Mrs. Fenech-Adami Nation mOllrlls'is-sinjnra Mer' 'She was ...
OSTEOPOROSI, INTEGRAZIONE, ATTIVITA’ FISICA · Isaia GC et al Osteoporos Int 2003 Adami S et al...
27
OSTEOPOROSI, INTEGRAZIONE, ATTIVITA’ FISICA G.C. Isaia Torino 31 Ottobre 2015 A.O.U. CITTA’ DELLA SALUTE E DELLA SCIENZA DI TORINO S.C. GERIATRIA E MALATTIE METABOLICHE DELL’OSSO Centro di Riferimento Regionale per le Malattie Metaboliche dell’osso
Transcript of OSTEOPOROSI, INTEGRAZIONE, ATTIVITA’ FISICA · Isaia GC et al Osteoporos Int 2003 Adami S et al...
OSTEOPOROSI, INTEGRAZIONE, ATTIVITA’ FISICA
G.C. Isaia
Torino 31 Ottobre 2015
A.O.U. CITTA’ DELLA SALUTE E DELLA SCIENZA DI TORINO
S.C. GERIATRIA E MALATTIE METABOLICHE DELL’OSSO
Centro di Riferimento Regionale per le Malattie Metaboliche dell’osso
AGENDA
• Factors linking muscle to bone
• Hypovitaminosis D affects muscleand bone
• Relationship between muscle and bone in clinical studies
• Conclusions
MUSCLE & BONE
Muscle and bone tissues are jointed in muscolar-
skeletal system
The sarcopenia and lack in muscle strenght induce
reduction in bone mass, through osteocyte activity
The ageing processes are characterized by loss of
muscle and bone mass (Sarcopenia & Osteoporosis)
Sarcopenia is often complicated by falls and
subsequent fragility fractures
Sarcopenia could be evaluated by DXA
MYOSTATIN AND MUSCLE
Rodino-Kaplac RL et al Muscle Nerve. 2009
Bowser M et al Exp Gerontol. 2013
MYOSTATIN AND BONE
OSTEOGLYCIN INDUCES OB DIFFERENTIATION
Tnanaka K et al. J Biochem 2012
Bone, 2015
Irisina *
* Grano M et al PNAS, 2015
PNAS, 2015
PNAS, 2015
ADIPOSE TISSUE
BONE CELLS
IMMUNE SYSTEM
PPR
PPR
Inflammation induced bone loss
OB
OC
OS
Modified from D’Amelio P. in “Modern Insights Into Disease From Molecules to Man: Cytokines” 2011.
LINKAGE BETWEEN BONE AND OTHER SYSTEMS
IMMUNE SYSTEM
CARDIOVASCULAR SYSTEM
KIDNEY
PARATHYROIDS
SEXUAL HORMONES
PTH
CALCIUM
PHOSPHATE
reuptake
CALCIUM
PHOSPHATE
reuptake
1idroxylation
of vitamin D
GUT
DMP-1
PHEXMECHANICAL LOAD
FGF-23
AGENDA
• Factors linking muscle to bone
• Hypovitaminosis D affects muscleand bone
• Relationship between muscle and bone in clinical studies
• Conclusions
Isaia GC et al Osteoporos Int 2003
Adami S et al Bone 2009
Adami S et al Bone 2008
Prevalence of Vitamin D inadequacy in Italy
0
10
20
30
40
50
60
70
80
90
100
<25nmol/l <35 nmol/l <50nmol/l <60 nmol/l <75 nmol/l
Pre
vale
nce P
erc
en
tElderly Young
Severe Vit. D deficiency is found in > 50% of elderly subjects; inadequate levels in > 95%.
Inadequate Vit D values are found in > 50% of young “healthy” subjects.
Carenza Insufficienza
25OH D
Human skeletal muscle express VDR
Pfeifer M, et al Osteoporosis Int 2012Houston et al J Gerontol A Biol Sci Med Sci 2007
• Regulation of calcium transport• Uptake of inorganic phosphate for production of energy-rich• phosphate compounds• Protein synthesis
VITAMIN D AND MUSCULAR DEVELOPMENT
Garcia LA et al. Endocrinology 2011Venning G. BMJ 2005
VITAMIN D
VITAMIN D
VITAMIN D
Vitamin D and the risk of falls
Bischoff-Ferrari et al BMJ 2009
Mee Kyoung K et al, JCEM 2011Ji AS et al JAGS 2012Abdelouahid T et al, Age and Ageing 2013
Low 25OH Vitamin D/high PTH and sarcopenia: longitudinal Aging Study Amsterdam
Visser et al JCEM 2003
AGENDA
• Factors linking muscle to bone
• Hypovitaminosis D affects muscleand bone
• Relationship between muscle and bone in clinical studies
• Conclusions
Muscle size correlate with bone size
Edwards M, et al J Bone Miner Res. 2013
2011
L’ESERCIZIO PREVIENE LE CADUTE
Magnus K et al Food and Nutr Res 2008
Which type of exercise? COMB exercise programmes: significant effect on BMD at
neck of femur, spine; and trochanter. The risk of fracture in exercise groups was lower than that of controls.
DWBHF exercise (jogging, jumping and vibration platforms): significant effect on BMD at total hip and trochanter, compared to the control groups, but no effect at any other site
DWBLF exercise (walking or Tai chi): effect on BMD at two sites; spine and wrist.
NWBHF exercise (progressive resistance exercise): significant effect on BMD neck of femur and spine.
SWB exercise (e.g. single leg standing): significant effect on BMD at the hip.
AGENDA
• Factors linking muscle to bone
• Hypovitaminosis D affects muscleand bone
• Relationship between muscle and bone in clinical studies
• Conclusions
CONCLUSIONS• Muscle and bone share several common
regulatory factors
• Muscle mass and strenght influence bone
• Hypovitaminosis D is a common risk factor of
sarcopenia and osteoporosis
• There is insufficient evidence from randomised
trials to determine the effects of any particular
mobilisation strategy or programme started either
in the early or later rehabilitation period after hip
fracture surgery
