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Vicenza, Italy

Romagnoli E.,University of Rome La Sapienza | Cipriani C.,University of Rome La Sapienza | Nofroni I.,University of Rome La Sapienza | Castro C.,University of Rome La Sapienza | And 7 more authors.
Bone | Year: 2013

Background: Patients with primary hyperparathyroidism (PHPT) generally show reduced bone mineral density (BMD) at cortical sites with relatively preserved trabecular bone. However, the increased fracture risk at all skeletal sites suggests that areal BMD probably is not effective in capturing all the determinants of bone strength. "Trabecular Bone Score" (TBS) has been recently proposed as an indirect measure of bone micro-architecture. Our study was aimed to investigate TBS in patients with PHPT. Methods: Seventy-three Caucasian postmenopausal women with PHPT and 74 age-matched healthy women (C) were studied. In all participants BMD at lumbar spine (LS) and at femoral sites (Neck-FN and total hip-TH) was measured by DXA and, in 67 patients and 34 C, also at the distal 1/3 of the radius (R). TBS was measured in the region of LS-BMD. Spine X ray was assessed in all patients. Results: Mean TBS values were significantly reduced in PHPT (1.19 ± 0.10) compared to C (1.24 ± 0.09, p. < 0.01). Patients and controls did not differ for age, years since menopause (YSM), BMI, 25(OH)D serum levels, creatinine clearance, LS-BMD and FN-BMD. On the contrary, mean BMD values at both TH and R were significantly lower in PHPT patients compared to controls (p < 0.01 and p < 0.0001, respectively). In PHPT with vertebral fractures (VF. +, n = 29) TBS was significantly lower than in those without fracture (VF. -, n = 44)(1.14 ± 0.10 vs. 1.22 ± 0.10, respectively; p < 0.01), whose TBS values did not differ from C. Mean TBS values in patients with (n = 18) and without (n = 55) non-vertebral fractures did not significantly differ (1.16 ± 0.09 vs. 1.20 ± 0.11). The presence of vertebral fractures was independently associated with the reduction of TBS (OR = 0.003, 95% CI = 0-0.534, p = 0.028) and with YSM (OR = 1.076, 95% CI = 1.017-1.139, p = 0.011), but not with age, the reduction of LS-BMD and the increase of BMI. The combination of YSM > 10. years plus TBS < 1.2 was associated with a significant risk of VF (OR = 11.73, 95% CI 2.43-66.55, p < 0.001). A TBS value < 1.2 showed a better performance in individuating VF (sensibility 79.3%, specificity 61.4%, positive predictive value 57.5%, and negative predictive value 81.8%) in respect to YSM > 10. years. Conclusions: TBS seem. s to indirectly reflect an alteration of bone micro-architecture in postmenopausal women with PHPT. © 2012 Elsevier Inc. Source


Ferreli C.,University of Cagliari | Atzori L.,University of Cagliari | Manunza F.,University of Cagliari | Pau M.,Unit of Dermatology | Caddori A.,Unit of Internal Medicine
Giornale Italiano di Dermatologia e Venereologia | Year: 2014

Granuloma annulare (GA) is an acquired, usually self-limiting, asymptomatic granulomatous skin disease with well recognized clinical and histological features that occurs in children and adults generally before the age of 30. Five clinical types are described including the localized, generalized, subcutaneous, perforating, and patch forms. The possible role of immune dysregulation has been pointed out in the pathogenesis of GA, as it has been reported in association with several diseases and conditions like diabetes, thyroid diseases, malignancies, tuberculosis, human immunodeficiency, Epstein Barr and hepatitis C virus infection. Drug-induced GA is a rare presentation, that can appear similar or identical to idiopathic GA. We present a 75-year-old Caucasian man with a violaceous ring-like firm, papular eruption, localized on the dorsal aspect of both hands, with histological features of GA, which subsequently resolved with the discontinuation of thalidomide he had started 1 month earlier for the treatment of a multiple myeloma. The lesions appeared with renewed intensity after resuming a therapy cycle. Jones's algorithm for the diagnosis of adverse drug reactions (ADR) showed a certain association, thus the final diagnosis of thalidomide-induced GA was made. Source


Carnevale V.,Unit of Internal Medicine | Romagnoli E.,University of Rome La Sapienza | D'Erasmo L.,University of Rome La Sapienza | D'Erasmo E.,University of Rome La Sapienza
Nutrition, Metabolism and Cardiovascular Diseases | Year: 2014

This review focuses on the mechanisms determining bone fragility in patients with type 2 diabetes mellitus (T2DM). Despite bone mineral density (BMD) is usually normal or more often increased in these patients, fracture incidence is high, probably because of altered bone "quality". The latter seems to depend on several, only partly elucidated, mechanisms, such as the increased skeletal content of advanced glycation end-products causing collagen deterioration, the altered differentiation of bone osteogenic cells, the altered bone turnover and micro-architecture. Disease duration, its severity and metabolic control, the type of therapy, the presence or absence of complications, as like as the other known predictors for falls, are all relevant contributing factors affecting fracture risk in T2DM. In these patients the estimate of fracture risk in the everyday clinical practice may be challenging, due to the lower predictive capacity of both BMD and risk factors-based algorithms (e.g. FRAX). © 2014 Elsevier B.V. Source


Carnevale V.,Unit of Internal Medicine
Journal of endocrinological investigation | Year: 2010

Several findings indicate that adipose tissue and bone have a complex reciprocal relationship. The two cells lineages share a common progenitor, and adipocyte endocrine activity may influence bone metabolism. Recent evidence from animal models suggests that bone cells may contribute regulating energy metabolism. Source


Verso M.,University of Perugia | Agnelli G.,University of Perugia | Ageno W.,University of Insubria | Imberti D.,Unit of Internal Medicine | And 4 more authors.
Thrombosis Research | Year: 2012

Background: The long-term clinical outcome of VTE has been essentially assessed in cohorts of selected patients. The aim of this multicenter registry was to prospectively assess the long-term clinical outcome in a cohort of unselected patients with objectively confirmed acute VTE. Materials and Methods: Death and VTE recurrence at 24 months were the main study outcomes. Univariate and multivariate survival analyses were performed according to the Kaplan-Meyer and Cox proportional hazard model, respectively. Results: 2119 patients with acute VTE were included in the registry: 1541 (72.7%) with deep vein thrombosis, 206 (9.7%) with pulmonary embolism and 372 (17.6%) with both. Information about death was available in 2021 patients (95.4%) and about recurrence in 1988 patients (93.8%). 167 patients (4.55% patient-year) died during follow-up. After adjusting for age, cancer (Hazard ratio [HR]: 7.2; 95%CI 4.8-10.8), long-term heparin treatment (HR: 2.5; 95%CI 1.8-3.5), in-hospital management of VTE (HR: 2.0; 95%CI 1.3-3.0), and ileo-caval thrombosis (HR: 1.7; 95%CI 1.2-2.4) were found to be independent predictors of death. 124 (3.63% patient-year) patients had a VTE recurrence during follow-up. In-hospital management of VTE (HR: 1.8; 95%CI 1.2-2.9), male gender (HR: 1.7; 95%CI 1.2-2.4) were independent risk factors for recurrent VTE. Cancer (HR: 1.6; 95%CI 1.0-2.8) showed a trend for increased risk of VTE recurrence (p = 0.056). The reported rate of major bleeding was 2.5%. Conclusions: In a large cohort of unselected VTE patients, cancer, ileo-caval thrombosis, long-term heparin treatment and in-hospital management were associated with increased mortality during long-term follow-up. In-hospital management, male gender were associated with an increased risk of VTE recurrence. © 2012 Elsevier Ltd. Source

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