Background: Axial Spondyloarthritis (axSpA) represents an inflammatory disorder primarily affecting the axial skeleton, peripheral joints, and enthesis. The severe form of axSpA is ankylosing spondylitis (AS), distinguished by significant bone damage. Joint pain, stiffness, and functional impairment precipitate diminished physical activity and adoption of a sedentary lifestyle. The persistent inflammation and decreased physical activity contribute to complications such as osteoporosis and potentially sarcopenia, denoting a condition characterized by low muscle mass, diminished strength, and impaired physical performance. Despite the anticipated higher prevalence of sarcopenia in individuals with AS, existing evidence remains inconclusive, primarily due to study heterogeneity and the utilization of outdated criteria. Objectives: This systematic literature review seeks to identify and critically evaluate pertinent studies concerning compromised muscle health in AS, taking into account the most recent pathophysiological mechanisms that interconnect bone, enthesis, joints, and muscles. The objective is to reevaluate the influence of diminished muscle mass and strength on the progression of AS, thereby instigating potential future investigations and targeted interventions aimed at enhancing patient functionality and overall quality of life. Methods: This review adheres to PRISMA guidelines. The Scopus, PubMed, and Web of Science databases were searched for articles on muscle mass, muscle strength and axSpA. The methodological quality of the studies included in the review was evaluated using the Newcastle-Ottawa Scales for observational studies and for case-control studies. Inclusion criteria were: (a) studies investigating the relationship between muscle mass and muscle strength, and axSpA, comparing patients to healthy controls or different rheumatic disease; (b) population aged ≥18 years; (c) defined and validated criteria to assess the presence of sarcopenia; and (d) English language and availability of full text of the original research paper. Results: A total of 190 papers were identified through the searches, with 14 meeting the inclusion criteria, forming a global cohort of 1233 AS patients. Among these, 1 study was prospective, while 11 were case-control studies, and 2 were cross-sectional studies. Methodological approaches to assess muscle mass and strength exhibited heterogeneity across the studies, with varied techniques employed for evaluating appendicular and truncal mass and strength. Rather than the explicit diagnosis of sarcopenia, pre-sarcopenia or probable sarcopenia was frequently observed in subjects with AS, characterized by a significant reduction in muscle strength, particularly in the lower limbs. The status of pre-sarcopenia appears to be associated with elevated AS disease activity, implying that inflammation leading to pain, restricted movement, and diminished physical activity may play a pivotal role in the muscular health of AS patients. Conclusion: Our review confirms the presence of a correlation between AS and the decline in muscle strength, likely indicative of sarcopenia, even in patients of a young age. While the exact mechanisms contributing to muscle damage remain a subject of debate, factors such as inflammation, diminished physical activity, a sedentary lifestyle, glucocorticoid therapy, and neuromuscular impairment may play significant roles (refer to Figure 1). Effectively managing AS patients necessitates a multidisciplinary non-pharmacological approach, emphasizing the early implementation of physical therapy and rehabilitation programs, as bDMARDs alone prove insufficient for the restoration of optimal muscle health. REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests: None declared.Figure 1Potential mechanisms in the association between Ankylosing Spondylitis and muscle health.

Osteoporotic fragility fractures (FF), particularly those affecting the hip, represent a major clinical and socio-economic concern. These fractures can lead to various adverse outcomes, which may be exacerbated by the presence of sarcopenia, especially among older and frail patients. Early identification of patients with FF is crucial for implementing effective diagnostic and therapeutic strategies to prevent subsequent fractures and their associated consequences. The Hip-POS program, implemented at Azienda Ospedale-Università Padova, is a Fracture Liaison Service (FLS) program to evaluate patients aged > 50 years old admitted with fragility hip fractures, involving an interdisciplinary team. After the identification of patients with hip fractures in the Emergency Department, a comprehensive evaluation is conducted to identify risk factors for further fractures, and to assess the main domains of multidimensional geriatric assessment, including muscle status. Patients are then prescribed with anti-fracture therapy, finally undergoing periodic follow-up visits. During the first five months, a total of 250 patients were evaluated (70.4

INTRODUCTION:The growing demographic presence of the transgender (TGD) population has sparked an increase in clinical investigations focusing on the impacts of gender-affirming hormone therapy (GAHT) in adults with gender dysphoria. Despite this surge in studies, there remains a significant gap in the literature regarding the health status of older TGD individuals. This review aims to assess prevalent pathological conditions within the TGD population, specifically concentrating on aging-related diseases investigated to date. METHODS:A systematic search across Embase Ovid, Scopus, PubMed, Cochrane Library, and Web of Science databases was conducted to identify articles reporting on the aging process in TGD individuals. Methodological quality was evaluated using Newcastle-Ottawa Scale (NOS) scores. RESULTS:Initial database searches yielded 12,688 studies, which were refined to 18 through elimination of duplicates and title/abstract review. Following a comprehensive appraisal, nine studies were included in the systematic review. These articles, published between 2017 and 2023, involved a total of 5403 participants. The evidence indicates a noteworthy percentage of the TGD population being at risk for cardiovascular diseases, experiencing depression or disability, and demonstrating hesitancy toward major recommended screening programs. CONCLUSIONS:Limited studies on older TGD individuals highlight not only an organic risk of chronic diseases but also a cognitive/psychiatric risk that should not be underestimated. Further research is imperative to deepen our understanding of the pathophysiological mechanisms involved in the health challenges faced by older TGD individuals.

Objectives This study aimed to investigate the psychological impact of the COVID-19 pandemic on healthcare workers (HCWs) in geriatric settings. Design Online cross-sectional survey. Settings and Participants 394 geriatric HCWs in Italy. Measurements The survey was developed by a multidisciplinary team and disseminated in April 2022 to the members of two geriatric scientific societies (Italian Society of Geriatrics and Gerontology and Italian Association of Psychogeriatrics). The survey examined the experiences related to the COVID-19 pandemic, as well as psychological burden and support. Work-related anxiety and distress related to the pandemic were studied using the SAVE-9 scale (Stress and Anxiety to Viral Epidemics). Results Three hundred sixty-four participants (92.4%) changed their job activity during the pandemic and about half (50.9%) failed to cope with this change, 58 (14.7%) had increased work-related anxiety, and 39 (9.9%) work-related stress levels. Three hundred forty (86.3%) participants reported acute stress reaction symptoms, including irritability, depressed mood, headache, anxiety, and insomnia, and 262 (66.5%) required psychological support, mainly from friends/relatives (57.9%) and/or colleagues (32.5%). Furthermore, 342 participants (86.8%) recognized they would benefit from informal and formal psychological support in case of future similar emergencies. Conclusions This study highlights the high psychological burden experienced by geriatric HCWs in Italy during the COVID-19 pandemic and emphasizes the need for supportive interventions.

Purpose Preliminary data suggested that bone mineral density (BMD) in transgender adults before initiating gender-affirming hormone therapy (GAHT) is lower when compared to cisgender controls. In this study, we analyzed bone metabolism in a sample of transgender adults before GAHT, and its possible correlation with biochemical profile, body composition and lifestyle habits (i.e., tobacco smoke and physical activity). Methods Medical data, smoking habits, phospho-calcic and hormonal blood tests and densitometric parameters were collected in a sample of 125 transgender adults, 78 Assigned Females At Birth (AFAB) and 47 Assigned Males At Birth (AMAB) before GAHT initiation and 146 cisgender controls (57 females and 89 males) matched by sex assigned at birth and age. 55 transgender and 46 cisgender controls also underwent a complete body composition evaluation and assessment of physical activity using the International Physical Activity Questionnaire (IPAQ). Results 14.3% of transgender and 6.2% of cisgender sample, respectively, had z-score values < -2 ( p = 0.04). We observed only lower vitamin D values in transgender sample regarding biochemical/hormonal profile. AFAB transgender people had more total fat mass, while AMAB transgender individuals had reduced total lean mass as compared to cisgender people (53.94 ± 7.74 vs 58.38 ± 6.91, p < 0.05). AFAB transgender adults were more likely to be active smokers and tend to spend more time indoor. Fat Mass Index (FMI) was correlated with lumbar and femur BMD both in transgender individuals, while no correlations were found between lean mass parameters and BMD in AMAB transgender people. Conclusions Body composition and lifestyle factors could contribute to low BMD in transgender adults before GAHT.