Background: Chronic kidney disease–mineral and bone disorder(CKD-MBD) is a common complication of CKD. It will cause renal osteopathy and vascular calcification. Methods: The patients were divided into four groups: CKD1-2 stage, CKD3-5ND stage, CKD5D stage and calciphylaxis. We analyzed the differences and variation tendency among groups. Logistic regression analysis showed the protect and risk factors for osteoporosis. Finally, we drew the ROC curves to explore if the BTMs can predict the osteoporosis. Results: 326 CKD patients was included. With the progression of the CKD, bone mineral density (BMD) decreased and bone turnover biomarkers(BTMs) became disordered, calciphylaxis patients were more serious than general dialysis patients. Logistic regression analysis showed that male(OR=0.558;OR=0.554)and BMI(OR=0.890;OR=0.911) were the protect factors of both left total hip and lumbar bone loss. LogPTH(OR=5.140)was risk factor of left total hip bone loss. ALP(OR=1.008) was risk factor for lumbar bone loss. The AUC of PTH and ALP were the highest one in the ROC curve of left total hip and lumbar respectively. Conclusions: When the GFR decreased, BMD and BTMs became abnormal gradually. The BMD of calciphylaxis patients were lower than other patients. PTH and ALP were risk factors and best predictors for osteoporosis in CKD patients.
Ibrahim Npochinto Moumeni, Ibrahim Npochinto Moumeni, Ibrahim Npochinto Moumeni
et al.
BackgroundIn July 2025, the WHO African Regional Committee adopted an ambitious strategy to address the 63% rehabilitation access gap through a comprehensive five-pillar framework. However, systematic educational exclusion of rehabilitation in African medical curricula may undermine implementation across all strategic pillars.MethodsAnalysis of the WHO AFRO 2025–2035 strategy implementation framework, complemented by systematic curriculum assessment across Central African medical schools and ethnographic observations from Cameroon documenting current access barriers and workforce knowledge gaps.ResultsMedical schools across Central Africa systematically exclude rehabilitation from curricula, with the University of Dschang representing a rare exception (4 h annually). This educational vacuum generates cascading failures: policymakers cannot prioritize services they don’t understand (Pillar 1: Governance), physicians cannot refer to specialists they’ve never encountered (Pillar 2: Workforce), evidence-based interventions are dismissed in favor of pharmaceuticals (Pillar 3: Service Delivery), rehabilitation needs remain invisible in data systems (Pillar 4: Information), and financing mechanisms struggle to support undervalued services (Pillar 5: Resources). Field evidence reveals patients traveling over 1,000 km for rare rehabilitation expertise, reflecting profound system-level educational failures.ConclusionWithout urgent educational reform, the WHO strategy risks replicating historical implementation failures despite comprehensive policy architecture. Educational exclusion represents not a peripheral concern but a foundational threat to strategy success. Medical curriculum integration offers a cost-effective, scalable intervention that amplifies all five strategic pillars. African health leaders must prioritize educational reform as essential infrastructure, not optional enhancement.
Ibrahim Npochinto Moumeni, France Mourey, Faustin Atemkeng Tsatedem
et al.
Background: Access to rehabilitation services in sub-Saharan Africa is severely limited, with the WHO reporting that more than 63 % of people in the region do not receive needed rehabilitation services. This study analyzes how the exclusion of rehabilitation from medical curricula in Cameroon affects care access and evaluates implications for implementing the WHO Regional Strategy to Strengthen Rehabilitation in Health Systems 2025–2035. Methods: We employed a sequential mixed-methods design comprising: (1) qualitative interviews with medical education leaders (n = 12) from 7 medical schools, analyzed using reflexive thematic analysis; and (2) clinical observation of 847 consecutive rehabilitation consultations over 24 months at Bafoussam Regional Hospital, evaluating referral patterns, prescription quality, and geographic patient distribution. We implemeted and assessed a 4 h rehabilitation education module for 2 promotions (year five) medical students. Results: Interviews revealed three mechanisms maintaining rehabilitation's exclusion from medical education: coercive (all 12 interviewees noted absence from accreditation requirements), normative (10/12 cited professional hierarchies that devalue rehabilitation), and mimetic (8/12 described uncritical curriculum replication from other schools). Analysis of 847 rehabilitation consultations showed that only 4.8 % of prescriptions included adequate clinical context; nearly half of patients (47 %) traveled over 100 km to access care. Physician specialty (OR = 3.7, 95 % CI: 2.1–6.4), recent graduation (OR = 1.9, 95 % CI: 1.1–3.2), and personal rehabilitation experience (OR = 4.3, 95 % CI: 2.5–7.6) predicted higher-quality referrals. The 4-h educational intervention at University of Dschang improved students' rehabilitation knowledge from 41.3 % to 78.7 % (p < 0.001) and referral confidence from 23 % to 87 % (p < 0.001). Conclusion: The exclusion of rehabilitation from medical curricula in Cameroon is associated with widespread “Single Practitioner Syndrome”—a phenomenon where care becomes centralized around rare practitioners, creating systemic inefficiencies and access barriers. Even minimal educational interventions show potential for significant improvement in knowledge and referral practices. Implementation of the WHO Regional Strategy will require addressing these foundational educational barriers while acknowledging resource constraints in Central African health systems.
Angela Sheu, Christopher P. White, Jacqueline R. Center
Skeletal fragility is an increasingly recognised, but poorly understood, complication of both type 1 and type 2 diabetes. Fracture risk varies according to skeletal site and diabetes-related characteristics. Post-fracture outcomes, including mortality risk, are worse in those with diabetes, placing these people at significant risk. Each fracture therefore represents a sentinel event that warrants targeted management. However, diabetes is a very heterogeneous condition with complex interactions between multiple co-existing, and highly correlated, factors that preclude a clear assessment of the independent clinical markers and pathophysiological drivers for diabetic osteopathy. Additionally, fracture risk calculators and routinely used clinical bone measurements generally underestimate fracture risk in people with diabetes. In the absence of dedicated prospective studies including detailed bone and metabolic characteristics, optimal management centres around selecting treatments that minimise skeletal and metabolic harm. This review summarises the clinical landscape of diabetic osteopathy and outlines the interplay between metabolic and skeletal health. The underlying pathophysiology of skeletal fragility in diabetes and a rationale for considering a diabetes-based paradigm in assessing and managing diabetic bone disease will be discussed.
Objectives: This systematic review and meta-analysis aimed to evaluate the prevalence of bone destruction in patients with Talaromyces marneffei infection, examine distribution patterns of bone lesions, and assess differences between HIV-positive and HIV-negative patients. Methods: Following PRISMA guidelines, 15 studies involving 839 patients were analyzed. Random-effects meta-analysis was performed to estimate prevalence and odds ratios. Study quality was assessed using ROBINS-I. Results: The overall prevalence of bone destruction was 18% (95% CI: 10-27%). HIV-negative patients showed significantly higher odds of bone destruction (OR: 0.09, 95% CI: 0.02-0.37%). Bone lesions were widely distributed, with osseous involvement (45.7-71.4%) more prevalent than articular (7.1-66.7%). The skull, ribs, and lumbar vertebrae were commonly affected. Conclusion: Bone destruction is a significant complication in TM infection, particularly in HIV-negative patients. The diverse anatomical distribution emphasizes the need for comprehensive skeletal assessment in suspected cases.
Murtadha Ali Nazzal, Abdulkareem M. Jewad, Hasan Abd Ali Khudhair
BACKGROUND:
β-thalassemia major (β-TM) is a genetic disorder characterized by excessive iron accumulation caused by continued blood transfusion, together with the development of chronic anaemia, which may also cause complications related to weakened bones.
OBJECTIVES:
The purpose of this research was to investigate and compare the concentration levels of different biochemical markers related to mineral metabolism; phosphate (PO4), calcium (Ca+2), vitamin D3 (VD3), and the hormonal markers related to bone metabolism; parathyroid hormone (PTH) and fibroblast growth factor 23 (FGF-23) against those of healthy controls (HCs), as well as the levels of the biomarker used to evaluate the potential for iron overload; ferritin (FER) and the concentration of hemoglobin (Hb).
MATERIALS AND METHODS:
Between September 2024 and January 2025, at the Thi-Qar Centre for Genetic Disorders in Thi-Qar, Iraq, an investigation was carried out with a biochemical design as a case-control trial. The sample consisted of 50 β-TM patients matched on sex between the ages of 18-45 years, who were compared to 49 HCs (24 male, 25 female), and were between the ages of 18-49 years. The serum concentrations of the study biomarkers were assessed using either spectrophotometric or standardised immunoassays and analysed using either the Mann-Whitney U Test, Chi-Square, t-test or Spearman's correlation coefficient.
RESULTS:
There was a statistically significant (P < 0.001) increase in FGF-23, PO4 and FER levels in patients compared to the healthy group with significantly decreased levels of VD3, Ca+2, PTH and Hb. There was a very strong negative correlation between PTH and PO4 (r = -0.93; P < 0.001) and a strong positive correlation between PTH and Ca2+ (r = 0.57; P < 0.001). FGF-23 levels were also elevated, yet there were no statistically significant correlations between FGF-23 and any of the other parameters included in this analysis. Therefore, it appears that FGF-23 is regulated in a different manner than the other biomarkers assessed in this study.
CONCLUSIONS:
Dysregulated levels of mineral and/or hormonal suggest decreased bone turnover in patients with β-TM.
Diseases of the circulatory (Cardiovascular) system
Pierpaolo Panebianco, Gianluca Testa, Giulia Barbagallo
et al.
<b>Background/Objectives:</b> Osteoporosis is a skeletal disorder characterized by reduced bone mineral density (BMD) and increased fracture risk. Chronic inflammation is implicated in osteoporosis pathogenesis, with inflammatory mediators promoting bone resorption. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are markers of systemic inflammation and have emerged as potential indicators of bone health. This study’s aim was to highlight the potential role of the NLR and PLR as markers of bone health in postmenopausal women affected by osteoporosis or osteopenia and to evaluate the possible influence of autoimmune disease in this context. <b>Methods</b>: This cross-sectional study included 124 postmenopausal women diagnosed with osteopenia or osteoporosis at the Orthopedic Unit of the Policlinico G. Rodolico in Catania, Italy. Demographic, clinical, laboratory, and diagnostic imaging data were collected. The NLR and PLR were calculated from complete blood counts, and BMD was measured using dual-energy X-ray absorptiometry (DEXA). Statistical analyses included correlations, group comparisons, and multiple and logistic regressions. <b>Results</b>: The NLR and PLR did not directly correlate with BMD or fracture incidence. However, the PLR weakly correlated with vitamin D levels. Notably, women without Hashimoto’s thyroiditis exhibited higher NLR values than those with the condition. Hypertensive women had a lower PLR than non-hypertensive women, while euthyroid women had a higher PLR than hyperthyroid or hypothyroid women. Multiple regression analysis revealed that age, BMI, CKD stage, vitamin D levels, NLR, PLR, diabetes, and autoimmune diseases significantly predicted BMD at the femur neck, with the PLR contributing significantly. Logistic regression confirmed these predictors for osteoporosis or osteopenia, with an increased PLR being associated with a higher likelihood of osteoporosis. <b>Conclusions</b>: While the NLR and PLR may not independently predict bone health, their inclusion in a multifactorial assessment considering age, BMI, vitamin D, and comorbidities could enhance osteoporosis management.
Raffaella Panza, Filippo Piarulli, Valentina Rizzo
et al.
Abstract Background Positional plagiocephaly is an asymmetrical flattened skull deformity whose incidence increased significantly in the last decades. Osteopathic treatment has been suggested to tackle early deformational sequences, in order to ensure the correct development of the child. The aim of the study was to assess the effectiveness of osteopathic treatment of positional cranial deformities in infants. Methods Retrospective observational study carried out at the Section of Neonatology and Neonatal Intensive Care Unit of the Department of Interdisciplinary Medicine of University of Bari, Italy in collaboration with a specialized pediatric osteopath. Results 424 infants were enrolled. Isolated positional plagiocephaly affected the vast majority of infants (n. 390, 91.98%); 34 patients (8.02%) were diagnosed with positional brachycephaly. Both infant groups (positional plagiocephaly and positional brachycephaly) had a median severity score of 3 (IQR: 3 – 3 and 2 – 3, respectively) and benefited from a median of 3 osteopathic sessions (IQR 3–4 and 2–4, respectively). Higher severity scores of positional asymmetries were significantly more common in preterm neonates (Pearson chi2: 11.58; p-value: 0.021) and in males (Pearson chi2: 10.06; p-value: 0.039). Conclusions Significant improvements in positional cranial deformations of children were obtained after only five osteopathic treatments provided in the first months of life. The osteopathic treatment could positively impact the clinical history of patients with positional plagiocephaly and positional brachycephaly. Implication for practice • Positional plagiocephaly is increasingly common among infants and may cause moderate to severe neurodevelopmental adverse effects. • Osteopathic treatment may tackle early deformational sequences, in order to ensure the correct development of the child. • Our study reveals that cranial asymmetry of infants with positional plagiocephaly is significantly reduced after only five osteopathic treatments provided in the first months of life. • Osteopathic treatment should be offered as a first line approach to young infants diagnosed with positional plagiocephaly.
Matrix metalloproteinases (MMPs) and tissue inhibitor of metalloproteinases (TIMPs) play a vital role in the pathogenesis of multiple myeloma (MM), especially for tumor invasion and osteolytic osteopathy. By breaking down extracellular matrix (ECM) components and releasing the proteins composing the ECM and growth factors, as well as their receptors, MMPs affect tissue integrity and promote cancer cell invasion and metastasis. A vital pathophysiological characteristic of MM is the progress of osteolytic lesions, which are brought on by interactions between myeloma cells and the bone marrow microenvironment. MMPs, certainly, are one of the fundamental causes of myeloma bone disease due to their ability to degrade various types of collagens. TIMPs, as important regulators of MMP hydrolysis or activation, also participate in the occurrence and evolution of MM and the formation of bone disease. This review focuses on the role of MMP-1, MMP-2, MMP-7, MMP-9, MMP-13, MMP-14, and MMP-15 and the four types of TIMPs in the invasion of myeloma cells, angiogenesis, osteolytic osteopathy, to offer some novel perspectives on the clinical diagnostics and therapeutics of MM.
Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Anna Baranowska, Karina Szczypiór-Piasecka, Alicja Mińko
et al.
Abstract
Introduction: Malignant neoplasms of bones and articular cartilage resulting from the operation of the mesenchymal sales cell valuation bank. Cells can differentiate in many countries. in. chondrocytes, osteoblasts or adipocytes The bone cancer that occurs is osteosarcoma. In second place is chondrosarcoma (chondrosarcoma).
Materials and methods: The work was written based on the development of a patient who had the further development of the femur part of the former cartilage sarcoma radio station. The entire treatment procedure at the Department of Orthopedics, Traumatology and Oncology of the Musculoskeletal System, located at Unii Lubelskiej 1 street in Szczecin.
Results: At the main point of treatment of the hospital clinic, the patient, the patient who returns as good working point, points to restore lost functions, as well as self-service learning.
Conclusion: Rehabilitation is an indispensable carrier of services for cancer patients. Introducing modern techniques such as therapy and osteopathy to rehabilitation, ensuring the economy of therapy.
During the late nineteenth and early twentieth centuries, osteopathic information was circulated by way of pamphlets and postcards. Several osteopathic historical pamphlets and postcards from the D’Angelo Library collection have been researched and digitized in order to preserve these osteopathic artifacts and highlight their historical significance for the current profession.
Bibliography. Library science. Information resources, Medicine
Guzel M. Nurullina, Guzyal I. Akhmadullina, Irina S. Maslova
Parathyroid hormone (PTH) regulates the maintenance of serum calcium concentration in strict limits through direct effects on bones and kidneys and indirectly due to the effect on the gastrointestinal tract. PTH also regulates phosphorus metabolism. Secondary hyperparathyroidism develops in response to a decreased serum calcium and vitamin D levels, leading to an increased bone resorption. However, the increase in parathyroid hormone above the reference values is not observed in all cases of vitamin D deficiency or hypocalcemia. Supressed or inadequately normal PTH in these conditions is referred to as functional hypoparathyroidism. Various theories have been suggested to explain the functional hypoparathyroidism: magnesium deficiency, intestinal calcistat, lower reference values for plasma PTH compared to current cut off interval, biological variations of vitamin D-binding protein. However, at present none of these theories are generally accepted. The clinical significance of functional hypoparathyroidism may be that vitamin D deficiency, hypocalcemia, and hypomagnesemia are associated with a risk of fracture, regardless PTH level.
Lilit V. Egshatyan, Natalya G. Mokrisheva, Lyudmila Ya. Rozhinskaya
In the treatment of secondary hyperparathyroidism of end-stage chronic kidney disease, vitamin D receptor activation and allosteric modulators of the calcium-sensing receptor inhibit glandular hyperplasia, reduce parathyroid hormone levels, impact on bone turnover and mineral density. But the use of calcimimetic and vitamin D analogs or mimetics did not reduce the need for parathyroidectomy for refractory hyperparathyroidism. The enlarged parathyroid gland and gland nodular transformation became refractory to medical therapy and patient need for parathyroidectomy. Tertiary hyperparathyroidism is a state of excessive secretion of parathyroid hormone after a long period of secondary hyperparathyroidism and renal transplantation.
In this article, we present the case of a Caucasian male with chronic kidney disease (end-stage on chronic hemodialysis and after kidney transplantation) and different forms of hyperparathyroidism (secondary and tertiary). Our case study shows that only a multi-interventional strategy is likely to be more effective treatment in cases of severe and refractory to medical therapy hyperparathyroidism.
G A Melnichenko, Zh E Belaya, L Ya Rozhinskaya
et al.
Представлено краткое изложение клинических рекомендаций по диагностике и лечению остеопороза, разработанных членами Российской ассоциации эндокринологов при участии членов Российской ассоциации по остеопорозу (ревматологов, травматологов, терапевтов, гинекологов-эндокринологов). Рекомендации разработаны с позиций доказательной медицины, в соответствии с требованиями к составлению клинических рекомендаций Минздрава России, опубликованными в 2016 г. Значительное место в изложении отведено диагностике остеопороза у взрослых, дифференциальной диагностике с другими метаболическими заболеваниями скелета, а также принципам патогенетического лечения остеопороза. Клинические рекомендации полезны будут как врачам общей практики, так и специалистам, прежде всего эндокринологам, ревматологам, травматологам-ортопедам, гинекологам, нефрологам, гастроэнднрологам и неврологам, так как остеопороз является мультифакториальным и мультидисциплинарным заболеванием
Длительная иммобилизация изменяет процесс ремоделирования костной ткани, что в свою очередь приводит к постепенному снижению ее минеральной плотности костный ткани (МПКТ) и формированию постиммобилизационного остеопороза (ПИОП). Известно, что кальций является фактором определяющим снижение МПК при первичном системном остеопорозе (ОП). В отношении постиммобилизационного остеопороза (ПИОП) дискуссия многих установленных параметров продолжается. Целью исследования явилось изучение особенностей минерального обмена в динамике формирования постиммобилизационного остеопороза (ПИОП). Материал и методы. Эксперимент проведен на 90 самцах и самках крыс линии «Vistar» весом 90-110 г, содержавшихся в условиях вивария, при температуре 200-220С и световом режиме «день-ночь», на стандартном рационе. В возрасте трех месяцев крысам (опытная группа) моделировали ИОП, резекцией костей голени правой задней конечности на уровне ее проксимального эпиметафиза (40 крыс), таким образом получая неопороспособное бедро. Сроки наблюдения: на 30, 60, 120, 150, 180, 210, 240 и 270 сутки после операции. Контрольная группа - 40 интактных животных, того же пола и возраста, соответственно срокам наблюдения в опытной группе. Контроль формирования остеопоротических изменений в бедренных костях животных проводили рентгенографическим и морфологическим методами. Результаты. У всех животных максимальное накопление магния в костной ткани соответствовало 210 суткам эксперимента, однако в динамике формировании ПИОП уровень концентрации магния оставалось ниже в 1,6-5,4 раза по сравнению с физиологическими значениями (p<0,05). У интактных крыс прирост содержания магния составил всего 58,9% по сравнению с началом эксперимента (p<0,05), в то время как в опытной группе - только 40,2% (p<0,05), что составило 68% физиологической нормы (p<0,05). Таким образом, дефицит магния при ИОП обнаружили в течении восьми месяцев после операции, своего максимума он достиг на 180 сутки эксперимента - в 5,4 раза ниже физиологического уровня. Выявлено, что дефицит мания и неорганического фосфора оказывает негативное влияние на синтез как органического, так и минерального матрикса костной ткани при иммобилизации, тем самым снижая эффективность костеобразования. Выводы. Исследования костной ткани экспериментальных крыс, после ампутации голени, обнаружили значительное нарушение минерализации внеклеточного матрикса, при формировании остеопоротических изменений: максимальный дефицит кальция составил 45%, фосфора - 80%, магния - 82% в сравнении с физиологическими значениями интактных животных. При высоком дефиците макроэлементов ремоделирование костной ткани значительно «страдает», так как показано, что «допустимый» дефицит, не оказывающий существенного влияния на ремоделирование кости не превышает 20%. Следовательно, особенностью минерального гомеостаза при иммобилизационном остеопорозе в эксперименте является выраженный пролонгированный дефицит макроэлементов костной ткани, главным образом магния и неорганического фосфора, а затем и кальция.
Vega Rodríguez N, Limiñana Cañal JM, Arbelo Rodríguez A
et al.
Fundamento: La fractura de cadera constituye la complicación clínica más grave de la osteoporosis, por su elevada morbilidad y mortalidad.
Método: Hemos estudiado las características epidemiológicas y demográficas de la totalidad de fractura de cadera por fragilidad ocurridas en pacientes de &Ge; 50 años de edad y recogidas en la isla de Gran Canaria durante el quinquenio 2007-2011, a partir de los Servicios de Admisión, Codificación, Urgencias y Traumatología de todos los hospitales de Gran Canaria, tanto de la red asistencial pública como privada.
Resultados: Se recogieron un total de 2.222 fracturas de cadera de las cuales 1.593 (71,7%) se produjeron en mujeres y 629 (28,3%) en hombres. La relación mujer/hombre fue de 2,53. La media de la edad de producción de fracturas de cadera fue de 79 ± 9,7 años. A lo largo de los 5 años, el número total (hom-bres y mujeres) de fracturas de cadera anuales osciló entre 402 (año 2007) y 504 (año 2010). El número de fracturas de cadera aumentó con la edad hasta la década de los 90 años. La incidencia anual global fue de 150 casos/100.000 habitantes &Ge; 50 años, siendo en las mujeres de 205,4 casos respecto a la po-blación de este sexo y edad, y en los hombres de 89,1 casos respecto a la población de hombres &Ge; 50 años. Durante los meses de invierno se produjo el 29,7% del total de fracturas, un 7,5% más de las que ocurrieron durante los meses de verano (22,2%).
Conclusiones: Durante el período 2007 a 2011, la incidencia de fractura de cadera en Gran Canaria se mantuvo más o menos estable, siendo en todos los años mayor en las mujeres que en los hombres, y aumentando con la edad hasta los 90 años. El mayor número de fracturas de cadera se produjo durante los meses de invierno, siendo semejante durante la primavera, verano y otoño.
Gutiérrez Medina S, Díaz Curiel M, Cabello Úbeda A
et al.
Los efectos adversos del hipertiroidismo en el hueso están descritos desde hace años. Las hormonas tiroideas son necesarias para el crecimiento, la maduración, el metabolismo y el remodelado óseo. No obstante, la tirotoxicosis no tratada cursa con un aumento del remodelado, osteopenia u osteoporosis y un incremento en el riesgo de fractura. Desde la introducción de fármacos antitiroideos y el radioyodo, la patología ósea hipertiroidea es menos frecuente. A continuación se presenta un caso poco habitual de una paciente con tirotoxicosis asintomática que debuta con un aumento del remodelado óseo.
Zh E Belaya, L Ya Rozhinskaya, N V Dragunova
et al.
Purpose. Endogenous Cushing’s syndrome (CS), usually affecting young and otherwise healthy patients, is a good model to validate the effects of supraphysiological levels of glucocorticoids in humans. This study evaluates circulating levels of extracellular antagonists of Wnt/ß-catenin signaling pathway (sclerostin, Dickkopf1 (Dkkl), secretedfrizzled-related protein 1 (SFRP1)) along with osteoprotegerin (OPG) and soluble receptor activator of nuclear factor kappa-beta ligand (RANKL) in patients with CS as compared to healthy individuals. Materials and methods. Forty patients with clinically and biochemically evident CS and 40 sex, age and body-mass index matched healthy individuals provided fasting serum samples (8:00-10:00AM) for measurement of sclerostin, SFRP1 and Dkkl, RANKL., OPG along with bone turnover markers. Serum samples on RANKL., OPG., Dkkl, SFRP1, sclerostin were frozen and then concurrently measured by an enzyme immunoassay (ELISA) using commercially available reagents. Serum samples on osteocalcin (OC), carboxyterminal cross-linked telopeptide of type I collagen (CTx), cortisol in serum and saliva were assayed by electrochemiluminescence (ECLIA) Cobas e601 Roche. Urinary free cortisol (24hUFC) was measured by an immunochemiluminescence assay (extraction with diethyl ether) on a Vitros ECi. All participants were questioned regarding any recent low traumatic fractures. Patients with CS underwent standard spinal radiographs in anterior-posterior and lateral positions of the vertebrae Th4-L4 (Axiom Icons R200 "Siemens"). Results. Patents with CS (30 (26-40) years old with 24hUFC 2575 (1184-4228) nmol/l (Me (Q25-Q75)) had suppressed OC and normal CTx levels as compared to healthy subjects. A significant correlation, which we observed between OC and CTx (po=0.724 (p<0.001)) among the healthy volunteers, weakened to a non-significant level (po - 0.285 (p=0.083)) when analyzing patients with CS only. 24hUFC correlated with OC po = - 0.464 p=0.003, but not with CTx po= 0.245 (p=0.132) in patients with CS. Patients with CS had higher sclerostin levels versus healthy control subjects (p=0.032). Differences in sclerostin were due to the lack of lower sclerostin values rather than an increase in protein levels above the upper-limits of the healthy control individuals. Sclerostin levels higher than 662 pg/ml were four times more frequent in patients with CS as compared to healthy subjects (OR=4,19, 95% CI 1,44-12,22), p=0,006. Dkk1, SFRP1 did not differ from the control group. Patients with CS had a significantly lower level of RANKL (0.083 (0.075 0.093) pmol/L) as compared to healthy subjects (0.106 (0.089 0.131) pmol/L) p<0.001. Conversely, no difference was found between the OPG level in patients with CS (6.65 (4.92-7.66) pmol/L) and healthy individuals (5.77 (5.00-6.40) pmol/L), p=0.14. RANKL was lower (p=0.02) and OPG was higher (p=0.04) in patients with CS and low traumatic fractures (n=19) versus patients without fractures (n=21). Conclusions. Patients with CS have higher sclerostin level as compared to healthy subjects. Hypercotisolism prevents the normal physiological suppression of sclerostin rather than raising its absolute level. Of all the tested proteins (sclerostin, Dkk1, SFRP1, RANKL., OPG) only sclerostin seems to be a promising therapeutic approach to treating osteoporosis in patients with endogenous CS.
<p>Abstract</p> <p>Background</p> <p>Spinal manipulation and acupuncture can be helpful in reducing the symptoms of musculoskeletal (MSK) pain. Both approaches are currently recommended by NICE as treatment options for patients with persistent low back pain. However, there has been no previous evaluation of a GP service using them together for MSK pain. The purpose of this study was to evaluate acceptability and outcomes for an osteopathy and acupuncture service (delivered by complementary therapy practitioners) for patients with MSK problems provided within a General Practice.</p> <p>Methods</p> <p>Patients were asked to complete a questionnaire before and after their course of treatment. Outcome measures included the Bournemouth Questionnaire (measuring MSK problems), EuroQoL-5D (measuring quality of life), medication use, physical activity and general well-being. Non-parametric tests were used to compare pre- and post- treatment variables. Qualitative data, regarding participants' views on the service, were collected from patients via a service survey and healthcare professionals via interviews. Qualitative data were analysed using thematic analysis.</p> <p>Results</p> <p>123 adults with MSK problems were referred into the service (79 female and 44 male, mean age 49 years). Complete patient questionnaire data sets (pre- and post- treatment) were available for 102 participants; 91 completed a service survey. All healthcare professionals involved in the service participated in interviews including all seven GPs and the administration manager at the practice, as well as the three acupuncture/osteopathy practitioners.</p> <p>Patient outcomes: comparisons between pre and post-treatment revealed a statistically significant improvement in MSK pain (p < 0.0001) and quality of life (p < 0.0001), and a statistically significant reduction in medication use (p < 0.0001). Qualitative analysis found that patients reported improvements in their MSK pain, mobility, other physical health conditions, well-being and self-management of their MSK problem.</p> <p>Acceptability of the service: overall patients and healthcare professionals were satisfied with the service and its provision within the Practice. Patients reported wanting increased appointment availability and flexibility, and more sessions. Complementary therapy practitioners reported finding the high number of referrals of chronic patients challenging, and wanting increased communication with GPs.</p> <p>Conclusions</p> <p>Provision of acupuncture and osteopathy for MSK pain is achievable in General Practice. A GP surgery can quickly adapt to incorporate complementary therapy provided key principles are followed.</p>