Abstract Type 1 diabetes mellitus (T1DM) can lead to severe diabetic osteopathy, largely driven by alterations in the bone marrow hypoxic microenvironment and damage to type H vessels. This study employed multimodal imaging—including DCE-MRI, Micro-CT, and USPIO-enhanced MRI—to enable early in vivo assessment of hypoxic changes and type H vessel impairment in a T1DM rabbit model. Experiments involved 20 rabbits with alloxan-induced T1DM and controls, evaluated four months post-modeling. Imaging revealed significant differences in bone marrow microcirculatory perfusion and vascular permeability in T1DM rabbits, along with elevated USPIO uptake and regional heterogeneity that correlated with type H vessel distribution. Accompanying pathological changes were confirmed via immunofluorescence, qPCR, and transmission electron microscopy, suggesting an association of the AGEs/ROS-HIF-1α-VEGF pathway with these microvascular lesions. Our findings offer visual and quantitative imaging evidence to inform future clinical strategies targeting type H vessel hypoxia in diabetic osteopathy.
Aim or purpose: To investigate bone compartment-specific senescence heterogeneity in type 2 diabetic mice, focusing on spatiotemporal p16/p21 expression patterns and differential efficacy of senolytic therapies. Materials and methods: Longitudinal profiling (1-6 weeks post-diabetes induction) of femoral cortical and marrow tissues in p21-3MR transgenic mice (n=6/group) integrated the following approaches: (1) Senescence flux analysis: Senescence-Associated β-galactosidase and senescence-associated secretory phenotype factor arrays; (2) Molecular cartography: p16/p21 co-localization via mRFP-IF; (3) Targeted interventions: dasatinib and quercetin (D+Q) therapy vs ganciclovir nanotherapy.All experimental protocols were approved by the Animal Ethics Committee. Results: (1) Spatiotemporal divergence in diabetic bone aging was observed: bone marrow exhibited early-onset p21-related senescence, whereas cortical bone demonstrated progressive p16-related pathology.(2) Therapeutic efficacy mapping revealed compartment-specific responses:D+Q therapy showed superior cortical bone rejuvenation (P<0.01), whereas p21-targeted monotherapy preferentially attenuated marrow senescence (p21high cell reduction: 73% vs 15% in cortex, P<0.001).(3) This compartmentalized senescence paradigm establishes dual therapeutic targets for diabetic osteopathy, proposing bone structure-specific intervention strategies to address aging heterogeneity. Conclusions: This pioneering study employing the p21-3MR model unveils spatiotemporal heterogeneity in diabetic bone-adipose axis senescence and delineates compartment-specific therapeutic efficacy of anti-aging interventions. The findings establish a novel therapeutic paradigm: cortical bone preferentially responds to D+Q, whereas marrow senescence requires p21-targeted strategies. Future investigations should prioritize mechanistic decoding of p21high adipocyte populations in metabolic dysregulation, to advance personalized senotherapy for diabetic osteopathy.
Ruben Tovar Ochovo, Diego F. Hidalgo, Roy La Touche
Osteopathy is categorized as complementary and alternative medicine. It is a profession which is presentin most countries, with a variety of practices and regulations. While it is sometimes integrated withinother disciplines of manual therapy, such as physiotherapy, unlike the latter, osteopathy continues to be based on philosophical principles that shape its identity, anchoring it to the 19th century. However, theseosteopathic tenets do not meet the criteria of representativeness and truthfulness and thus, cannot coexist with a science-based medical practice. This commentary analyzes the underlying theoretical principles that dictate osteopathic care, its deficiencies and weaknesses and why they might place osteopathy in the realm of pseudoscience
Seyed Arman Zakaryaei, Majid RAVANBAKHSH, Hazhir JAVAHERIZADEH
et al.
ABSTRACT Background: Functional constipation (FC) is a common global high prevalence issue in children. Objective: The purpose of the present study is to evaluate the effect of visceral manipulation (VM) on children with chronic interacble FC unresponsive to the standard treatment. Methods: This study was conducted as a randomized, single-blind controlled trial. Fifty-two children with refractory chronic functional constipation unresponsive to the standard medical treatment were randomly allocated to two groups of 26 control (standard medical care (SMC)) and 26 intervention (SMC with VM) for 4 weeks. Abdominal pain, painful defecation, stool consistency, defecation frequency, and the dose of oral laxative were evaluated before and after the treatment period using the Pain Rating Scale, Bristol stool form scale, and patient/parents report. Results: At the end of treatment, except for the dose of oral laxative in the control group, all of the results showed a significant difference in both groups (P<0.05). The dose of oral laxative in the intervention group decreased significantly (P<0.05), however, no significant change was observed in the control group (P>0.05). In the intervention group comparison, statistically significant differences were found in all variables except the Bristol stool form scale (P<0.05). The Bristol stool form scale after treatments was not different when the groups were compared (P=0.32), but the number of subjects who had normal stool consistency was significantly increased in the intervention group than in the control group (P<0.05). Conclusion: VM can be considered as a possible treatment without side effects besides SMC for the management of chronic FC. Further studies are needed to investigate the long-term effect of VM.
Diseases of the digestive system. Gastroenterology
Osteopoikilosis (disseminated osteopathy condensans, stained bones) is an asymptomatic osteosclerotic dysplasia of uncertain etiology. The symptoms are very slight or absent, differing from the striking bone sclerosis lesions. The course of osteopoikilosis is benign and stable, its diagnosis is almost always incidental. We present the case of a 17-year-old girl with chronic pain in both knees, who was studied by Rx on her knees, observing multiple sclerotic lesions corroborated in the pelvis, proximal femur and lumbar spine. The inconsistency between such striking images and the scarcity of symptoms was interesting. Finally, the patient was diagnosed with osteopoikilosis. She and her relatives were explained about her condition, the consequences of this pathology and she was prescribed medical treatment for pain, and orthopedic consultations with follow-up were scheduled for chronic pain.
Abstract Background The intent of this meta-analysis was to examine the efficacy of thoracolumbar interfascial plane block (TLIP) for pain control after lumbar spinal surgery. Methods Randomized controlled trials (RCTs) published on PubMed, CENTRAL, Scopus, Embase, and Web of Science databases up to February 10, 2023, comparing TLIP with no or sham block or wound infiltration for lumbar spinal surgeries were included. Pain scores, total analgesic consumption, and postoperative nausea and vomiting (PONV) were analyzed. Results Seventeen RCTs were eligible. Comparing TLIP with no block or sham block, the meta-analysis showed a significant decrease of pain scores at rest and movement at 2 h, 8 h, 12 h, and 24 h. Pooled analysis of four studies showed a significant difference in pain scores at rest between TLIP and wound infiltration group at 8 h but not at 2 h, 12 h, and 24 h. Total analgesic consumption was significantly reduced with TLIP block as compared to no block/sham block and wound infiltration. TLIP block also significantly reduced PONV. GRADE assessment of the evidence was moderate. Conclusion Moderate quality evidence indicates that TLIP blocks are effective in pain control after lumbar spinal surgeries. TLIP reduces pain scores at rest and movement for up to 24 h, reduces total analgesic consumption, and the incidence of PONV. However, evidence of its efficacy as compared to wound infiltration of local anesthetics is scarce. Results should be interpreted with caution owing low to moderate quality of the primary studies and marked heterogeneity.
Orthopedic surgery, Diseases of the musculoskeletal system
Lorenzo Arcuri, Giacomo Consorti, M. Tramontano
et al.
Background Despite controversy regarding its validity and clinical usefulness, manual examination findings still have an important role for manipulative therapies. As an example, somatic dysfunction (SD) remains central to osteopathic practice.This study aims to explore the experienced osteopaths' attitudes concerning SD and its role in osteopathic practice. This qualitative research could contribute to building a consistent paradigm for manual intervention in all musculoskeletal manipulations. Methods A thematic analysis with grounded theory elements was used. Data were collected through semi-structured interviews carried out between February and April 2021. A purposive sample of twenty professional osteopaths with past experience in osteopathic care was chosen to reflect the phenomenon's variety. The data analysis was done inductively and in tandem with the recruiting to keep track of data saturation. Results Eleven osteopaths participated in the study. Three main themes emerged from the data analysis: (1) SD as a safe tissue-touch-based communication tool between operator and person complex adaptive health system; (2) The treatment of SD is shareable between osteopaths, other health professionals, and the patients involved in the therapeutic pathway improving body awareness and health; (3) The development of the SD concept in research and practice to better clarify osteopathic profession identity and definition. Conclusions A panel of expert osteopaths consider the concept of SD as a valuable tool integrated into the osteopathic evaluation and treatment process. The shared concept and clinical application of SD is informed by person-centered care concepts and from the fields of neuroscience, cognitive and complexity science. Our study reports a common need among osteopaths to develop an evidence-based framework of SD to allow the best development of the osteopathic profession.
R. Zegarra-Parodi, Francesca Baroni, C. Lunghi
et al.
Historical osteopathic principles and practices (OPP)—considering the patient as a dynamic interaction of the body, mind, and spirit and incorporating the body’s self-healing ability into care—are inherited from traditional/complementary and alternative (CAM) principles. Both concepts are familiar to contemporary osteopathic practitioners, but their incorporation into healthcare for evidence-informed, patient-centered care (PCC) remains unclear. Further, a polarity exists in the osteopathic profession between a ‘traditional-minded’ group following historical OPP despite evidence against those models and an ‘evidence-minded’ group following the current available evidence for common patient complaints. By shifting professional practices towards evidence-based practices for manual therapy in line with the Western dominant biomedical paradigm, the latter group is challenging the osteopathic professional identity. To alleviate this polarity, we would like to refocus on patient values and expectations, highlighting cultural diversity from an anthropological perspective. Increasing an awareness of diverse sociocultural health assumptions may foster culturally sensitive PCC, especially when including non-Western sociocultural belief systems of health into that person-centered care. Therefore, the current medical anthropological perspective on the legacy of traditional/CAM principles in historical OPP is offered to advance the osteopathic profession by promoting ethical, culturally sensitive, and evidence-informed PCC in a Western secular environment. Such inclusive approaches are likely to meet patients’ values and expectations, whether informed by Western or non-Western sociocultural beliefs, and improve their satisfaction and clinical outcomes.
Fibrous dysplasia is a rare disease, a slowly progressive benign pseudotumoral osteopathy, characterized by a proliferation of connective fibrous tissue that replaces the medullary bone with trabeculated bone. It affects mainly the skull, the maxillofacial region and the long bones. It is a congenital and metabolic disorder. We present the case of a 20-year-old female patient from Tanzania, with a history of good health, who presented to the department of maxillofacial surgery of the Kitui Country Referral Hospital, Kenia, due to an abnormal and deforming growth in the lower third of the face, with more than six years of progress. She reported difficulty speaking, pain while eating hard food and having had repeated infectious processes. On intraoral examination a displacement of the left dental structures was found, as well as bleeding and reddened mucus with indentations resulted from the trauma caused by the upper teeth on the tumoral surface. She had a bad oral hygiene, halitosis and a curvature of the tongue and of the structures of the floor of the mouth towards the opposing side. CT scan showed an expansible image, with intralesional calcifications, that occupied the whole left mandibular region. A preoperative incisional biopsy was performed, which showed a mandibular fibrous dysplasia. Exeresis of the tumoral mass was performed with the placement of a titanium plate, restoring the lost mandibular bone and thus securing the space for future bone reconstructions. The early diagnosis of this condition would avoid aggressive procedures, making it possible to preserve the possible greatest amount of healthy bone.
Francesca Baroni, M. Tramontano, N. Barsotti
et al.
Abstract Objectives The construct of the osteopathic structure-function models is reported as a cornerstone of clinical reasoning and treatment processes. Nevertheless, there are no shared procedures described for their use in clinical practice. The present narrative review aims to analyze a more comprehensive perspective on the phenomenon. Methods A structured narrative review was conducted. A database search was conducted using Pubmed, ScienceDirect, and Google Scholar. Peer-reviewed papers without specifying limits on dates and design were included. Results Twenty-five findings were reported and grouped into two main themes: 1) Debate on models and theoretical frameworks for osteopathic care; 2) Clinical reasoning and decision-making process in the osteopathic field. Conclusions An integrated osteopathic care approach based on the structure/function models represents a starting point to establish a shared osteopathic diagnostic and clinical reasoning and an evidence-informed practice promoting health in an interdisciplinary person-centered care process. The present review highlights the limited amount of literature on using osteopathic conceptual models in decision-making and treatment strategies. A research plan is required to develop a common framework for an evidence-based osteopathic practice that promotes well-being in an interdisciplinary person-centered care process.
Abstract A current osteopathic tenet inherited from Native American principles involves viewing each person as a dynamic interaction of body-mind-spirit (BMS). Because of its traditional medicine heritage and current evidence-based approach, the osteopathic profession is, arguably, uniquely positioned to promote evidence-informed person-centered approaches that transcend improvements in pain and musculoskeletal function. It may be particularly relevant in the context of integrating the BMS tenet into osteopathic care according to the diversity of patients’ values and sociocultural assumptions towards health, symptoms, and subsequent care, which range from the typical Western to complementary and alternative medicine perspectives. There is currently a lack of robust clinical practice frameworks in this area, confusing patients and practitioners and blurring professional identities. The current commentary provides an opportunity to initiate discussions in the profession with a rationale for creating a roadmap to develop an evidence-informed framework for osteopathic care that integrates the BMS tenet.
Background Despite the growth of the osteopathic profession in Spain in the last few years, reliable information regarding professional profile and prevalence is still lacking. The Osteopathic Practitioners Estimates and RAtes (OPERA) project was developed as a European-based survey dedicated to profiling the osteopathic profession across Europe. The present study aims to describe the characteristics of osteopathic practitioners, their professional profile and the features of their clinical practice. Methods A voluntary, validated online-based survey was distributed across Spain between January and May 2018. The survey, composed of 54 questions and 5 sections, was formally translated from English to Spanish and adapted from the original version. Because there is not a unique representative osteopathic professional body in Spain, a dedicated website was created for this study, and participation was encouraged through both specific agreements with national registers/associations and an e-based campaign. Results A total of 517 osteopaths participated in the study, of which 310 were male (60%). The majority of respondents were aged between 30–39 years (53%) and 98% had an academic degree, mainly in physiotherapy. Eighty-five per cent of the respondents completed a minimum of four-year part-time course in osteopathy. Eighty-nine per cent of the participants were self-employed. Fifty-eight per cent of them own their clinic, and 40% declared to work as sole practitioner. Thirty-one per cent see an average of 21 to 30 patients per week for 46–60 minutes each. The most commonly used diagnostic techniques are movement assessment, palpation of structures/position and assessment of tenderness and trigger points. Regarding treatment modalities, articulatory/mobilisation techniques followed by visceral techniques and progressive inhibition of neuromuscular structures is often to always used. The majority of patients estimated by the respondents sought osteopathic treatment for musculoskeletal problems mainly localised on the lumbar and cervical region. The majority of respondents manifest a robust professional identity and a collective desire to be regulated as a healthcare profession. Conclusions This study represents the first published document to determine the characteristics of the osteopathic practitioners in Spain using large, national data. To date, it represents the most informative document related to the osteopathic community in Spain. It brings new information on where, how, and by whom osteopathy is practised in the country. The information provided could potentially influence the development of the profession in Spain.
Abstract Chronic pain is a common condition that often interferes with work or other activities. Guidelines support the use of non-pharmacological treatments, such as spinal manipulation, in patients with chronic pain. Osteopathic physicians in the United States are uniquely positioned to manage chronic pain because their professional philosophy embraces the biopsychosocial model and they are trained in the use of osteopathic manipulative treatment (OMT) to complement conventional medical care. This narrative review provides current perspectives on the osteopathic approach to chronic pain management, including evidence for the efficacy of OMT based on systematic searches of the biomedical literature and the ClinicalTrials.gov database. Men, persons with low levels of education, and non-White and Hispanic patients are significantly less likely to have received OMT during their lifetime. Patients with low back and neck pain are most likely to be treated with OMT, and osteopathic manipulative medicine specialty physicians and family medicine physicians most often use OMT. However, many osteopathic physicians report using OMT infrequently. Although OMT is considered safe, based on millions of patient encounters over more than a century, there is limited evidence on its efficacy in treating chronic pain. The lone exception involves chronic low back pain, wherein there is evidence from systematic reviews, a large clinical trial, and observational studies. There is lesser evidence to support cost effectiveness and patient satisfaction associated with OMT for chronic pain. The only clinical practice guideline established by the American Osteopathic Association recommends that OMT should be used to treat chronic low back pain in patients with somatic dysfunction. Given the philosophy of osteopathic medicine, universal training of osteopathic physicians to use OMT, and national guidelines supporting non-pharmacological treatments for chronic pain, it is unclear why OMT use is reported to be remarkably low in physician surveys.
Andrea Manzotti, F. Cerritelli, Erica Lombardi
et al.
BACKGROUND Osteopathic manipulative treatment (OMT) has been successfully tested in the context of preterm infants. No studies, however, have been conducted to investigate the OMT immediate effects on physiological measurements, such as partial oxygen saturation (SpO2) and heart rate (HR). The purpose of the present study was to assess the effect of osteopathic treatment on SpO2 and HR values and to compare it with 10 min of static touch. MATERIALS AND METHODS Ninety-six preterm infants (41 male), aged 33.5 weeks (±4.3) with mean weight at birth of 2067gr (±929) were recruited from the neonatal intensive care unit (NICU) of the Buzzi Hospital in Milan, and randomly allocated to two groups: OMT and Static Touch. Each protocol session consisted of: a) 5-min Pre-touch baseline recording, b) 10-min touch procedure, c) 5-min post-touch recording. Primary and secondary outcomes were, respectively, the baseline changes of HR and SpO2. RESULTS The 2 × 2 repeated measure ANOVA for HR showed a statistically significant effect (F (1,94) = 5.34; p < 0.02), revealing that the OMT group decreases the HR value at T2 (p = 0.006). In contrast, SpO2 analysis showed an increase of SpO2 value where the OMT group demonstrated higher values at T2 (p = 0.04). CONCLUSION Results from the present study suggest that a single osteopathic intervention may induce beneficial effects on preterm physiological parameters. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03833635 - Date: February 7, 2019.
Christopher N. Matthews, Danielle C Estrada, M. George-Weinstein
et al.
Abstract Context Analyzing factors that may enhance osteopathic applicants’ likelihood of matching is warranted given that United States osteopathic and allopathic residency programs will have a single accreditation system in 2020. Objectives To determine the impact of research accomplishments and experiences on osteopathic and allopathic residency matching. Methods Analysis of variance, t test, and odds ratios were used to examine data from the National Resident Matching Program Charting Outcomes from 2016 and 2018. Relationships between match status and medical degree, specialty matching, and mean numbers of research accomplishments and experiences in the Main Residency Match were analyzed. Results Matched osteopathic and allopathic applicants had significantly greater numbers of research accomplishments (mean [SD], 5.18 [4.34]) than unmatched applicants (3.66 [2.87]) (P=.006). Applicants who matched (mean [SD], 2.81 [1.64]) had similar numbers of research experiences to those who did not match (2.43 [1.26]) (P=.068). Matched and unmatched allopathic applicants’ research accomplishments (5.91 [3.72]) were significantly greater than that of osteopathic applicants (2.60 [2.90]) (P<.001). Significant differences also were found between the means of research experiences of matched and unmatched osteopathic (mean [SD], 1.73 [1.21]) and allopathic applicants (3.36 [1.25], P<.001). Matched and unmatched osteopathic applicants’ had similar means for research accomplishments (mean [SD], 3.00 [3.64] and 2.20 [1.84], respectively; P=.242) and experiences (1.79 [1.31] and 1.66 [1.12], respectively; P=.664). By contrast, significant differences were found between the numbers of research accomplishments for matched (mean [SD], 6.97 [4.07]) vs unmatched (4.86 [3.02]) allopathic applicants (P=.007). The only subspecialty for which research experiences of osteopathic applicants correlated with matching was physical medicine and rehabilitation (OR, 2.75; 95% CI, 1.30-5.84). Conclusion Research seems to have a greater influence on matching for allopathic than osteopathic applicants. Although both osteopathic and allopathic programs have standards pertaining to scholarly activity, allopathic medical schools may place a greater emphasis on research. Increasing osteopathic medical students’ exposure to research is predicted to enhance their competitiveness for matching and help develop skills relevant to the practice of evidence-based medicine.
J. Phillips, Andrea L. Wendling, A. Bentley
et al.
BACKGROUND AND OBJECTIVES The United States needs more family physicians. Projections based on current trends show a deficit of 52,000 primary care physicians by 2025. Eight national family medicine (FM) organizations have set an ambitious goal of increasing the proportion of US medical school graduates who enter FM residencies to 25% by 2030. This paper describes the most recent number and percentage of students from each US medical school entering Accreditation Council for Graduate Medical Education (ACGME)-accredited FM residency programs, long-term trends in the contribution of allopathic and osteopathic medical schools to the FM workforce, and medical school characteristics associated with higher proportions of FM graduates. METHODS Data about graduates entering US ACGME-accredited FM residency programs were collected using an annual program census and supplemental sources. Longitudinal census data from allopathic and osteopathic schools were combined to examine trends over time. ANOVA analyses were conducted to compare schools by percent of graduates entering FM, public/private ownership, allopathic/osteopathic, size, and presence of FM department. Medical school length of operation was correlated with percentage of students entering FM. RESULTS The overall proportion of US students entering ACGME-accredited FM programs has increased modestly over the past decade. Currently, only 12.6% of US allopathic and osteopathic seniors enter ACGME-accredited FM programs. Individual medical schools' contributions to the FM workforce are described. CONCLUSIONS The proportion of US medical students beginning ACGME-accredited FM residency programs has increased slightly over the last decade. However, significant changes to undergraduate medical education are needed to meet the nation's primary care needs.
Introducción: Varios estudios de barrido genómico (GWAS) y otros focalizados en el gen de la esclerostina (SOST) han encontrado que algunos polimorfismos de SOST se asocian con la masa ósea y el riesgo de fracturas. El objetivo de este estudio fue analizar la relevancia funcional de ciertos polimorfismos de la región promotora de SOST, en relación con la expresión y la metilación de dicho gen.
Material y método: Para ello, se determinaron los alelos de los polimorfismos rs851054, rs851056, rs10534024, rs1234612 y se analizó la metilación de ADN de 33 muestras de suero y de hueso, procedentes de pacientes intervenidos para colocar una prótesis de cadera, mediante pirosecuenciación tras conversión con bisulfito. Además, en el hueso se estudió la expresión de SOST. Por último, se clonaron diferentes alelos del promotor de SOST en vectores reporteros dobles con el gen de la luciferasa bajo dicho promotor y el gen de la fosfatasa alcalina bajo un promotor constitutivo.
Resultados: El análisis de metilación de la región promotora de SOST en ADN libre en suero y en ADN de hueso no reveló diferencias estadísticamente significativas en relación con los alelos de los polimorfismos analizados (p>0,05). Sin embargo, las transfecciones con los vectores reporteros mostraron una elevada actividad transcripcional, independientemente del vector utilizado.
Conclusión: No hemos encontrado una asociación clara entre los distintos alelos y la metilación de ADN de la región promotora del gen SOST. Son necesarios más estudios para determinar los efectos funcionales de los polimorfismos sobre la metilación y expresión del gen de SOST y los efectos sobre la masa ósea.
Bruno Bordoni*,1, Fabiola Marelli2,3, Bruno Morabito2,3,4 & Beatrice Sacconi4,5 1Foundation Don Carlo Gnocchi IRCCS, Department of Cardiology, Institute of Hospitalization & Care with Scientific Address, S Maria Nascente, Via Capecelatro 66, Milan 20100, Italy 2CRESO, School of Osteopathic Centre for Research & Studies, Gorla Minore (VA) Piazza XXV Aprile 4, 21055, Italy 3CRESO, School of Osteopathic Centre for Research & Studies, Via Fanella, 91 61032 Fano (Pesaro Urbino), Italy 4Department of Radiological, Oncological & Anatomopathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy 5Center for Life Nano Science@Sapienza, Istituto Italiano di Tecnologia, Viale Regina Elena 291, Rome, Italy * Author for correspondence: bordonibruno@hotmail.com