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The study was aimed at evaluating the prevalence of osteoporosis, defined by BMD and the National Bone Health Alliance (NBHA) criteria, and the prevalence of clinical risk factors for fractures in Italian postmenopausal women. This is a cross-sectional, multicenter, cohort study evaluating 3247 postmenopausal women aged ≥ 50 and older in different areas of Italy in the period 2012–2014. All the participants were evaluated as far as anthropometrics; questionnaires for FRAX®and DeFRA calculation were administered and bone mineral density was measured at lumbar spine, femoral neck and total hip by DXA. The prevalence of osteoporosis, as assessed by BMD and NBHA criteria was 36.6 and 57%, respectively. Mean ± SD values of FRAX®and DeFRA were: 10.2 ± 7.3 and 11 ± 9.4 for major fractures, and 3.3 ± 4.9 and 3.9 ± 5.9 for hip fractures, respectively. Among clinical risk factors for fracture, the presence of previous fracture, particularly non-spine/non-hip fracture, parental history of hip fracture and current smoking were the most commonly observed. Our study showed that more that the half of postmenopausal women aged 50 and older in Italy has osteoporosis on the basis of the NBHA criteria. There is a relevant high risk of femur fracture, as assessed by the FRAX®and DeFRA and previous fracture, parental history of hip fracture and current smoking are the most common risk factors. The data should be considered particularly in relation to the need to increase prevention strategies on modifiable risk factors and therapeutic intervention.

To investigate the effect of 18 months’ parathyroid hormone 1–84 (PTH 1–84) treatment on serum levels of bone morphogenetic protein 4 (BMP4) and vascular endothelial growth factor (VEGF), in postmenopausal women with established osteoporosis. Thirty-seven postmenopausal women with osteoporosis (mean age 72.9 ± 8.1 years old) and 23 healthy controls (mean age 68.9 ± 9.9 years old) were enrolled. Patients were treated with daily subcutaneous injections of PTH (1–84) 100 mcg for 18 months, plus calcium 1 gr and vitamin D 800 IU per os daily. Blood samples were taken every 6 months during the study. At baseline, there were no differences considering anthropometric parameters, co-morbidities, current medications used between patients and controls. Mean serum VEGF levels were significantly higher in osteoporotic patients compared to controls (436.7 ± 259.7 vs. 260.3 ± 184.3 pg/ml, p= 0.006), while there were no differences in mean serum values of BMP4 (5.3 ± 1.7 vs. 5.7 ± 1.6 pg/ml, p= 0.40). Serum VEGF levels increased by approximately 20% after 12 months of PTH (1–84) treatment compared to baseline (p= 0.03) and by 22% after 18 months (p= 0.01). A significant increase of 10% in mean serum BMP4 levels was observed after 18 months of PTH (1–84) treatment compared to baseline (p= 0.02). In the control group we found no differences after 18 months compared to baseline in BMP4 (5.7 ± 1.6 vs. 6.0 ± 1.5 pg/ml, p= 0.53) and VEGF (260.3 ± 184.3 vs. 257.4 ± 107.1 pg/ml, p= 0.94). PTH (1–84) treatment increased serum levels of VEGF and BMP4 in postmenopausal women with severe osteoporosis.

Background/Objectives:: There are conflicting data on the effect of a gluten-free diet (GFD) on the nutritional status of celiac patients. In the present study, we evaluated, in adult celiac patients, the influence of a long-term, strictly GFD on their nutritional status and compared it with matched healthy volunteers. Subjects/Methods:: Our study included 39 celiac patients and 39 healthy volunteers. The body mass index (BMI) of patients and controls was evaluated at enrollment, while the patients’ BMI before the GFD was retrieved from clinical records. In addition, at enrollment, in both groups, we compared BMI, fat mass (FM), bone mineral density (BMD), as well as their dietary intake, recorded on a 7-day diary. Results:: At the time of diagnosis, the majority of celiac patients (82.0%) had a normal BMI or were overweight, while 10.3% were malnourished. After the GFD, patients with a normal BMI showed a significant weight increase (P=0.002), but none of them switched in the overweight or obese category. Two (50%) of the four malnourished patients achieved a normal BMI. Controls and patients on a GFD had a similar BMI, FM, BMD and total calorie intake, but the amount of lipids and fiber intake was significantly different in the two groups (P=0.003 and P<0.0001, respectively). Conclusions:: Our study demonstrates that a GFD is able to improve the nutritional status of celiac patients without inducing overweight or obesity. Our findings are related to a celiac population adopting a GFD based on a Mediterranean-type diet.

The effect of mechanical stresses on osteogenesis, the viability of osteocytes and their metabolic activity in organ culture of bones intermittently loaded “in vitro” are reported.

Summary The effect of oestrogen replacement on bone metabolism and serum cytokine levels (IL1, IL6) was investigated in surgical menopause. The study included 40 female subjects; 10 healthy premenopausal women underwent total hysterectomy without oophorectomy. Thirty healthy premenopausal women underwent total hysterectomy with bilateral oophorectomy. They were randomly divided into 3 groups of 10 subjects. The first group received natural estradiol (0,05 mg/day) for 6 months; the second group received natural estradiol (0,05 mg/day) and medroxyprogesteron acetate (10 mg/day) for 6 months, the third group received no therapy.

Summary A 64-year old man, presenting pain in his back and left sciatalgia, was found to have a mixed sclerosing bone dystrophy with features resembling osteopoikilosis and osteopathia striata. Oval and round densities were found in the humeral heads, elbows, wrists, hands, pelvis, knees, feet. Striata densities were in the diaphyses of metacarpal and metatarsal bones. Bone scan was negative. Standard biochemical examinations of the blood and urine were negative. According to our investigations no evidence of osteopoikilosis other sclerosing bone dystrophies were found in the family of our patient. These data were discussed.

Summary The effects of vitamin C on 1,25(OH)2D3 synthesis in humans were evaluated; the study included 20 females. They were divided into 2 groups. The first of the 10 subjects (age range 55–71) received ascorbic acid at a dose of 150 mg/die i.v. for 10 days; the second 10 subjects (age range 55–69) received a placebo i.v. for 10 days. In a later study (after a 30-day washout) the same two groups were tested for the second time with ascorbic acid at a dose of 1,000 mg/die i.v. for 10 days and placebo i.v. for 10 days. Serum calcium and phosphorus, serum Ca++, serum proteins, blood and urinary pH, serum 25(OH)D3 and 1,25(OH)2D3, serum PTH, urinary hydroxyprolin were tested before and after the treatments. In the first study a significant increase in serum 1,25(OH)2D3 was observed after ascorbic acid while no significant variation was observed for the other parameters. In the second study, a significant increase in serum Ca++ and a significant decrease in serum 1,25(OH)2D3 were observed after ascorbic acid while no significant variation was observed for the other parameters. The authors conclude that ascorbic acid promotes 1,25(OH)2D3 synthesis at a paraphysiologic dose (150 mg/die) in humans but this synthesis is inhibited at higher doses (1,000 mg/die). The latter effect by Ca++ or by an effect of ascorbate on 1 alpha-hydroxylase enzyme could be mediated.

Summary With the aim of evaluating the role of 1,25 dihydroxyvitamin D in the pathogenesis of osteoporosis, this hormone was studied in 90 subjects. They were divided into three groups: the first group consisted of 30 normal female subjects (aged 30 to 45); the second group comprised 30 elderly female subjects (aged 67 to 90) the third group consisted of female patients (aged 65 to 87) with clinical and radiological evidence of osteoporosis. Variations of serum 1,25 dihydroxyvitamin D, after stimulation with oral P04 (1.000 mg/day for 10 days) and stimulation with oral Ca (1.000 mg/day for 10 days), were studied in 16 osteoporotic females (10 of them received P04) and six Ca (Controls). This second study was performed to evaluate the renal 1-alpha-hydroxylation. No significant variation between serum 1,25 dihydroxyvitamin D of elderly and osteoporotic females was observed when compared with normal young healthy subjects. Moreover, a significant increase in serum 1,25(OH)2D after oral P04 was found in accordance with a significant increase in serum parathormone. These data demonstrate that changes in serum 1,25(OH)2D levels did not seem to play a significant part in the pathogenesis of osteoporosis in our population neither could a deficit of renal 1-alpha-hydroxylation be demonstrated.

Summary Biopsy specimens of the synovial membrane were obtained during arthroscopy and surgical meniscectomy from the knees of 20 patients with meniscus lesions. The aim of this study was to identify the morphological and immunological changes which appear in the synovium during the earliest phase of osteoarthrosis. Interstitial deposits of IgG and, in some cases, C3 were found not only in patients with evident arthrotic degeneration (cartilaginous lesions and synovitis), but also in patients who showed no overt arthrotic changes. Furthermore, light and electron microscopy showed an increased number of mast-cells with peculiar semilunar or piecemeal aspects of their secretory granules. These ultrastructural modifications are characteristic of slow, chronic release of mediators in response to a constant, moderate degranulatory stimulus. Our findings suggest that synovial changes may occur before the advent of cartilage degenertion and that the latter may be directly influenced by early pathological changes in the synovial membrane.

Summary The authors, using the experimental pattern of bone rarefaction induced by a low calcium diet, tried to determine if 25-hydroxycholecalciferol, administered at doses and according to procedures similar to those used in osteoporosis, might interfere in such a process of rarefaction. The statistical evaluation of the results concerning the size of the amount of spongy bone presented evidence for the sharp decrease in the specific bone volume in rats placed on a low calcium diet as compared to control rats. Such a difference is found even between rats treated with 25-OH-D3. Nonetheless, the authors reported a difference — although not statistically significant — that indicated an increase in the amount of bone in rats on a normal diet but treated with vitamin D as compared to control rats. In conclusion: 25-OH-D3 by itself, the diet being the same, was not able to ameliorate the amount of bone.

Two cases of prolidase deficiency in two siblings are presented. The patients complained of the typical clinical symptoms of the disease, including chronic leg ulcerations resembling vasculitis. They were mentally retarded, had typical facial characteristics, splenomegaly, and haematologic anomalies. Biochemical and morphological investigations confirmed the diagnosis. In these cases, alterations of the peripheral nervous system and decreased IgA levels were demonstrated for the first time.

We studied an echographic technique by which precise reproducible measurements of articular cartilage thickness of the knee is possible. Two groups of individuals were studied: a group of 18 patients with gonarthrosis and a control group of 10 normal individuals. The group of 18 patients with gonarthrosis was studied by ultrasound (US) before knee prosthesis surgery. The cartilage thickness was measured within the weight-bearing area. US re-evaluation and histological measurements were made on the pathological specimen following the operation. Results of pre- and post-operative US data were compared with histological data. A good correlation between these measurements was found [P(t)>10%]. In order to have comparative reference values of the articular cartilage within the weight-bearing area of the femoral trochlea a group of 10 control subjects was also studied with US as above. We found that the articular cartilage thickness of the femoral trochlea in the weight-bearing area has a mean of 2.2±0.3 mm for the lateral condyle and 2.3±0.2 mm for the medial condyle. The intra-observer and inter-observer difference in measurements was evaluated with Student's t-test. Our data demonstrate that US measurements of articular cartilage thickness of femoral condyles is a sensitive and reproducible technique which permits early diagnosis and management of knee arthropathy as well as quantification of cartilage damage.

Abstract.: The effects of a polymethylmetacrylate (PMMA) powder with a diameter between 0.5 and 25 μm have been studied in vitro on several human osteoblast populations obtained from different sources. Parameters of cell activity such as cell growth, collagen synthesis, osteocalcin, and interleukin-6 (IL-6) production have been evaluated. Cell proliferation and collagen synthesis were inhibited after exposure to bone cement, whereas osteocalcin and IL-6 production were stimulated. These results suggest that PMMA particles could affect osteoblast activity in a way that could contribute, together with other factors, to periprosthetic osteolysis through two different pathways: a reduced periprosthetic bone formation due to the reduced osteoblast proliferation and collagen synthesis, and an osteoblast-mediated activation of osteoclastic bone resorption as suggested by the increased osteocalcin and IL-6 synthesis. In fact, osteocalcin has been demonstrated to have a role in osteoclast recruitment to bone surfaces, and IL-6 is known to induce osteoclastogenesis and to directly stimulate bone resorption.

Twenty-five patients with radiological and clinical evidence of osteoporosis were studied. Nineteen patients received oral phosphorus at a dose of 1,000 mg/die for 10 days followed by salmon calcitonin (100 U MRC/die) for 20 days. Six patients received only oral calcium at a dose of 1,000 mg/die). In the first group, a significant increase in serum osteocalcin and parathyroid hormone, after administration of phosphorus and persisting after treatment with salmon calcitonin, was found. No variation in the controls was observed. In a later study, a significant increase in serum 1,25 dihydroxyvitamin D (1,25(OH)2D3), after receiving phosphorus and persisting after salmon calcitonin, was demonstrated. In accordance with the authors' results, phosphorus could be considered a useful activator of bone formation and this stimulus by parathyroid hormone was mediated. Finally, the positive effects of phosphorus on circulating 1,25(OH)2D3 must be considered for a good treatment protocol of osteoporosis.

Summary A case of arthritis dermatitis syndrome observed after a biliopancreatic bypass for morbid obesity is described. The syndrome had begun 10 days after surgery and involved the knees, ankles, elbows and wrists and erythema nodosum on the legs. After 15 days treatment with sulfasalazine and steroid the symptoms disappeared. The immunologic aetiology of the disease was postulated and the observation of the syndrome, for the first time, after a biliopancreatic bypass suggested that the manifestation of the disease is independent of the kind of the surgical procedures used for the treatment of the morbid obesity.

Summary An echographic study of Tietze's syndrome was carried out. Three patients with clinical evidence of Tietze's syndrome were examined. Ten normal volunteers were studied as controls. In Tietze's syndrome a dishomogeneous increase of the echogenicity in pathological cartilage and an increased thickness vs. the oposite normal side were observed. A moderate thickness and a decreased echogenicity of surrounding soft tissues was observed in one case.

Summary Osteocalcin or bone GLA protein (BGP) is found at high levels in only two tissues, the extracellular matrix of bone and dentine. Tissue culture experiments have demonstrated that BGP is synthesized by two osteoblastic osteosarcoma cell lines (ROS 2/3 and 17/2) and by normal osteoblastic cells in primary culture. BGP was not found in rat cartilage nor in liver, kidney, lung, spleen, brain, heart, thymus, skeletal muscle. In this study secretion of BGP was assayed by RIA in the supernatants of 48-hour cultures of peripheral blood lymphocytes or monocytes. Lymphocyte cultures were carried out using RPMI-1640 supplemented with L-glutamine and antibiotics at the concentration of 1×106 cells/ml and activated by PHA (10 ng/ml). Peripheral blood monocytes were purified by adherence to plastic Petri dishes and treated with cold PBS supplemented with EDTA. Monocytes were cultured as previously described and stimulated with LPS (50 ug/ml). Cell-free supernatants were obtained by centrifugation and stored at −20°C, until the BGP assay was performed. The authors did not observe secretion of detectable amounts of BGP in the supernatants of short-term lymphocyte or monocyte cultures. These data indicate that circulating mononuclear cells are not involved in BGP synthesis and secretion.

Summary A case of pachydermoperiostosis is described. Interesting features were the presence of carpal and tarsal tunnel syndromes, chronic leg ulcerations and large calcification of the Achilles tendon. Neurological alterations were explained by the stenosis of the tunnels secondary to the periosteal apposition. Chronic leg ulcerations were probably due to neurological and circulatory alterations.

The authors briefly review the tests available for precocious diagnosis of glaucomatous neuropticopathy. They present a casefile of 54 ocular hypertensive eyes examined by NFA and blue-on-yellow perimetry to verify the equivalence of these two different tests in the precocious diagnosis of glaucoma. The results point up a perfect correspondence in 50% of the cases. They conclude by stressing the necessity of having a screening available for the precocious diagnosis of glaucoma with the use of more tests that have standardized and reliable parameters.

The scope of this work was to evaluate the effect on ocular pressure and on ocular blood flow of latanoprost 0.005% eye‐drops. Included in the study were 12 patients (24 eyes) with POAG, aged between 37 and 48 years, non‐smokers, refractions between ±3D, Haemorrheological parameters within normal, not in ocular or systemic vasoactive therapy. Each patient had one eye treated with latanoprost 0.005% and the other with timolol 0.05%. The choroidal perfusion was measured by Langham's POBF system during the first day of therapy and then after 7, 15, 30, 60, 90 and 180 days. The maximum pressure decrease after the first administration of latanoprost was at the twelfth hour; after 6 months of therapy, mean IOP reduction was 32.6%. POBF values increased up to 55.8% in the first day and then settled at 22.6% at the end of the study. Timolol showed a similar pressure progress, but its haematic perfusion values were distinctly lower. In conclusion, latanoprost is efficacious in POAG therapy since it unites a positive optic nerve head perfusion effect with hypotensive efficacy.