A multidisciplinary approach and a daily calorie-counted diet can lead to significant weight loss in teenage and adult PWS patients. This approach would also be suitable in treating patients with other obesity syndromes with mental retardation.
Objective: The aim of this observational study, promoted by the Health Authorities of the Regione Veneto (Italy), is to assess the prevalence of the most relevant environmental and individual risk factors in subjects with a recent hip fracture. Methods: Patients aged more than 60 years of both genders with a recent hip fracture not associated with malignancies, were administered questionnaires on dietary habits, sun exposure, and disability score. A complete family, pharmacological and pathology history was collected together with information on previous falls, details of the fracture index, and anthropometric data. In all subjects, blood was taken for the measurement of serum 25 hydroxy-vitamin D (25OHD). Results: The study included 704 patients (573 women and 131 men). Mean age was 81±8 years (range 60-102). Severe pre-fracture disability was a common feature (58%) associated with multiple co-morbidities (84%), more frequently cardio- vascular and neurological diseases, and specific medications. In a large proportion (86%) of the patients, environmental or individual risk factors for falling were found. Vitamin D insufficiency (serum 25OHD levels <75 nmol/l) was quite common (70%), particularly in the regional Health Districts were strategies for preventing vitamin D deficiency were not implemented (91%). Only a small proportion (17%) of the study population had been evaluated and treated for osteoporosis. Conclusions: In senile patients with a recent hip fracture, pre-existing disability, multiple co-morbidities, high risk of falling and inadequate intake of calcium and vitamin D is relatively common. Community and case-finding interventions aimed at selecting subjects at high risk of osteoporosis, preventing vitamin D and dietary calcium deficiency, and increasing awareness on the environmental risks of falling are highly warranted
IntroductionLong-term survivorship of total hip arthroplasty is strictly related to the bone-host interaction, where bone remodeling is the main factor [1]. The evaluation of bone mass surrounding the implant is the most reliable method, starting from the common observation that bone reacts to stable and well functioning implants with bone apposition according to Wolff's law, while bone resorption is the typical response to an unstable and mal-loading implant [2][3][4].In the last ten years, dual energy X-ray absorptiometry (DEXA) has become more popular among investigators of bone mineral density (BMD) around femoral stems, making it possible to quantify the bone filling, the space between bone and stem (interface bone growth), and the dynamic process of reabsorption, apposition and transformation which involves the whole bone segment containing the implant (bone remodeling) [5][6][7].The first experience with DEXA started in the early 1990s, with observations regarding application and limits and then moving to clinical trials [8,9]. The new concept of minimally invasive surgery in the field of total hip arthroplasty means, in our opinion, not only a small incision, but also a physiological load transfer from the stem to the bone with a conservative stem design, like CFP prosthetic stem (Waldemar Link, Hamburg, Germany).Abstract Periprosthetic bone remodeling, and its evaluation, are the keys of long-term survival of cementless total hip arthroplasty. Dual energy X-ray absorptiometry (DEXA) is the most accurate method to measure bone mineral density, evaluating the effects of bone-prosthesis interactions. We studied, 4 years after implantation, 10 patients who underwent total hip arthroplasty with the CFP prosthetic stem and TOP acetabular cup (Waldemar Link, Hamburg, Germany). Our results demonstrate minimal periprosthetic bone loss compared to that normally observed with conventional stems. A few cases exhibited an increase in BMD. We believe that primary stability, prosthetic design, preservation of natural neck anteversion and off-set, better function related to muscle lever arm, and physiological bone loading with natural stress distribution are the keys of this succesful mini-invasive total hip replacement system.
Objective: The aim of the study was to assess the use of Non Steroidal Anti-Inflammatory Drugs (NSAIDs) in patients with a history of osteoporotic vertebral fractures. Methods: We investigated 119 patients with postmenopausal osteoporosis complicated by one or more non recent vertebral fractures. Results: More than 60% of the patients took at least one dose of NSAID weekly. The most prescribed NSAID was nimesulide, at a dose with an exclusively antalgic effect. Patients with wedge fracture and those with a documented vertebral fracture in the last 12 months were those taking NSAIDs more frequently. 77% of the patients that used NSAIDs had concomitant features of osteoarthritis, mainly at the spine or at the knee. The use of NSAIDs was negatively related to the use of specific therapy for osteoporosis, particularly for oral daily tablets. Conclusions: This study highlights the significant use of NSAIDs in patients with osteoporotic vertebral fractures and the overlap between osteoporosis, osteoarthritis and related treatments
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