Ouniversity Rheumatology

San Cesario di Lecce, Italy

Ouniversity Rheumatology

San Cesario di Lecce, Italy

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Muratore M.,Ouniversity Rheumatology | Quarta E.,Ouniversity Rheumatology | Quarta L.,Ouniversity Rheumatology | Calcagnile F.,Ouniversity Rheumatology | And 4 more authors.
Clinical Cases in Mineral and Bone Metabolism | Year: 2012

Studies of the mechanisms of periprosthetic bone loss have led to the development of pharmacologic strategies intended to enhance bone mass recovery after surgery and consequently prevent aseptic loosening and prolong the implant survival. Bisphosphonates, potent anti-resorptive drugs widely used in the treatment of osteoporosis and other disorders of bone metabolism, were shown to be particularly effective in reducing periprosthetic bone resorption in the first year after hip and knee arthroplasty, both cemented and cementless. Based on these results, we investigated the inhibitory effects of ibandronate on periprosthetic bone loss in a 2-year study of postmenopausal women that underwent cementless total hip arthroplasty. In the first 6 months both groups (A, treated with ibandronate 3 mg i.v. within five days after surgery and then with oral ibandronate 150 mg/month, plus calcium and vitamin D supplementation; and B, treated with calcium and vitamin D supplementation only) experienced bone loss, though to a lesser extent in group A. After 12 months, group A showed a remarkable BMD recovery, that was statistically significant versus baseline values (about +1, 74% of global BMD) and most evident in region R1 (+3, 81%) and R2 (+4, 12%); in group B, on the contrary, BMD values were unchanged compared with those at 6 months post-surgery. Quality of life scores also showed a greater improvement in group A, both at 6 and 12 months after surgery, likely because of the pain-reducing effects of ibandronate treatment.


Villani V.,R.Ø.S.A. | Conversano F.,National Research Council Italy | Aventaggiato M.,R.Ø.S.A. | Chiriaco F.,National Research Council Italy | And 2 more authors.
3rd IMEKO TC13 Symposium on Measurements in Biology and Medicine 2014: New Frontiers in Biomedical Measurements | Year: 2014

Osteoporosis is considered as a major public health problem, second only to cardiovascular diseases. The gold standard for its diagnosis is currently represented by dual energy X-ray absorptiometry (DXA), which, however, suffers from some important drawbacks. In order to overcome such limitations, the use of ultrasound (US) techniques has been proposed. In this paper, a novel approach to the diagnosis of osteoporosis through US scans on lumbar spine and proximal femur is described. The approach relies on the estimation of diagnostic parameters by measuring the degree of similarity between the spectra of the raw radiofrequency (RF) echo signals and reference spectral models of osteoporotic or healthy bones. Reference models are representative of the features of either osteoporotic or healthy bone structures and are matched with subject age, sex, ethnic group and body mass index to take into account variations in bone physiological condition and subject anatomy. In this paper, the methods implemented to build the database of reference models and to estimate diagnostic parameters are presented. The performance of the approach was assessed on a total of 145 Caucasian underweight and normal-weighted women with age in the range from 46 to 55. Performance was assessed through direct comparison with DXA results. The obtained median relative error in the estimation of bone mineral density was as low as 9.1% on women aged 51 to 55 years and 12.0% on women with age in the range from 46 to 50 years. Moreover, for the two groups, the estimation error was lower than 20% for 81% and 78.6% of subjects, respectively. Therefore, the proposed method combines the advantages of the use of US techniques with a remarkable diagnostic accuracy, thus lending itself to the possibility of being used for population mass screenings. Copyright © (2014) by the International Measurement Confederation (IMEKO) All rights reserved.


Casciaro S.,National Research Council Italy | Renna M.D.,National Research Council Italy | Pisani P.,National Research Council Italy | Greco A.,Echolight S.r.l. | And 2 more authors.
3rd IMEKO TC13 Symposium on Measurements in Biology and Medicine 2014: New Frontiers in Biomedical Measurements | Year: 2014

Osteoporosis is the most common disorder of bone metabolism, with a high rate of diffusion, especially in the elderly population. The main consequence of osteoporosis is bone fragility, with the consequently increased risk of fracture. Vertebral and hip fractures represent one of the most important causes of morbidity and disability and cause also high economic costs for the National Healthcare Systems. The currently accepted "gold standard" method for osteoporosis diagnosis is represented by the evaluation of bone mineral density (BMD) through dual X-ray absorptiometry (DXA). However, DXA presents some considerable limitations such as the exposition to ionizing radiations, employment of bulky devices and high costs of management. This paper gives an overview of the most widely used X-ray based techniques to perform osteoporosis diagnosis and describes the working principles of non-invasive ultrasound (US) based methods for bone densitometry, underlining the corresponding advantages and limitations for their use in the clinical practice. Moreover, the article illustrates the effectiveness of an innovative US technique, directly applicable on the main anatomical reference sites, in terms of diagnostic accuracy and fracture risk prediction. Early diagnosis is the key to resize the impact of osteoporosis on healthcare systems. Therefore, it would be necessary to encourage the widespread use of quick, cheap and non-invasive screening techniques. Copyright © (2014) by the International Measurement Confederation (IMEKO) All rights reserved.


Aventaggiato M.,Echolight Srl | Conversano F.,National Research Council Italy | Pisani P.,National Research Council Italy | Casciaro E.,National Research Council Italy | And 4 more authors.
IET Science, Measurement and Technology | Year: 2016

Aim of this study was to perform a detailed clinical validation of a new fully automatic algorithm for vertebral interface segmentation in echographic images. Abdominal echographic scans of lumbar vertebrae L1-L4 were carried out on 150 female subjects with variable age and body mass index (BMI). Acquired datasets were automatically processed by the algorithm and the accuracy of the obtained segmentations was then evaluated by three independent experienced operators. Obtained results showed a very good specificity in vertebra detection (93.3%), coupled with a reasonable sensitivity (68.1%), representing a suitable compromise between the detection of a sufficient number of vertebrae for reliable diagnoses and the limitation of the corresponding computation time. Importantly, there was only a minimum presence of 'false vertebrae' detected (2.8%), resulting in a very low influence on subsequent diagnostic analyses. Furthermore, the algorithm was specifically tuned to provide an improved sensitivity (up to 73.1%) with increasing patient BMI, to keep a suitable number of correctly detected vertebrae even when the acquisition was intrinsically more difficult because of the augmented thickness of abdominal soft tissues. The proposed algorithm will represent an essential added value for developing echographic methods for the diagnosis of osteoporosis on lumbar vertebrae. © The Institution of Engineering and Technology.


Greco A.,Echolight Srl | Pisani P.,National Research Council Italy | Conversano F.,National Research Council Italy | Soloperto G.,Echolight Srl | And 3 more authors.
Measurement: Journal of the International Measurement Confederation | Year: 2016

Aim of this paper was to assess the clinical effectiveness of a novel ultrasound (US) approach for the estimation of bone fragility. A total of 85 female patients (40-80. years) were recruited and underwent conventional DXA investigations of both lumbar spine and proximal femur, an abdominal US scan of the lumbar spine and the FRAX® questionnaire for the calculation of osteoporotic fracture probabilities. Acquired US data were analyzed through an automatic algorithm that calculated the Fragility Score (F.S.), a parameter that estimates skeletal fragility from dedicated spectral and statistical analyses. F.S. showed a good correlation with the most reliable fracture risk predictions obtained by FRAX® (r = 0.71, p <. 0.001). Since this correlation level with FRAX® outcomes was much better than lumbar BMD one (|. r| = 0.43) and very similar to that obtained for femoral neck BMD (|. r| = 0.72), F.S. has the potential to become a simple and non-ionizing method for bone fragility assessment. © 2016 Elsevier Ltd.


Conversano F.,National Research Council Italy | Franchini R.,National Research Council Italy | Greco A.,Echolight srl | Soloperto G.,National Research Council Italy | And 12 more authors.
Ultrasound in Medicine and Biology | Year: 2015

We investigated the possible clinical feasibility and accuracy of an innovative ultrasound (US) method for diagnosis of osteoporosis of the spine. A total of 342 female patients (aged 51-60y) underwent spinal dual X-ray absorptiometry and abdominal echographic scanning of the lumbar spine. Recruited patients were subdivided into a reference database used for US spectral model construction and a study population for repeatability and accuracy evaluation. US images and radiofrequency signals were analyzed via a new fully automatic algorithm that performed a series of spectral and statistical analyses, providing a novel diagnostic parameter called the osteoporosis score (O.S.). If dual X-ray absorptiometry is assumed to be the gold standard reference, the accuracy of O.S.-based diagnoses was 91.1%, with k=0.859 (p<0.0001). Significant correlations were also found between O.S.-estimated bone mineral densities and corresponding dual X-ray absorptiometry values, with r2 values up to 0.73 and a root mean square error of 6.3%-9.3%. The results obtained suggest that the proposed method has the potential for future routine application in US-based diagnosis of osteoporosis. © 2015 World Federation for Ultrasound in Medicine & Biology.


Casciaro S.,National Research Council Italy | Renna M.D.,National Research Council Italy | Conversano F.,National Research Council Italy | Soloperto G.,National Research Council Italy | And 4 more authors.
3rd IMEKO TC13 Symposium on Measurements in Biology and Medicine 2014: New Frontiers in Biomedical Measurements | Year: 2014

Osteoporosis and overweight/obesity constitute major worldwide public health burdens that are associated with aging. The gold standard for osteoporosis diagnosis is currently represented by bone mineral density (BMD) measurement through dual-energy X-ray absorptiometry (DXA). However, DXA cannot be used for early diagnosis through population mass screenings due to ionizing radiation employment. Because of this, generally, only people considered at high risk of fracture (underweight women after the menopause) undergo to osteoporosis screening. In fact, a significant risk factor for fracture is the low body mass index (BMI), while the tendency to overweight or obesity delays osteoporosis onset. Nevertheless, a high proportion of women after the menopause develop intra-abdominal adiposity, which leads to metabolic disorders and osteoporosis. This paper describes the diagnostic accuracy of a novel ultrasound (US)-based method to perform spinal densitometry. The proposed innovative methodology is based on a combined analysis of both echographic images and "raw" radiofrequency US signals. The diagnostic output is represented by the same parameters provided by DXA (BMD, T-score, Z-score). The efficiency of the proposed methodology was evaluated on a cohort of 280 overweight or obese (BMI > 25 kg/m2) female patients in the age range 45-65 years. For 81.4% of the patients, US diagnosis (osteoporotic, osteopenic, healthy) was the same of the corresponding DXA one, showing the high accuracy of the proposed US technique, especially in the youngest patients (86.4% of correct diagnoses in the age range 45-50 y). A good correlation was also found between the diagnostic parameters provided by both US and DXA methods: All obtained values of Pearson coefficient (r) were within the interval 0.66-0.76 (p<0.001). Then, this new non-ionizing approach to spinal bone densitometry has the potential for being extremely useful for early osteoporosis diagnosis through population mass screenings. Copyright © (2014) by the International Measurement Confederation (IMEKO) All rights reserved.


Conversano F.,National Research Council Italy | Casciaro E.,National Research Council Italy | Franchini R.,National Research Council Italy | Soloperto G.,National Research Council Italy | And 5 more authors.
IEEE International Ultrasonics Symposium, IUS | Year: 2013

Aim of this work was to carry out a first clinical validation of a new ultrasound (US)-based approach to bone densitometry of lumbar spine. A total of 290 female patients were enrolled for this study (45-75 years of age, body mass index (BMI)<40 kg/m2) and all of them underwent two different diagnostic investigations: a lumbar DXA (dual-energy X-ray absorptiometry) and an US scan of the same vertebras, performed with an echographic device configured for the acquisition of both echographic images and unfiltered radiofrequency signals. US data analysis was carried out through an innovative algorithm, whose main features include: a) measurements are always performed on a specific region of interest of the vertebra, identified on the basis of both morphologic and spectral characteristics; b) analysis takes into account patient BMI; c) the algorithm is integrated with a reference database containing model acquisitions for different combinations of patient age, sex and BMI. Accuracy of final algorithm output, represented by the same diagnostic parameters of a DXA investigation, was evaluated through a direct comparison with DXA results. For 84.5% of the patients US diagnosis (osteoporotic, osteopenic, healthy) coincided with the corresponding DXA one and this accuracy level was not appreciably influenced by patient age nor by BMI. The proposed approach represents the first US method for osteoporosis diagnosis which is directly applicable on spine and has the potential to be effectively used for population mass screenings. © 2013 IEEE.


Pisani P.,National Research Council Italy | Conversano F.,National Research Council Italy | Chiriaco F.,National Research Council Italy | Quarta E.,Ouniversity Rheumatology | And 4 more authors.
Measurement: Journal of the International Measurement Confederation | Year: 2016

Aim of this paper was to assess the diagnostic accuracy of a novel ultrasound (US) approach for femoral neck densitometry. A total of 173 female patients (56–75 years) were recruited and all of them underwent a dual X-ray absorptiometry (DXA) of the proximal femur and an US scan of the same anatomical district. Acquired US data were analysed through a novel algorithm that performed a series of spectral and statistical analyses in order to calculate bone mineral density employing an innovative method. Diagnostic accuracy of US investigations was quantitatively assessed through a direct comparison with DXA results. The average diagnostic agreement resulted pretty good (85.55%), with a maximum (88.00%) in correspondence of the youngest investigated patients (56–60 y). Overall, diagnostic accuracy showed only minimal variations with patient age, indicating that the proposed approach has the potential to be effectively employable for osteoporosis diagnosis in the whole considered age interval. © 2016 Elsevier Ltd


Casciaro S.,National Research Council Italy | Conversano F.,National Research Council Italy | Pisani P.,National Research Council Italy | Greco A.,National Research Council Italy | And 2 more authors.
2015 IEEE International Symposium on Medical Measurements and Applications, MeMeA 2015 - Proceedings | Year: 2015

Aim of this work was to evaluate the effectiveness of a recently introduced ultrasound (US) method for osteoporosis diagnosis, when extensively used in a clinical context to investigate adult women of variable age. A total of 384 female patients (46-65 years; body mass index < 25 kg/m2) underwent a spinal dual X-ray absorptiometry (DXA) and an abdominal US scan of lumbar spine, acquiring both echographic images and unprocessed radiofrequency signals. US data were analyzed through a new fully automatic algorithm, which performed a series of spectral and statistical analyses to calculate the parameter called Osteoporosis Score (O.S.). Diagnostic effectiveness of O.S. was assessed through a direct comparison with DXA measurements (assumed as the gold standard reference), quantifying the agreement between the two methods through accuracy calculation, Cohen's kappa (k) and Pearson correlation coefficient (r). The overall accuracy of O.S.-based diagnoses resulted 84.6%, ranging from a minimum of 81.7% for the oldest patients (aged in 61-65 y) to a maximum of 87.2% for the youngest patients (aged in 46-50 y). Cohen's kappa showed an analogous trend, confirming a significant agreement between DXA and US-based diagnoses along the whole considered age interval (k=0.758, p<0.0001). A good correlation was also found between O.S.-derived BMD values and corresponding DXA measurements (r=0.72, p<0.001). These results demonstrated that US-measured O.S. is significantly correlated with spinal BMD in normal-and under-weight adult women belonging to a wide age interval. Therefore, the routine clinical application of this innovative approach to osteoporosis diagnosis can be envisioned. © 2015 IEEE.

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