Search

Objective: Changes in body composition during weight loss programs might have a significant effect on long-term results. The aim of this study was to test these changes by dual energy x-ray absorptiometry (DXA) in obese women enrolled into two different weight loss medical programs. Methods: We prospectively studied 71 women assigned to either an intensive 3-mo cognitivebehavioral therapy (CBT) or a 1-mo nutritional counseling plan (NCP). All patients underwent DXA whole-body scan before treatment and after 3, 6, and 12 mo. Fat mass (FM), non-bone lean mass (LM) and bone mineral content were assessed at whole-body and regional levels. Android visceral adipose tissue (VAT) also was estimated. Results: Twenty-three patients missed one or more follow-up controls and were excluded from the final analysis. Twenty-seven patients (body mass index [BMI] 41.9 6.7 kg/m2) remained in the CBT group and 21 (BMI 33.4 +/- 4 kg/m2) in the NCP group. The progressive decrease of BMI in both groups was associated with reduced whole-body and regional FM, which was more marked in CBT. During follow-up, a progressive decrease of total FM-to-LM and android FM-to-LM ratios were observed both in CBT (D12-mo versus baseline -7.8 +/-9.6% and -9.5 +/-12.7%, respectively; P < 0.01) and NCP (D12-mo versus baseline -5.9 +/-9.6% and -7 +/-13.4%, respectively; P < 0.05). VAT was the parameter showing the largest decrease (-14.2 +/-17.4% and -11.3 +/-18.2% at 12 mo, respectively in CBT and NCP; P < 0.05). Conclusions: Lifestyle-induced weight loss is associated with selective changes in body composition parameters, regardless of initial BMI and treatment program, limiting sarcopenic obesity. DXA may quantify the metabolically healthier redistribution of total and regional FM and VAT.

The approach for extra-articular procedures around the hip is described, with focus on three main pathological entities. Indications with steps from anatomy review to techniques and materials, drugs, and appropriate aftercare management are included for a user-friendly and near-at-hand use.

The approach for intra-articular injection/aspiration procedures in the coxofemoral joint is reviewed. Indications are briefly listed. Anatomy, techniques and materials, drugs and appropriate aftercare management as well as potential procedure-related symptoms and consequent treatment are included.

Summary: The detection of changes in lean mass (LM) distribution can help to prevent disability. This study assessed the degree of association between anthropometric measurements and dual-energy X-ray absorptiometry (DXA) body composition (BC) parameters of the upper and lower limbs in a healthy general population and collected DXA age- and sex-specific values of BC that can be useful to build a reference standard. Purpose: The primary aim of this study was to investigate the reliability of some widely available anthropometric measurements in the assessment of body composition (BC) at the limbs, especially in terms of muscle mass, in a large sample of healthy subjects of different age bands and sex, using fat mass (FM) and lean mass (LM) parameters derived by dual-energy X-ray absorptiometry (DXA) as the gold standard. The secondary aim was to collect DXA age- and sex-specific values of BC of left and right limbs (upper and lower) in a healthy Italian population to be used as reference standards. Methods: Two hundred fifty healthy volunteers were enrolled. Arm circumference (AC) and thigh circumference (ThC) were measured, and total and regional BC parameters were obtained by a whole-body DXA scan (Lunar iDXA, Madison, WI, USA; enCORE™ 2011 software version 13.6). Results: FM/LM showed only fair correlation with AC and ThC in females (r = 0.649 and 0.532, respectively); in males and in the total population, the correlation was low (r = 0.360 or lower, and p non-statistically significant). AC and ThC were not well representative of arms LM in both genders (females r = 0.452, males r = 0.530) independently of age. In general, men of all age groups showed higher values of LM and lean mass index (LMI) in both total and segmental upper and lower limbs. In males, the maximum LM and LMI were achieved in the fifth decade in both upper and lower limbs and then started to decrease with aging. In females, no significant modification with aging was identified in LM and LMI. Conclusion: According to our results, anthropometry is not well representative of LM of arms in both genders, independently of age; therefore, a densitometric examination should be considered for a correct assessment of BC at limbs.

Spondyloarthritides are of a group of inflammatory rheumatic diseases, with negative rheumatoid factor, associated with the HLA-B27 gene. They comprise ankylosing spondylitis, psoriatic arthritis, reactive arthritis, and enteropathic-related spondylitis. The presence of sacroiliitis represents the most characteristic feature of these disorders and is an important criterion in diagnosis. Nonradiographic axial spondyloarthritis is a new classification concept. Conventional radiography is recommended as the first imaging method to diagnose sacroiliitis and different entities and to monitor established structural changes.

This article focuses on nonspinal fragility or insufficiency fractures. Fragility fractures occur when normal levels of energy are applied to weakened bone, and they normally represent spontaneous fractures or traumatic fractures from minimal energy trauma that would not normally result in fracture in healthy people. This is the case in osteoporosis, where there is reduction of bone mass as well as loss of normal trabecular architecture leading to changes in structural characteristics that compromise biomechanics. The prevalence and most common locations, as well as clinical and diagnostic aspects, of nonspinal fragility fractures are presented. Osteoporosis is highly prevalent and can have different causes. The most common ones are primary, such as postmenopausal and senile osteoporosis, and secondary to several causes. Clinically, patients with insufficiency fractures present with pain, in many cases severe, and usually no history of trauma or eventually a history of minor trauma, such as a fall from standing height. If some cases, when these fractures are not displaced, detection is a challenge. In other cases, due to their location and equivocal features, differential diagnosis with malignancy has to be made. Radiographs, magnetic resonance imaging, multidetector computed tomography, positron emission tomography-computed tomography, and radionuclide scans have diverse roles in the diagnosis of insufficiency fractures.