Ultrasound evaluation of bone in sport: the role of physical activity in young volleyball females players.

Physical activity represents an effective incentive to achieve and maintain the peak bone mass. Our study has been evaluating the heel ultra-sound parameters in a group of female volleyball players. We found some interesting results as follows: BMD estimated, 0.675±0.144 g/cm2; QUI 120.2±20.9; SOS 1590.4±32.3 m/S; BUA 95.5±20.1 dB/ MHz. Each parameter observed on the volleyball players group has resulted significantly higher (p<0.05-0.01) compared to the same parameters within the control group. Our work confirms that an aerobic physical activity represents an effective mechanical stimulus to the bone, allowing of observing an index of bone quality significantly higher compared to the people who does not do any regular physical activity.

Osteoporosis prevention: a reasoned examination of food habits and physical activities in a schoolchildren population in central Italy.

OBJECTIVE: The dietary intake of calcium is fundamental for prevention of osteoporosis, especially in the first three decade of age to gain a valid peak bone mass; moreover physical activity is important for the same reason. The objective of our research is to examine the food habits and the way to practice sport in a homogenous population of schoolchildren. MATERIALS AND METHODS: Data were collected by an original questionnaire in 500 schoolchildren (238 males, 262 females, 9-12 yrs) living in the centre of Italy. RESULTS: Data show that the calcium intake decreases while the age increases. According to the recommended daily calcium dose, the percentages of insufficient calcium intake were 21% in the 6 years old group, 35% in the 7 to 10 years old group and 52.5% in the 11 to 14 years old group. Milk and dairy products cover 57% of the calcium needs (17% and 40% respectively), water covers 24% and the other foodstuffs 19%; moreover most children (43.5%) practice non competitive sports with a preference (58.3%) for no-weightbearing sports (mainly cycling) over weightbearing sports (mainly football). CONCLUSIONS. This survey suggests that a high percentage of young people do not take the recommended daily dose of calcium (especially interesting that becoming older with consequent lower parental control over the diet, the higher the incidence of poor calcium intake increases), then it would be recommendable to establish a national health program promoting appropriate physical exercise plus a correct calcium intake as early as the primary school.

[Evaluation of the peak bone mass by quantitative heel ultrasound in young women of the centre of Italy]. / Valutazione ultrasonometrica calcaneare del picco di massa ossea in giovani donne dell'Italia centrale.

OBJECTIVE: To measure the reference young adult mean values in healthy women of the centre of Italy by Quantitative heel UltraSound (QUS). METHODS: The study group was composed by 70 caucasian women: mean age was 25.4 years (Standard Deviation 4.7), mean weight was 58 Kg (SD 8.2), mean height was 166 cm (SD 5.8), mean BMI was 20.9 kg/m 2 (SD 2.5). Every subject was evaluated firstly with an original questionnaire to discover risk factors (like for example steroids consumption, recent fractures of the lower limb), then was measured by quantitative heel ultrasonometry Hologic Sahara. RESULTS: Mean extimated Bone Mineral Density (BMD) 0.588 g/cm 2 (SD 0.124) mean Quantitative Ultrasound Index (QUI) 105.0 (SD 19.6), mean Speed of Sound (SOS) 1564.2 m/s (SD 31.4), mean Broadband Ultrasound Attenuation (BUA) 84.8 dB/MHz (SD 17.4). No significant correlation was found between QUS parameters and anthropometric data. A correlation was found between every QUS parameters. No significant differences were found about QUI and extimated BMD, between our results and Hologic normative data for European women. CONCLUSIONS: It is very important to develop specific reference values for any measurement device and site of skeleton especially in the age of reaching the peak bone mass because the T score is then measured referring to these data. Usually the normative data are supplied by manufacturer and are based on large multicentric study. In our opinion it could be helpful to verify if these data are compatible with the population examined in every region.

[The usefulness of the quantitative ultrasound to diagnose glucocorticoids induced osteoporosis]. / Utilità dell'ultrasonometria calcaneare nella diagnosi dell'osteoporosi da steroidi.

BACKGROUND: The aim of this study was to evaluate the utilization of heel ultrasonometry in the diagnosis of glucocorticoid induced osteoporosis. METHODS: The study group included 108 caucasian women, ranging in age from 30 to 81 years. They were all affected by inflammatory disorders (rheumatoid arthritis and other connective tissue diseases) and had been in chronic glucocorticoid therapy for at least 8 months, at an average daily dosage of not less than 7.5 mg of prednisolone. The control group was composed of 112 women. Every subject was evaluated by a heel ultrasonography (Hologic Sahara). RESULTS: The ultrasonometry data average values noted were: QUI (Quantitative Ultrasound Index) 71* (86); SOS (Speed of Sound) 1324 m/sec* (1541); BUA (Broadband Ultrasound Attenuation) 61 dB/MHz (62). The asterisk shows a statistically significant difference in comparison to the value in brackets. QUI/Stiffness and SOS had reached a significant statistic value in all the age groups, with regard to average values of patients not on glucocorticoid therapy. The BUA values did not demonstrate a significant difference, even if they always appeared inferior to the average observed (except in the range 60-70 years age group). CONCLUSIONS: The concept that osteoporosis is a disease characterized exclusively to a reduction in bone density, now leaves room for consideration that corresponds with the concepts of quantitative and quality elements. Chronic glucocorticoid therapy is one of the major causes of osteoporosis. The use of glucocorticoids increases the risk of fractures, independently from the bone ùineral BMD in the various ages, which therefore cannot be explained solely by the reduced BMD. Ultrasound may provide information on the bone structure, and so its eventual modification, after chronic glucocorticoid therapy. Our results show that bone ultrasonometry is able to detect a population in chronic glucocorticoid therapy in comparison with those not treated. BUA and SOS are reduced in all the patients. Our experience derives that in the chronic glucocorticoid therapy patients, a major prevalence is noted of SOS which may provide information on the modification of the bone structure.

Proprioceptive training and prevention of anterior cruciate ligament injuries in soccer.

This commentary describes a program developed to help reduce the incidence of anterior cruciate ligament injuries in soccer players. The basic principles underlying the injury prevention protocol are described with respect to the proprioceptive control mechanisms at the knee joint. This is followed by a detailed description of the program.

Results of arthroscopic excision of the fragment in the treatment of osteochondritis dissecans of the knee.

PURPOSE: To evaluate clinical and radiological results of arthroscopic excision of the fragment and debridement of the crater in the treatment of osteochondritis dissecans of the knee (OCD). TYPE OF STUDY: Case series. METHODS: We investigated 20 patients with partial or complete detachment of the OCD fragment. The average age at surgery was 21 years (range, 12 to 32 years). All the patients were treated by the same surgeon. They were evaluated at an average follow-up of 9 years (range, 6 to 17 years). RESULTS: The combined subjective and objective evaluation showed excellent and good results for 85% of the patients. Radiographic studies showed 2 grades of worsening (from no degenerative signs preoperatively to narrowing of the joint line up to 50% at follow-up) in 1 patient (5%). One grade of worsening (Fairbank's changes without joint space narrowing) was found in 45% of weight-bearing anteroposterior radiographic views and in 35% of weight-bearing bent knee posteroanterior views. Statistical correlations were significant between radiographic degenerative changes and the size of the osteochondral lesion at surgery, with larger lesions resulting in greater degenerative changes. CONCLUSIONS: The arthroscopic removal of an osteochondral fragment and debridement of the crater is a viable option in the treatment of grade III and IV OCD lesions. Results are better in lesions less than 2 cm(2).

Onset of myasthenia gravis in a patient affected by rheumatoid arthritis never treated with disease-modifying anti-rheumatic drugs.

We describe a patient affected by rheumatoid arthritis (RA) that developed myasthenia gravis (MG) after 20 years of illness. The peculiarity of this case concerns both the rare association between these diseases and the fact that the patients had never assumed disease modifying antirheumatic drugs. These treatments have been associated in some clinical reports with the onset of MG during the clinical course of RA. To our knowledge this is the first case described in medical literature up to now.

[Intra-articular administration of galactosaminoglucuronoglycan sulfate in moderate primary gonarthritis. A pilot study]. / Somministrazione intra-articolare di galattosaminoglucuronoglicano solfato nella gonartrosi primaria di grado moderato. Studio pilota.

BACKGROUND: The present study has been carried out in order to assess the clinical and functional efficacy and tolerability of galactosa-minoglucuronoglycan sulphate (GGGS). The molecule has been intra-articularly administered in patients affected by moderate primary gonarthritis, according to clinical and functional parameters. METHODS: At the beginning and at the end of each period of treatment the following parameters have been evaluated: spontaneous pain, provoked pain, pain during active movement, pain during passive movement, pain at rising (7-8:00 a.m.) pain at bed time (10:00 p.m.), execution time (expressed in seconds) of up-down from a chair (five times), execution time (expressed in seconds) to walk 15 meters. Fifty patients affected by osteoarthritis of the knee were treated weekly, during one year, for two periods of six weeks each with a total amount of 12 injections. RESULTS: Treatment with Galactosaminglucuronoglycan sulphate (GGGS) seems to be effective in the therapy of osteoarthritis of the knee. The pain scores decreased and the functional levels significantly (p < 0.01) improved in a large proportion of patients and GGGS was very well tolerated. CONCLUSIONS: This study suggests that intra-articular treatment is a substantially new way for GGGS administration in the therapy of osteoarthritis of the knee.

Galactosaminoglucuronoglycan sulphate in the treatment of osteoarthritis: clinical efficacy and tolerance of oral and intra-articular administrations.

The clinical efficacy and the tolerance of galactosaminoglucuronoglycan sulphate (GGGS), administered both orally and intra-articularly were evaluated for the treatment of generalized and localized osteoarthritis (OA). The study included 154 patients: 52 treated orally with GGGS, observed during three periods of three consecutive months of therapy followed by eight weeks of withdrawal, 52 treated only with non-steroidal anti-inflammatory drugs (NSAIDs), and 50 patients treated two times in a year with a total of twelve (6 x 2) knee intra-articular weekly injections. The tolerance to GGGS was excellent, and the monitoring of the clinical measurements revealed a significant improvement of the articular data with a decreasing of NSAID's consumption.