Clinical Guidelines on Calcium and Vitamin D Supplementation

Journal of Research and Practice on the Musculoskeletal System JOURNAL OF RESEARCH AND PRACTICE ON THE MUSCULOSKELETAL SYSTEM Proceedings Abstracts of the Scientific Meeting of the Hellenic Osteoporosis Foundation Clinical Guidelines on Calcium and Vitamin D supplementation Certainties and concerns on the osteoporosis treatment 14th-16th December 2018, Thessaloniki, Greece Organizer: George Trovas, MD, PhD DIAGNOSIS AND CLINICAL SIGNIFICANCE OF for the differential diagnosis of a bone lesion inside a OSTEOPOROTIC VERTEBRAL FRACTURES vertebrae, including primary or metastatic bone tumors. MRI provides evidence of a recent vertebral fracture, Konstantinos D. Stathopoulos Postgraduate Course on Bone Metabolic Diseases, National and which is accompanied by bone marrow oedema, and has Kapodistrian University of Athens, School of Medicine, Athens, no radiation, but is an expensive and not readily available technique. The clinical significance of osteoporotic Greece vertebral fractures in the context of bone strength is that Vertebral fractures of the thoracic and lumbar spine are they are indicators of increased fracture risk, especially considered the most common type of fracture in patients in untreated individuals. It has been shown that previous with osteoporosis. They may present as early as the sixth vertebral fractures increase about 3-fold the risk of a new decade of life and their prevalence increases with age. vertebral fracture and about 1,5-2-fold of a non vertebral They are usually attributed to low energy falls (i.e fall fracture in osteoporotic women. It has also been shown from a standing height), but can also occur without falling, that the number and severity of prevalent vertebral most often while bending or trying to lift a heavy object. In fractures further increases the risk of various osteoporotic such cases, pain may be acute and vertebral fractures are fractures. Patients with spinal deformities such as thus termed as clinical. However, in many cases, vertebral kyphosis due to multiple vertebral fractures, are also fractures remain asymptomatic and are usually diagnosed most likely to suffer complications of the cardiopulmonary on routine X-rays of the spine or chest, thereby called system as well as pain, related disability and decreased morphometric or radiological fractures. Morphometric physical activity, possibly increasing bed-rest days or fractures are usually underestimated from radiologists requiring hospitalisation. The social and economic burden or clinicians worldwide who fail to acknowledge their of osteoporotic vertebral fractures, as well as morbidity clinical significance, and in many occasions may not even and mortality, are increasing in the western world, and it be reported in the diagnosis. Clinical signs of previous is considered mandatory for health systems to develop vertebral fractures may include a marked kyphosis of the improved strategies in order to identify and effectively thoracic spine and/or loss of height of >2-3 cm. Diagnostic treat patients with such fractures. tools include lateral x-rays of the thoracic and lumbar spine, vertebral fracture assessment by dual energy X-ray absorptiometry (VFA), computerised tomography (CT) or IS BALLOON KYPHOPLASTY A SAFE AND magnetic resonance imaging (MRI). Grade and severity EFFECTIVE TREATMENT FOR OSTEOPOROTIC of vertebral fractures on lateral x-rays may be calculated VERTEBRAL COMPRESSION FRACTURES? using various available methods, one of the most common Kleovoulos Anagnostidis being the Genant semi-quantitative method; a 20-25% Euromedica Kyanous Stavros General Hospital, Thessaloniki, decrease in (anterior/central/posterior) vertebral height Greece is considered a Grade 1 fracture, 25-40% a Grade 2 fracture and >40% a Grade 3 fracture. VFA provides an Osteoporotic vertebral compression fractures commonly accurate quantitative assessment of a depression of an afflict most aged people back pain, functional disability, endplate that is achieved with minimal radiation doses. substantial vertebral deformity, increased adjacent spinal Published under Creative Common License CC BY-NC-SA 4.0 (Attribution-Non Commercial-ShareAlike) Common License CC BY-NC-SA 4.0 (Attribution-Non Creative Published under Computerised tomography may be additionally used fractures and decreased quality of life. www.jrpms.eu 10.22540/JRPMS-03-032 JRPMS | March 2019 | Vol. 3, No. 1 | 32-44 32 Abstracts of the Scientific Meeting of HELIOST, 14-16/12/2018, Thessaloniki, Greece Percutaneous vertebral augmentation included percutaneous Despite the advent of newer and highly accurate diagnostic vertebroplasty and percutaneous balloon kyphoplasty are modalities, osteoporosis still is most commonly diagnosed used for the treatment of osteoporotic vertebral compression at conventional radiography, albeit this modality is able fractures. to help detect bone loss only when a substantial amount of We performed a systematic review of literature, comparing such occurs. the outcomes of balloon kyphoplasty with conservative Morphometric methods, based on vertebral height treatment. Outcomes included back pain, back disability, measurements, are used to identify vertebral fractures. new vertebral compression fractures, quality of life and These measurements may be obtained from conventional adverse events. spine measurements (morphometric x-ray radiology), The literature suggests that kyphoplasty is associated with or absorptiometry images (morphometric x-ray greater improvement in pain, disability quality of life and absorptiometry). an increase in risk of early adverse events compared with Quantitative US is used to measure and access tissue nonsurgical management. properties, offering quick and simple measurements at low cost without any radiation exposure, but cannot be used as a standard tool in the diagnosis of osteoporosis because THE ROLE OF VITAMIN D IN THE RISK AND of the diversity of the devices and having different levels PROGRESSION OF PRIMARY OSTEOARTHRITIS of validating data for association with DXA measured bone Nikolaos Galanopoulos1, Nikolaos Loizidis2 density and fracture risk. 1Outpatient Rheumatology Department of University General Quantitative CT provides separate estimates of trabecular Hospital of Evros, Alexandroupolis, Thrace, Greece and cortical BMD as a true volumetric mineral density 2Fourth University Department of Internal Medicine, General in milligrams per cm3 and can be performed at axial and Hospital of Thessaloniki Ippokratis, Greece peripheral sites. It allows assessment of both volumetric BMD and microarchitecture, thereby providing separate The low serum level of vitamin D of the patients with consideration of bone density and bone geometry. Overall, osteoarthritis (OA) affects the structure and function this leads to a more detailed understanding of the changes increases the risk of involvement. Have been correlated with in the bone. Disadvantages include a considerable radiation the pain of the affected joints, the progression of the OA and dose, high cost, and degree of operator dependence, as well so the restriction of physical ability and the decrease of the as limited scanner access. quality of life of the OA patients. Have also been described its Peripheral Quantitative CT allows separate assessment of relationship with the decrease of muscle power (in particular cortical and trabecular bone and yields direct information of the lower limbs). The prevalence of low serum level of on bone geometry at several appendicular sites. It also vitamin D is high in osteoarthritis patients undergoing of provides information on the mass and distribution of orthopedic joint surgery and may affect its outcomes. The bone material that can be integrated into indexes of supplementation of vitamin D leads to the improvement of the joints’ cartilage architecture, the decrease of the pain of bone stability in response to bending and torsional loads, the affected joints as well as the improvement of the physical which are the most important biomechanical measures of ability and the quality of life of the OA patients. susceptibility fractures and may improve accuracy in the prediction of fractures. Advances in MRI software have allowed for substantially ΒeyonD DXA: THE DIAGNOSTIC MODALITIES FOR enhanced trabecular bone architecture imaging. Lack of radiation makes MR imaging attractive in particular for INVESTIGATING MUSCULOSKELETAL DISEASE scientific and clinical studies. The technique has been Athanasios Karponis established mainly for peripheral imaging of the distal Orthopaedic Surgeon, Kianous Stavros - Euromedica Clinic radius, tibia, and calcaneus, but recently to femur, as well. Οsteoporosis is a common metabolic disease and is Of note, trabecular bone network is revealed indirectly characterized by reduced bone density and microarchitectural through marrow visualization and appears as a signal void deterioration of bone, resulting in increased fracture risk. surrounded by high signal intensity fatty bone marrow. Therefore appropriate diagnosis and monitoring are required Studies have confirmed that the procedure can be used to to reduce the burden of osteoporosis-related fractures. detect differences in trabecular structure depending on DXA currently provides the most widely accepted method patient age, BMD and osteoporotic status. Its main use lies for assessment of osteoporosis, used as gold standard in in the differential diagnosis of osteoporotic spinal fractures postmenopausal women. However, it still has a number and malignancies. of

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