Osteoporosis poses a significant public health issue. National Societies have developed Guidelines for the diagnosis and treatment of this disorder with an effort of adapting specific tools for risk assessment on the peculiar characteristics of a given population. The Italian Society for Osteoporosis, Mineral Metabolism and Bone Diseases (SIOMMMS) has recently revised the previously published Guidelines on the diagnosis, riskassessment, prevention and management of primary and secondary osteoporosis. The guidelines were first drafted by a working group and then approved by the board of SIOMMMS. Subsequently they received also the endorsement of other major Scientific Societies that deal with bone metabolic disease. These recommendations are based on systematic reviews of the best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on leading experts' experience and opinion, and on good clinical practice. The osteoporosis prevention should be based on the elimination of specific risk factors. The use of drugs registered for the treatment of osteoporosis are recommended when the benefits overcome the risk, and this is the case only when the risk of fracture is rather high as measured with variables susceptible to pharmacological effect. DeFRA (FRAX® derived fracture risk assessment) is recognized as a useful tool for easily estimate the long-term fracture risk. Several secondary forms of osteoporosis require a specific diagnostic and therapeutic management.

The ageing process is characterized by a decline in muscle mass and strength, when this process outreaches pathological levels it is defined sarcopenia. This condition is associated with greater likelihood of recurrent falls and greater risk of mortality and less consistently associated with risk of hip fracture and functional limitation. On the other hand, ageing heavily affects bone inducing changes in bone structure - progressive decrease in trabecular thickness and increase in cortical porosity -, loss of bone mass and increase in bone turnover. There is an important interplay between muscle and skeletal systems: muscle contractions during anti-gravitational and physical activities apply mechanical stress to bones, influencing bone density, strength and microarchitecture, thus a decrease in muscle function is related to lower bone strength and predisposes to osteoporosis. Osteoporosis and sarcopenia show multiple common pathogenetic pathways, both systemic and local: reduction in anabolic hormones, chronic inflammatory condition, inactivity. In particular, several skeletal muscle-derived cytokines are able to directly influence bone. Vitamin D adequate levels are crucial for both bone and muscle function. Musculoskeletal impairment causes an important burden of disability and disease in older patients, a better understanding of pathogenesis and muscle-bone crosstalk could lead to improve prevention strategies and therapeutic options.

The number of nursing home residents being admitted to hospital has been increasing. Residents in nursing homes (NH) are an increasingly vulnerable group with complex medical and care needs. Access to acute care will always be an important component of quality care for nursing homes residents. Nevertheless, reducing preventable hospitalization is fundamental in terms of better quality of care, improved health and cost savings. Evidence indicates that many hospitalizations of NH residents could be avoided, but it is not so clear what specific interventions or combination of interventions effectively decrease potentially avoidable hospital admissions. The objective of this work is a revision of more recent literature on problems and possibile solutions to manage the difficult reationship between hospital and nursing homes.

We evaluated the effect of parathyroid hormone (PTH) on Wnt10b production by immune system cells in humans. We showed that bone anabolic effect of intermittent PTH treatment may be amplified by T cells through increased production of Wnt10b. Chronic increase in PTH as in primary hyperparathyroidism does not increase Wnt10b expression.

In this study we investigated the calcitonin (CT) pattern both in basal conditions and after calcium infusion before and one month after oophorectomy in 17 premenopausal women. In addition, 13 oophorectomized women were randomly allocated to two groups, one given hormone replacement treatment and the other untreated, and CT response to hypercalcemia was reevaluated one year later. CT response to calcium infusion was significant only before oophorectomy and one year after estrogen-progestogen treatment, whereas there was no response one month after oophorectomy or after one year without hormone replacement therapy. Our data indicate that both estrogen secretion and replacement treatment may be important factors in CT response.

Searchable abstracts of presentations at key conferences on calcified tissues ISSN 2052-1219 (online)

OBJECTIVE. To search for brain abnormalities in patients with Paget’s disease of the bone (PBD) carrying mutations in SQSTM1 gene using voxel-based morphometry. BACKGROUND. Recently, mutations in the sequestosome 1 (SQSTM1) gene, which encodes the autophagic p62 protein, have been described in patients with Frontotemporal Lobar Degeneration (FTLD) and/or Amyotrophic Lateral Sclerosis (ALS). SQSTM1 mutations have been described in approximately 25% of patients with familial PBD. Neurologic involvement in these patients have not yet been investigated. METHODS. 12 newly diagnosed patients with familial PBD (5 males, 7 females, mean age ± SD: 59 ± 8 yrs) carrying SQSTM1 gene mutations (E396X, M404V, G425R), and 12 healthy controls were recruited for the study. On examination, PDB patients show no signs of any neurological diseases and neuropsychological screening was normal. Structural MRI scans of all participants were acquired on a 1.0 T Impact Magnetom Imager scanner. Whole brain scans were obtained as high-resolution T1-weighted 3D MP-RAGE. Images were analyzed with FSL-VBM 4.1. All patients underwent clinical and neuropsychological assessment (MMSE, Semantic Fluency, Phonemic Fluency, Attentional Matrices, Corsi Span, Short Story Recall, Token test). Anxiety and depression were also evaluated with self-administered questionnaires (STAI-X1, STAI-X2, BDI). RESULTS. PDB patients carrying SQSTM1 gene mutations had significantly lesser (p<0.01) regional gray matter density in right middle temporal gyrus, right parahippocampal gyrus and left lingual gyrus, in comparison with controls. Age-related reduction in gray matter density was significantly (p<0.001) increased in PDB patients than in controls within a large brain network (including precuneus, cingulum and fronto-temporal lobes, especially on the left side). CONCLUSIONS. Our study shows that, in patients with PDB carrying SQSTM1 gene mutations, there is a significant gray matter decrease even in absence of neurologic symptoms. The clinical relevance our findings requires additional investigations. Disclosure: Dr. Rainero has nothing to disclose. Dr. Rubino has nothing to disclose. Dr. D9Agata has nothing to disclose. Dr. Rossetti has nothing to disclose. Dr. Gastaldi has nothing to disclose. Dr. Bergui has nothing to disclose. Dr. Orsi has nothing to disclose. Dr. Pinessi has nothing to disclose. Dr. Isaia has nothing to disclose. Dr. Di Stefano has nothing to disclose.

Introduction. This study was performed to evaluate if an early discharge to a Hospital at Home Service (HHS) produced differences in all cause mortality (combined endpoint) and hospital readmissions in elderly patients affected by severe heart failure.Methods. From September 1st 2008 to May 31st 2010, patients 65 years or older admitted to the Emergency Department of the San Giovanni Battista Hospital of Turin for acute decompensated CHF were selected. Patients were randomly assigned to two groups: 26 hospitalized in general wards where they received routine hospital care (group 1), 26 hospitalized and early discharged to the Hospital at Home Service- HHS (within 120 hours) (group 2).Results. Patients were very old (mean age 81 years), comorbid, 73% had severe symptoms of heart failure (NYHA IV), without differences between the two groups. No differences in mortality and hospital readmission rates were found. Mood level improved in HHS patients only.Discussion. This is a pilot study on early discharge for elderly patients with advanced heart failure. Home care should be considered as an important element toward adjusting the transition in frail hospitalized patients effectively.

Introduction. The aim of the study was to evaluate the main features of patients 65 years of age or older admitted to the Emergency Department (ED) for a fall and analyze consequences of falls, new falling events and related predicting factors, hospital recovery rate and institutionalization at 1 month follow-up.Methods. From February 1st to April 30th 2011, 100 patients 65 years of age or older admitted to the ED of the San Giovanni Battista Hospital of Turin for a fall were selected. In the ED a baseline multidimensional assessment was performed. On discharge, we evaluated: allocation, complications, length of hospital stay and diagnosis. At one-month follow-up new falling events, mortality, hospital readmission rate and institutionalization were evaluated.Results. The enrolled patients were very old (mean age 82.5 years), comorbid and in polipharmacy. Twenty four percent of the falls produced traumas, 51% required hospitalization. At 1-month follow-up, 85 patients lived at home, 13 were institutionalized and 2 died. Recurrent falls occurred in 12% of the subjects.Discussion. Patients who access the ED for a fall are often very old and frail. Falls are frequently responsible for traumas and fractures which can determine longer hospitalization or institutionalization. There is need to introduce prevention strategies in order to reduce the incidence of the events and improve quality of life in the elderly with previous falls.

Introduction. The objective of the study was to evaluate the epidemiology of pressure ulcers and the characteristics of an elderly population with pressure sores admitted to the Hospital at Home Service (HHS) of the San Giovanni Battista Hospital (Torino, Italy). Methods. A descriptive study was conducted on patients admitted to the HHS from January 1st to June 30th 2010, referred from the Emergency Department or other hospital wards. Results. Data of 36 patients with pressure sores were analyzed: 34 patients presented an ulcer upon admission and 2 patients developed pressure ulcers during hospitalization. Patients were very old (mean age 85 years), comorbid, functionally impaired. 50% of patients had stage I ulcers, 28% stage II, 22% stage III-IV; 50% of patients had more than one pressure sore. Most patients were discharged to their home (61%), with programmed health care services in about 17% of cases; mortality rate was 30.5%. Discussion. In our study prevalence rates (about 13%) agree with international data; incidence (0.6%) was lower than data from hospital wards. A possible explanation could be that patients who are at home continue to be followed not only by a multidisciplinary team, but can also rely on the presence of a costant caregiver, who if appropriately educated by the geriatric team, can provide specific and ongoing care.

The aim of this preliminary research is to investigate the reliability of a new qualitative parameter, called Trabecular Bone Score (TBS), recently proposed for evaluating the microarchitectural arrangement of cancellous bone in scans carried out by dual energy X-ray absorptiometry (DXA). Vertebral bodies of 15 fresh samples of lumbar spines of adult pig were analysed either in basal conditions and with altered microarchitecture of the cancellous bone obtained by progressive drilling. The examined bony areas do not show changes in bone mineral density (BMD), whereas TBS values decrease with the increasing alteration of the vertebral microtrabecular structure. Our preliminary data seem to confirm the reliability of TBS as a qualitative parameter useful for evaluating the microarchitectural strength in bony areas quantitatively analysed by DXA.

Objectives. The aim of this study is to identify among caregivers of patients affected by Alzheimer's disease the emerging needs while they care for these patients. Methods. Between July 2008 and February 2009 we administered an anonymous questionnaire to 100 caregivers of patients affected by Alzheimer's disease attending the Memory Clinic of the Geriatrics section of the San Giovanni Battista hospital of Turin. Questions were asked to evaluate the knowledge that caregivers have about the disease. Caregiver's stress was evaluated by using the CBI scale and behavioural disease was evaluated by CMAI score. Results. Knowledge of district services was good about ADI, UVA, Day Care Centers and RSA, but it was insufficient about hospitalization at home and Respite care. The mean CBI score shows a mild-moderate caregiver's stress that is significantly associated with cognitive impairment, and with the care time. Conclusions. The study shows that healthcare professionals need to provide more information to guarantee a better management of the patient.

Background : Osteoporosis is a highly prevalent disease and fractures are a major cause of disability and morbidity. Aim : The purpose of this study was to characterize post-menopausal women attending osteoporosis centers in Italy, to evaluate physician management, and to determine the incidence of first osteoporotic fracture. Subjects and methods : PROTEO-1 was an observational longitudinal study with a 12-month follow-up. Data were collected from women attending osteoporosis centers. Women without prevalent fracture were eligible to enter the 1-yr follow-up phase: the clinical approach to patients according to their fracture risk profile and the incidence of fracture were recorded. Results : 4269 patients were enrolled in 80 centers in the cross-sectional phase; 34.2% had an osteoporotic fracture at baseline. Patients with prevalent fractures were older and more likely to be treated compared with non-fractured patients. The incidence of vertebral or hip fracture after 1 yr was 3.84%, regardless of the calculated risk factor profile, and was significantly higher in patients with back pain at baseline (4.2%) compared with those without back pain (2.2%; p=0.023). Generally, physicians prescribed more blood exams and drugs to patients at higher risk of fracture. Among fractured patients only 24% were properly treated; the rate of non-responders to treatment was about 4%. Conclusions : In a large, unselected sample of post-menopausal women attending osteoporosis centers, those without previous fracture were at substantial risk of future fracture, regardless of their theoretical low 10-yr fracture risk. The presence of back pain in women without previous fracture warrants close attention.

Introduction. Malnutrition is a frequent condition among the elderly. The present study aims to evaluate the risk of malnutrition in a sample of elderly patients affected by cognitive impairment but still living at home. Methods. From April to September 2005, all patients affected by cognitive disorders and consecutively admitted to the Memory Clinic of the Geriatric Section of the San Giovanni Battista Hospital of Torino, were asked to participate to the present observational study. At baseline, demographic data, past and recent clinical data and socio-economic status were collected. Cognitive, behaviour, and nutritional status were evaluated using the Mini Mental State Examination (MMSE), the Neuropsychiatric Inventory (NPI) and the Mini Nutritional Assessment (MNA). Results. The MNA total score was significantly related with age (p = 0.01), mean duration of dementia (p = 0.001), severity of cognitive (p = 0.001) and behaviour (p = 0.001) status. In particular, risk of malnutrition was related with delusions (p = 0.001), depression/dysphoria (p = 0.001), appetite/eating (p = 0.001), wandering (p = 0.001), agitation/aggression (p = 0.01). Discussion. The present study confirms that elderly patients with dementia present a risk of malnutrition that seems to be strictly related with patients' age and duration of disease. Moreover, malnutrition is related with severity of cognitive impairment and behavioural problems. The evaluation of nutritional status in elderly demented subjects could prevent and diagnose nutrition related problems.