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In the last few years physical activity has assumed an important role as a factor of prevention and therapy in various pathologies, in particular in degenerative diseases of adulthood and geriatric age. Physical activity therefore represents a primary and secondary prevention tool and of therapy in association with pharmacological and / or surgical devices and assumes a decisive role in the integrated management of chronic diseases; skeletal, neuromuscular, cardiovascular and renal. Chronic kidney diseases are now a vast problem involving not only nephrologists but also general's doctors and numerous categories of specialists. They are progressive diseases often linked to risk factors, such as diabetes and hypertension, which in the last stage provide for the use of dialysis and transplantation as a solution. An early diagnosis can allow an appropriate management of the disease in order to slow down its evolution towards the more advanced stages. The National Kidney Foundation Disease Outcomes Quality Initiative underlines the importance of an active lifestyle in people with chronic renal disease and in particular it has been repeatedly stressed that physical activity should be considered as a milestone in the treatment of the disease . People with chronic kidney disease and especially those on dialysis are sedentary, at a high risk of cardiovascular disease. Indeed, it should be borne in mind that dialysis subjects often have a rather high age, on average around 70 years, and often present comorbidities and physical disabilities, which increase the tendency of these subjects to a greater sedentary lifestyle compared to peer subjects healthy age. In the dialysis patient there is also a close correlation between nutritional status and physical activity; protein-calorie malnutrition reduces physical performance by promoting inactivity which in turn leads to a reduction in muscle tone and muscle trophism and therefore reduces lean body mass and tolerance to exercise. Physical inactivity, together with cigarette smoking, high blood pressure and dyslipidemia, are among the four main cardiovascular risk factors with economic consequences in terms of health expenditure. There is a dose-response relationship between the transition from sedentary lifestyle to moderate physical activity and health benefits. Sedentary lifestyle, which affects around 60% of the world's population, is correlated with an increased incidence of chronic degenerative diseases and premature death. it is estimated that eliminating the sedentary risk factor could reduce heart disease by 15-39%, strokes by 33%, colon cancer by 22-33% and bone fractures by 18%.

Objectives. SSc patients are recognized as presenting an increased risk of altered bone mass. The aim of this study was to assess the bone quality, by trabecular bone score (TBS), in SSc patients in correlation with different levels of microvascular damage, as evaluated by nailfold videocapillaroscopy (NVC), and to compare the results regarding bone quality with RA patients and healthy subjects (CNT). Methods. Eighty-four SSc patients, 98 RA patients and 60 CNT, were studied. BMD (g/cm(2)) of the lumbar spine (L1-L4) was analysed by DXA scan. Lumbar spine bone quality was derived from each spine DXA examination using the TBS analysis. NVC patterns were analysed. Results. A total of 56/84 SSc patients (66%) as well as 78/98 RA patients (80%) showed bone loss at DXA and BMD was found to be significantly lower than in the CNT (P< 0.001). Similarly, lumbar spine TBS was found to be significantly lower in SSc and RA patients than in CNT (P< 0.001). TBS values were found to be lower in SSc with a late NVC pattern, compared with the active or early pattern (late vs active and early pattern, P< 0.001). There was no statistically significant difference in the mean lumbar spine TBS between SSc and RA patients (P = 0.238). Conclusion. The data obtained showed significantly lower bone quality (lower TBS and BMD) in SSc and RA patients compared with CNT. The bone quality seemed lower in SSc patients with more altered microvasculature (late NVC pattern).