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La polyarthrite rhumatoïde est le rhumatisme inflammatoire chronique le plus fréquent. Nous assistons à un vieillissement de la population générale et donc de la population atteinte de polyarthrite rhumatoïde soulevant alors la question du rapport bénéfice/risque à l'introduction d'une thérapie ciblée. Le but de notre étude était ainsi d'évaluer la persistance thérapeutique à un an d'une thérapie ciblée débutée chez un patient âgé de plus de soixante-quinze ans atteint d'une polyarthrite rhumatoïde et d'identifier les facteurs associés à celle-ci notamment selon la ligne thérapeutique. Il s'agit d'une étude observationnelle, descriptive, rétrospective, monocentrique. Les patients étaient inclus au centre hospitalo-universitaire de Lille d'après le recueil de données de l'étude CORHUM (NCT04426279) et la file active de consultations externes. Soixante-quinze patients ont été inclus avec un âge médian de 79,0 ans. À un an, 62,51 % des patients poursuivaient toujours leur thérapie ciblée avec une médiane de survie calculée à 668 jours (Fig. 1). Pour toutes causes confondues d'arrêt, on retrouvait, en excluant les autres raisons, 58,33 % d'arrêts pour inefficacité et 41,67 % pour intolérance avec la survenue d'un effet indésirable grave chez 9 patients. La persistance thérapeutique à un an des thérapies ciblées introduites chez des patients âgés d'au moins soixante-quinze ans atteints de polyarthrite rhumatoïde apparaît satisfaisante. On retient en principale cause d'arrêt l'inefficacité mais avec un signal d'alerte quant à la survenue d'effets indésirables dits graves et constituant donc un point de vigilance et d'amélioration de la prise en charge de cette population. Une des clés d'amélioration pourrait être la sollicitation plus systématique de nos confrères gériatres pour évaluation de la notion de fragilité et conduire à une prise en charge optimale de patients ayant plus de comorbidités. Nous soulignons l'importance de la complémentarité des compétences et pouvons envisager, au minimum, au cas par cas, une évaluation pluridisciplinaire. [ABSTRACT FROM AUTHOR]

L'augmentation du risque de fracture en cas de sarcopénie reste débattue [1] , et les études publiées sont peu comparables, notamment du fait de l'utilisation de définitions variées de la sarcopénie. Notre objectif était d'évaluer si les statuts pré-sarcopénique et sarcopénique sont associés à une augmentation du risque de fracture. Il s'agissait d'une étude rétrospective utilisant la cohorte de la UK Biobank, et les critères de l'European Working Group on Sarcopenia in Older People 2 (EWGSOP2) [2]. La force musculaire était mesurée par le grip test, et l'indice de masse musculaire squelettique (SMI) était calculé à partir des données de bio-impédance. La pré-sarcopénie était définie comme une force musculaire abaissée associée à un SMI normal, tandis que la sarcopénie était définie comme une force musculaire abaissée associée à un SMI abaissé. Ces deux statuts, regroupés ci-après sous le nom PreSarc, étaient évalués comme facteurs prédictifs de fracture, par rapport au statut non-sarcopénique (NonSarc). Les évènements fracturaires recueillis étaient les suivants : « toute localisation fracturaire compatible avec une fracture ostéoporotique » (ci-après nommé « fracture »), et « toute localisation fracturaire compatible avec une fracture majeure » (ci-après nommé « fracture majeure »). D'autres analyses en sous-groupes étaient réalisées, notamment chez les non-sarcopéniques ayant une valeur basse de SMI (en regard d'une force musculaire normale). Les associations étaient évaluées à l'aide de modèles à risques proportionnels de Cox, ajustés sur de nombreux facteurs de risque de sarcopénie et de fracture (dont les données socio-démographiques, un équivalent de la densité minérale osseuse par densitométrie, les antécédents de chute et de fracture). Les hazard ratios ajustés (HR) et leurs intervalles de confiance à 95 % sont rapportés. Au total, 387 025 participants (54,4 % de femmes, âge médian de 58,0 (IQR : [51,0 ; 63,0] ans)) étaient inclus. L'étude dénombrait à l'inclusion 18 257 (4,7 %) participants pré-sarcopéniques et 1 124 (0,3 %) participants sarcopéniques. Au cours du suivi, d'une durée médiane de 12,0 (IQR : [11,4 ; 12,6]) ans, 18 300 (4,7 %) participants présentaient au moins un diagnostic de fracture incidente. Le groupe PreSarc était significativement associé à un risque augmenté de fracture (HR = 1,23, [1,16 ; 1,30]), comparé au groupe NonSarc, et était également significativement associé à un risque accru de fracture majeure (HR = 1,26 [1,17 ; 1,35]). En analysant séparément les participants pré-sarcopéniques et sarcopéniques, ces deux conditions étaient toujours associées à un risque accru de fractures, avec respectivement HR = 1,23 [1,16 ; 1,30] et HR = 1,22 [1,01 ; 1,47]. Une augmentation du risque de fractures était également constatée chez les participants NonSarc avec une valeur basse de SMI, par rapport aux NonSarc avec une valeur normale de SMI (HR = 1,19, [1,10 ; 1,29]). Cette étude démontre que les patients pré-sarcopéniques et sarcopéniques présentent un risque modérément augmenté de fractures par rapport aux non-sarcopéniques. Ce risque est aussi modérément augmenté chez les non-sarcopéniques avec une faible valeur de SMI, par rapport aux non-sarcopéniques avec SMI normal. Cela fait discuter de l'intérêt d'une mesure systématique la masse musculaire chez tous les patients à risque de sarcopénie, y compris ceux ayant une force musculaire normale, ce qui n'est actuellement pas recommandé dans les directives de l'EWGSOP2. [ABSTRACT FROM AUTHOR]

Summary: The Medication Use Patterns, Treatment Satisfaction, and Inadequate Control of Osteoporosis Study (MUSIC-OS) is a prospective, observational study of women with osteoporosis in Europe and Canada. At baseline, patients with gastrointestinal symptoms reported lower adherence to osteoporosis treatment, treatment satisfaction, and health-related quality of life, than those without gastrointestinal symptoms. Introduction: The aim of the study was to examine gastrointestinal (GI) symptoms and the association between GI symptoms and treatment adherence, treatment satisfaction, and health-related quality of life (HRQoL) among osteoporotic women in Europe and Canada. Methods: Baseline results are reported here for a prospective study which enrolled postmenopausal, osteoporotic women who were initiating (new users) or continuing (experienced users) osteoporosis treatment at study entry (baseline). A patient survey was administered at baseline and included the occurrence of GI symptoms during 6-month pre-enrolment, treatment adherence (adherence evaluation of osteoporosis (ADEOS), score 0-22), treatment satisfaction (Osteoporosis Treatment Satisfaction Questionnaire for Medications (OPSAT-Q), score 0-100) and HRQoL (EuroQol-5 dimension (EQ-5D) utility, score 0-1; OPAQ-SV, score 0-100). The association between GI symptoms and ADEOS (experienced users), OPSAT-Q (experienced users), and HRQoL (new and experienced users) was assessed by general linear models adjusted for patient characteristics. Results: A total of 2959 patients (2275 experienced and 684 new users) were included. Overall, 68.1 % of patients experienced GI symptoms in the past 6 months. Compared with patients without GI symptoms, patients with GI symptoms had lower mean baseline scores on most measures. The mean adjusted differences were ADEOS, −0.43; OPSAT-Q, −5.68; EQ-5D, −0.04 (new users) and −0.06 (experienced users), all P < 0.01. GI symptoms were also associated with lower OPAQ-SV domain scores: physical function, −4.17 (experienced users); emotional status, −4.28 (new users) and −5.68 (experienced users); back pain, −5.82 (new users) and −11.33 (experienced users), all P < 0.01. Conclusions: Patients with GI symptoms have lower treatment adherence and treatment satisfaction and worse HRQoL than patients without GI symptoms. [ABSTRACT FROM AUTHOR]

Osteoporosis accounts for about 3 % of total European health-care spending. The low proportion of costs for the pharmacological prevention of osteoporotic fracture means that it is highly cost saving, especially in patient with severe osteoporosis or patients who cannot take certain osteoporosis medications due to issues of contraindications or tolerability. Following recent regulatory changes, strontium ranelate is now indicated in patients with severe osteoporosis for whom treatment with other osteoporosis treatments is not possible, and without contraindications including uncontrolled hypertension, established, current or past history of ischaemic heart disease, peripheral arterial disease, and/or cerebrovascular disease. We review here today's evidence for the safety and efficacy of strontium ranelate. The efficacy of strontium ranelate in patients complying with the new prescribing information (i.e. severe osteoporosis without contraindications) has been explored in a multivariate analysis of clinical trial data, which concluded that the antifracture efficacy of strontium ranelate is maintained in patients with severe osteoporosis without contraindications and also demonstrated how the new target population mitigates risk. Strontium ranelate is therefore an important alternative in today's management of osteoporosis, with a positive benefit-risk balance, provided that the revised indication and contraindications are followed and cardiovascular risk is monitored. The bone community should be reassured that there remain viable alternatives in patients in whom treatment with other agents is not possible and protection against the debilitating effects of fracture is still feasible in patients with severe osteoporosis. [ABSTRACT FROM AUTHOR]

L'objectif de cette étude était de comparer l'incidence de nouvelles fractures dans 2 cohortes de femmes ostéoporotiques traitées soit par risédronate gastro-résistant, soit par tout autre BPO. Il s'agit d'une étude observationnelle rétrospective conduite dans une population de femmes des États-Unis issue d'une base de données d'assurance de santé (2009–2019). Pour être sélectionnées dans l'étude, les patientes devaient avoir un diagnostic d'ostéoporose et une délivrance de BPO, soit de risédronate gastro-résistant, soit de tout autre BPO (alendronate, ibandronate, risédronate). Les patientes ont été réparties soit dans la cohorte risedronate gastro-résistant, soit dans la cohorte autres BPO selon la délivrance initiale et pairées sur la base de leurs caractéristiques. Seules les patientes observées pour un minimum de 2 ans sans changement de traitement ont été sélectionnées. Les taux d'incidence de nouvelles fractures pour 1000 femme-années ont été comparées entre les 2 cohortes en utilisant le ratio du taux d'incidence (Incidence rate ratio–IRR). Résultats 2726 patientes ont été incluses dans chaque cohorte. Les 2 cohortes étaient comparables en termes d'âge (médiane 60 ans), de comorbidités et de prévalence fracturaire (1,7 % dans chaque groupe). La durée moyenne d'observation était de 4,51 ans. L'incidence des fractures observée était significativement inférieure dans le groupe risédronate gastro-résistant comparé au groupe des autres BPO, de 17 % pour l'ensemble des fractures [IRR = 0,83 (0,70–0,97)] et de 29 % pour les fractures vertébrales cliniques [IRR = 0,71 (0,54–0,95)] (p < 0,05 pour les deux). Le délai d'apparition du premier événement fracturaire était plus long dans le groupe risédronate gastro-résistant, devenant statistiquement significatif à partir de 36 mois, la différence s'accentuant avec le temps avec un taux de fractures respectivement de 11,85 % et de 14,44 % à 60 mois (p = 0,015). La comparaison entre le groupe risédronate gastro-résistant et le sous-groupe traité par alendronate (qui représentait 2/3 des délivrances dans la cohorte autres BPO) a porté sur 1807 patientes dans chaque groupe. Elle a également mis en évidence une incidence fracturaire pour le groupe risédronate gastro-résistant plus basse que pour le groupe alendronate de 19 % pour l'ensemble des fractures [IRR = 0,81 (0,66–0,98)] et de 31 % pour les fractures vertébrales cliniques [IRR = 0,69 (0,49–0,97)] (p < 0,05 pour les deux). La persistance des traitements était faible avec respectivement 63 et 69 % de femmes ayant interrompu leur traitement à 1 an dans le groupe des autres BPO et dans le groupe risédronate gastro-résistant. Dans cette étude et avec les limites d'interprétation inhérentes à sa méthodologie, l'incidence fracturaire était significativement plus basse chez les femmes ostéoporotiques traitées par risédronate gastro-résistant comparée à celles traitées par l'alendronate et plus généralement par l'ensemble des autres BPO. La persistance sous traitement n'explique pas ces résultats, ce qui suggère l'existence d'autres mécanismes pour expliquer cette différence. [ABSTRACT FROM AUTHOR]

L'inflammation chronique dans la polyarthrite rhumatoïde (PR) est un déterminant majeur de la survenue d'une ostéoporose secondaire. Le tofacitinib (Tofa), un inhibiteur de la voie de signalisation JAK-STAT, est capable de contrôler l'activité inflammatoire chez les patients atteints de PR et son mécanisme d'action pourrait conduire à des interactions directes avec l'os [1,2]. L'objectif principal de ce travail était de déterminer l'impact du Tofa sur les cellules du microenvironnement osseux dans des conditions inflammatoires. En particulier, nous avons étudié son effet sur la différenciation des cellules stromales dérivées de la moelle osseuse humaine (hBMSCs) vers les cellules ostéoblastiques (Ob) mais aussi vers les adipocytes médullaires (Ad) car le déséquilibre compétitif entre l'adipogenèse et l'ostéoblastogenèse est un processus mécanistique clé dans l'ostéoporose. Les hBMSCs (RoosterBio) ont été différenciées en Ob ou Ad dans des milieux appropriés pendant 3 jours avec le Tofa, utilisé à 200 nM, 400 nM (équivalent de la posologie de 5 mg ×2/jour) et 800 nM, et avec 1 ng/mL de TNFα afin de reproduire la condition d'inflammation dans la PR. Pour évaluer l'effet du Tofa sur des Ad matures, un traitement similaire a été appliqué pendant 6 jours sur des Ad dérivés des hBMSCs à 14 jours de différenciation. Les effets du Tofa ont été déterminés par un test de viabilité, une analyse d'expression génique et des tests biochimiques. En parallèle, dans une étude pilote, l'adiposité médullaire via la fraction graisseuse a été mesurée par IRM (technique Dixon) initialement et à 6 mois chez 9 patients atteints de PR traités par tofacitinib (étude TOFAT : NCT04175886). Les tests de cytotoxicité ont démontré que la viabilité cellulaire était très peu affectée sous Tofa et/ou TNFα. En condition non-inflammatoire et après 3 jours de différenciation Ob, le Tofa utilisé à 400 nM a conduit à une diminution significative de 2 fois l'expression génique de Runx2 (facteur de transcription clé de l'ostéogenèse) (p < 0,05). Au contraire, après trois jours de différenciation, les Ad traités sous Tofa 200, 400 et 800 nM, présentaient une forte augmentation de l'expression génique de PPARγ2, C/EBPα (deux facteurs de transcription clés de la différenciation des Ad) et de la Perilipine 1 (marqueur associé à la formation de gouttelettes lipidiques) par rapport au contrôle (p < 0,05). En condition inflammatoire, les niveaux d'expression génique de Runx2 n'étaient pas affectés quel que soit le traitement Tofa appliqué. Cependant, le traitement Tofa semblait limiter l'action négative du TNFα sur la différenciation des Ad. En effet, le niveau d'expression génique de PPARγ2 a été fortement augmenté avec la combinaison de TNFα et de Tofa 200, 400 et 800 nM par rapport aux Ad traitées par TNFα seul (p < 0,05). Cet effet positif sur l'adipogenèse en condition inflammatoire était aussi soutenu par une augmentation de la densité des Ad différenciées après traitement sous Tofa. Par ailleurs, nous avons retrouvé une augmentation significative de la fraction graisseuse à six mois de traitement par tofacitinib chez 9 patients atteints de PR (46,2 ± 7,0 % contre 53,2 ± 9,2 %, p < 0,01). Les données suggèrent une action stimulatrice du Tofa sur l'engagement et la différenciation des Ad. Ces résultats in vitro sont corrélés par des données cliniques préliminaires. L'augmentation de l'adiposité médullaire observée sous Tofa ne semble pas en faveur d'un effet positif du traitement sur l'os. [ABSTRACT FROM AUTHOR]

Le but de cette étude était de comparer les changements des marqueurs du remodelage osseux (BTM) après gastrique by-pass (RYGB) et sleeve gastrectomie (SG), et d'étudier leur association avec des marqueurs d'intérêt prédéfinis. Il s'agit d'une étude ancillaire d'une cohorte prospective (ABOS). Les patients SG présentant une obésité sévère et de 40 ans ou plus ont été appariés individuellement à des patients RYGB pour l'âge, le sexe, l'indice de masse corporelle (IMC) et le statut ménopausique. Les BTM, ainsi que les marqueurs d'intérêt prédéfinis (hormones calciotropes, calcium total, insuline, sclérostine et adipokines), ont été mesurés à l'inclusion, à 12 et 24 mois après la chirurgie bariatrique. Soixante-quatre patients (66 % de femmes) avaient un âge moyen (ET) de 49,6 ans (5,1) et un IMC moyen (ET) de 45,0 kg/m2 (6,0). Entre 0 et 12 mois, une augmentation significative des BTM a été observée dans les deux groupes (valeurs de p < 0,001). De plus, le RYGB était associé à une augmentation plus importante du télopeptide C-terminal (β-CTX) et du propeptide N-terminal du procollagène de type 1 (PINP) par rapport au SG (valeurs de p < 0,0001). De 12 à 24 mois, une diminution significative des BTM a été observée dans les deux groupes, mais aucune différence significative n'a été trouvée entre RYGB et SG. Cependant, les BTM ne sont pas revenus aux niveaux de base. Ainsi, un haut degré de remodelage osseux a été maintenu dans les deux groupes jusqu'à 24 mois. Les changements de PINP et de β-CTX à 12 mois étaient indépendamment associés au type d'intervention chirurgicale, après ajustement pour le poids ou chaque marqueur d'intérêt prédéfini (tous p < 0,0001). Fig. 1 Le RYGB était associé à une augmentation plus importante des BTM que la SG à 12 et 24 mois. Il persistait un haut niveau de remodelage osseux jusque 24 mois dans les 2 groupes. [ABSTRACT FROM AUTHOR]

Jusqu'à la publication des nouvelles recommandations françaises sur la prise en charge des arthrites septiques (AS) en 2020 [1] , notre pratique médicale reposait essentiellement sur les recommandations françaises de 1991 [2]. Comment étaient prises en charge les AS au cours des onze années précédant la publication des nouvelles recommandations ? Quels étaient les points forts de notre pratique et à l'inverse, y a-t-il des points à améliorer ? Nous avons mené une étude rétrospective dans le service de Rhumatologie du CHU de Lille, portant sur 115 patients présentant une AS bactérienne sur articulation native périphérique entre le 1er janvier 2009 et le 31 décembre 2020, dont 68 patients inclus entre 2015–2020. Nous avons écarté les patients inclus dans un essai interventionnel et ceux répondant aux critères d'exclusion des recommandations françaises 2020. Nos objectifs étaient d'évaluer l'adéquation de la prise en charge des AS sur articulation native périphérique au CHU de Lille entre 2015–2020 par rapport aux nouvelles recommandations Françaises et de décrire l'épidémiologie et la prise en charge des AS au CHU de Lille entre 2009 et 2020. En population totale, l'AS concernait surtout les hommes (68 hommes, soit 59,1 %) avec une moyenne d'âge de 59,7 ans. Les comorbidités les plus représentées étaient la présence d'une arthropathie sous-jacente (50 patients, soit 43,5 %), d'un diabète de type 1 ou type 2 (33 patients soit 28,7 %) et d'une néoplasie (25 patients soit 21,7 %). L'atteinte monoarticulaire (87,8 %) du genou (42,4 %) à staphylocoque (60,2 %) prédominait. Une endocardite était retenue dans 16,5 % des cas. L'évolution était défavorable (survenue d'un décès en lien avec l'AS, récidive de l'AS et/ou morbidité articulaire séquellaire) dans 25,2 % des cas. En comparant les patients de 2009–2014 à ceux de 2015–2020, on observait une diminution de la durée médiane d'antibiothérapie (43,5 jours [42,0 ; 86,0] versus 42,0 jours [32,0 ; 46,0] p < 0,010), ainsi qu'une augmentation du recours à un avis infectiologique (70,2 % versus 98,5 % p < 0,001). Par rapport aux nouvelles recommandations françaises, nous sommes en adéquation concernant la documentation microbiologique avant l'antibiothérapie (100 % d'hémocultures et 97,1 % de ponction articulaire entre 2015–2020). Certains points restent à améliorer ; 64,2 % des patients entre 2015–2020 avait une durée d'antibiothérapie totale comprise entre 4 à 6 semaines, seuls 73,5 % des patients entre 2015–2020 ont bénéficié d'une prise en charge rééducative à la sortie du service et 29,7 % des patients entre 2015–2020 ont été suivis sur une période de 6 mois à l'issu de l'hospitalisation. Cette étude suggère une adéquation satisfaisante de la prise en charge des AS dans notre service par rapport aux nouvelles recommandations françaises. Une progression doit être obtenue concernant la durée de l'antibiothérapie, la prise en charge rééducative ou encore le suivi des patients. [ABSTRACT FROM AUTHOR]

Le traitement antalgique médicamenteux recommandé en première intention dans la gonarthrose est le paracétamol. Du fait de son efficacité limitée, il est fréquemment remplacé par les opioïdes faibles (OF) malgré leur mauvaise tolérance, particulièrement chez les patients âgés. L'objectif de cette étude était de comparer l'efficacité antalgique et la tolérance d'un nouveau dispositif TENS de dernière génération, miniaturisé, flexible et connecté au smartphone (C-TENS) à celles des OF dans la prise en charge de la douleur chronique, modérée à sévère, chez des patients souffrant de gonarthrose. Étude de phase 3, en non-infériorité, multicentrique, prospective, randomisée, en simple aveugle sur le critère principal d'efficacité, contrôlée sur 3 mois, en deux groupes parallèles et comparant C-TENS aux OF. Critères principaux d'évaluation : intensité moyenne de la douleur à M3 (échelle numérique de 0 à 10) et nombre d'EI potentiellement liés aux traitements et évalués sur 3 mois de suivi (per protocole [PP] et intention de traiter [ITT]). Dans le groupe C-TENS, les patients positionnaient les électrodes selon un protocole standardisé. Dans le groupe OF, les investigateurs pouvaient choisir le traitement, l'adapter et/ou le remplacer si besoin. La limite de non-infériorité retenue a été 0,825 (limite en valeur absolue de la différence entre deux traitements actifs dans la douleur) et en deçà d'une différence cliniquement significative. Cent dix patients (55 par groupe) ont été randomisés : 48/55 (C-TENS) (87,3 %) et 44/55 (OF) (80,0 %) ont été suivis 3 mois. La non-infériorité du C-TENS a été démontrée en ITT et PP. À M3, intensité de la douleur (PP population) était de 3,87 (2,12) (C-TENS) comparée à 4,66 (2,37) (OF) (différence : −0,79 [0,44]). Une analyse de supériorité en ITT, prévue au protocole, a mis en évidence une meilleure efficacité de C-TENS (p = 0,0124). Le nombre d'EI potentiellement imputables aux traitements a été inférieur dans le groupe C-TENS (n = 7 vs n = 36, p < 0,001). À M3, le groupe C-TENS a atteint la réduction minimale cliniquement importante d'intensité de la douleur de 2,0 points avec −2,1 (2,3) alors que dans le groupe OF la réduction n'était que de −1,1 (2,1) ; différences inter-groupes significatives : 1,3 [0,6–2,0] p = 0,0007 (M1) et 0,9 [0,2–1,7], p = 0,0247 (M3). Dans le groupe OF, les EI ont été systémiques, correspondant à ceux rapportés avec les opioïdes alors que dans le groupe C-TENS ils étaient locaux (réactions cutanées de type érythème). C-TENS s'est montré plus efficace et mieux toléré que les OF pour traiter la douleur chronique de la gonarthrose. Ce nouveau dispositif TENS pourrait constituer une alternative non-pharmacologique intéressante aux traitements pharmacologiques de la douleur de gonarthrose. [ABSTRACT FROM AUTHOR]

Summary: A high prevalence of low bone mineralization is documented in adult patients with cystic fibrosis (CF). Osteopenia is present in as much as 85% of adult patients and osteoporosis in 13 to 57% of them. In children, studies are discordant probably because of different control database. Denutrition, inflammation, vitamin D and vitamin K deficiency, altered sex hormone production, glucocorticoid therapy, and physical inactivity are well known risk factors for poor bone health. Puberty is a critical period and requires a careful follow-up for an optimal bone peak mass. This review is a consensus statement established by the national working group of the French Federation of CF Centers to develop practice guidelines for optimizing bone health in patients with CF. Recommendations for screening and for calcium, vitamin D and K supplementation are given. Further work is needed to define indications for treatment with biphosphonates and anabolic agents. [Copyright &y& Elsevier]

Dans les lombosciatiques par conflit disco-radiculaire non compliquées, plusieurs essais randomisés contrôlés n'ont pas mis en évidence de différence significative sur la douleur et le handicap fonctionnel à 1 an entre prise en charge médicale et chirurgicale [1]. C'est pourquoi un geste radical n'est proposé, en dehors des situations nécessitant une intervention en urgence, qu'aux patients en échec du traitement médico-infiltratif. C'est dans ce contexte que nous avons voulu évaluer le taux de chirurgie chez les patients hospitalisés en rhumatologie pour une lombosciatique par hernie discale et identifier les facteurs prédictifs de recours à la chirurgie. Il s'agit d'un travail rétrospectif et monocentrique réalisé entre janvier 2014 et décembre 2018 dans un centre tertiaire. Sur les 450 patients hospitalisés pour une lombosciatique par hernie discale, 405 ont été inclus, après exclusion des patients justifiant d'une chirurgie en urgence. L'objectif principal était de déterminer la fréquence du recours à la chirurgie à 1 an de l'hospitalisation. L'objectif secondaire était d'identifier les facteurs prédictifs du recours à la chirurgie. Le recours à la chirurgie a été évalué à l'aide de la méthode de Kaplan–Meier et les facteurs associés en utilisant des modèles à risques proportionnels de Cox univariés, puis multivariés. Parmi les patients, 52,8 % étaient des femmes et l'âge moyen était de 47,5 ans (18–91 ans), avec un IMC moyen à 27,4 kg/m2. Le trajet radiculaire était réparti de manière équilibrée avec 44,7 % de trajets L5, 45,2 % de trajets S1 et 4,2 % de trajets mixtes L5 et S1 (Fig. 1). La fréquence du recours à la chirurgie à 1 an de l'hospitalisation était de 34,8 %, avec un délai médian de recours à une chirurgie de 31 jours (interquartile range : 3–112). En analyse multivariée, le fait d'être actif professionnellement (OR : 2,3 [1,5 ; 3,6]), l'impulsivité aux efforts physiologiques (OR : 2,0 [1,3 ; 3,1]), un déficit moteur à 4/5 (OR : 1,7 [1,2 ; 2,4]), la durée d'évolution de la symptomatologie avant l'hospitalisation supérieure à 3 mois (OR : 1,7 [1,1 ; 2,5]) et le nombre d'infiltrations (OR : 1,4 [1,2 ; 1,7]) étaient prédictifs d'une chirurgie. Dans notre étude, plus d'un tiers des patients sont opérés dans l'année, ce qui est comparable aux études antérieures [2]. Ce taux concerne une population hospitalisée dans un centre tertiaire, ce qui ne reflète probablement pas l'ensemble des lombosciatiques discales, et notamment ambulatoires. Des facteurs prédictifs de recours à la chirurgie ont été identifiés, notamment le fait d'être actif ou de présenter un déficit à 4/5. Le recours à un nombre plus important d'infiltrations est un facteur confondant, qui reflète peut-être l'intensité de la symptomatologie. La durée d'évolution supérieure à 3 mois avant la prise en charge hospitalière est un paramètre sur lequel il serait possible d'influer via une prise en charge plus précoce. [ABSTRACT FROM AUTHOR]

Suite à l'actualisation des recommandations françaises concernant les arthrites septiques (AS) sur articulation native, qui a été présentée lors du 32e congrès français de rhumatologie, nous avons souhaité évaluer l'adéquation entre notre prise en charge actuelle et celle récemment proposée, en vue d'identifier d'éventuels paramètres à optimiser. Il s'agit d'une étude rétrospective, monocentrique. Nous avons inclus tous les patients hospitalisés dans le service de rhumatologie au CHU de Lille entre le 1er janvier 2015 et le 31 décembre 2018 pour une AS bactérienne sur articulation native périphérique. Nous avons procédé à une analyse descriptive de cette population, puis nous avons étudié l'adéquation entre notre prise en charge et les recommandations actuelles. Sur les 48 patients inclus, 64,6 % étaient des hommes et l'âge moyen était de 61 ans. Parmi les patients, 33,3 % étaient diabétiques, et 27,1 % présentaient une néoplasie (solide ou hémopathie). Le genou était l'articulation la plus touchée (56,2 % des cas). L'AS est une urgence diagnostique (principe A) : le délai moyen de prise en charge de nos patients était de 17,2 ± 27,8 jours. Une ponction articulaire est indispensable avant toute antibiothérapie, sauf Quick Sequential Organ Failure Assessment (qSOFA) ≥ 2 (recommandation 3) : 93,8 % de nos patients bénéficiaient d'une ponction articulaire avant antibiothérapie. Cette ponction permettait de retrouver un germe dans 75,6 % des cas. Au moins 2 paires d'hémocultures sont nécessaires avant toute antibiothérapie (recommandation 5) : 100 % de nos patients en ont bénéficié, avec un germe identifié dans 40,0 % des cas. Les radiographies sont utiles au diagnostic d'arthropathie préexistante et pour le suivi structural (recommandation 6) : des radiographies étaient réalisées dans 98 % des cas au diagnostic d'AS et dans 54,0 % des cas à la première consultation de suivi. La recherche d'endocardite infectieuse (EI) par échographie transthoracique (ETT) doit être faite en cas d'AS à staphylocoque doré, streptocoque buccodentaire ou digestif, entérocoque, avec ou sans bactériémie (recommandation 8) : 70,8 % de nos patients bénéficiaient d'une ETT, quel que soit le germe. Dans 50 % des AS à staphylocoque doré, une EI n'était pas recherchée. L'antibiothérapie doit être adaptée aux résultats bactériologiques, hors critères de gravité (recommandation 9) : l'antibiothérapie était adaptée dans 75,0 % des cas. La durée totale d'antibiothérapie doit être de 4–6 semaines en moyenne (recommandation 10) : 50,0 % de nos patients ont reçu entre 4 et 6 semaines d'antibiothérapie. Un drainage articulaire peut être réalisé en cas de persistance d'un épanchement articulaire abondant (recommandation 11) : 54,2 % des patients bénéficiaient d'un drainage articulaire. Une prise en charge rééducative précoce adaptée à la douleur est indispensable (recommandation 13) : 73 % des patients de notre service bénéficiaient d'une prise en charge rééducative. Ce travail a mis en lumière notre adéquation avec les recommandations concernant la recherche d'un germe avant tout traitement, le taux d'évaluation structurale ou encore la mise en place d'une rééducation précoce. Il a également mis en exergue des points à améliorer tels que le délai de prise en charge ou la recherche d'une EI en cas d'infection à staphylocoque doré. [ABSTRACT FROM AUTHOR]

We conducted a review of 10 national guidelines from five EU countries to identify similarities or differences in recommendations for the management of patients with osteoporosis. We found general alignment of key recommendations; however, there are notable differences, largely attributed to country-specific approaches to risk assessment and reimbursement conditions., Introduction: The classification of fracture risk is critical for informing treatment decisions for post-menopausal osteoporosis. The aim of this review was to summarise 10 national guidelines from five European countries, with a focus on identifying similarities or differences in recommendations for the management of patients with osteoporosis., Methods: We summarised the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Disease-International Osteoporosis Foundation guidelines and reviewed guidelines from France, Germany, Italy, Spain and the UK., Results: The approach to risk assessment differed across the guidelines. In France, and Spain, risk assessment was based on DXA scans and presence of prior fractures, whereas UK, German and Italian guidelines recommended use of a validated risk tool. These differences led to distinct definitions of very high and high-risk patients. Guidelines aligned in recommending antiresorptive and anabolic agents as pharmacologic options for the management of osteoporosis, with sequential treatment recommended. There was agreement that patients at high or very high risk of fracture or with severe osteoporosis should receive anabolic agents first, followed by antiresorptive drugs. Variations were identified in recommendations for follow up of patients on anti-osteoporosis therapies. Reimbursement conditions in each country were a key difference identified., Conclusions: Criteria for risk assessment of fractures differ across European guidelines which may impact treatment and access to anabolic agents. Harmonisation across EU guidelines may help identify patients eligible for treatment and impact treatment uptake. However, country-specific reimbursement and prescribing processes may present a challenge to achieving a consistent approach across Europe., (© 2024. The Author(s).)

Bone forming agents, also known as anabolic therapies, are essential in managing osteoporosis, particularly for patients at very high-risk of fractures. Identifying candidates who will benefit the most from these treatments is crucial. For example, this group might include individuals with severe osteoporosis, multiple vertebral fractures, a recent fragility fracture or those unresponsive to antiresorptive treatments. Definitions of patients with a very high fracture risk vary across nations, are often based on fracture history, bone mineral density (BMD), and/or fracture risk calculated by FRAX® or other algorithms. However, for very high-risk patients, anabolic agents such as teriparatide, abaloparatide, or romosozumab are commonly recommended as first-line therapies due to their ability to stimulate new bone formation and improve bone microarchitecture, offering significant benefits in rapid fracture reduction over antiresorptive therapies. The cost-effectiveness of these agents is a critical consideration for decision-makers. Despite their higher costs, their effectiveness in significantly reducing fracture risk and improving quality of life can justify the investment, especially when long-term savings from reduced fracture rates and associated healthcare costs are considered. Additionally, after completing a course of anabolic therapy, transitioning to antiresorptive agents like bisphosphonates or denosumab is crucial to maintain the gains in bone density and minimize subsequent fracture risks. This sequential treatment approach ensures sustained protection and optimal resource utilization. In summary, the effective use of bone forming agents in osteoporosis requires a comprehensive strategy that includes accurate patient identification, consideration of cost-effectiveness, and implementation of appropriate sequential treatments, ultimately maximizing patient outcomes and healthcare efficiency., (© 2024. The Author(s).)

Objectives: The efficacy of anti-IL-6 receptors such as tocilizumab (TCZ) was demonstrated in patients with PMR in two recent randomized controlled trials. The objective of this multicentre retrospective study was to assess the efficacy of TCZ in PMR patients requiring glucocorticoid (GC)-sparing treatment, as well as different strategies for TCZ withdrawal., Methods: We conducted a multicentre study in French tertiary healthcare departments for patients with PMR. PMR patients receiving off-label TCZ between 2015 and 2022 were included. The primary endpoint was the proportion of patients tapering to GCs ≤5 mg/day 6 months after the first TCZ infusion. The secondary endpoints were the proportion in whom GC was discontinued during follow-up, and the proportion of patients in whom TCZ was discontinued., Results: Fifty-three PMR patients were included. Thirty-one patients suffered from active PMR despite conventional synthetic DMARDs. GCs were ≤5 mg/day in 77% of the patients (95% CI 36-89) at 6 months, and in 97% of the patients at 12 months. Six and 12 months after the first TCZ infusion, the proportions of GC-free patients were 22.5% (95% CI 12.7-37.8) and 58.3% (95% CI 43.2-74.1), respectively. Among TCZ withdrawal strategies, TCZ infusion spacing and TCZ dose reduction were more successful (success in 87% and 79% of attempts, respectively) than TCZ discontinuation (success in 52% of attempts; P = 0.012 and P = 0.039, respectively)., Conclusion: In GC-dependent PMR patients, treatment with TCZ led to a drastic decrease in GC dose and remission of PMR. TCZ dose reduction or TCZ infusion spacing are good options to consider in TCZ withdrawal., (© The Author(s) 2023. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Objective: To develop recommendations for the routine management of patients with polymyalgia rheumatica (PMR)., Methods: Following standard procedures, a systematic review of the literature by five supervised junior rheumatologists, based on the questions selected by the steering committee (5 senior rheumatologists), was used as the basis for working meetings, followed by a one-day plenary meeting with the working group (15 members), leading to the development of the wording and determination of the strength of the recommendations and the level of agreement of the experts., Results: Five general principles and 19 recommendations were drawn up. Three recommendations relate to diagnosis and the use of imaging, and five to the assessment of the disease, its activity and comorbidities. Non-pharmacological therapies are the subject of one recommendation. Three recommendations concern initial treatment based on general corticosteroid therapy, five concern the reduction of corticosteroid therapy and follow-up, and two concern corticosteroid dependence and steroid-sparing treatments (anti-IL-6)., Conclusion: These recommendations take account of current data on PMR, with the aim of reducing exposure to corticosteroid therapy and its side effects in a fragile population. They are intended to be practical, to help practitioners in the day-to-day management of patients with PMR., (Copyright © 2024 The Authors. Published by Elsevier Masson SAS.. All rights reserved.)

Historically, osteoporosis has been viewed as a disease of women, with research, trials of interventions and guidelines predominantly focused as such. It is apparent, however, that this condition causes a substantial health burden in men also, and that its assessment and management must ultimately be addressed across both sexes. In this article, an international multidisciplinary working group of the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases presents GRADE-assessed recommendations for the diagnosis, monitoring and treatment of osteoporosis in men. The recommendations are based on a comprehensive review of the latest research related to diagnostic and screening approaches for osteoporosis and its associated high fracture risk in men, covering disease burden, appropriate interpretation of bone densitometry (including the use of a female reference database for densitometric diagnosis in men) and absolute fracture risk, thresholds for treatment, and interventions that can be used therapeutically and their health economic evaluation. Future work should specifically address the efficacy of anti-osteoporosis medications, including denosumab and bone-forming therapies., (© 2024. Springer Nature Limited.)

We used data from a Fracture Liaison Service to compare the mean T-scores of obese and non-obese patients after a recent fragility fracture. After adjusting for age, sex, and diabetes mellitus, T-score values were significantly higher at all measurement sites in obese patients, with a mean difference of 1 SD., Purpose: This study aimed to compare the mean T-scores of obese and non-obese patients after recent fragility fractures., Methods: Over a period of 5 and a half years, from January 2016 to May 2021, patients from a fracture liaison service were identified and their demographic characteristics, osteoporosis risk factors, BMD T-scores, and fracture sites were compared between obese (BMI ≥ 30 kg/m 2 ) and non-obese (19 kg/m 2  < BMI < 30 kg/m 2 ) patients., Results: A total of 712 patients were included (80.1% women; mean age 73.8 ± 11.3 years). Sixteen % had type 2 diabetes mellitus and 80% had a major osteoporotic fracture (MOF). 135 patients were obese and 577 non-obese, with obese patients younger (p < 0.001) and more frequently female (p = 0.03). Obese patients presented with fewer hip fractures (10% vs. 21%, p = 0.003) and more proximal humerus fractures (16% vs. 7%, p < 0.001) than non-obese patients. After adjusting for age, sex, and diabetes mellitus, BMD T-score values were significantly higher at all measurement sites (lumbar spine, total hip, and femoral neck) in obese patients than in non-obese patients for all types of fractures, with a mean difference of 1 standard deviation (p < 0.001 for all comparisons). The same results were observed in the population limited to MOF., Conclusions: Given the crucial role of BMD T-score in determining the need for anti-osteoporotic medication following fragility fractures, it is reasonable to question the existing T-score thresholds in obese patients., (© 2024. International Osteoporosis Foundation and Bone Health and Osteoporosis Foundation.)

Proton pump inhibitors (PPIs) are widely used for acid-related gastrointestinal disorders; however, concerns have arisen about their prolonged and inappropriate use. Although generally considered safe, recent evidence has linked PPI use with an increased risk of kidney disease, stomach cancer, pneumonia, dementia, cardiovascular events and potential bone health problems. This systematic review examines the effects of PPIs on bone health, including osteoporosis and changes in phosphocalcic and magnesium metabolism, through a comprehensive analysis of the recent literature. The relationship between PPIs, bone mineral density and fracture risk, especially in populations with comorbidities, is complex and we propose a focus based on recent data. Studies of the effect of PPI use on bone mineral density have shown mixed results and require further investigation. Observational studies have indicated an increased risk of fractures, particularly vertebral fractures, associated with PPI use. Recent meta-analyses have confirmed an association between PPI use and hip fractures with a dose-dependent effect. More recently, PPIs have been associated with serious disturbances in phosphocalcic and magnesium metabolism that require careful management and discontinuation. Proton pump inhibitor-induced hypomagnesemia (PPIH) is a well-established phenomenon. In addition, hypocalcemia secondary to severe hypomagnesemia has been described. Despite growing evidence of PPI-related risks, further research is essential to better understand the complex mechanisms, as most data are from observational studies and do not establish a causal relationship. This review emphasizes the need for judicious prescription practices, particularly in long-term use scenarios and rheumatological contexts., (Copyright © 2024 Société française de rhumatologie. Published by Elsevier Masson SAS. All rights reserved.)

Background: Few studies on the risk of incident major adverse cardiac and cerebrovascular events (MACCEs) in sarcopenia have been reported. The objective was to assess the association between presarcopenia and sarcopenia and a higher risk of MACCEs., Methods: This study on the UK Biobank prospective cohort, used data collected between 2006 and 2021. Community-dwelling Caucasian participants aged 37 to 73 years were included if values for Handgrip Strength (HGS) and Skeletal Muscle Index (SMI) were available and if no history of MACCEs was reported. Exposure was assessed using the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) criteria. Muscle strength was measured using HGS, and muscle mass using the SMI. Presarcopenia was defined through the two definitions available in the literature, as low HGS with normal SMI and as normal HGS with low SMI, whereas sarcopenia was defined as low HGS with low SMI. The main outcome was to determine whether presarcopenia and/or sarcopenia were predictors of MACCEs (composite events)., Results: A total of 406,411 included participants (women: 55.7%) were included. At baseline, there were 18,257 (4.7%) presarcopenics-subgroup n°1 (low HGS only), 7940 (2.1%) presarcopenics-subgroup n°2 (low SMI only), and 1124 (0.3%) sarcopenics. Over a median follow-up of 12.1 years (IQR: [11.4; 12.8]), 28,300 participants (7.0%) were diagnosed with at least one event. Compared to NonSarc, presarcopenic (subgroups n°1 and n°2) and sarcopenic status were significantly associated with a higher risk of MACCEs (respectively fully adjusted HRs: HR = 1.25 [95% CI: 1.19; 1.31], HR = 1.33 [95% CI: 1.23; 1.45] and HR = 1.62 [95% CI: 1.34; 1.95])., Conclusions: In a community-dwelling population, the risk of MACCEs was higher in both presarcopenic and sarcopenic participants., (© 2023 The Authors. Journal of the American Geriatrics Society published by Wiley Periodicals LLC on behalf of The American Geriatrics Society.)

Objective: The EULAR task force recently published the difficult-to-treat RA (D2T RA) definition, however, a definition of D2T axSpA is still lacking and limitations in this definition exist. The objectives were to study the characteristics of D2T axSpA patients using the EULAR definition and to study a subgroup of patients with a predefined more stringent definition including a temporal criterion., Methods: A multicentric retrospective study was performed. D2T axSpA was defined as failure of≥2 b/tsDMARDs with different mechanism of action. Very D2T axSpA was defined as failure of≥2 b/tsDMARDs in less than 2 years of follow-up. D2T and Very D2T axSpA patients were compared to non-D2T (nD2T) axSpA patients., Results: Three hundred and eleven axSpA patients were included: 88 D2T axSpA (28.3%) and 223 non-D2T (nD2T) axSpA (71.7%). Peripheral involvement was more prevalent in the D2T group (34.9 vs. 21.4%; P=0.015). BASDAI level at baseline was higher in the D2T group (63.7±16.5 vs. 58.8±14.7; P=0.015). Fibromyalgia was found to be more frequent in the D2T group vs nD2T group (P<0.001). Twelve patients (3.8%) were categorized as very D2T axSpA. Compared to nD2T, Very D2T patients had a higher CRP level at baseline (42.0±31.3 vs. 17.8±23.1; P=0.010). IBD prevalence at baseline was higher in the very D2T group (41.7 vs. 3.1%; P<0.001). None of the very D2T patients presented a fibromyalgia., Conclusion: D2T axSpA was associated with higher disease activity, peripheral involvement, extra-musculoskeletal manifestations and fibromyalgia. Very D2T patients represented a minim proportion of patients after applying a more stringent definition including a temporal criterion of 2 years and might be independent from fibromyalgia., (Copyright © 2023 Société française de rhumatologie. Published by Elsevier Masson SAS. All rights reserved.)

Objective: The EULAR task force recently published the difficult-to-treat rheumatoid arthritis (D2T RA) criteria, however, a definition of D2T patients in psoriatic arthritis (PsA) is still lacking. To date, we have little data concerning D2T PsA, especially in real-world. One of the limitations of the D2T RA EULAR definition is the absence of a temporal criterion. The primary endpoint of this work was to study the characteristics of D2T PsA patients using the EULAR definition. The second objective was to study a sub-group of patients with a predefined more stringent definition including a temporal criterion., Methods: A retrospective study was performed in a tertiary center. D2T PsA was defined as failure of ≥ 2 b/tsDMARDs with different mechanism of action. Very D2T PsA was defined as failure of ≥ 2 b/tsDMARDs in less than 2 years of follow-up. D2T and Very D2T PsA patients were compared to nD2T PsA patients using statistical tests., Results: 150 PsA patients were included (from 2004 to 2015): 49 D2T PsA and 101 nD2T PsA. D2T PsA was associated with a higher prevalence of axial involvement (p=0.030), axial and/or peripheral structural damage (p=0.007) at baseline and more bDMARDs discontinuation due to poor dermatological control (p=0.005). There was no significant difference regarding comorbidities such as obesity, smoking status, fibromyalgia or depression. In multivariate analysis, peripheral structural damage at baseline was found to be a predictive factor for D2T PsA with an OR of 2.57 (1.16 to 5.69; p=0.020). 17 PsA (11.3%) patients were categorized as Very D2T PsA. When compared to nD2T group, proportion of obesity was higher (p=0.015) and axial involvement was more prevalent in the Very D2T group (p=0.020)., Conclusion: D2T PsA patients had a higher prevalence of axial involvement, peripheral structural damage and therapeutic discontinuation due to poor dermatological control whereas Very D2T PsA patients were more likely obese with axial involvement. Very D2T PsA represent a minim proportion among patients when applying a more stringent definition. Pending the PsA D2T definition by the European and American societies, this study highlights some characteristics that may help practitioners better identify D2T patients., Competing Interests: Declaration of Competing Interest Cécile Philippoteaux has no competing interest. Anne Marty-Ané has no competing interest. Emeline Cailliau has no competing interest. Julien Labreuche has no competing interest. Peggy Philippe received honorary fees from Abbvie, MSD, Novartis and Sanofi. Bernard Cortet has no competing interest. Julien Paccou has no competing interest. René-Marc Flipo is a member of the advisory board at Pfizer, MSD, Abbvie, Janssen, Celltrion, BMS and Sanofi. He received honorary fees from Pfizer, MSD, Abbvie, Janssen, Celltrion, BMS, Sanofi, Lilly, Galapagos, Novartis, Nordic Pharma, Roche-Chugai. Jean-Guillaume Letarouilly reports a research grant from Pfizer. He received honorary fees from Abbvie, Amgen, Biogen, BMS, Galapagos, Janssen-Cilag, MSD and Novartis, (Copyright © 2023 Elsevier Inc. All rights reserved.)

Studies on the fracture risk in presarcopenic and sarcopenic patients report contradictory results. The objective was to assess whether presarcopenia and sarcopenia are associated with an increase in fracture risk. We conducted a retrospective study using the UK Biobank cohort and the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) criteria. Muscle strength was evaluated using hand-grip strength (HGS) and muscle mass using the skeletal muscle index (SMI; from bioimpedance analysis). Presarcopenia was defined through the two definitions available in the literature, as low HGS with normal SMI and as normal HGS with low SMI, and sarcopenia as low HGS and low SMI. Fracture events were recorded as "fracture" (location compatible with an osteoporotic origin) and "major osteoporotic fracture" (MOF), as listed in the FRAX tool. Associations were assessed using Cox proportional hazards models, adjusted for sarcopenia and osteoporosis risk factors. Adjusted hazard ratios (HR a ) and their 95% confidence intervals (CI) were reported. A total of 387,025 participants (women 54.4%; median age 58.0 years; interquartile range [IQR] 51.0-63.0 years) were included. At baseline, there were 18,257 (4.7%) presarcopenic participants-subgroup 1 (low HGS only), 7940 (2.1%) presarcopenic participants-subgroup 2 (low SMI only), and 1124 (0.3%) sarcopenic participants. Over a median follow-up of 12.0 years (IQR 11.4-12.6 years), 18,300 (4.7%) participants were diagnosed with at least one incident fracture. Presarcopenic (subgroups 1 and 2) and sarcopenic status were significantly associated with a higher risk of fracture (respectively adjusted HRs: HR = 1.26 [1.19-1.33], HR = 1.20 [1.11-1.30], HR = 1.30 [1.08-1.56]) and with a higher risk of MOF (respectively adjusted HRs: HR = 1.30 [1.21-1.40], HR = 1.19 [1.08-1.72], HR = 1.18 [0.93-1.49]). In a middle-aged population, the fracture and MOF risks were higher in both presarcopenic and sarcopenic participants compared with nonsarcopenic participants. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR)., (© 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).)

Introduction: Recently, a study showing the non-inferiority of a single injection of sodium hyaluronate plus sorbitol (Synolis VA ® ) compared to hylan G-F20 (Synvisc-One ® ) over a 24-week period in patients with knee osteoarthritis was published. The objective of the present study is to assess if a short-term response to a single injection of sodium hyaluronate plus sorbitol can be maintained over a 6 month-period and if the maintenance of the response to treatment is dependent on the functional status at baseline., Methods: Responders to treatment at days 28, 84, and 168 were evaluated according to the responder criteria proposed by the OMERACT-OARSI. The Western Ontario and McMaster Universities Arthritis Index (WOMAC) was used to assess functional status at baseline. All analyses were adjusted for age, gender, BMI, and baseline WOMAC total score using data from the intention-to-treat (ITT) population., Results: Out of the 96 patients included in the study who were receiving Synolis VA ® , 59.38% were responders at day 28 according to the OMERACT/OARSI responder criteria, 59.78% at day 84, and 64.52% at day 168. Among the responders at D28, the probability of being responder at D84 and D168 was significantly higher than among non-responders, with corresponding odds ratio (95% CI) of 2.85 (1.07-7.59) and 7.28 (2.53-20.93), respectively. Patients with a poorer physical function at baseline were more likely to respond to the treatment at all time points, compared to those with a better physical function (OR 3.74 [1.37-10.21])., Conclusions: An early response of a single injection of sodium hyaluronate plus sorbitol is predictive of long-term response, up to 24 weeks. Patients with a poorer physical function may best benefit from the treatment., (© 2023. The Author(s).)

Context: Noninvasive assessment of proton density fat fraction (PDFF) by magnetic resonance imaging (MRI) may improve the prediction of fractures., Objective: This work aimed to determine if an association exists between PDFF and fractures., Methods: A case-control study was conducted at Lille University Hospital, Lille, France, with 2 groups of postmenopausal women: one with recent osteoporotic fractures, and the other with no fractures. Lumbar spine and proximal femur (femoral head, neck, and diaphysis) PDFF were determined using chemical shift-based water-fat separation MRI (WFI) and dual-energy x-ray absorptiometry scans of the lumbar spine and hip. Our primary objective was to determine the relationship between lumbar spine PDFF and osteoporotic fractures in postmenopausal women. Analysis of covariance was used to compare PDFF measurements between patient cases (overall and according to the type of fracture) and controls, after adjusting for age, Charlson comorbidity index (CCI) and BMD., Results: In 199 participants, controls (n = 99) were significantly younger (P < .001) and had significantly higher BMD (P < 0.001 for all sites) than patient cases (n = 100). A total of 52 women with clinical vertebral fractures and 48 with nonvertebral fractures were included. When PDFFs in patient cases and controls were compared, after adjustment on age, CCI, and BMD, no statistically significant differences between the groups were found at the lumbar spine or proximal femur. When PDFFs in participants with clinical vertebral fractures (n = 52) and controls were compared, femoral neck PDFF and femoral diaphysis PDFF were detected to be lower in participants with clinical vertebral fractures than in controls (adjusted mean [SE] 79.3% [1.2] vs 83.0% [0.8]; P = 0.020, and 77.7% [1.4] vs 81.6% [0.9]; P = 0.029, respectively)., Conclusion: No difference in lumbar spine PDFF was found between those with osteoporotic fractures and controls. However, imaging-based proximal femur PDFF may discriminate between postmenopausal women with and without clinical vertebral fractures, independently of age, CCI, and BMD., (© The Author(s) 2023. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Introduction: Bone marrow adipose tissue (BMAT) is associated with aging, osteoporosis, and chronic kidney disease (CKD). To date, the association between BMAT and kidney function in postmenopausal women has not been thoroughly investigated. The main purpose of this study was to determine whether a relationship exists between proton density fat fraction (PDFF) and kidney function in postmenopausal women., Methods: We investigated the cross-sectional association between estimated glomerular filtration rate (eGFR) - calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation - and PDFF - measured at the lumbar spine and proximal femur using Water Fat Imaging (WFI) MRI - in 199 postmenopausal women from the ADIMOS cohort study. We also performed DXA scans and laboratory measurements of sclerostin and c-terminal Fibroblast Growth Factor 23 (cFGF23)., Results: Participants' mean age was 67.5 (standard deviation, SD 10.0) years. Their median eGFR was 85.0 (interquartile range, IQR 72.2-95.0) ml/min/1.73 cm 2 , and their mean lumbar spine PDFF was 57.9 % (SD 9.6). When classified by eGFR-based CKD stages, 41.7 % of the cohort had an eGFR ≥ 90 ( n  = 83), 47.2 % had an eGFR of 60-89.9 ( n  = 94), and 11.1 % had an eGFR of 30-59.9 ( n  = 22). Participants with eGFR ≥ 90 had a lower lumbar spine PDFF than those with eGFR 60-89.9 (mean 55.8 % (9.8) vs. 58.9 % (9.0), p  = 0.031) and those with eGFR 30-59.9 (55.8 % (9.8) vs. 60.8 % (9.8), p  = 0.043). However, the differences did not remain significant after adjusting for predetermined confounders, including age, diabetes, Charlson comorbidity index, recent history of fragility fracture, appendicular lean mass, and lumbar spine BMD. The inclusion of sclerostin and/or cFGF23 as suspected mediators did not alter the findings. When proximal hip imaging-based PDFF was considered, no significant differences were found between the eGFR categories in the unadjusted and adjusted analyses., Conclusion: No evidence of an association between kidney function and bone marrow adiposity was found either in the lumbar spine or proximal femur in a cohort of postmenopausal women., Competing Interests: Anne Cotten has received an honorarium from Novartis. Bernard Cortet has received honoraria from Alexion, Amgen, Expanscience, Kyowa-Kirin, MSD, Novartis, Theramex, UCB and Viatris. Julien Paccou has received honoraria from Amgen, MSD, Eli Lilly, Kyowa-Kirin, Theramex and Pfizer. For the remaining authors, none were declared., (© 2023 The Authors. Published by Elsevier Inc.)

Background: In response to the gradual decline in the number of prescriptions for anti-osteoporosis medication (AOM) following fragility fractures, fracture liaison services (FLSs) have been set up around the world with the aim of filling this treatment gap. Several studies have already reported the benefits of such organizations, particularly in reducing fracture risk, mortality rates and healthcare costs, and literature on FLSs has increased at a steady pace over time., Methods: A narrative review was conducted on the latest available findings on the effectiveness of FLSs. Various approaches to implementing an effective FLS program are discussed., Results: FLS programs have enhanced the management of osteoporosis-related fractures. However, several studies have highlighted that not all FLSs are necessarily effective in reducing subsequent fracture risk and mortality. Long-term AOM persistence and monitoring are another critical issue in FLS programs. A few studies have reported that FLSs are associated with an improvement in AOM persistence, regardless of the type of AOM. Practitioners in the FLS setting need to be aware of the impact of recency of fracture and fracture recurrence rates, and the need for timely interventions. The administration of zoledronic acid in an in-patient setting may improve AOM treatment rates in patients, who often encounter obstacles to outpatient follow-up. Introducing 'vertebral fracture identification services' in FLS programs is also an option. However, doing so leads to an increase in workload and this would need to be considered by any FLS that is considering introducing such a service. Evidence suggests that digital technologies can support (i) multidisciplinary teams in providing the best possible patient care based on current evidence, and (ii) patient self-management. However, as the methodological quality of many of the studies evaluating these technologies was poor, their validity of their results is limited., Conclusion: Further research should focus on the optimal implementation of post-fracture care using automated systems, and standardized reporting of patient's characteristics and outcome measures using key performance indicators., (Copyright © 2023 Société française de rhumatologie. Published by Elsevier Masson SAS. All rights reserved.)

Objectives: Although paravertebral intramuscular fatty infiltration (known as myosteatosis) following a vertebral fracture is well-known, scarce data are available regarding interactions between muscle, bone, and other fat depots. Based on a homogeneous cohort comprising postmenopausal women with or without a history of fragility fracture, we aimed to better depict the interrelationship between myosteatosis and bone marrow adiposity (BMA)., Methods: 102 postmenopausal women were included, 56 of whom had a fragility fracture. Mean proton density fat fraction (PDFF) was measured in the psoas (PDFF Psoas ) and paravertebral (PDFF Paravertebral ) muscles at the lumbar level, as well as in the lumbar spine and non-dominant hip using chemical shift encoding-based water-fat imaging. Visceral adipose tissue (VAT) and total body fat (TBF) were assessed using dual X-ray absorptiometry. Statistical models were adjusted for age, weight, height (all comparisons), and bone mineral density (when considering BMA)., Results: PDFF in the psoas and paravertebral muscles was higher in the fracture group compared to controls even after adjustment for age, weight, and height (PDFF Psoas = 17.1 ± 6.1% versus 13.5 ± 4.9%, p=0.004; PDFF Paravertebral = 34.4 ± 13.6% versus 24.9 ± 8.8%, p=0.002). Higher PDFF Paravertebral was associated with lower PDFF at the lumbar spine ( β = -6.80 ± 2.85, p=0.022) among controls but not in the fracture group. In both groups, a significant relationship between higher PDFF Psoas and higher VAT was observed ( β = 20.27 ± 9.62, p=0.040 in the fracture group, and β = 37.49 ± 8.65, p<0.001 in the control group). Although solely observed among controls, a similar relationship was observed between PDFF Paravertebral and TBF ( β = 6.57 ± 1.80, p<0.001). No significant association was observed between BMA and other fat depots., Conclusion: Myosteatosis is not associated with BMA among postmenopausal women with fragility fractures. Whereas myosteatosis was associated with other fat depots, BMA appears uniquely regulated., Competing Interests: JP has received honoraria from Amgen, MSD, Eli Lilly, and Pfizer. BC has received honoraria from Amgen, Eli Lilly, Expanscience, Ferring, Medtronic, Novartis, Nordic, Roche Diagnostics, and Theramex. AC has received honoraria from Novartis. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Badr, Dapvril, Lombardo, Khizindar, Martin, Cortet, Cotten and Paccou.)

For a better understanding of the pathophysiology of spondyloarthropathy (SpA), a detailed anatomical description of the sacroiliac joint is required because sacroiliitis is the earliest and most common sign of SpA and an essential feature for the diagnosis of ankylosing spondylitis. Beyond the anatomy, the histopathology of sacroiliac entheses and immunological mechanisms involved in sacroiliitis are crucial for a better understanding of disease causation. In this narrative review, we discuss the core anatomical, histological, and immunohistological observations involved in the development of sacroiliitis, focusing particularly on imaging-based information associated with sacroiliitis. Finally, we try to answer the question of whether at the sacroiliac joint, enthesitis precedes synovitis and subchondral bone changes in SpA., Competing Interests: BC was employed by Alexion, Amgen, Kyowa Kirin, Lilly, MSD, Novartis, Theramex, Sublimed, UCB, and Viatris. BG was employed by Lilly, Sandoz, AbbVie, Viatris, Fresenius Kabi, and Pfizer. TL was employed by AbbVie, Boehringer Ingelheim, BMS, Fresenius, Galapagos, Lilly, Medac, MSD, Nordic Pharma, Novartis, Pfizer, Roche–Chugai, UCB. EL was employed by AbbVie, Expanscience, Pfizer, Janssen, Lilly, Novartis, and UCB. HM was employed by AbbVie, Accord, BMS, Celltrion, Janssen, Lilly, Nordic, Novartis, Pfizer, UCB, Sandoz, and Sanofi. CP was employed by Novartis, AbbVie, Pfizer, Sandoz, BMS, UCB, Janssen, Lilly, and Celltrion. AT was employed by AbbVie, Fresenius Kabi, Galapagos, Lilly, MSD, Novartis, Pfizer, and UCB. The remaining author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Prati, Lequerre, Le Goff, Cortet, Toumi, Tournadre, Marotte and Lespessailles.)

Introduction: This article presents the initial recommendations of the French Rheumatology Society (Société Française de Rhumatologie - SFR) and the Osteoporosis Research and Information Group (Groupe de Recherche et d'Informations sur les Ostéoporoses - GRIO) on the role of diet in the prevention and treatment of osteoporosis., Methods: The recommendations were produced by a working group composed of rheumatologists, physician nutrition specialists and a geriatrician. Fifteen (15) questions pertaining to "daily practices" were preselected by the working group. For the literature review, the working group focussed mainly on the effects of diet on bone mineral density (BMD) and fractures, and primarily on meta-analyses of longitudinal studies and dietary intervention studies., Results: A Mediterranean-type diet and the daily consumption of 2 to 3 dairy products are recommended. Together, these provide the calcium and "high quality" protein required to maintain a normal calcium-phosphorus balance and bone metabolism, and are associated with lower fracture risk. Conversely, unbalanced Western diets, vegan diets, weight-loss diets in non-overweight individuals, alcohol consumption and daily consumption of sodas are advised against. In terms of the beneficial effects on bone mineral density and fracture risk, current scientific data are either insufficient or too divergent to recommend increasing or restricting the consumption of tea or coffee, vitamins other than vitamin D, vitamin D-enriched or phytoestrogen-rich foods, calcium-enriched plant-based beverages, oral nutritional supplements, or dietary sources of prebiotics and probiotics., Conclusions: These are the first set of recommendations addressing the role of diet in the prevention and treatment of osteoporosis. More research is necessary to direct and support guidelines., (Copyright © 2022 Société française de rhumatologie. Published by Elsevier Masson SAS. All rights reserved.)

The study results indicate that women with osteoporosis initiated on gastro-resistant risedronate have a lower risk of fracture than those initiated on immediate release risedronate or alendronate. A large proportion of women discontinued all oral bisphosphonate therapies within 1 year of treatment start., Purpose: Using a US claims database (2009-2019), we compared risk of fractures between women with osteoporosis initiated on gastro-resistant (GR) risedronate and those initiated on (a) immediate release (IR) risedronate or (b) immediate release alendronate., Methods: Women aged ≥ 60 years with osteoporosis who had ≥ 2 oral bisphosphonate prescription fills were followed for ≥ 1 year after the first observed bisphosphonates dispensing (index date). Fracture risk was compared between the GR risedronate and IR risedronate/alendronate cohorts using adjusted incidence rate ratios (aIRRs), both overall and in subgroups with high fracture risk due to older age or comorbidity/medications. Site-specific fractures were identified based on diagnosis codes recorded on medical claims using a claims-based algorithm. Persistence on bisphosphonate therapy was evaluated for all groups., Results: aIRRs generally indicated lower fracture risk for GR risedronate than IR risedronate and alendronate. When comparing GR risedronate to IR risedronate, statistically significant aIRRs (p < 0.05) were observed for pelvic fractures in the full cohorts (aIRRs = 0.37), for any fracture and pelvic fractures among women aged ≥ 65 years (aIRRs = 0.63 and 0.41), for any fracture and pelvic fractures among women aged ≥ 70 years (aIRRs = 0.69 and 0.24), and for pelvic fracture among high-risk women due to comorbidity/medications (aIRR = 0.34). When comparing GR risedronate to alendronate, statistically significant aIRRs were observed for pelvic fractures in the full cohorts (aIRR = 0.54), for any fracture and wrist/arm fractures among women aged ≥ 65 years (aIRRs = 0.73 and 0.63), and for any fracture, pelvic, and wrist/arm fractures among women aged ≥ 70 years (aIRRs = 0.72, 0.36, and 0.58). In all cohorts, ~ 40% completely discontinued oral bisphosphonates within 1 year., Conclusions: Discontinuation rates of oral bisphosphonate therapy were high. However, women initiated on GR risedronate had a significantly lower risk of fracture for several skeletal sites than women initiated on IR risedronate/alendronate, particularly those aged ≥ 70 years., (© 2023. The Author(s).)

Sclerostin is a Wnt signaling pathway inhibitor that negatively regulates bone formation. Bone-marrow-derived stromal cell (BMSC) differentiation is influenced by the Wnt pathway, leading to the hypothesis that higher levels of sclerostin might be associated with an increase in bone marrow adiposity (BMA). The main purpose of this study was to determine whether a relationship exists between circulating sclerostin and BMA in post-menopausal women with and without fragility fractures. The relationships between circulating sclerostin and body composition parameters were then examined. The outcomes measures included vertebral and hip proton density fat fraction (PDFF) using the water fat imaging (WFI) MRI method; DXA scans; and laboratory measurements, including serum sclerostin. In 199 participants, no significant correlations were found between serum sclerostin and PDFF. In both groups, serum sclerostin was correlated positively with bone mineral density (R = 0.27 to 0.56) and negatively with renal function (R = -0.22 to -0.29). Serum sclerostin correlated negatively with visceral adiposity in both groups (R = -0.24 to -0.32). Serum sclerostin correlated negatively with total body fat (R = -0.47) and appendicular lean mass (R = -0.26) in the fracture group, but not in the controls. No evidence of a relationship between serum sclerostin and BMA was found. However, serum sclerostin was negatively correlated with body composition components, such as visceral adiposity, total body fat and appendicular lean mass.

The purpose of this study was to evaluate the implementation of the European Calcified Tissue Society (ECTS) 2022 recommendations on the prevention and treatment of osteoporosis secondary to bariatric surgery. The ECTS 2022 recommendations were applied in a retrospective cohort of postmenopausal women and men aged 50 years and older who were undergoing or had already undergone bariatric surgery. Osteoporosis medication was indicated if any of the following criteria were met: (i) history of recent (within 2 years) fragility fracture after the age of 40 years, (ii) BMD T score ≤ -2 at any of the sites of measurement, and (iii) FRAX ® ≥ 20% for major osteoporotic fractures and/or ≥3% for hip fractures. Of the 170 patients (144 women, mean age 59 (55 to 63) years) included between February 2019 and March 2022, 33 were eligible for osteoporosis medication based on the ECTS 2022 recommendations, i.e., a prevalence of 19.6% [CI95%: 13.9%; 26.5%]. Most patients met the BMD T score ≤ -2 criterion ( n = 25/170, 14.7% [CI95%: 9.7%; 20.9%]) and/or the history of recent fragility fracture criterion ( n = 12/170, 7.1% [CI95%: 3.7%; 12.0%]). In this study, a fifth of our population was found to be eligible for osteoporosis medication after the application of the ECTS 2022 recommendations.

Background: Disc-related sciatica is a frequent condition. Most cases of sciatica evolve favorably. Although several randomized controlled trials have reported that surgery is more effective than conservative management in the short-term, no significant differences in pain or functional disability have been reported in the longer term. As such, discounting complications requiring urgent intervention, surgery is generally only performed in patients in whom medical treatment has failed. Our objective was to determine the rate and predictive factors of surgical treatment one year after in-hospital conservative management of disc-related sciatica., Methods: Retrospective, observational, single-center study conducted in the Rheumatology Department of the Lille University Hospital Center between 2014 and 2018., Results: In the study population (n=405), the frequency of surgery one year after hospitalization was 34.8%. Median time to surgery was 31 days. In multivariate analysis, working [odds ratio (OR) 2.3, 95% confidence interval (CI): 1.5; 3.6)], impulsive pain (OR 2.0, 95% CI: 1.3; 3.1), motor loss (OR 1.7; 95% CI: 1.2; 2.4) and number of infiltrations (OR 1.4, 95% CI: 1.2; 1.7) were predictive of surgery. A decrease in numeric pain-scale rating of the leg between the beginning and end of hospitalization was associated with fewer cases of surgery (OR 0.921, 95% CI: 0.861; 0.985)., Conclusions: A proportion of 34.8% of the patients hospitalized for disc-related sciatica did undergo surgery within one year of our medical management protocol. Several predictive factors for surgery were found., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jss.amegroups.com/article/view/10.21037/jss-22-43/coif). The authors have no conflicts of interest to declare., (2022 Journal of Spine Surgery. All rights reserved.)

Introduction: This article presents the initial recommendations of the Groupe de Recherche et d'Information sur les Ostéoporoses (Osteoporosis Research and Information Group [GRIO]) and the Société Française de Rhumatologie (French Rheumatology Society [SFR]) on the prevention and treatment of osteoporosis secondary to bariatric surgery., Methods: The recommendations were produced by a working group comprising 4 expert rheumatologists, 3 medically qualified nutritionists, 2 obesity surgeons, 1 physical activity specialist, and 1 patient-association representative., Results: The following generally recommended measures apply to all patients with an indication for bariatric surgery or who have already undergone bariatric surgery: normalize calcium and protein intake, attain a 25(OH) vitamin D concentration of between 30 and 60ng/mL; prevent the risk of falls, and introduce a suitable regimen of physical activity. An initial assessment of fracture risk should be routinely performed - ideally before the first bariatric surgery procedure - (i) in the case of RYGB and biliopancreatic diversion, regardless of age, (ii) in patients at high risk of fracture, regardless of age, and (iii) in all menopausal women and all men ≥ 50 years old, regardless of the type of bariatric surgical procedure. The fracture risk assessment is based on a determination of osteoporosis risk factors and bone mineral density measurements. Anti-osteoporosis treatment - zoledronic acid as the first line of treatment - is indicated for menopausal women and men ≥ 50 years old with (i) a history of severe fracture, regardless of T-score, (ii) a history of non-severe fracture and a T-score ≤ -1, and (iii) no history of fracture and a T-score ≤ -2., Conclusions: There is an increased risk of fracture after bariatric surgery. Clinicians should focus their attention on patients at high fracture risk such as postmenopausal women and men older than 50 years. More research is necessary to direct and support guidelines., (Copyright © 2022 Société française de rhumatologie. Published by Elsevier Masson SAS. All rights reserved.)

Oral bisphosphonates are a key intervention in the treatment of osteoporosis and in reducing the risk of fragility fractures. Their use is supported by over 3 decades of evidence; however, patient adherence to oral bisphosphonates remains poor in part due to complex dosing instructions and adverse events, including upper gastrointestinal symptoms. This problem has led to the development of novel oral bisphosphonate formulations. Buffered, effervescent alendronate is dissolved in water and so seeks to reduce upper gastro-intestinal adverse events, and gastro-resistant risedronate aims to reduce the complexity of dosing procedure (e.g. fasting prior to consumption) whilst still maintaining the efficacy of fracture risk reduction. Clinical trials and real-world data have been employed to demonstrate some benefits in terms of reduced upper gastro-intestinal adverse events, adherence, persistence and health economic outcomes. This report describes the result of an ESCEO (European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis) expert working group, which explores where oral bisphosphonates sit in current clinical practice guidelines, review their risk-benefit profile and the consequences of poor adherence before exploring novel oral bisphosphonate formulations and their potential clinical and health economic impact. Further research is required but there are signs that these novel, oral bisphosphonate formulations may lead to improved tolerance of oral bisphosphonates and thus, improved adherence and fracture outcomes., (© 2022. The Author(s).)

Vitamin D is a key component for optimal growth and for calcium-phosphate homeostasis. Skin photosynthesis is the main source of vitamin D. Limited sun exposure and insufficient dietary vitamin D supply justify vitamin D supplementation in certain age groups. In older adults, recommended doses for vitamin D supplementation vary between 200 and 2000 IU/day, to achieve a goal of circulating 25-hydroxyvitamin D (calcifediol) of at least 50 nmol/L. The target level depends on the population being supplemented, the assessed system, and the outcome. Several recent large randomized trials with oral vitamin D regimens varying between 2000 and 100,000 IU/month and mostly conducted in vitamin D-replete and healthy individuals have failed to detect any efficacy of these approaches for the prevention of fracture and falls. Considering the well-recognized major musculoskeletal disorders associated with severe vitamin D deficiency and taking into account a possible biphasic effects of vitamin D on fracture and fall risks, an European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) working group convened, carefully reviewed, and analyzed the meta-analyses of randomized controlled trials on the effects of vitamin D on fracture risk, falls or osteoarthritis, and came to the conclusion that 1000 IU daily should be recommended in patients at increased risk of vitamin D deficiency. The group also addressed the identification of patients possibly benefitting from a vitamin D loading dose to achieve early 25-hydroxyvitamin D therapeutic level or from calcifediol administration., (© 2022. The Author(s).)

Objective: Little is known about body composition in patients with psoriatic arthritis (PsA). Our objective was to compare body composition parameters in PsA patients and healthy controls and then investigate the effects of ustekinumab (UST) on body composition in patients with PsA., Methods: At baseline, 30 PsA patients were compared cross-sectionally with 60 healthy controls without PsA, matched for age, sex, menopausal status, and body mass index (BMI). Thirty active PsA patients treated with UST were included in a 6-month open follow-up study. Body composition parameters were measured at baseline and 6 months of treatment., Results: Body composition parameters were different in PsA patients compared to healthy controls; in PsA patients, total and appendicular lean mass were lower (P = 0.013 and P = 0.010, respectively), whereas total fat mass was higher (P < 0.001). In 30% of the PsA patients, skeletal muscle mass was below the cutoff for low muscle quantity (men 7.26 kg/m 2 , women 5.5 kg/m 2 ), whereas no such change was observed in the control group. After 6 months of treatment with UST, there was no significant change in BMI in 18 of the PsA patients. Total lean mass decreased slightly (P = 0.046), whereas fat mass tended to increase, but not significantly. No significant changes in appendicular lean mass and skeletal muscle mass index were observed., Conclusion: In this study, we found that PsA patients had higher fat mass and lower lean mass than healthy controls. At 6-months of treatment, total lean mass decreased slightly, whereas fat mass tended to increase, but not significantly., (© 2021 American College of Rheumatology.)