Orthopedics, Rheumatology

Introduction. Osteoporosis is a metabolic skeletal disease characterized by bone mineral density reduction, which may lead to an increased risk of bone fractures. Obesity is a condition of excessive body fat that causes or aggravates many public health problems. As it is easy to be measured, body mass index is widely used as an index of the degree of obesity. Material and Methods. The study included 1.372 female orthopedic patients between the ages of 30 to 79 years who visited the Clinical Centre of Vojvodina in Novi Sad to have a dual-energy x-ray absorptiometry (DEXA) examination in the period from March, 2010 to June, 2013. The following anthropometric data were collected: body mass index, body weight, height, dual-energy x-ray absorptiometry T-score and bone mineral density (BMD), as well as some other data. Results. The mean age was 62.08 years, the mean weight was 73.59 kg and the mean height was 1.6 m. There were 392 participants in the group of normal body mass index, 14 pa...

The purpose of this paper was to review the available approaches for bone strength assessment, osteoporosis diagnosis and fracture risk prediction, and to provide insights into radiofrequency echographic multi spectrometry (REMS), a non-ionizing axial skeleton technique. Methods A working group convened by the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis met to review the current image-based methods for bone strength assessment and fracture risk estimation, and to discuss the clinical perspectives of REMS. Results Areal bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DXA) is the consolidated indicator for osteoporosis diagnosis and fracture risk assessment. A more reliable fracture risk estimation would actually require an improved assessment of bone strength, integrating also bone quality information. Several different approaches have been proposed, including additional DXA-based parameters, quantitative computed tomography, and quantitative ultrasound. Although each of them showed a somewhat improved clinical performance, none satisfied all the requirements for a widespread routine employment, which was typically hindered by unclear clinical usefulness, radiation doses, limited accessibility, or inapplicability to spine and hip, therefore leaving several clinical needs still unmet. REMS is a clinically available technology for osteoporosis diagnosis and fracture risk assessment through the estimation of BMD on the axial skeleton reference sites. Its automatic processing of unfiltered ultrasound signals provides accurate BMD values in view of fracture risk assessment. Conclusions New approaches for improved bone strength and fracture risk estimations are needed for a better management of osteoporotic patients. In this context, REMS represents a valuable approach for osteoporosis diagnosis and fracture risk prediction.

Biologics are substances synthetized from biological sources used in the prevention and treatment of several diseases. Rheumatologists have many years of experience with biologics for the treatment of immune-mediated diseases and osteoporosis. Randomized clinical trials and postmarketing studies have demonstrated that treatment with biologics can result, albeit infrequently, in serious adverse events. To date, several risk mitigation strategies have been identified and implemented. The objective of the present perspective review is to examine the risk mitigation strategies of biologic treatments, with special focus on anti-tumor necrosis factors and denosumab.

Introduction/Objective. The Sarcopenia Quality of Life (SarQoLR) questionnaire is a patient-reported outcome measure specific to sarcopenia. The objective was to translate the SarQoLR questionnaire from English into Serbian and to investigate its psychometric performance. Methods. A five-stage forward-backward methodology with pre-test was used to translate the questionnaire. The validation sample in this study consisted of elderly, community-dwelling volunteers of both sexes. Three methods were used to screen for and diagnose sarcopenia: the SARC-F questionnaire (high/ low risk), low handgrip strength [probable sarcopenia in the European Working Group on Sarcopenia in Older People (EWGSOP2) algorithm], and the complete EWGSOP2 criteria. We investigated the questionnaire?s discriminative power, internal consistency, construct validity, and floor and ceiling effects. Results. The SarQoLR questionnaire was translated into Serbian. The validation study included 699 participants. In tot...

Introduction/Objective. Low bone mineral density (BMD) is commonly associated with alterations of nutritional status. The aims of the present study were to evaluate the prevalence of low BMD and its associated nutritional risk factors in Vojvodina population and to use linear regression equations to predict the BMD by using a simple marker of nutritional status, body mass index (BMI). Methods: In this retrospective, cross-sectional study, the study population was subjects who were undergoing assessment of BMD between January to December 2017 and met the study inclusion criteria. A total of 1974 patients (1866 women and 108 men) were included in this analysis of nutritional status according to anthropometry and BMI index, and dual-energy X-ray absorptiometry (DEXA) measurements of BMD of the femoral neck and lumbar spine. The relationship between BMI and BMD was analysed by linear regression equation. Results: Median age was 63 (56-70) years. Considering nutritional status category, ...

The Ukrainian Association of Osteoporosis, its members and international colleagues are mourning the sudden death of Professor Vladyslav Povoroznyuk, who passed away on June 12, 2021, at the age of 66 years. He has served as the President of the Ukrainian Association of Osteoporosis; President of the Ukrainian Association of Andropause, Menopause, Bone and Joint Disease; Head of the Ukrainian Division of the European Vitamin D Association (EVIDAS); Head of the Department of Clinical Physiology and Pathology of the Locomotor Apparatus of the Dmitry F. Chebotarev Institute of Gerontology of the National Academy of Medical Sciences of Ukraine; Director of the Ukrainian Scientific Medical Centre of Osteoporosis; the Honoured Scientist and Technology Expert of Ukraine; and as the Editor-in-Chief of the “Pain. Joints. Spine” and “Problems of Osteology” journals. Professor V.V. Povoroznyuk started his scientific career at the Institute of Gerontology (Kyiv, Ukraine). In 1988, he defended h...

Osteoporosis care has evolved markedly over the last 50 years, such that there are now an established clinical definition, validated methods of fracture risk assessment and a range of effective pharmacological agents. Currently, bone-forming (anabolic) agents, in many countries, are used in those patients who have continued to lose bone mineral density (BMD), patients with multiple subsequent fractures or those who have fractured despite treatment with antiresorptive agents. However, head-to-head data suggest that anabolic agents have greater rapidity and efficacy for fracture risk reduction than do antiresorptive therapies. The European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) convened an expert working group to discuss the tools available to identify patients at high risk of fracture, review the evidence for the use of anabolic agents as the initial intervention in patients at highest risk of fracture and consid...

The aim of this study was to compare the functional results of non-operative and different operative techniques of managing humeral shaft fractures. The average follow-up was one year after the trauma in 61 patients with united fracture, where the initial method of treatment was the definitive one. The patients were divided into four groups: 22 were treated with hanging cast, 20 with intramedullary nails, 10 with dynamic-compressive plates and screws and 9 with external fixators. We estimated the presence of bone union by radiographic and clinical evaluation and compared the results with Constant and Mayo scores. The etiology of injuries was falls and traffic accidents in 87% of cases. The hanging cast group had the most of elbow contractures and insufficient results of functional scales. The plating group had lower average values of scores than nails, especially considering the elbow function. Among subgroups, the locked intramedullary nails had better results than Ender nails. The...

Osteoarthritis (OA) is the most common joint condition and, with a burgeoning ageing population, is due to increase in prevalence. Beyond conventional medical and surgical interventions, there are an increasing number of ‘alternative’ therapies. These alternative therapies may have a limited evidence base and, for this reason, are often only afforded brief reference (or completely excluded) from current OA guidelines. Thus, the aim of this review was to synthesize the current evidence regarding autologous chondrocyte implantation (ACI), mesenchymal stem cell (MSC) therapy, platelet-rich plasma (PRP), vitamin D and other alternative therapies. The majority of studies were in knee OA or chondral defects. Matrix-assisted ACI has demonstrated exceedingly limited, symptomatic improvements in the treatment of cartilage defects of the knee and is not supported for the treatment of knee OA. There is some evidence to suggest symptomatic improvement with MSC injection in knee OA, with the sug...

Summary Introduction. Synovial chondromatosis is a benign disease of synovial membrane usually affecting knee, elbow and shoulder joints. It rarely appears as a solitary formation and exceptionally within Hoffa's fat pad. Case Report. We report a case of solitary synovial chondromatosis within Hoffa's fat pad as a cause of its impingement in a female patient aged 63. At first, the patient had anterior knee pain with limited extension of the knee. Standard radiogram showed only mild patellofemoral osteoarthritic chang- es. Magnetic resonance of the knee showed ovoid solitary forma- tion within Hoffa's fat pad repressing its superior part between the kneecap and distal femur. Histopathological examination con- firmed a case of extra-articular synovial chondromatosis. The tu- morous mass was extracted surgically en bloc. Conclusion. Soli- tary synovial chondromatosis is an uncommon cause of Hoffa's fat pad impingement and anterior knee pain in elderly female pa- tients ...

Hand osteoarthritis is the most common joint condition and is associated with significant morbidity. It is of paramount importance that patients are thoroughly assessed and examined when complaining of hand stiffness, pain, deformity or disability and that the patient’s concerns and expectations are addressed by the healthcare professional. In 2019 the American College of Rheumatology and Arthritis Foundation (ACR/AF) produced guidelines which included recommendations for the treatment of hand osteoarthritis. An ESCEO expert working group (including patients) was convened and composed this paper with the aim to assess whether these guidelines were appropriate for the treatment of hand osteoarthritis therapy in Europe and whether they met with the ESCEO patient-centered approach. Indeed, patients are the key stakeholders in healthcare and eliciting the patient’s preference is vital in the context of an individual consultation but also for informing research and policy-making. The pat...

Knee osteoarthritis (OA) is one of the most common and disabling medical conditions. In the case of moderate to severe pain, a single intervention may not be sufficient to allay symptoms and improve quality of life. Examples include first-line, background therapy with symptomatic slow-acting drugs for OA (SYSADOAs) or non-steroidal anti-inflammatory drugs (NSAIDs). Therefore, the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) performed a review of a multimodal/multicomponent approach for knee OA therapy. This strategy is a particularly appropriate solution for the management of patients affected by knee OA, including those with pain and dysfunction reaching various thresholds at the different joints. The multimodal/multicomponent approach should be based, firstly, on different combinations of non-pharmacological and pharmacological interventions. Potential pharmacological combinations include SYSADOAs and NSAIDs, NSAIDs and weak opioids, and intra-articular treatments with SYSADOAs/NSAIDs. Based on the available evidence, most combined treatments provide benefit beyond single agents for the improvement of pain and other symptoms typical of knee OA, although further high-quality studies are required. In this work, we have therefore provided new, patient-centered perspectives for the management of knee OA, based on the concept that a multimodal, multicomponent, multidisciplinary approach, applied not only to non-pharmacological treatments but also to a combination of the currently available pharmacological options, will better meet the needs and expectations of patients with knee OA, who may present with various phenotypes and trajectories.

Bone turnover markers (BTMs) have important role in the management of osteoporosis. Recently the clinical application of BTMs has achieved significant progress and measurement of BTMs give us better understanding of pathogenesis of osteoporosis. However, the use of BTMs is still insufficient in Korea. We summarized the available methods and standard interval of the BTMs in Korea. Also we reviewed published literatures on preanalytical variability in the measurement of BTMs and provided recommendations for standardized sample handling and patient preparation for reducing those pre-analytical variabilities. The clinical application of BTMs in patients with chronic kidney disease who have a higher fracture risk than the general population is summarized.

Purpose: The purpose of this paper was to review the available approaches for bone strength assessment, osteoporosis diagnosis and fracture risk prediction, and to provide insights into radiofrequency echographic multi spectrometry (REMS), a non-ionizing axial skeleton technique. Methods: A working group convened by the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis met to review the current image-based methods for bone strength assessment and fracture risk estimation, and to discuss the clinical perspectives of REMS. Results: Areal bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DXA) is the consolidated indicator for osteoporosis diagnosis and fracture risk assessment. A more reliable fracture risk estimation would actually require an improved assessment of bone strength, integrating also bone quality information. Several different approaches have been proposed, including additional DXA-based parameters, quantitative c...

Oral bisphosphonates are a key intervention in the treatment of osteoporosis and in reducing the risk of fragility fractures. Their use is supported by over 3 decades of evidence; however, patient adherence to oral bisphosphonates remains poor in part due to complex dosing instructions and adverse events, including upper gastrointestinal symptoms. This problem has led to the development of novel oral bisphosphonate formulations. Buffered, effervescent alendronate is dissolved in water and so seeks to reduce upper gastro-intestinal adverse events, and gastro-resistant risedronate aims to reduce the complexity of dosing procedure (e.g. fasting prior to consumption) whilst still maintaining the efficacy of fracture risk reduction. Clinical trials and real-world data have been employed to demonstrate some benefits in terms of reduced upper gastro-intestinal adverse events, adherence, persistence and health economic outcomes. This report describes the result of an ESCEO (European Society...