseline and after 1, 2, 3, 6, 9 and 12 months: serum bone turnover markers (CTX, P1nP, B-ALP), bone modulators (Dkk-1, sclerostin, vitamin D, PTH, OPG and RANKL), BMD and radiographic parameters (modified Sharp van der Heijde score [mSvdH], bone health index [BHI] and metacarpal index [MCI]). Disease activity and glucocorticoid intake was monitored. 33 patients were enrolled in the study. We found a significant increase in markers of bone formation (B-ALP and P1nP) from baseline to M6 and M12. PTH increased significantly at M6 but not at M12. All other bone markers and modulators did not change. We found a significant decrease in BHI and MCI from baseline to M12 (median difference - 0.17 95% CI - 0.42 to - 0.10, p 0.001 and - 0.09 95% CI - 0.23 to - 0.07, respectively). BMD at femoral neck transitorily decreased at M6 (mean difference - 0.019 g/cm2 95% CI - 0.036 to - 0.001 p 0.04). BMD at total hip, lumbar spine and mSvdH score did not change significantly. P1nP delta at M12 correlated with delta mSvdH. Treatment with abatacept was associated with a significant increase in bone formation markers. The secondary and transient increase in PTH serum levels may be responsible of the transitory bone loss.
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Affiliation(s)
- Giovanni Adami
- Rheumatology Unit, Azienda Ospedaliera Universitaria Integrata di Verona, University of Verona, Pz Scuro 10, 37134, Verona, Italy.
| | - Giovanni Orsolini
- Rheumatology Unit, Azienda Ospedaliera Universitaria Integrata di Verona, University of Verona, Pz Scuro 10, 37134, Verona, Italy
| | - Maurizio Rossini
- Rheumatology Unit, Azienda Ospedaliera Universitaria Integrata di Verona, University of Verona, Pz Scuro 10, 37134, Verona, Italy
| | - Elisa Pedrollo
- Rheumatology Unit, Azienda Ospedaliera Universitaria Integrata di Verona, University of Verona, Pz Scuro 10, 37134, Verona, Italy
| | - Anna Fratucello
- Research Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Angelo Fassio
- Rheumatology Unit, Azienda Ospedaliera Universitaria Integrata di Verona, University of Verona, Pz Scuro 10, 37134, Verona, Italy
| | - Ombretta Viapiana
- Rheumatology Unit, Azienda Ospedaliera Universitaria Integrata di Verona, University of Verona, Pz Scuro 10, 37134, Verona, Italy
| | - Stefano Milleri
- Centro Ricerche Cliniche (CRC), Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Elena Fracassi
- Rheumatology Unit, Azienda Ospedaliera Universitaria Integrata di Verona, University of Verona, Pz Scuro 10, 37134, Verona, Italy
| | - Riccardo Bixio
- Rheumatology Unit, Azienda Ospedaliera Universitaria Integrata di Verona, University of Verona, Pz Scuro 10, 37134, Verona, Italy
| | - Davide Gatti
- Rheumatology Unit, Azienda Ospedaliera Universitaria Integrata di Verona, University of Verona, Pz Scuro 10, 37134, Verona, Italy
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Fassio A, Atzeni F, Rossini M, D’Amico V, Cantatore F, Chimenti MS, Crotti C, Frediani B, Giusti A, Peluso G, Rovera G, Scolieri P, Raimondo V, Gatti D. Osteoimmunology of Spondyloarthritis. Int J Mol Sci 2023; 24:14924. [PMID: 37834372 PMCID: PMC10573470 DOI: 10.3390/ijms241914924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/15/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023] Open
Abstract
The mechanisms underlying the development of bone damage in the context of spondyloarthritis (SpA) are not completely understood. To date, a considerable amount of evidence indicates that several developmental pathways are crucially involved in osteoimmunology. The present review explores the biological mechanisms underlying the relationship between inflammatory dysregulation, structural progression, and osteoporosis in this diverse family of conditions. We summarize the current knowledge of bone biology and balance and the foundations of bone regulation, including bone morphogenetic protein, the Wnt pathway, and Hedgehog signaling, as well as the role of cytokines in the development of bone damage in SpA. Other areas surveyed include the pathobiology of bone damage and systemic bone loss (osteoporosis) in SpA and the effects of pharmacological treatment on focal bone damage. Lastly, we present data relative to a survey of bone metabolic assessment in SpA from Italian bone specialist rheumatology centers. The results confirm that most of the attention to bone health is given to postmenopausal subjects and that the aspect of metabolic bone health may still be underrepresented. In our opinion, it may be the time for a call to action to increase the interest in and focus on the diagnosis and management of SpA.
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Affiliation(s)
- Angelo Fassio
- Dipartimento di Medicina, Università di Verona, 37124 Verona, Italy; (M.R.); (D.G.)
| | - Fabiola Atzeni
- Unità Operativa Complessa di Reumatologia Azienda Ospedaliero Universitaria Policlinico “G. Martino” di Messina, 35128 Messina, Italy; (F.A.); (V.D.)
| | - Maurizio Rossini
- Dipartimento di Medicina, Università di Verona, 37124 Verona, Italy; (M.R.); (D.G.)
| | - Valeria D’Amico
- Unità Operativa Complessa di Reumatologia Azienda Ospedaliero Universitaria Policlinico “G. Martino” di Messina, 35128 Messina, Italy; (F.A.); (V.D.)
| | - Francesco Cantatore
- Unità Operativa Complessa di Reumatologia Universitaria, Polic. “Riuniti” di Foggia, 71122 Foggia, Italy;
| | - Maria Sole Chimenti
- Dipartimento di Medicina dei Sistemi, Reumatologia, Allergologia e Immunologia Clinica Università di Roma Tor Vergata, 00133 Rome, Italy;
| | - Chiara Crotti
- UOC Osteoporosi e Malattie Metaboliche dell’Osso Dipartimento di Reumatologia e Scienze Mediche ASST-G. Pini-CTO, 20122 Milan, Italy;
| | - Bruno Frediani
- Department of Medical, Surgical and Neuroscience Sciences, Rheumatology University of Siena, 53100 Siena, Italy;
| | - Andrea Giusti
- SSD Malattie Reumatologiche e del Metabolismo Osseo, Dipartimento delle Specialità Mediche, ASL3, 16132 Genova, Italy;
| | - Giusy Peluso
- UOC di Reumatologia-Fondazione Policlinico Universitario Agostino Gemelli-IRCSS, 00168 Rome, Italy;
| | - Guido Rovera
- Ospedale S. Andrea, Divisione Reumatologia, 13100 Vercelli, Italy;
| | - Palma Scolieri
- Ambulatorio di Reumatologia Ospedale Nuovo Regina Margherita ASL ROMA1, 00153 Rome, Italy;
| | | | - Davide Gatti
- Dipartimento di Medicina, Università di Verona, 37124 Verona, Italy; (M.R.); (D.G.)
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15
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Adami G, Fassio A, Rossini M, Benini C, Pistillo F, Viapiana O, Bertelle D, Gatti D. Bone Loss in Inflammatory Rheumatic Musculoskeletal Disease Patients Treated With Low-Dose Glucocorticoids and Prevention by Anti-Osteoporosis Medications. Arthritis Rheumatol 2023; 75:1762-1769. [PMID: 37094379 DOI: 10.1002/art.42529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 03/05/2023] [Accepted: 04/04/2023] [Indexed: 04/26/2023]
Abstract
OBJECTIVE The negative effects of glucocorticoids on bone depend on dose and treatment duration. However, it is unclear whether a safe dose exists, especially for patients with inflammatory rheumatic musculoskeletal diseases (iRMDs). We undertook this study to determine the effects of glucocorticoid doses on bone health in iRMD patients. METHODS We conducted a longitudinal cohort study on women with iRMD. Bone mineral density (BMD) and fractures were assessed prospectively and compared to a matched cohort without iRMD. Kaplan-Meier curves with log rank test were made for iRMD patients (stratified for glucocorticoid use and dose) and the matched cohort. Multivariable Cox regression survival models were also employed to analyze the effect of glucocorticoids on fracture. RESULTS A total of 884 women with iRMD and 1,766 controls (matched for age, T score, and 10-year fracture risk) were included in the study and followed up for up to 6 years. BMD decreased significantly in all patients receiving glucocorticoids who were not receiving anti-osteoporosis treatment (-4.26% for ≥5 mg/day of prednisone equivalent, P = 0.0011; -4.23% for 2.5-5 mg/day, P = 0.0422; -2.66% for 0-2.5 mg/day, P = 0.0006). Anti-osteoporosis treatment (largely bisphosphonates) prevented bone loss only in patients receiving <5 mg/day of prednisone equivalent. Fracture incidence was higher in patients with iRMD compared to controls, but only glucocorticoid doses ≥5 mg/day were associated with significantly higher risk of fracture. CONCLUSION Glucocorticoid doses as low as 2.5 mg/day were associated with BMD loss in iRMD patients, but this effect was preventable. BMD loss in patients receiving ≥5 mg/day was not totally prevented by anti-osteoporosis medications currently used in clinical practice, resulting in higher risk of fracture.
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Affiliation(s)
| | - Angelo Fassio
- Rheumatology Unit, University of Verona, Verona, Italy
| | | | | | | | | | | | - Davide Gatti
- Rheumatology Unit, University of Verona, Verona, Italy
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Adami G, Fassio A, Pistillo F, Benini C, Viapiana O, Rossini M, Gatti D. Factors associated with radiographic progression in rheumatoid arthritis starting biological diseases modifying anti-rheumatic drugs (bDMARDs). Ther Adv Musculoskelet Dis 2023; 15:1759720X231174534. [PMID: 37780955 PMCID: PMC10540567 DOI: 10.1177/1759720x231174534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 04/22/2023] [Indexed: 10/03/2023] Open
Abstract
Background Biological DMARDs (bDMARDs) have been proven to prevent joint damage and bone erosions. Nevertheless, approximately 15% of rheumatoid arthritis (RA) patients on bDMARDs will progress despite good control of joint inflammation. Objectives The objective of our study is to investigate the factors associated with radiological progression of patients treated with bDMARDs. Design We conducted a retrospective analysis of longitudinally collected data on RA patients starting bDMARDs. Methods Presence or development of new erosions was assessed by a skilled rheumatologist at the time of the visit (baseline and 12 months thereafter). To determine the predictors of erosions, we employed multivariable logistic regression models. Discriminatory capacity for the prediction of new erosion development was assessed with receiver operating characteristic (ROC) curve, which was based on the logistic regression model. Results A total of 578 RA patients starting bDMARDs were included in the study. Overall, 46 patients (approximately 10%) had radiographic progression (at least one new erosion) at 12 months of follow-up. The factors independently associated with higher risk of developing new erosions while on bDMARD were younger age, high disease activity at baseline, not being treated with cDMARDs, and presenting with erosions at baseline. In addition, we built a predictive model that can accurately foresee new erosions (AUC 0.846) in patients receiving bDMARDs. Conclusion We found that baseline erosive disease, higher disease activity during treatment, younger age, and monotherapy were the factors independently associated with the development of bone erosions. Our study may inform future targeted intervention in RA patients at risk of radiographic progression.
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Affiliation(s)
- Giovanni Adami
- Rheumatology Unit, University of Verona, Pz Scuro 10, 37134 Verona, Italy
| | - Angelo Fassio
- Rheumatology Unit, University of Verona, Verona, Italy
| | | | | | | | | | - Davide Gatti
- Rheumatology Unit, University of Verona, Verona, Italy
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17
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Cianferotti L, Porcu G, Ronco R, Adami G, Alvaro R, Bogini R, Caputi AP, Frediani B, Gatti D, Gonnelli S, Iolascon G, Lenzi A, Leone S, Michieli R, Migliaccio S, Nicoletti T, Paoletta M, Pennini A, Piccirilli E, Rossini M, Tarantino U, Brandi ML, Corrao G, Biffi A. The integrated structure of care: evidence for the efficacy of models of clinical governance in the prevention of fragility fractures after recent sentinel fracture after the age of 50 years. Arch Osteoporos 2023; 18:109. [PMID: 37603196 PMCID: PMC10442313 DOI: 10.1007/s11657-023-01316-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 07/21/2023] [Indexed: 08/22/2023]
Abstract
Randomized clinical trials and observational studies on the implementation of clinical governance models, in patients who had experienced a fragility fracture, were examined. Literature was systematically reviewed and summarized by a panel of experts who formulated recommendations for the Italian guideline. PURPOSE After experiencing a fracture, several strategies may be adopted to reduce the risk of recurrent fragility fractures and associated morbidity and mortality. Clinical governance models, such as the fracture liaison service (FLS), have been introduced for the identification, treatment, and monitoring of patients with secondary fragility fractures. A systematic review was conducted to evaluate the association between multidisciplinary care systems and several outcomes in patients with a fragility fracture in the context of the development of the Italian Guidelines. METHODS PubMed, Embase, and the Cochrane Library were investigated up to December 2020 to update the search of the Scottish Intercollegiate Guidelines Network. Randomized clinical trials (RCTs) and observational studies that analyzed clinical governance models in patients who had experienced a fragility fracture were eligible. Three authors independently extracted data and appraised the risk of bias in the included studies. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation methodology. Effect sizes were pooled in a meta-analysis using random-effects models. Primary outcomes were bone mineral density values, antiosteoporotic therapy initiation, adherence to antiosteoporotic medications, subsequent fracture, and mortality risk, while secondary outcomes were quality of life and physical performance. RESULTS Fifteen RCTs and 62 observational studies, ranging from very low to low quality for bone mineral density values, antiosteoporotic initiation, adherence to antiosteoporotic medications, subsequent fracture, mortality, met our inclusion criteria. The implementation of clinical governance models compared to their pre-implementation or standard care/non-attenders significantly improved BMD testing rate, and increased the number of patients who initiated antiosteoporotic therapy and enhanced their adherence to the medications. Moreover, the treatment by clinical governance model respect to standard care/non-attenders significantly reduced the risk of subsequent fracture and mortality. The integrated structure of care enhanced the quality of life and physical function among patients with fragility fractures. CONCLUSIONS Based on our findings, clinicians should promote the management of patients experiencing a fragility fracture through structured and integrated models of care. The task force has formulated appropriate recommendations on the implementation of multidisciplinary care systems in patients with, or at risk of, fragility fractures.
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Affiliation(s)
- L Cianferotti
- Italian Bone Disease Research Foundation (FIRMO), Florence, Italy
| | - G Porcu
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy.
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.
| | - R Ronco
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy.
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.
| | - G Adami
- Rheumatology Unit, University of Verona, Verona, Italy
| | - R Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - R Bogini
- Local Health Unit (USL) Umbria, Perugia, Italy
| | - A P Caputi
- Department of Pharmacology, School of Medicine, University of Messina, Sicily, Italy
| | - B Frediani
- Department of Medicine, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - D Gatti
- Rheumatology Unit, University of Verona, Verona, Italy
| | - S Gonnelli
- Department of Medicine, Surgery and Neuroscience, Policlinico Le Scotte, University of Siena, Siena, Italy
| | - G Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - A Lenzi
- Department of Experimental Medicine, Sapienza University of Rome, Viale del Policlinico, Rome, Italy
| | - S Leone
- AMICI Onlus, Associazione nazionale per le Malattie Infiammatorie Croniche dell'Intestino, Milan, Italy
| | - R Michieli
- Italian Society of General Medicine and Primary Care (SIMG), Florence, Italy
| | - S Migliaccio
- Department of Movement, Human and Health Sciences, Foro Italico University, Rome, Italy
| | - T Nicoletti
- CnAMC, Coordinamento nazionale delle Associazioni dei Malati Cronici e rari di Cittadinanzattiva, Rome, Italy
| | - M Paoletta
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - A Pennini
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - E Piccirilli
- Department of Clinical Sciences and Translational Medicine, University of Rome "Tor Vergata", Rome, Italy
- Department of Orthopedics and Traumatology, "Policlinico Tor Vergata" Foundation, Rome, Italy
| | - M Rossini
- Rheumatology Unit, University of Verona, Verona, Italy
| | - U Tarantino
- Department of Clinical Sciences and Translational Medicine, University of Rome "Tor Vergata", Rome, Italy
- Department of Orthopedics and Traumatology, "Policlinico Tor Vergata" Foundation, Rome, Italy
| | - M L Brandi
- Italian Bone Disease Research Foundation (FIRMO), Florence, Italy
| | - G Corrao
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - A Biffi
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy.
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.
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Giollo A, Bixio R, Gatti D, Viapiana O, Idolazzi L, Dejaco C, Rossini M. Challenge of diagnosing ANCA-associated vasculitis during COVID-19 pandemic: a missed 'window of opportunity'. Ann Rheum Dis 2023; 82:e181. [PMID: 32816699 DOI: 10.1136/annrheumdis-2020-218830] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 08/11/2020] [Indexed: 12/24/2022]
Affiliation(s)
- Alessandro Giollo
- Department of Medicine, Rheumatology Unit, Universita degli Studi di Verona, Verona, Italy
| | - Riccardo Bixio
- Department of Medicine, Rheumatology Unit, Universita degli Studi di Verona, Verona, Italy
| | - Davide Gatti
- Department of Medicine, Rheumatology Unit, Universita degli Studi di Verona, Verona, Italy
| | - Ombretta Viapiana
- Department of Medicine, Rheumatology Unit, Universita degli Studi di Verona, Verona, Italy
| | - Luca Idolazzi
- Department of Medicine, Rheumatology Unit, Universita degli Studi di Verona, Verona, Italy
| | - Christian Dejaco
- Department of Rheumatology and Immunology, Medical University Graz, Graz, Austria
- Department of Rheumatology, Hospital of Brunico (SABES-ASDAA), Brunico, Italy
| | - Maurizio Rossini
- Department of Medicine, Rheumatology Unit, Universita degli Studi di Verona, Verona, Italy
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Migliaccio S, Moretti A, Biffi A, Ronco R, Porcu G, Adami G, Alvaro R, Bogini R, Caputi AP, Cianferotti L, Frediani B, Gatti D, Gonnelli S, Lenzi A, Leone S, Nicoletti T, Paoletta M, Pennini A, Piccirilli E, Michieli R, Tarantino U, Rossini M, Corrao G, Brandi ML, Iolascon G. Medication holidays in osteoporosis: evidence-based recommendations from the Italian guidelines on 'Diagnosis, risk stratification, and continuity of care of fragility fractures' based on a systematic literature review. Ther Adv Musculoskelet Dis 2023; 15:1759720X231177110. [PMID: 37359175 PMCID: PMC10286165 DOI: 10.1177/1759720x231177110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 04/24/2023] [Indexed: 06/28/2023] Open
Abstract
Background Noncommunicable, chronic diseases need pharmacological interventions for long periods or even throughout life. The temporary or permanent cessation of medication for a specific period, known as a 'medication holiday,' should be planned by healthcare professionals. Objectives We evaluated the association between continuity (adherence or persistence) of treatment and several outcomes in patients with fragility fractures in the context of the development of the Italian Guidelines. Design Systematic review. Data Sources and Methods We systematically searched PubMed, Embase, and the Cochrane Library up to November 2020 for randomized clinical trials (RCTs) and observational studies that analyzed medication holidays in patients with fragility fracture. Three authors independently extracted data and appraised the risk of bias of the included studies. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation methodology. Effect sizes were pooled in a meta-analysis using random effects models. Primary outcomes were refracture and quality of life; secondary outcomes were mortality and treatment-related adverse events. Results Six RCTs and nine observational studies met our inclusion criteria, ranging from very low to moderate quality. The adherence to antiosteoporotic drugs was associated with a lower risk of nonvertebral fracture [relative risk (RR) 0.42, 95% confidence interval (CI) 0.20-0.87; three studies] than nonadherence, whereas no difference was detected in the health-related quality of life. A reduction in refracture risk was observed when continuous treatment was compared to discontinuous therapy (RR 0.49, 95% CI 0.25-0.98; three studies). A lower mortality rate was detected for the adherence and persistence measures, while no significant differences were noted in gastrointestinal side effects in individuals undergoing continuous versus discontinuous treatment. Conclusion Our findings suggest that clinicians should promote adherence and persistence to antiosteoporotic treatment in patients with fragility fractures unless serious adverse effects occur.
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Affiliation(s)
- Silvia Migliaccio
- Department of Movement, Human and Health Sciences, Foro Italico University, Rome, Italy
| | - Antimo Moretti
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli,” Napoli, Italy
| | - Annalisa Biffi
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
| | - Raffaella Ronco
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
| | - Gloria Porcu
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
| | | | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | | | | | | | - Bruno Frediani
- Department of Medicine, Surgery and Neurosciences, Rheumatology Unit, Azienda Ospedaliero-Universitaria Senese, University of Siena, Siena, Italy
| | - Davide Gatti
- Rheumatology Unit, University of Verona, Verona, Italy
| | - Stefano Gonnelli
- Department of Medicine, Surgery and Neuroscience, Policlinico Le Scotte, University of Siena, Siena, Italy
| | - Andrea Lenzi
- Department of Experimental Medicine, Viale del Policlinico, Sapienza University of Rome, Rome, Italy
| | - Salvatore Leone
- AMICI Onlus, Associazione nazionale per le Malattie Infiammatorie Croniche dell’Intestino, Milan, Italy
| | - Tiziana Nicoletti
- CnAMC, Coordinamento nazionale delle Associazioni dei Malati Cronici e rari di Cittadinanzattiva, Rome, Italy
| | - Marco Paoletta
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli,” Napoli, Italy
| | - Annalisa Pennini
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Eleonora Piccirilli
- Department of Clinical Sciences and Translational Medicine, University of Rome “Tor Vergata,” Rome, Italy
- Department of Orthopedics and Traumatology, “Policlinico Tor Vergata” Foundation, Rome, Italy
| | - Raffaella Michieli
- Italian Society of General Medicine and Primary Care (SIMG), Florence, Italy
| | - Umberto Tarantino
- Department of Clinical Sciences and Translational Medicine, University of Rome “Tor Vergata,” Rome, Italy
- Department of Orthopedics and Traumatology, “Policlinico Tor Vergata” Foundation, Rome, Italy
| | | | - Giovanni Corrao
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
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Adami G, Idolazzi L, Benini C, Fracassi E, Carletto A, Viapiana O, Gatti D, Rossini M, Fassio A. Secukinumab retention rate is greater in patients with psoriatic arthritis presenting with axial involvement. Reumatismo 2023; 75. [PMID: 37154254 DOI: 10.4081/reumatismo.2023.1559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 04/14/2023] [Indexed: 05/10/2023] Open
Abstract
Psoriatic arthritis (PsA) is an inflammatory disease characterized by peripheral and axial involvement. Biological disease-modifying antirheumatic drugs (bDMARDs) are the mainstream treatment for PsA and bDMARDs retention rate is a proxy for the drug's overall effectiveness. However, it is unclear whether IL-17 inhibitors can have a higher retention rate than tumor necrosis factor (TNF) inhibitors, in particular in axial or peripheral PsA. A real-life observational study was conducted on bDMARD naïve PsA patients initiating TNF inhibitors or secukinumab. Time-to-switch analysis was carried out with Kaplan-Meyer curves (log-rank test) truncated at 3 years (1095 days). Sub-analyses of Kaplan-Meyer curves between patients presenting with prevalent peripheral PsA or prevalent axial PsA were also conducted. Cox regression models were employed to describe predictors of treatment switch/swap. Data on 269 patients with PsA naïve to bDMARD starting either TNF inhibitors (n=220) or secukinumab (n=48) were retrieved. The overall treatment retention at 1 and 2 years was similar for secukinumab and TNF inhibitors (log-rank test p NS). We found a trend towards significance in the Kaplan-Meyer at 3 years in favor of secukinumab (log-rank test p 0.081). Predominant axial disease was significantly associated with a higher chance of drug survival in secukinumab users (adjusted hazard ratio 0.15, 95% confidence interval = 0.04-0.54) but not in TNF inhibitor users. In this real-life, single-center, study on bDMARD naïve PsA patients, axial involvement was associated with longer survival of secukinumab but not of TNF inhibitors. Drug retention of secukinumab and TNF inhibitors were similar in predominantly peripheral PsA.
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Affiliation(s)
- G Adami
- Rheumatology Unit, University of Verona.
| | - L Idolazzi
- Rheumatology Unit, University of Verona.
| | - C Benini
- Rheumatology Unit, University of Verona.
| | - E Fracassi
- Rheumatology Unit, University of Verona.
| | - A Carletto
- Rheumatology Unit, University of Verona.
| | - O Viapiana
- Rheumatology Unit, University of Verona.
| | - D Gatti
- Rheumatology Unit, University of Verona.
| | - M Rossini
- Rheumatology Unit, University of Verona.
| | - A Fassio
- Rheumatology Unit, University of Verona.
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Coccia F, Pietrobelli A, Zoller T, Guzzo A, Cavarzere P, Fassio A, Flodmark CE, Gatti D, Antoniazzi F. Vitamin D and Osteogenesis Imperfecta in Pediatrics. Pharmaceuticals (Basel) 2023; 16:ph16050690. [PMID: 37242473 DOI: 10.3390/ph16050690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 04/19/2023] [Accepted: 04/28/2023] [Indexed: 05/28/2023] Open
Abstract
Osteogenesis Imperfecta (OI) is a heterogeneous group of inherited skeletal dysplasias characterized by bone fragility. The study of bone metabolism, in these disease, is problematic in terms of clinical and genetic variability. The aims of our study were to evaluate the importance of Vitamin D levels in OI bone metabolism, reviewing studies performed on this topic and providing advice reflecting our experience using vitamin D supplementation. A comprehensive review on all English-language articles was conducted in order to analyze the influence of vitamin D in OI bone metabolism in pediatric patients. Reviewing the studies, contradictory data were found on the relationship between 25OH vitamin D levels and bone parameters in OI, and in several studies the baseline levels of 25OH D were below the threshold value of 75 nmol/L. In conclusion, according to the literature and to our experience, we highlight the importance of adequate vitamin D supplementation in children with OI.
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Affiliation(s)
- Francesco Coccia
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Clinic, School of Medicine, University of Verona, 37129 Verona, Italy
| | - Angelo Pietrobelli
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Clinic, School of Medicine, University of Verona, 37129 Verona, Italy
- Pediatric Clinic C, Azienda Ospedaliera Universitaria Integrata, 37126 Verona, Italy
- Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA
| | - Thomas Zoller
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Clinic, School of Medicine, University of Verona, 37129 Verona, Italy
| | - Alessandra Guzzo
- Department of Pathology and Diagnostics, School of Medicine, University of Verona, 37129 Verona, Italy
| | - Paolo Cavarzere
- Pediatric Clinic C, Azienda Ospedaliera Universitaria Integrata, 37126 Verona, Italy
| | - Angelo Fassio
- Department of Medicine, School of Medicine, University of Verona, 37129 Verona, Italy
| | - Carl-Erik Flodmark
- Department of Clinical Sciences, Faculty of Medicine, University of Lund, 22100 Lund, Sweden
| | - Davide Gatti
- Department of Medicine, School of Medicine, University of Verona, 37129 Verona, Italy
| | - Franco Antoniazzi
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Clinic, School of Medicine, University of Verona, 37129 Verona, Italy
- Pediatric Clinic C, Azienda Ospedaliera Universitaria Integrata, 37126 Verona, Italy
- Center for the Diagnosis and Treatment of Rare Skeletal Diseases of the Developmental Age of the Veneto Region, 37126 Verona, Italy
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Lamperti M, Rutkowski L, Gatti D, Gotti R, Moretti L, Polli D, Cerullo G, Marangoni M. A stimulated Raman loss spectrometer for metrological studies of quadrupole lines of hydrogen isotopologues. Mol Phys 2023. [DOI: 10.1080/00268976.2023.2196353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Affiliation(s)
- Marco Lamperti
- Dipartimento di Fisica - Politecnico di Milano and IFN-CNR, Lecco, Italy
| | - Lucile Rutkowski
- Univ Rennes, CNRS, IPR (Institut de Physique de Rennes)-UMR 6251, Rennes, France
| | - Davide Gatti
- Dipartimento di Fisica - Politecnico di Milano and IFN-CNR, Lecco, Italy
| | - Riccardo Gotti
- Dipartimento di Fisica - Politecnico di Milano and IFN-CNR, Lecco, Italy
| | - Luca Moretti
- Dipartimento di Fisica - Politecnico di Milano and IFN-CNR, Lecco, Italy
| | - Dario Polli
- Dipartimento di Fisica - Politecnico di Milano and IFN-CNR, Lecco, Italy
| | - Giulio Cerullo
- Dipartimento di Fisica - Politecnico di Milano and IFN-CNR, Lecco, Italy
| | - Marco Marangoni
- Dipartimento di Fisica - Politecnico di Milano and IFN-CNR, Lecco, Italy
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23
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Pisani P, Conversano F, Muratore M, Adami G, Brandi ML, Caffarelli C, Casciaro E, Di Paola M, Franchini R, Gatti D, Gonnelli S, Guglielmi G, Lombardi FA, Natale A, Testini V, Casciaro S. Fragility Score: a REMS-based indicator for the prediction of incident fragility fractures at 5 years. Aging Clin Exp Res 2023; 35:763-773. [PMID: 36752950 PMCID: PMC10115670 DOI: 10.1007/s40520-023-02358-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 01/20/2023] [Indexed: 02/09/2023]
Abstract
BACKGROUND Accurate estimation of the imminent fragility fracture risk currently represents a challenging task. The novel Fragility Score (FS) parameter, obtained during a Radiofrequency Echographic Multi Spectrometry (REMS) scan of lumbar or femoral regions, has been developed for the non-ionizing estimation of skeletal fragility. AIMS The aim of this study was to assess the performance of FS in the early identification of patients at risk for incident fragility fractures with respect to bone mineral density (BMD) measurements. METHODS Data from 1989 Caucasians of both genders were analysed and the incidence of fractures was assessed during a follow-up period up to 5 years. The diagnostic performance of FS to discriminate between patients with and without incident fragility fracture in comparison to that of the BMD T-scores measured by both Dual X-ray Absorptiometry (DXA) and REMS was assessed through ROC analysis. RESULTS Concerning the prediction of generic osteoporotic fractures, FS provided AUC = 0.811 for women and AUC = 0.780 for men, which resulted in AUC = 0.715 and AUC = 0.758, respectively, when adjusted for age and body mass index (BMI). For the prediction of hip fractures, the corresponding values were AUC = 0.780 for women and AUC = 0.809 for men, which became AUC = 0.735 and AUC = 0.758, respectively, after age- and BMI-adjustment. Overall, FS showed the highest prediction ability for any considered fracture type in both genders, resulting always being significantly higher than either T-scores, whose AUC values were in the range 0.472-0.709. CONCLUSION FS displayed a superior performance in fracture prediction, representing a valuable diagnostic tool to accurately detect a short-term fracture risk.
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Affiliation(s)
- Paola Pisani
- Institute of Clinical Physiology, National Research Council, Lecce, Italy
| | | | | | - Giovanni Adami
- Rheumatology Unit, University of Verona, Policlinico GB Rossi, Verona, Italy
| | | | - Carla Caffarelli
- Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico Le Scotte, Siena, Italy
| | - Ernesto Casciaro
- Institute of Clinical Physiology, National Research Council, Lecce, Italy
| | - Marco Di Paola
- Institute of Clinical Physiology, National Research Council, Lecce, Italy
| | - Roberto Franchini
- Institute of Clinical Physiology, National Research Council, Lecce, Italy
| | - Davide Gatti
- Rheumatology Unit, University of Verona, Policlinico GB Rossi, Verona, Italy
| | - Stefano Gonnelli
- Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico Le Scotte, Siena, Italy
| | - Giuseppe Guglielmi
- Department of Clinical and Experimental Medicine, Foggia University School of Medicine, Foggia, Italy
| | | | | | - Valentina Testini
- Department of Clinical and Experimental Medicine, Foggia University School of Medicine, Foggia, Italy
| | - Sergio Casciaro
- Institute of Clinical Physiology, National Research Council, Lecce, Italy.
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Vitale S, Palumbo E, Polesel J, Hebert JR, Shivappa N, Montagnese C, Porciello G, Calabrese I, Luongo A, Prete M, Pica R, Grimaldi M, Crispo A, Esindi N, Falzone L, Mattioli V, Martinuzzo V, Poletto L, Cubisino S, Dainotta P, De Laurentiis M, Pacilio C, Rinaldo M, Thomas G, D'Aiuto M, Serraino D, Massarut S, Ferraù F, Rossello R, Catalano F, Banna GL, Messina F, Gatti D, Riccardi G, Libra M, Celentano E, Jenkins DJA, Augustin LSA. One-year nutrition counselling in the context of a Mediterranean diet reduced the dietary inflammatory index in women with breast cancer: a role for the dietary glycemic index. Food Funct 2023; 14:1560-1572. [PMID: 36655860 DOI: 10.1039/d2fo02198f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background: the Mediterranean diet, the low dietary glycemic index (GI) and the dietary inflammation index (DII®) have been associated with lower risk of breast cancer (BC) incidence and mortality. Objective: to investigate whether one-year nutrition counselling in the context of a Mediterranean diet, with or without low-GI carbohydrates counselling, may influence the DII in women with BC. Methods: data were obtained from participants of DEDiCa trial randomized to a Mediterranean diet (MD, n = 112) or a Mediterranean diet with low-GI carbohydrates (MDLGI, n = 111). The diet-derived DII and GI were calculated from 7-day food records while Mediterranean diet adherence from PREDIMED questionnaire. Differences between study arms were evaluated through Fisher's exact test or Mann-Whitney test and associations with multivariable regression analyses. Results: Mediterranean diet adherence significantly increased by 15% in MD and 20% in MDLGI with no difference between arms (p < 0.326). Dietary GI significantly decreased from 55.5 to 52.4 in MD and 55.1 to 47.6 in MDLGI with significant difference between arms (p < 0.001). DII significantly decreased by 28% in MD and 49% in MDLGI with no difference between arms (p < 0.360). Adjusting for energy intake (E-DII) did not change the results. Higher Mediterranean diet adherence and lower dietary GI independently contributed to DII lowering (β-coefficient -0.203, p < 0.001; 0.046, p = 0.003, respectively). Conclusions: DII and E-DII scores decreased significantly after one-year with 4 nutrition counselling sessions on the Mediterranean diet and low GI. Increased adherence to the Mediterranean diet and low GI independently contributed to the DII changes. These results are relevant given that lowering the inflammatory potential of the diet may have implications in cancer prognosis and overall survival.
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Affiliation(s)
- Sara Vitale
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy.
| | - Elvira Palumbo
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy.
| | - Jerry Polesel
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano (CRO) IRCSS, Aviano, Italy
| | - James R Hebert
- Cancer Prevention and Control Program and Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA.,Department of Nutrition, Connecting Health Innovations LLC, Columbia, SC, 29201, USA
| | - Nitin Shivappa
- Cancer Prevention and Control Program and Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA.,Department of Nutrition, Connecting Health Innovations LLC, Columbia, SC, 29201, USA
| | | | - Giuseppe Porciello
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy.
| | - Ilaria Calabrese
- Healtcare Direction, "A. Cardarelli" Hospital, 80131 Naples, Italy
| | - Assunta Luongo
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy.
| | - Melania Prete
- Division of Radiotherapy, "Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli", 80131, Naples, Italy
| | - Rosa Pica
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy.
| | - Maria Grimaldi
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy.
| | - Anna Crispo
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy.
| | - Nadia Esindi
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Luca Falzone
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy.
| | - Veronica Mattioli
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano (CRO) IRCSS, Aviano, Italy
| | - Valentina Martinuzzo
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano (CRO) IRCSS, Aviano, Italy
| | - Luigina Poletto
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano (CRO) IRCSS, Aviano, Italy
| | - Serena Cubisino
- Department of Biomedical and Biotechnological Sciences, Oncologic, Clinical and General Pathology Section, University of Catania, Catania, Italy
| | - Patrizia Dainotta
- Department of Biomedical and Biotechnological Sciences, Oncologic, Clinical and General Pathology Section, University of Catania, Catania, Italy
| | - Michelino De Laurentiis
- Division of Breast Oncology, Istituto Nazionale Tumori - IRCCS "Fondazione Giovanni Pascale", Naples, Italy
| | - Carmen Pacilio
- Division of Breast Oncology, Istituto Nazionale Tumori - IRCCS "Fondazione Giovanni Pascale", Naples, Italy
| | | | | | | | - Diego Serraino
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano (CRO) IRCSS, Aviano, Italy
| | - Samuele Massarut
- Chirurgia Oncologica del Seno - Centro di Riferimento Oncologico (CRO) IRCCS, Aviano, Italy
| | | | | | | | | | | | | | - Gabriele Riccardi
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Massimo Libra
- Department of Biomedical and Biotechnological Sciences, Oncologic, Clinical and General Pathology Section, University of Catania, Catania, Italy
| | - Egidio Celentano
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy.
| | - David J A Jenkins
- Department of Nutritional Sciences and Medicine, Temerty, Faculty of Medicine, University of Toronto, Toronto, Canada.,Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Canada.,Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Canada.,Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada
| | - Livia S A Augustin
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy.
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Adami G, Olivi P, Pontalti M, Benini C, Ramazzini L, Magnan B, Bertoldo E, Gatti D, Fassio A, Rossini M, Negri S. Association between acute exposure to environmental air pollution and fragility hip fractures. Bone 2023; 167:116619. [PMID: 36442796 DOI: 10.1016/j.bone.2022.116619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 10/03/2022] [Accepted: 11/17/2022] [Indexed: 11/27/2022]
Affiliation(s)
| | - Pietro Olivi
- Orthopedic Unit, University of Verona, Verona, Italy.
| | | | | | | | - Bruno Magnan
- Orthopedic Unit, University of Verona, Verona, Italy.
| | | | - Davide Gatti
- Rheumatology Unit, University of Verona, Verona, Italy.
| | - Angelo Fassio
- Rheumatology Unit, University of Verona, Verona, Italy
| | | | - Stefano Negri
- Orthopedic Unit, University of Verona, Verona, Italy.
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26
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Adami G, Gatti D, Fassio A, Viapiana O, Rossini M. Cardiovascular Safety of Romosozumab: New Insights from Postmenopausal Women with Chronic Kidney Disease. J Bone Miner Res 2023; 38:354-355. [PMID: 36330828 DOI: 10.1002/jbmr.4724] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022]
Affiliation(s)
| | - Davide Gatti
- Rheumatology Unit, University of Verona, Verona, Italy
| | - Angelo Fassio
- Rheumatology Unit, University of Verona, Verona, Italy
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27
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Elkhazraji A, Shakfa MK, Lamperti M, Hakimov K, Djebbi K, Gotti R, Gatti D, Marangoni M, Farooq A. High-resolution molecular fingerprinting in the 11.6-15 µm range by a quasi-CW difference-frequency-generation laser source. Opt Express 2023; 31:4164-4178. [PMID: 36785391 DOI: 10.1364/oe.480107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/02/2023] [Indexed: 06/18/2023]
Abstract
We report an approach for high-resolution spectroscopy using a widely tunable laser emitting in the molecular fingerprint region. The laser is based on difference-frequency generation (DFG) in a nonlinear orientation-patterned GaAs crystal. The signal laser, a CO2 gas laser, is operated in a kHz-pulsed mode while the pump laser, an external-cavity quantum cascade laser, is finely mode-hop-free tuned. The idler radiation covers a spectral range of ∼11.6-15 µm with a laser linewidth of ∼ 2.3 MHz. We showcase the versatility and the potential for molecular fingerprinting of the developed DFG laser source by resolving the absorption features of a mixture of several species in the long-wavelength mid-infrared. Furthermore, exploiting the wide tunability and resolution of the spectrometer, we resolve the broadband absorption spectrum of ethylene (C2H4) over ∼13-14.2 µm and quantify the self-broadening coefficients of some selected spectral lines.
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28
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Adami G, Fassio A, Rossini M, Bertelle D, Pistillo F, Benini C, Viapiana O, Gatti D. Tapering glucocorticoids and risk of flare in rheumatoid arthritis on biological disease-modifying antirheumatic drugs (bDMARDs). RMD Open 2023; 9:rmdopen-2022-002792. [PMID: 36599630 DOI: 10.1136/rmdopen-2022-002792] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/21/2022] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Glucocorticoids are still a mainstream of rheumatoid arthritis (RA) treatment. Reducing glucocorticoids should be attempted in all patients. However, choosing the right tapering strategy is challenging. The primary aim of our study is to determine the dose-response association between glucocorticoid tapering and risk of flare in RA. METHODS We conducted a case-crossover study to determine the factors associated to higher risk of flare in patients with RA. In case-crossover studies time-varying factors are assessed before events (hazard periods) and before control periods. We defined hazard periods as the 6 months immediately preceding flares of RA. Control periods were the 6 months prior to visits without flare. Exposure of interest was the tapering of glucocorticoids to various doses. RESULTS 508 patients with RA were included in the study and 267 (52.5%) had at least a flare and served as the case-crossover study population. 1545 visits were available for analysis and 345 (22.3%) flares were recorded. Discontinuation of glucocorticoids (ie, tapering to doses of 0 mg/day) and tapering to 0-2.5 mg/day was associated with higher risk of flare (adjusted OR (aOR) of 1.45, 95% CI: 1.13 to 2.24 and aOR of 1.37; 95% CI: 1.06 to 2.01, respectively). Tapering to doses >2.5 mg/day was not associated with significantly higher risk of flare. CONCLUSIONS We found that tapering to doses of >2.5 mg/day was generally effective in terms of risk of flare. Flare risk was higher when glucocorticoids were tapered to doses ≤2.5 mg/day. Our study might help design new tapering strategies in patients with RA on biological disease-modifying antirheumatic drugs.
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Affiliation(s)
- Giovanni Adami
- Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy
| | - Angelo Fassio
- Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy
| | - Maurizio Rossini
- Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy
| | - Davide Bertelle
- Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy
| | - Francesca Pistillo
- Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy
| | - Camilla Benini
- Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy
| | - Ombretta Viapiana
- Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy
| | - Davide Gatti
- Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy
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29
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Adami G, Benini C, Vantaggiato E, Rotta D, Viapiana O, Gatti D, Rossini M, Iagnocco A. Response to: 'Correspondence on 'Gender disparity in authorship of guidelines and recommendations in rheumatology'' by Stewart et al. Ann Rheum Dis 2023; 82:e8. [PMID: 33144305 DOI: 10.1136/annrheumdis-2020-219305] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 10/16/2020] [Indexed: 02/03/2023]
Affiliation(s)
| | | | | | - Denise Rotta
- Rheumatology Unit, University of Verona, Verona, Italy
| | | | - Davide Gatti
- Rheumatology Unit, University of Verona, Verona, Italy
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30
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Corrao G, Biffi A, Porcu G, Ronco R, Adami G, Alvaro R, Bogini R, Caputi AP, Cianferotti L, Frediani B, Gatti D, Gonnelli S, Iolascon G, Lenzi A, Leone S, Michieli R, Migliaccio S, Nicoletti T, Paoletta M, Pennini A, Piccirilli E, Rossini M, Tarantino U, Brandi ML. Executive summary: Italian guidelines for diagnosis, risk stratification, and care continuity of fragility fractures 2021. Front Endocrinol (Lausanne) 2023; 14:1137671. [PMID: 37143730 PMCID: PMC10151776 DOI: 10.3389/fendo.2023.1137671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/27/2023] [Indexed: 05/06/2023] Open
Abstract
Background Fragility fractures are a major public health concern owing to their worrying and growing burden and their onerous burden upon health systems. There is now a substantial body of evidence that individuals who have already suffered a fragility fracture are at a greater risk for further fractures, thus suggesting the potential for secondary prevention in this field. Purpose This guideline aims to provide evidence-based recommendations for recognizing, stratifying the risk, treating, and managing patients with fragility fracture. This is a summary version of the full Italian guideline. Methods The Italian Fragility Fracture Team appointed by the Italian National Health Institute was employed from January 2020 to February 2021 to (i) identify previously published systematic reviews and guidelines on the field, (ii) formulate relevant clinical questions, (iii) systematically review literature and summarize evidence, (iv) draft the Evidence to Decision Framework, and (v) formulate recommendations. Results Overall, 351 original papers were included in our systematic review to answer six clinical questions. Recommendations were categorized into issues concerning (i) frailty recognition as the cause of bone fracture, (ii) (re)fracture risk assessment, for prioritizing interventions, and (iii) treatment and management of patients experiencing fragility fractures. Six recommendations were overall developed, of which one, four, and one were of high, moderate, and low quality, respectively. Conclusions The current guidelines provide guidance to support individualized management of patients experiencing non-traumatic bone fracture to benefit from secondary prevention of (re)fracture. Although our recommendations are based on the best available evidence, questionable quality evidence is still available for some relevant clinical questions, so future research has the potential to reduce uncertainty about the effects of intervention and the reasons for doing so at a reasonable cost.
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Affiliation(s)
- Giovanni Corrao
- National Centre for Healthcare Research and Pharmacoepidemiology, Laboratory of the University of Milano-Bicocca, Milan, Italy
- Department of Statistics and Quantitative Methods, Unit of Biostatistics, Epidemiology, and Public Health, University of Milano-Bicocca, Milan, Italy
- *Correspondence: Giovanni Corrao, ; Maria Luisa Brandi,
| | - Annalisa Biffi
- National Centre for Healthcare Research and Pharmacoepidemiology, Laboratory of the University of Milano-Bicocca, Milan, Italy
- Department of Statistics and Quantitative Methods, Unit of Biostatistics, Epidemiology, and Public Health, University of Milano-Bicocca, Milan, Italy
| | - Gloria Porcu
- National Centre for Healthcare Research and Pharmacoepidemiology, Laboratory of the University of Milano-Bicocca, Milan, Italy
- Department of Statistics and Quantitative Methods, Unit of Biostatistics, Epidemiology, and Public Health, University of Milano-Bicocca, Milan, Italy
| | - Raffaella Ronco
- National Centre for Healthcare Research and Pharmacoepidemiology, Laboratory of the University of Milano-Bicocca, Milan, Italy
- Department of Statistics and Quantitative Methods, Unit of Biostatistics, Epidemiology, and Public Health, University of Milano-Bicocca, Milan, Italy
| | | | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | | | | | - Luisella Cianferotti
- Italian Bone Disease Research Foundation, Fondazione Italiana Ricerca sulle Malattie dell’Osso (FIRMO), Florence, Italy
| | - Bruno Frediani
- Department of Medicine, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Davide Gatti
- Rheumatology Unit, University of Verona, Verona, Italy
| | - Stefano Gonnelli
- Department of Medicine, Surgery and Neuroscience, Policlinico Le Scotte, University of Siena, Siena, Italy
| | - Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Andrea Lenzi
- Department of Experimental Medicine, Sapienza University of Rome, Viale del Policlinico, Rome, Italy
| | - Salvatore Leone
- AMICI Onlus, Associazione Nazionale per le Malattie Infiammatorie Croniche dell’Intestino, Milan, Italy
| | - Raffaella Michieli
- Italian Society of General Medicine and Primary Care Società Italiana di Medicina Generale e delle cure primarie (SIMG), Florence, Italy
| | - Silvia Migliaccio
- Department of Movement, Human and Health Sciences, Foro Italico University, Rome, Italy
| | - Tiziana Nicoletti
- CnAMC, Coordinamento nazionale delle Associazioni dei Malati Cronici e rari di Cittadinanzattiva, Rome, Italy
| | - Marco Paoletta
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Annalisa Pennini
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Eleonora Piccirilli
- Department of Clinical Sciences and Translational Medicine, University of Rome “Tor Vergata”, Rome, Italy
- Department of Orthopedics and Traumatology, “Policlinico Tor Vergata” Foundation, Rome, Italy
| | | | - Umberto Tarantino
- Department of Clinical Sciences and Translational Medicine, University of Rome “Tor Vergata”, Rome, Italy
- Department of Orthopedics and Traumatology, “Policlinico Tor Vergata” Foundation, Rome, Italy
| | - Maria Luisa Brandi
- Italian Bone Disease Research Foundation, Fondazione Italiana Ricerca sulle Malattie dell’Osso (FIRMO), Florence, Italy
- *Correspondence: Giovanni Corrao, ; Maria Luisa Brandi,
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Ghaffari B, Gatti D, Westermann R. Spatio-Temporal Visual Analysis of Turbulent Superstructures in Unsteady Flow. IEEE Trans Vis Comput Graph 2022; PP:1-14. [PMID: 37015508 DOI: 10.1109/tvcg.2022.3232367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
The large-scale motions in 3D turbulent channel flows, known as Turbulent Superstructures (TSS), play an essential role in the dynamics of small-scale structures within the turbulent boundary layer. However, as of today, there is no common agreement on the spatial and temporal relationships between these multiscale structures. We propose a novel space-time visualization technique for analyzing the temporal evolution of these multiscale structures in their spatial context and, thus, to further shed light on the conceptually different explanations of their dynamics. Since the temporal dynamics of TSS are believed to influence the structures in the turbulent boundary layer, we propose a combination of a 2D space-time velocity plot with an orthogonal 2D plot of projected 3D flow structures, which can interactively span the time and the space axis. Besides flow structures indicating the fluid motion, we propose showing the variations in derived fields as an additional source of explanation. The relationships between the structures in different spatial and temporal scales can be more effectively resolved by using various filtering operations and image registration algorithms. To reduce the information loss due to the non-injective nature of projection, spatial information is encoded into transparency or color. Since the proposed visualization is heavily demanding computational resources and memory bandwidth to stream unsteady flow fields and instantly compute derived 3D flow structures, the implementation exploits data compression, parallel computation capabilities, and high memory bandwidth on recent GPUs via the CUDA compute library.
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Varenna M, Gatti D, Zucchi F, Crotti C, Braga V, Iolascon G, Frediani B, Nannipieri F, Rossini M. Long-term efficacy and safety of neridronate treatment in patients with complex regional pain syndrome type 1: a pre-specified, open-label, extension study. Ther Adv Musculoskelet Dis 2022; 14:1759720X221142274. [PMID: 36569491 PMCID: PMC9772942 DOI: 10.1177/1759720x221142274] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 11/14/2022] [Indexed: 12/23/2022] Open
Abstract
Background No data on the permanent and curative effect of bisphosphonate treatment in patients with complex regional pain syndrome type-1 (CRPS-1) are currently available. The aim of this pre-specified, open-label, observational study was to evaluate the long-term efficacy and safety of neridronate treatment. Design A pre-specified, open-label, extension study. Methods Patients treated with intramuscular (IM) placebo in the double-blind phase of the study were assigned to 100 mg intravenous (IV) neridronate treatment administered 4 times over 10 days. These patients, together with those previously treated with 400 mg IM neridronate, were followed for 1 year. Efficacy was assessed using a visual analogue scale (VAS) pain score. Changes in clinical signs and symptoms, quality of life (QoL) using the Short Form Health Survey (SF-36), and the McGill Pain Questionnaire were also assessed. Results Benefits on pain, clinical and functional measures were maintained and further improved over 12 months in most patients treated with neridronate administered either IM or IV. In IM-treated patients, the percentage of those defined as responders (VAS score reduction ≥ 50%) progressively increased up to day 360 to 32 of 35 patients (91.4%). Among the 27 patients referred to as responders at the end of the double-blind phase, 26 reported the same result at day 360 (96.3%). In IV-treated patients, a responder rate of 88% (22 out 25) was found at day 360 (p = 0.66 between groups). Consistent improvements were also observed for all clinical signs and functional questionnaire. No drug-related adverse events were reported during the study. Conclusion In patients with acute CRPS-1, the benefit in pain, clinical, and functional measures observed a few weeks after neridronate treatment administered either IM or IV is maintained and further improved over 12 months. Parenteral neridronate induces permanent disease remission preventing chronic pain and motor dysfunction. Trial registration EU Clinical Trials Register (EudraCT Number): 2014-001156-28.
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Affiliation(s)
| | - Davide Gatti
- Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy
| | - Francesca Zucchi
- Bone Diseases Unit, Department of Rheumatology, Gaetano Pini Institute, Milan, Italy
| | - Chiara Crotti
- Bone Diseases Unit, Department of Rheumatology, Gaetano Pini Institute, Milan, Italy
| | | | - Giovanni Iolascon
- Department of Medical and Surgical Specialties, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | | | | | - Maurizio Rossini
- Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy
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Fassio A, Gatti D, Bertelle D, Fracassi E, Zanetti G, Viapiana O, Rossini M, Adami G. Comparable long-term retention rates and effects on bone mineral density of denosumab treatment in patients with osteoporosis with or without autoimmune inflammatory rheumatic diseases: real-life data. Ther Adv Musculoskelet Dis 2022; 14:1759720X221124543. [PMID: 36158710 PMCID: PMC9490481 DOI: 10.1177/1759720x221124543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 08/19/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives: To investigate whether concomitant autoimmune inflammatory rheumatic diseases (AIIRDs) represent a risk factor for denosumab discontinuation and to explore other possible predictors. Design: This is a real-life retrospective study conducted at our centre on consecutive patients who started treatment with denosumab from January 2014 to October 2021. Methods: Data on patients’ characteristics, denosumab prescriptions and reason for discontinuation were collected from their medical electronic records. A log-rank test was run to assess differences in the denosumab retention rate between the not AIIRD and AIIRD patients. A backward stepwise logistic regression was used to identify possible predictors of denosumab discontinuation. When available, BMD data of the lumbar spine and total hip were collected. Results: Three hundred and sixty-three patients were included (265 not AIIRD and 98 AIIRD; median follow-up, 44 months). Sixty-nine patients discontinued denosumab at any time point (4 due to patient’s decision, 3 due to medical decision, 62 were lost in follow-up). The log-rank test did not find a statistically significant difference for denosumab persistence between the two subgroups. In the binary logistic regression analysis, only older age at initiation and lower baseline serum 25-hydroxy vitamin D were confirmed as predictors for discontinuation. BMD significantly increased from baseline to the last prescription visit at both the lumbar spine and the total hip, without statistically significant differences in the not AIIRD and AIIRD patients. Conclusion: The present data seem to suggest that AIIRDs do not represent a risk factor for denosumab discontinuation. Furthermore, the presence of AIIRDs does not seem to impair its effectiveness in terms of BMD.
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Affiliation(s)
- Angelo Fassio
- Rheumatology Unit, University of Verona, Policlinico GB Rossi, Piazzale A. Scuro, 37134 Verona, Italy
| | - Davide Gatti
- Rheumatology Unit, University of Verona, Verona, Italy
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Adami G, Fassio A, Gatti D, Viapiana O, Rossini M. Acute Phase Reaction and Fracture Risk Reduction: Are Gamma-Delta T Cells and Hypovitaminosis D the Missing Link? J Bone Miner Res 2022; 37:1622. [PMID: 35233839 DOI: 10.1002/jbmr.4534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 12/22/2021] [Indexed: 11/08/2022]
Affiliation(s)
| | - Angelo Fassio
- Rheumatology Unit, University of Verona, Verona, Italy
| | - Davide Gatti
- Rheumatology Unit, University of Verona, Verona, Italy
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Adami G, Gavioli I, Rossini M, Viapiana O, Orsolini G, Benini C, Bertoldo E, Fracassi E, Gatti D, Fassio A. Real-life short-term effectiveness of anti-osteoporotic treatments: a longitudinal cohort study. Ther Adv Musculoskelet Dis 2022; 14:1759720X221105009. [PMID: 35784611 PMCID: PMC9243369 DOI: 10.1177/1759720x221105009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 05/16/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction: Randomized clinical trials have shown that anti-osteoporotic treatments can increase bone mineral density (BMD) and reduce the incidence of fragility fractures. However, data on the real-life effectiveness of anti-osteoporotic medications are still scarce. Methods: We conducted a cohort study on women at high risk of fracture. We retrieved clinical and densitometric data from the DeFRA database, which derives from the DeFRA tool, a web-based fracture risk assessment tool. Multivariable Cox regression survival models were employed to analyze the effectiveness of different anti-osteoporotic drugs on fracture. In sensitivity analyses, we conducted 1:1 propensity score matching analyses. Results: Data on 50,862 women were available. Among these, 3574 individuals had at least two consecutive visits. The crude fracture rate was 91.9/1000 person-year for non-treated patients. The crude fracture rate in bisphosphonate users was 72.1/1000 person-year, in denosumab users was 58.2/1000 person-year, and in teriparatide users was 19.3/1000 person-year. Overall, we found that bisphosphonate use was associated with a 30% lower risk of fracture compared to no treatment [adjusted hazard ratio (aHR): 0.70, 95% confidence interval (CI): 0.50–0.98]. Treatment with denosumab and teriparatide were associated with 60% and 90% lower risk of fracture, respectively (aHR: 0.43, 95% CI: 0.24–0.75 and aHR: 0.09, 95% CI: 0.01–0.70). Bisphosphonate use was associated with a lower risk of fracture only after 1 year of treatment. Conclusion: In conclusion, we found that all anti-osteoporotic medications considered in the study effectively reduced the risk of fracture in the real-life. The effect of bisphosphonate on fracture risk was apparent only after the first year of treatment. Our findings do not support the use of bisphosphonates in patients at imminent risk of fracture.
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Affiliation(s)
- Giovanni Adami
- Rheumatology Unit, University of Verona, Pz Scuro 10, 37134 Verona, Italy
| | - Irene Gavioli
- Rheumatology Unit, University of Verona, Verona, Italy
| | | | | | | | | | | | | | - Davide Gatti
- Rheumatology Unit, University of Verona, Verona, Italy
| | - Angelo Fassio
- Rheumatology Unit, University of Verona, Verona, Italy
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Adami G, Pontalti M, Benini C, Fassio A, Bertoldo E, Gatti D, Rossini M. OP0071 ASSOCIATION BETWEEN LONG-TERM EXPOSURE TO AIR POLLUTION AND IMMUNE-MEDIATED DISEASES: A POPULATION-BASED COHORT STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundEnvironmental air pollution has been associated with disruption of the immune system at a molecular level.ObjectivesThe primary aim of the present study is to describe the association between long-term exposure to air pollution and risk of developing immune-mediated conditions.MethodsWe conducted a retrospective observational study on a nation-wide dataset of women and men. Diagnoses of various immune-mediated diseases were retrieved. Data on the monitoring of PM10 and PM2.5 concentrations were retrieved from the Italian institute of environment protection and research (ISPRA). The long-term average PMs concentrations were the exposure of interest. Every study subject was linked to a PMs exposure value, which resulted from the average concentration of urban, rural and near-traffic stations of the subject residency from January 2013 to November 2020. Patients were linked to the nearest air quality station through ZIP code centroids. Generalized linear models were employed to determine the relationship between autoimmune diseases prevalence and PM. The fully adjusted model included age, body mass index (BMI), menopause, glucocorticoid treatment, treatment with adjuvant hormone therapy for breast or prostate cancer, specialty of the physician that entered the data and macro-area of residency (stratified as a categorical variable: northern Italy, central Italy and southern Italy.Results81,363 subjects were included in the study. We found a positive association between PM10 and the risk of autoimmune diseases (ρ +0.007, p 0.014). Every 10 µg/m3 increase in PM10 concentration was associated with an incremental 7% risk of having autoimmune disease. Exposure to PM10 above 30 µg/m3 and PM2.5 above 20 µg/m3 was associated with a 12% and 13% higher risk of autoimmune disease pooled together, respectively (aOR 1.12, 95% CI 1.05-1.20 and aOR 1.13, 95% CI 1.06-1.20). Exposure to PM10 was associated with an increased risk of rheumatoid arthritis (aOR 1.408, 95% CI 1.271-1.560) but no other autoimmune diseases, whereas exposure to high levels of PM2.5 were associated with an increased risk of rheumatoid arthritis (aOR 1.559, 95% CI 1.401-1.734), CTDs (aOR 1.147, 95% CI 1.024-1.286) and IBDs (1.206, 95% CI 1.028-1.415) but no other autoimmune diseases.ConclusionLong-term exposure to air pollution was associated with higher risk of developing autoimmune diseases, in particular rheumatoid arthritis, CTDs and IBD. Chronic exposure to levels above the threshold for human protection was associated with a 10% higher risk of developing immune-mediated diseases.Disclosure of InterestsGiovanni Adami Shareholder of: Galapagos, Theramex, Marco Pontalti: None declared, Camilla Benini: None declared, Angelo Fassio: None declared, Eugenia Bertoldo: None declared, Davide Gatti: None declared, Maurizio Rossini Shareholder of: Abbvie, Amgen, Bms, Eli Lilly, Galapagos, Novartis, Pfizer, Sandoz, Theramex, Ucb.
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Fassio A, Gatti D, Gatti M, Rossini M, Bertoldo E, Adami G. AB1019 THE EFFECTS OF THREE DIFFERENT VITAMIN D3 SUPPLEMENTATION REGIMENS IN DEFICIENT SUBJECTS ON INFLAMMATORY CYTOKINES – A RANDOMISED OPEN-LABEL PARALLEL GROUPS STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundThe effects of cholecalciferol supplementation on the regulation of inflammatory cytokines are still unclear.ObjectivesThis is a preliminary analysis on exploratory outcomes the DIBA/11 RCT [1,2] and aimed to compare the effects on serum inflammatory cytokines of three different regimes of cholecalciferol supplementation in vitamin D-deficient subjects.MethodsWe evaluated, in healthy subjects affected by vitamin D deficiency (defined as 25OHD<20 ng/mL), 18 to 60 years of age, the efficacy of three different oral supplementation regimens: daily 10,000Iu administered for 8 weeks (group A), weekly 50,000Iu (group B) for 12 weeks and biweekly 100,000Iu (group C) for 12 weeks.Serum TNFα, interleukin-6 (IL6), interleukin-17 (IL17) and interleukin-10 (IL10) were dosed at baseline, Day 28, 53, 84 and 112. This study was approved by the institutional research committee (protocol identification: DIBA/11,EudraCT Number:2017-000194-36). Supported by Abiogen Pharma, Italy).ResultsA total of 75 subjects were randomized to receive one supplementation regimen. The descriptive of the sample at baseline and relative cytokines levels at the various observation points are reported in Table 1. The absolute changes of IL6, IL17 and IL10 are depicted in Figure 1. No significant differences were found among the three groups. TNFα was undetectable at baseline and at any time point.Table 1.anthropometrics and laboratory parameters at baseline (mean values ± standard deviation)ParameterAll patients (N=75)Daily 10.000 Ui(N = 25)Weekly 50.000 Ui(n = 25)Biweekly 100.000 Ui(N = 25)p-value (ANOVA)M:F31:4412:137:1812:13NSAge (years)34.1 ± 10.230.2 ± 9.936.7 ± 8.735.4 ± 11.00.059Body Weight (kg)66.7 ± 12.465.8 ± 13.267.8 ± 10.866.6 ± 13.7NSBMI23.1 ± 2.622.55 ± 2.723.8 ± 2.222.8 ± 2.7NSBaseline 25OHD (ng/mL)13.5 ± 3.714.6 ± 3.912.8 ± 313.5 ± 4.1NSBaseline IL-6 (pg/mL)1.3 ± 1.20.9 ± 0.61.4 ± 1.61.6 ± 1.3NSBaseline IL-17 (pg/mL)0.4 ± 1.80.7 ± 30.2 ± 1.10.2 ± 0.7NSBaseline IL-10 (pg/mL)0.9 ± 0.90.8 ± 0.71.2 ± 1.20.8 ± 0.7NSFigure 1.absolute changes of IL17, IL6 and IL10. *p<0.05 vs baseline.ConclusionIn the overall cohort we found slight decreases in serum IL6 and IL17 serum levels. No differences were found among groups.References[1]Fassio A, Adami G, Rossini M, et al. Pharmacokinetics of Oral Cholecalciferol in Healthy Subjects with Vitamin D Deficiency: A Randomized Open-Label Study. Nutrients. 2020;12(6).[2]Fassio A, Gatti D, Rossini M, et al. Pharmacodynamics of Oral Cholecalciferol in Healthy Individuals with Vitamin D Deficiency: A Randomized Open-Label Study. Nutrients. 2021;13(7):2293.Disclosure of InterestsAngelo Fassio: None declared, Davide Gatti Speakers bureau: Amgen, Celgene Eli-Lilly, MSD-Italia, Organon, UCB., Paid instructor for: Amgen, Celgene Eli-Lilly, MSD-Italia, Organon, UCB., Matteo Gatti: None declared, Maurizio Rossini Speakers bureau: Abiogen, Amgen, Abbvie, BMS, Celgene, Eli-Lilly, Galapagos, Grunenthal, MSD, Novartis, Pfizer, Sanofi, Sandoz, Theramex, UCB., Eugenia Bertoldo: None declared, Giovanni Adami: None declared
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Adami G, Pontalti M, Fassio A, Benini C, Gatti D, Negri S, Olivi P, Rossini M. POS1140 SHORT-TERM EXPOSURE TO FINE PARTICULATE MATTER AND RISK OF FRAGILITY HIP FRACTURES, A CASE-CROSSOVER STUDY ON 1,042 HIP FRACTURES. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundFragility femoral fracture is a common, world-spread, medical condition, that has a relevant impact both clinically and economically. Chronic exposure to environmental air pollution has been linked with a higher risk of developing osteoporosis. However, little is known regarding the relationship between short-term exposure to air pollution and bone fractures.ObjectivesOur study aims to investigate the link between short-term exposure to fine particulate matters and fragility hip fracturesMethodsWe retrieved data of patients suffering of hip fractures admitted to the Orthopedic Unit of the University of Verona Hospital from 2015 to 2020. We retrieved data on the monitoring of PM10 concentrations from the Italian institute of environment protection and research (ISPRA). We designed a case-crossover study to compare the exposure to particulate matters (PM10) in the 30-day period immediately before the fracture (hazard period) referent to a 30-day control period (from day -30 to -60 from the fracture). Exposure to PM10 was evaluated as mean value and AUC. Case-crossover is a peculiar study design applied to longitudinal datasets that controls for within-person time-invariant and between-patient confounders such as indoor air pollution, chronic comorbidities or concomitant medications and have been used extensively to study the effects of transient, short-term exposures on the risk of acute events (Figure 1A)Results1042 patients (73.7% female n=768), with a hip fracture admitted to the hospital were included in the study. Mean age of the cohort was 82.6 years (±9.55). Average exposure to PM 10 in the control period was 33,84 ug/mm3, cumulative exposure (AUC) was 952,42 ug/mm3 compared 31,72 ug/mm3 and AUC of 920,24 ug/mm3 in the hazard period (Figure 1B) The difference between levels of PM10 in the two periods was statistically significant as levels of PM10 was higher in the hazard period compared to control period, with a p-value = 0,027 (α <0,05) when comparing average concentrations in the two groups and a p-value = 0,024 (α <0,05), when comparing AUCs.ConclusionOur study suggests that the short-term exposure to environmental air pollution might increase the risk of femoral fragility fractures. Further studies should be taken to further investigate the biological mechanisms underlining this finding.Disclosure of InterestsGiovanni Adami Shareholder of: Theramex, Galapagos, Marco Pontalti: None declared, Angelo Fassio: None declared, Camilla Benini: None declared, Davide Gatti: None declared, Stefano Negri: None declared, Pietro Olivi: None declared, Maurizio Rossini Shareholder of: Abbvie, Amgen, Bms, Eli Lilly, Galapagos, Novartis, Pfizer, Sandoz, Theramex, Ucb.
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Fassio A, Andreola S, Gatti D, Gatti M, Gambaro G, Rossini M, Viapiana O, Zanetti G, Pistillo F, Messina V, Adami G. AB1017 RADIOFREQUENCY ECHOGRAPHIC MULTI-SPECTROMETRY (REMS) AND DUAL-ENERGY X-RAYS ABSORPTIOMETRY FOR THE EVALUATION OF BONE MINERAL DENSITY IN A PERITONEAL DIALYSIS SETTING. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundRadiofrequency echographic multi-spectrometry (REMS) is a novel ultrasound-based technique that has shown good reliability in the assessment of bone mineral density (BMD).ObjectivesThe aim of this study was to compare the performance of the REMS BMD assessment with dual-energy X-rays absorptiometry (DXA) in a cohort of patients affected by end-stage renal disease undergoing peritoneal dialysis (PD).MethodsConsecutive patients referring to the PD clinic of our hospital were enrolled. Lumbar spine and proximal femur REMS scans were performed, and lumbar spine (anteroposterior and laterolateral) and proximal femur DXA scans were performed as well. Clinical data were extracted from medical records. The risk assessment outputs of two fracture risk algorithms (FRAX and DeFRA), calculated upon the worst BMD obtained from either technique were compared as well. Analysis of variance (ANOVA) with post hoc analysis (Bonferroni) and a two-sided Student’s t-test were used to estimate the absolute differences between groups.Written informed consent was obtained from all participants included (protocol 1483 CESC).Results41 total patients were enrolled (Table 1). No significant differences were documented between the BMD T-scores measured through DXA or REMS at the proximal femur. At the lumbar spine, the DXA laterolateral T-score was not significantly different from that of REMS, while the DXA anteroposterior T-score was significantly higher than both the anteroposterior DXA and the REMS measurements (Figure 1, panel A and B). When either DXA or REMS was adopted, no significant difference in the fracture risk estimate was found for both algorithms (Figure 1, panel C and D).Table 1.anthropometrics, clinical and biochemical characteristics of the enrolled sample. CKD, chronic kidney disease; PTH, parathyroid hormone; ALP, alkaline phosphatase; IQR, interquartile range; VFA, vertebral fracture assessment.Sample size (M)41 (29)Age (y)Median [IQR]62 [52-73]Height (cm)Median [IQR]170 [165-176]Body weight (Kg)Median [IQR]74 [61-83]Body mass index (Kg/m2)Median [IQR]25 [22-27.8]Disease duration – CKD (months)Median [IQR]132 [48-140]Dialysis duration (months)Median [IQR]10 [3-24]S-calcium (mg/dL)Median [IQR]9.1 [8.6-9.4]S-phosphorous (mg/dL)Median [IQR]5.4 [4.6-6.4]PTH (pg/mL)Median [IQR]31.4 [22.8-46.8]25OH Vitamin D (nmol/L)Median [IQR]53 [36-72]Patients with morphometric fractures (VFA)15%Patients with femoral fractures2.4%Total n° of morphometric fractures12Figure 1.comparison of the mean T-scores (error bars represent 95%CI) measured with DXA and REMS at the lumbar spine (panel A), and at the femur (panel B). Comparison between the DeFRA DXA and REMS-derived outputs (panel C) and FRAX DXA and REMS-derived outputs (panel D) raw and after correction for TBS. DeFRA, FRAX-derived risk assessment tool; FRAX, Fracture Risk Assessment tool; AP, anteroposterior; LL, latero-lateral; TH, total hip; FN, femoral neck; TBS, trabecular bone score.ConclusionOur data showed a good agreement, in a real-life PD setting, between the DXA and REMS-derived BMDs and in the consequent fracture risk assessment obtained with the FRAX or DeFRA tools.Disclosure of InterestsAngelo Fassio: None declared, Stefano Andreola: None declared, Davide Gatti Paid instructor for: Amgen, Celgene Eli-Lilly, MSD-Italia, Organon, UCB., Consultant of: Amgen, Celgene Eli-Lilly, MSD-Italia, Organon, UCB., Matteo Gatti: None declared, Giovanni Gambaro Speakers bureau: Vifor Pharma, Maurizio Rossini Speakers bureau: Abiogen, Amgen, Abbvie, BMS, Celgene, Eli-Lilly, Galapagos, Grunenthal, MSD, Novartis, Pfizer, Sanofi, Sandoz, Theramex, UCB., Ombretta Viapiana: None declared, Giulia Zanetti: None declared, Francesca Pistillo: None declared, Valeri Messina: None declared, Giovanni Adami: None declared
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Pistillo F, Rossini M, Fassio A, Benini C, Gatti D, Adami G. AB1167 THE USE OF ORAL AMINO-BISPHOSPHONATES AND CORONAVIRUS DISEASE 2019 (COVID-19) OUTCOMES. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundThe determinants of the susceptibility to SARS-CoV-2 infection and severe Coronavirus Disease 19 (COVID-19) manifestations are yet not fully understood. Amino-bisphosphonates (N-BPs) have anti-inflammatory properties and have been shown to reduce the incidence of lower respiratory infections, cardiovascular events and cancer.ObjectivesWe conducted a population-based retrospective observational case control study with the primary objective of determining if oral N-BPs treatment can play a role in thesusceptibility to the development of severe COVID-19.MethodsAdministrative ICD-9-CM and ATC data, representative of Italian population (9% sample of the overallpopulation), were analyzed. Oral N-BPs (mainly alendronate and risedronate) were included in the analysis. Patients treated with bisphosphonates (cases) were randomly matched (1:1 ratio) for age, sex and for other clinically relevant variables (presence of treatments other than bisphosphonates and hospitalizations) with all the health-assisted population without this treatment (controls).ResultsIncidence of Covid-19 hospitalization was 12.32 [95%CI 9.61-15.04] and 11.55 [95%CI 8.91-14.20], of ICU utilization due to COVID-19 was 1.25 [95%CI 0.38-2.11] and 1.42 [95%CI 0.49-2.36] and of all-cause death was4.06 [95%CI 2.50-5.61] and 3.96 [95%CI 2.41-5.51] for oral N-BPs users and non-users, respectively (Figure 1A). Figure 1B Incidence and 95% CI of COVID-19 related events in N-BPs treated and untreated subjects with anti-osteoporotic drugs and without corticosteroids. C. Incidence and 95% CI of COVID-19 related events in N-BPs treated and untreated without previous vertebral or hip fragility fractures. D. Incidence of COVID-19related events in bisphosphonates treated and untreated patients without previous vertebral or hip fracture without corticosteroid prescriptions.ConclusionIn conclusion, we found that the incidence of COVID-19 hospitalization, intensive care unit (ICU) utilization and COVID-19 potentially related mortality were similar in N-BPs treated and non-treated subjects. Similar results were found in N-BPs versus other anti-osteoporotic drugs. We provided real-life data on the safety of oral N-BPs in terms of severe COVID-19 risk on a population-based cohort. Our results strongly support national and international guidelines that advocate against the discontinuation of oral bisphosphonates only for the fear of COVID-19.Disclosure of InterestsNone declared
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Fassio A, Andreola S, Gatti D, Gatti M, Gambaro G, Viapiana O, Messina V, Zanetti G, Pistillo F, Rossini M, Adami G. AB1018 RELATIONSHIP BETWEEN AORTIC CALCIFICATIONS AND DXA AND RADIOFREQUENCY ECHOGRAPHIC MULTI-SPECTROMETRY (REMS) ACQUISITIONS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundData on the relationship between peritoneal dialysis (PD), BMD and aortic calcifications (AOC) are lacking.Objectivesto study the relationship between the degree of AOC and DXA and Radiofrequency Echographic Multi-Spectrometry (REMS) acquisitions.MethodsConsecutive patients referring to the PD our clinic were enrolled. Lumbar spine (LS) and proximal femur REMS scans were performed, and LS (anteroposterior and laterolateral) and proximal femur DXA scans were performed as well. The degree of AOC was assessed through the semiquantitative score described by Kauppila et al, and applied to the laterolateral LS DXA scans. To test for correlations between different variables, we used the Pearson’s correlation for continuous variables and Spearman’s rho for discrete variables. Multiple regression analysis was performed to adjust for age and body mass index (BMI) the correlation between BMD and the CKD duration. Written informed consent was obtained from all participants (protocol 1483CESC).Results41 total patients were enrolled (29 males, 19 females). Median disease duration of CKD [IQR]: 132 months [48-140]. 15% had vertebral fractures at the DXA Vertebral Fracture Assessment (VFA). The median calcification score [IQR] was 2 [0-6] (min-max 0-20).We found a statistically significant positive correlation of moderate strength between the total calcification score and the difference between the DXA AP T-score and the DXA LL T-score at the LS (p<0.01, Spearman’s rho = 0.402), Figure 1.Figure 1.scatter plot reporting the relationship between the difference between the AP and LL T-scores and the aortic calcifications score.After adjustment for confounders, we found a significant negative between the LS and femoral neck BMD measured through REMS and CKD duration (Table 1). The same correlation was not significant then BMD was assessed with DXA.Table 1.multiple linear regression analysis for REMS T-score at each site after adjustment for age and BMI. BMI, body mass index; β, standardised coefficient.REMS lumbar spine T-scoreβpCKD duration (months)-0.2280.035Age (years)-0.511<0.01BMI (kg/m2)0.566<0.01REMS femoral neck T-scoreβpCKD duration (months)-0.2100.04Age (years)-0.612<0.01BMI (kg/m2)0.484<0.01REMS total hip T-scoreβpCKD duration (months)-0.1530.219Age (years)-0.523<0.01BMI (kg/m2)0.560<0.01ConclusionOur study confirmed that the overestimation of DXA BMD assessed with the anteroposterior scan is indeed influenced by AOC. Furthermore, our data suggest that REMS might be an interesting tool for the investigation of bone changes in CKD.Disclosure of InterestsAngelo Fassio: None declared, Stefano Andreola: None declared, Davide Gatti Speakers bureau: Amgen, Celgene Eli-Lilly, MSD-Italia, Organon, UCB, Paid instructor for: Amgen, Celgene Eli-Lilly, MSD-Italia, Organon, UCB, Matteo Gatti: None declared, Giovanni Gambaro Speakers bureau: Vitor Pharma, Ombretta Viapiana: None declared, Valeri Messina: None declared, Giulia Zanetti: None declared, Francesca Pistillo: None declared, Maurizio Rossini Speakers bureau: Abiogen, Amgen, Abbvie, BMS, Celgene, Eli-Lilly, Galapagos, Grunenthal, MSD, Novartis, Pfizer, Sanofi, Sandoz, Theramex, UCB., Giovanni Adami: None declared
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Adami G, Benini C, Fassio A, Bertoldo E, Viapiana O, Gatti D, Rossini M. OP0242 ASSOCIATION BETWEEN EXPOSURE TO FINE PARTICULATE MATTER AND OSTEOPOROSIS: A POPULATION-BASED COHORT STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundEnvironmental air pollution has been associated with disruption of bone health at a molecular level. Particulate matter (PM) exposure can simultaneously stimulate bone resorption and halt bone formation.ObjectivesThe primary aim of the present study is to describe the association between long-term exposure to PM and osteoporosis in a large cohort of women at high risk of fracture.MethodsClinical, demographic and densitometric data were extracted from the DeFRAcalc79 dataset, which gathers data on women at risk for osteoporosis. Data on the monitoring of PM10 and PM2.5 concentrations were retrieved from the Italian institute of environment protection and research (Istituto Superiore per la Protezione e la Ricerca Ambientale, ISPRA). Every study subject was linked to a PM exposure value, which resulted from the average concentration of urban, rural and near-traffic stations of the subject residency (ZIP code centroids 25 km) from January 2013 to December 2019. Generalized linear models with robust estimators were employed to determine the relationship between BMD and PM long-term exposure. We sequentially adjusted for confounders. Model 1 included age, body mass index (BMI), presence of prevalent fragility fractures, family history of vertebral or hip fractures, and menopause. Model 2 was further adjusted for glucocorticoid treatment and comorbidities. Model 3 (main model) added to model 2 the macro-area of residency (stratified as a categorical variable: northern Italy, central Italy and southern Italy).Results59,950 women from 110 Italian provinces were included in the study. PM 2,5 exposure was negatively associated with T-score levels at the femoral neck (β -0.005, 95 CI -0.007 to -0.003) and lumbar spine (β -0.003, 95% CI -0.006 to -0.001). Chronic exposure to PM2.5 above 25 μg/m3 was associated with a 16% higher risk of having osteoporotic T-score at any site (aOR 1.161, 95% CI 1.105 to 1.220), exposure to PM10 above 30 μg/m3 was associated with a 15% higher risk of having osteoporotic T-score at any site (aOR 1.148, 95% CI 1.098 to 1.200).ConclusionLong-term exposure to air pollution was associated with higher risk of osteoporosis. Femoral neck site seemed to be more susceptible to the detrimental effect of PM exposure than lumbar spine site.Disclosure of InterestsGiovanni Adami Shareholder of: Galapagos, Theramex, Camilla Benini: None declared, Angelo Fassio: None declared, Eugenia Bertoldo: None declared, Ombretta Viapiana: None declared, Davide Gatti: None declared, Maurizio Rossini Shareholder of: Abbvie, Amgen, Bms, Eli Lilly, Galapagos, Novartis, Pfizer, Sandoz, Theramex, Ucb.
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Cianferotti L, Delli Poggi C, Bertoldo F, Caffarelli C, Crotti C, Gatti D, Giannini S, Gonnelli S, Mazzantini M, Ombretta V, Sella S, Setti A, Varenna M, Zucchi F, Brandi ML. Persistence and recurrence in tumor-induced osteomalacia: A systematic review of the literature and results from a national survey/case series. Endocrine 2022; 76:709-721. [PMID: 35381903 PMCID: PMC9156492 DOI: 10.1007/s12020-022-03039-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 03/08/2022] [Indexed: 01/10/2023]
Abstract
PURPOSE Tumor induced osteomalacia (TIO) is a rare disease of mineral metabolism, whose clinical picture is dominated by hypophosphatemia usually due to an excess of circulating FGF23 produced by small mesenchymal tumors. Data on the real prevalence of the disease are lacking, with the knowledge of the disease mainly relying on case reports and small case series. No estimate is available on the prevalence of uncured TIO. METHODS National multi-center, cross-sectional and retrospective study on persistent or recurrent cases of TIO followed in referral centers for bone diseases; systematic review of the published persistent and recurrent cases of TIO. Data from patients consecutively evaluated in referral Italian centers for bone diseases were collected; a PubMed search on persistent, recurrent and unoperable cases of TIO was carried out. RESULTS Sixteen patients (mean age at diagnosis 52.5 ± 10.6 years) with persistent (n = 6, 37,5%), recurrent (n = 7, 43.7%) or not operable (n = 3, 18.8%) TIO were described. Delay in diagnosis (2.5 ± 1.3 years) was demonstrated. All patients experienced fragility fractures or pseudofractures and disabling bone and muscle pain. BMD was significantly reduced (mean T-score -2.7 ± 1.7 and -2.7 ± 0.9 at lumbar spine and femoral neck, respectively). Fourteen patients were maintained under therapy with phosphate salts and calcitriol, while in 2 patients therapy with burosumab, an anti-FGF23 antibody, was commenced. CONCLUSION A significant number of patients with TIO remain either undiagnosed for tumor localization or tumor recur or persist after surgery. These patients with active disease represent possible candidates for burosumab treatment.
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Affiliation(s)
- Luisella Cianferotti
- Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Bone Metabolic Diseases Unit, University Hospital of Florence, largo Palagi 1, 50139, Florence, Italy
| | - Chiara Delli Poggi
- Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Bone Metabolic Diseases Unit, University Hospital of Florence, largo Palagi 1, 50139, Florence, Italy
| | - Francesco Bertoldo
- Department of Medicine, University of Verona, Piazzale LA Scuro 10, Policlinico GB Rossi, Piazzale LA Scuro 10, 37134, Verona, Italy
| | - Carla Caffarelli
- Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico Le Scotte, Viale Bracci 2, 53100, Siena, Italy
| | - Chiara Crotti
- Bone Diseases Unit, Department of Rheumatology, Gaetano Pini Institute, Via Pini, 9, Milan, 20122, Italy
| | - Davide Gatti
- Rheumatology Section, Department of Medicine, University of Verona Hospital Trust, Policlinico G.B. Rossi, Piazzale LA Scuro 10, 37134, Verona, Italy
| | - Sandro Giannini
- Department of Medicine (DIMED), Clinica Medica Uno, University of Padua, via Nicolò Giustiniani, 2, 35128, Padua, Italy
| | - Stefano Gonnelli
- Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico Le Scotte, Viale Bracci 2, 53100, Siena, Italy
| | - Maurizio Mazzantini
- Rheumatology Unit, and Fracture Liaison Service, University Hospital of Pisa, via Roma 67, 56126, Pisa, Italy
| | - Viapiana Ombretta
- Rheumatology Section, Department of Medicine, University of Verona Hospital Trust, Policlinico G.B. Rossi, Piazzale LA Scuro 10, 37134, Verona, Italy
| | - Stefania Sella
- Department of Medicine (DIMED), Clinica Medica Uno, University of Padua, via Nicolò Giustiniani, 2, 35128, Padua, Italy
| | - Angela Setti
- Department of Medicine, University of Verona, Piazzale LA Scuro 10, Policlinico GB Rossi, Piazzale LA Scuro 10, 37134, Verona, Italy
| | - Massimo Varenna
- Bone Diseases Unit, Department of Rheumatology, Gaetano Pini Institute, Via Pini, 9, Milan, 20122, Italy
| | - Francesca Zucchi
- Bone Diseases Unit, Department of Rheumatology, Gaetano Pini Institute, Via Pini, 9, Milan, 20122, Italy
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Giollo A, Cioffi G, Ognibeni F, Aldegheri F, Bixio R, Gavioli I, Rotta D, Bertoldo E, Orsolini G, Gatti D, Rossini M, Viapiana O. POS0386 A NOVEL ECHOCARDIOGRAPHY METHOD FOR THE DETECTION OF SUBCLINICAL MYOCARDIAL FIBROSIS IN PATIENTS WITH SYSTEMIC SCLEROSIS: A CROSS-SECTIONAL STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundScar imaging echocardiography with ultrasound multi-pulse scheme (eSCAR) is a novel technique allowing detection of myocardial scars. eSCAR has never been explored in patients with systemic sclerosis (SSc).ObjectivesThe aim of our study was to examine whether eSCAR may detect subclinical myocardial fibrosis in SSc.MethodsIn this cross-sectional study conducted between 11/2020 and 02/2021, consecutive SSc patients from the University of Verona underwent cardiovascular disease (CVD) screening procedures including standard transthoracic echocardiography (TTE) and myocardial scars detection through the eSCAR technique. We excluded patients with prior history of structural heart disease and pulmonary hypertension. To validate eSCAR findings, we assessed myocardial function through global longitudinal strain (GLS) analysis by speckle tracking echocardiography (STE). We also conducted a case-control study comparing eSCAR findings in randomly selected SSc patients and non-SSc controls matched 1:1 for age, sex and number of CVD risk factors. The primary outcome was the proportion of patients with myocardial scars. Principal component analysis (PCA) was used to determine main eSCAR patterns. Multivariable linear regression analysis was used to minimise confounding.ResultsScar imaging echocardiography revealed that 42/92 (44%) SSc patients had myocardial scars involving a median [25th-75th percentile] of 4 [1-7] segments. PCA identified that myocardial scars localised mostly at the inferior and septal segments (inferoseptal pattern; Figure 1). STE validation confirmed that GLS was significantly reduced in SSc patients with inferoseptal scars (Table 1). Otherwise, all standard echocardiography measures were normal in both groups. In multivariable regression analysis, prior digital ulcerations (B=0.41, 95% CI 0.008 to 0.809, p=0.045) and body mass index (B=-0.06, 95% CI -0.113 to -0.015, p=0.012) were both significantly and independently associated with inferoseptal myocardial scars. Myocardial scars were found in 38% of SSc patients and no matched controls (p<0.0001).Table 1.Comparison of speckle tracking echocardiography (longitudinal myocardial strain) in eSCAR-positive (inferoseptal pattern) and eSCAR-negative (no inferoseptal pattern) patients.Speckle tracking echocardiographyeSCAR-positive (n= 8)eSCAR-negative (n=31)P-valueGLS global (%)- 20.24 (2.39)- 20.42 (3.65)0.895GLS 4-chambers (%)- 20.66 (1.91)- 20.09 (4.12)0.720GLS 2-chambers (%)- 23.02 (5.23)- 21.97 (3.89)0.924GLS 3-chambers (%)- 17.11 (2.60)- 19.31 (5.26)0.015GLS apical- anterior- 19.60 (6.12)- 17.72 (4.42)0.857- inferior- 26.89 (7.79)- 23.65 (5.46)0.581- lateral- 18.91 (2.04)- 18.13 (5.12)0.508- septal- 22.68 (7.14)- 21.76 (7.04)0.844GLS basal- anterior- 23.35 (3.82)- 22.75 (8.36)0.752- anteroseptal- 14.09 (4.74)- 18.66 (7.46)0.109- inferior- 22.69 (8.49)- 22.78 (6.94)0.818- lateral- 19.99 (7.68)- 22.55 (7.01)0.218- septal- 14.26 (4.63)- 18.07 (8.79)0.081GLS mid- inferior- 23.09 (6.12)- 22.58 (5.07)0.917- septal- 14.80 (5.69)- 17.50 (7.53)0.056- anterior- 20.54 (3.28)- 19.73 (6.520.026- anteroseptal- 14.70 (4.96)- 18.13 (5.20)0.010- lateral- 18.64 (5.79)- 20.09 (5.73)0.270Data are reported as mean (S.D.). GLS, global longitudinal strain.Figure 1.ConclusionThis simple ultrasound technique allows detection of myocardial dysfunction associated with scars in SSc patients, or its absence in matched controls. Patients with prior digital ulcerations and low body weight have the strongest association with inferoseptal myocardial scars. eSCAR may help detect subclinical myocardial fibrosis in SSc.Disclosure of InterestsNone declared
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Adami G, Gavioli I, Fassio A, Benini C, Bertoldo E, Viapiana O, Gatti D, Rossini M. OP0239 REAL-LIFE SHORT-TERM EFFECTIVENESS OF ANTI-OSTEOPOROTIC TREATMENTS: A LONGITUDINAL COHORT STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundData from randomized clinical trials showed that anti-osteoporotic treatments increase bone mineral density (BMD) and reduce the risk of fragility fractures. However, data on the real-life effectiveness of such medications is still scarce.ObjectivesThe primary objective of the present study is to assess the real-life effectiveness of anti-osteoporotic treatment in a representative cohort of Italian women at high risk of fractureMethodsWe conducted a cohort study on women at high risk of fracture. We retrieved clinical and densitometric data from the DeFRA database, which derives from the DeFRA tool, a web-based fracture risk assessment tool. Multivariable Cox regression survival models were employed to analyze the effectiveness of different anti-osteoporotic drugs on fracture. In sensitivity analyses we generated 1:1 matched cohorts of patients with prescription of bisphosphonates, denosumab, teriparatide or without any pharmacological prescription at baseline and 1:1 matched cohort based on the T-score variation over the time (increase in T-score vs decrease or stability in T-score values).ResultsData from 50,862 women were available. Among these, 3,574 individuals had at least 2 consecutive visits. The crude fracture rate was 91.9/1,000 person-year for non-treated patients. The crude fracture rate in bisphosphonate users was 72.1/1,000 person-year, in denosumab users was 58.2/1,000 person-year and in teriparatide users was 19.3/1000 person-year. Overall, we found that bisphosphonates were associated with a 30% lower risk of fracture compared to no treatment (aHR 0.70, 95% CI 0.50-0.98), denosumab and teriparatide were associated with 60% and 90% lower risk of fracture, respectively (aHR 0.43, 95% CI 0.24-0.75 and aHR 0.09, 95% CI 0.01-0.70). Bisphosphonate use was associated with a lower risk of fracture only after one year of treatment. In Figure 1 are presented the Kaplan Meier curves free from fragility fracture after propensity score matching.ConclusionIn conclusion, we found that all anti-osteoporotic medications effectively reduced the risk of fracture in the real-life. Bisphosphonate’s effect on fracture risk was apparent only after the first year of treatment. Our findings do not support the use of bisphosphonates in patients at imminent risk of fracture.Disclosure of InterestsGiovanni Adami Shareholder of: Theramex, Galapagos, IRENE GAVIOLI: None declared, Angelo Fassio: None declared, Camilla Benini: None declared, Eugenia Bertoldo: None declared, Ombretta Viapiana: None declared, Davide Gatti: None declared, Maurizio Rossini Shareholder of: Abbvie, Amgen, Bms, Eli Lilly, Galapagos, Novartis, Pfizer, Sandoz, Theramex, Ucb.
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Trentadue M, Sozzi C, Idolazzi L, Lazzarini G, Murano RS, Gatti D, Rossini M, Piovan E. Magnetic resonance imaging at 3.0-T in postmenopausal osteoporosis: a prospective study and review of the literature. Radiol Bras 2022; 55:216-224. [PMID: 35983340 PMCID: PMC9380604 DOI: 10.1590/0100-3984.2021.0124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 09/07/2021] [Indexed: 12/03/2022] Open
Abstract
Objective To promote advanced research using magnetic resonance imaging (MRI) in the diagnosis of and screening for osteoporosis by looking for correlations among the T-scores measured by dual-energy X-ray absorptiometry (DEXA), the apparent diffusion coefficient (ADC) values on diffusion-weighted imaging (DWI), and the T1-weighted signal intensity values. Materials and Methods This was a prospective study of postmenopausal women with no contraindications to MRI and no history of cancer who underwent DEXA within 30 days before or after the MRI examination. A 3.0-T scanner was used in order to acquire sagittal sequences targeting the lumbar spine. Results Thirteen women underwent DEXA and MRI. In two cases, the MRI was discontinued early. Therefore, the final sample comprised 11 patients. The ADC values and T1-weighted signal intensity were found to be higher in patients with osteoporosis. However, among the patients > 60 years of age with osteoporosis, ADC values were lower and T1-weighted signal intensity was even higher. Conclusion It is unlikely that MRI will soon replace DEXA for the diagnostic workup of osteoporosis. Although DWI and ADC mapping are useful for understanding the pathophysiology of osteoporosis, we believe that T1-weighted sequences are more sensitive than is DWI as a means of performing a qualitative analysis of vertebral alterations.
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Affiliation(s)
| | | | | | - Gianluigi Lazzarini
- Independent Researcher, self-employed Occupational Medicine specialist, Italy
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Fassio A, Andreola S, Gatti D, Gatti M, Gambaro G, Rossini M, Pisani P, Lombardi FA, Adami G. Radiofrequency Echographic Multi-Spectrometry (REMS) technology and DXA for BMD assessment in kidney transplant recipients. Bone Rep 2022. [DOI: 10.1016/j.bonr.2022.101463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Fassio A, Andreola S, Dartizio C, Bianco B, Gambaro G, Rossini M, Gatti D, Gatti M, Adami G. Relationship between aortic calcifications and DXA and Radiofrequency Echographic Multi-Spectrometry (REMS) acquisitions. Bone Rep 2022. [DOI: 10.1016/j.bonr.2022.101462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Fassio A, Andreola S, Gatti D, Gatti M, Rossini M, Messina V, Zanetti G, Adami G. Radiofrequency Echographic Multi-Spectrometry (REMS) and dual-energy X-rays absorptiometry for the evaluation of bone mineral density in a peritoneal dialysis setting. Bone Rep 2022. [DOI: 10.1016/j.bonr.2022.101461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Adami G, Pontalti M, Fassio A, Gatti D, Negri S, Olivi P, Rossini M. Short-term exposure to fine particulate matter and risk of fragility hip fractures, a case-crossover study on 1,042 hip fractures. Bone Rep 2022. [DOI: 10.1016/j.bonr.2022.101465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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