Objectives: The aim of this study was to analyse and compare the clinical profile, disease activity, extent of disabilities and response to treatment in patients with seropositive and seronegative Rheumatoid Arthritis (RA). Methods: A prospective observational study was conducted among 46 patients of RA at the General medicine and Rheumatology OPDs of a tertiary care hospital over a period of 18 months. The clinical profile, disease activity, extent of disabilities and response to treatment of patients with seropositive and seronegative RA was analysed and compared. Results: The number of joints involved as well as the outcome indicators (DAS 28 score, HAQ score, SDAI and CDAI) were significantly higher for the seronegative group of patients, indicating more inflammation, higher disease activity and slower response to treatment in the group. Rate of radiological progression of the disease was also higher in seronegative RA. Conclusion: Contrary to what was previously believed, patients with seronegative RA have a relatively later disease onset and more active disease at presentation. Physicians should be aware of the considerable clinical burden of seronegative RA, especially at the time of disease onset. However, given the small sample size of this study, these results require validation from larger cohorts.

Bone growth requires a balance of minerals such as calcium, phosphorus, and factors of bone biomineralization. The difference between jaws’ bones and the rest of the bones is the existence of teeth. Although the development of teeth has no similarities with bones, the biomineralization of both is happening at the same time. Consequently, the disturbances in the metabolism of minerals and peptides which participate in osteogenesis, have an impact on teeth, jaws, periodontal tissues, and oral mucosa. The hereditary and congenial metabolic bone diseases are being analysed and classified based on their genetic profile and oral manifestations. Regarding the categories, there are metabolic bone diseases caused by genetic mutations, like hereditary rickets, and others caused by chromosomal abnormalities, such as Down syndrome. In addition, many disorders are provoked by enzymatic dysfunction, disturbances of creation of polypeptide chain, while others have an unknown explanation. Many oral manifestations are related with problems in the dentition, oral mucosa, periodontal tissues, and jaws. Especially some syndromes present with cleft lip and palate. To conclude, there is a big variety of dental symptoms of these disorders, while the most frequent are the delayed eruption of teeth, oligodontia, a dysplastic enamel and dentine.

Hyperparathyroidism-jaw tumor syndrome is a rare disorder that is inherited in an autosomal dominant manner and predisposes to the development of parathyroid adenomas and carcinoma, ossifying jaw tumors, uterine neoplasms and renal cysts. It is caused by inactivating mutations in the gene CDC73 that it was first identified in 2002. The purpose of this narrative review is to highlight the genetic background of the syndrome and its clinical manifestations as well as to emphasize the significance of genetic testing in diagnosis from an early age. The clinical and familial features of the syndrome were collected by searching on electronic database PubMed/Medline using the MeSH terms “Hyperparathyroidism-jaw tumor syndrome” or “HPT-JT syndrome”. 246 articles were returned of which, 44 were reviews and 59 case reports. Two nationwide retrospective studies were found. This article is focused mainly on data from the last decade, as there seems to be a better understanding of the genetic basis due to the evolution of DNA sequencing techniques. To date, there have been over 200 patients reported in approximately 50 families carrying a germline mutation of CDC73 gene, suggesting that there should be an augmented awareness of identifying both patients and their relatives.

Implants are structures made of alloplastic materials. They are widely implemented in both orthopedics and dentistry in order to rehabilitate different parts of the body with predictable outcomes. Although plenty materials have been introduced, titanium still remains the gold standard in Implantology. MiRNAs constitute a group of small non-coding RNA sequences composed of approximately 22 nucleotides. It is a well-known fact that they play a significant role in various biological processes such as osseointegration and peri-implant health maintenance, promoting the differentiation of mesenchymal stem cells into osteoblast cells. They regulate bone remodeling and signaling pathways of bone formation as well. Moreover, miRNAs can be utilized as activators of implant surfaces, biomarkers in the diagnostic process and finally occupy a prominent place in the therapeutic approach in Implantology. Even though the importance of miRNAs in Implantology is obvious, more studies are needed for a complete comprehension of the effects triggered by miRNAs.

Denosumab is an antiresorptive agent that significantly reduces bone turnover markers, increases mineral density and as a result, decreases the risk of vertebral fractures. The drug holiday effect on denosumab is associated with a high risk of multiple vertebrae fractures soon after the withdrawal. Discontinuation reasons may vary, but common reasons are the patient’s will, discontinuation due to an upcoming dental procedure and long treatment period. Treatment of these fractures can be either surgical augmentation or conservative with the use of antiresorptive drugs. The purpose of this scientific paper is to review current data on the effect of either kyphoplasty or vertebroplasty on these types of fractures. Several studies showed that surgical augmentation is associated with a higher risk of multiple vertebrae fractures in comparison with conservative treatment and thus, it is not recommended, though more research is needed.

Spinal deformity is a common finding in patients with an underlying neurological disorder. The clinical course of patients with neuromuscular scoliosis depends on the nature, severity, and the overall impact of their neuromuscular disease. Progressive spinal deformity causes difficulty in mobility and seating status, and may be associated with cardiac and pulmonary complications. Management of neuromuscular scoliosis requires a multidisciplinary approach to obtain the best possible outcome. It is essential for patients to understand the nature of neuromuscular scoliosis, the potential risks and benefits of operative and nonoperative interventions. In this review, we discuss the causes, evaluation and management -both operative and nonoperative- of neuromuscular scoliosis.

Rheumatoid arthritis is a chronic inflammatory systemic autoimmune disorder that affects the joints, but often also other organs. It is the most common inflammatory rheumatic disease. Patients with rheumatoid arthritis suffer from chronic joint pain, disability, and increased mortality. The joints affected are usually those of the limbs, hands, and feet. If rheumatoid arthritis is not controlled with appropriate medication, it gradually leads over the years to destruction and permanent deformation of the joints, due to erosion of the cartilage and bone. The result of the condition is the disruption of joint mobility, the irreversible functional disability, the impairment of the patient's productivity and quality of life. The disease requires long-term medical monitoring and appropriate medication to suppress the inflammatory process, prevent deformities and maintain patients' functionality. One of the effects of the disease is the appearance of pannus, which is an aggressive structure in the inflamed rheumatoid joint that invades the cartilage and bone, thus causing irreversible joint damage. This article focuses bibliographically on rheumatoid arthritis and pannus to reveal the relationship between them.

Osteogenesis Imperfecta (OI) is a rare genetic disorder clinically characterized by skeletal and bone deformity, low bone mass, impaired bone strength, connective tissue symptoms and several extraskeletal symptoms. Mutations in the two genes that encode type I collagen are the most common cause of OI. During the last decade, numerous novel causative genes involved in collagen biosynthesis, modification, and secretion, osteoblast development and function, and bone homeostasis have been linked to recessive and dominant forms of OI. As a result, OI has evolved into a group of hereditary disorders that shed light on the factors that influence both quantity and quality of bone. In this review the molecular genetics and the clinical phenotypes of all types of OI are described.

On the field of non-pharmaceutical prevention and treatment of postmenopausal women's bone mineral density (BMD), exercise is undoubtedly a fundamental component, having a beneficial effect on a number of health parameters. Resistance training seems to adequately stimuli the musculoskeletal system on the physiology of bone tissue response. The study's objective was to analyze the most recent research on the clinical uses of resistance training in therapy regimens for postmenopausal women while analyzing and criticizing the data in light of the growing research heterogeneity. Data collection was carried out through electronic databases PubMed. Forty related meta-analysis and systematic reviews published on the last five years, were included as the sample for analysis. Studies regarding pharmaceutical and/or diet intervention were excluded. Results demonstrated that resistance training, either alone or in combination with other forms of exercise, significantly improved postmenopausal women's BMD. The workout criterion that suggests acceptable future study designs and exact research technique is intensity, which appears to be the most intriguing.

Objectives: Coexistence of varus deformity of knee and Medial Meniscus Posterior Root Tear (MMPRT) is known to have a rapid progression to medial compartment arthritis. Medial open wedge high tibial osteotomy (MOWHTO) with transtibial suture pullout for MMPRR is currently a preferred technique, although it is technically demanding. We describe a combination of technique of root repair with an all-suture soft anchor along with MOWHTO. Methods: In this prospective study, 25 patients of proximal tibial varus of more than five degrees with MMPRT and up to grade 2 medial compartment osteoarthritis (Kellgren-Lawrence classification) were operated at a single tertiary center. Arthroscopic root repair was performed with an all-suture anchor, followed by standard MOWHTO using a titanium locking plate. Functional and radiological outcomes were evaluated at 2-year follow-up. Results: Mean deformity (femorotibial angle) improved from 12 degrees varus pre-operatively to 5 degrees valgus at 2-year follow-up. Mean MPTA increased from 80.6 to 87.2 degrees. There was statistically significant improvement in mean pre-operative Lysholm score of 32 to 85 at 2-year follow-up. Conclusions: MMPRT repair with an all-suture anchor along with MOWHTO is a relatively easier and reproducible single stage technique, giving good functional and radiological outcomes at 2-year follow-up.

Fractures are a global health concern affecting millions of people annually, with the elderly being more susceptible. Although the majority of patients with fractures recover, approximately 10% of them, particularly the elderly, encounter difficulties in the healing process. Platelet-rich plasma (PRP) is a concentrated solution of platelets that contain numerous growth factors and other bioactive molecules, which make it effective in promoting tissue repair and regeneration. Additionally, PRP injections can enhance local blood flow and stimulate angiogenesis, which can contribute to better healing outcomes in the treated area. Recent literature reviews suggest that PRP has clinical efficacy in accelerating the fracture healing process, treating delayed unions and non-unions, and serving as an adjuvant method when used alone or in combination with surgical procedures. However, the clinical heterogeneity of the available studies warrants the need for further research with high-quality randomized controlled trials involving a large number of participants to provide appropriate guidelines for PRP use. The present narrative review aims to present the recent data in relation to the effectiveness of the use of the PRP injection technique in the process of bone fracture healing.

Lung cancer and lung cancer related metastatic spine disease had for many years a poor prognosis. However, after the introduction of molecule targeted agents into the treatment of lung cancer the survival has been prolonged. The prognostic scores, mainly represented by the revised Tokuhashi Score, that have been used in the last decades to predict the survival of the patients and guide the choice of the optimal treatment, classify the patients into short term (<6 months), intermediate (6-12 months) and long term (>12 months) survivors and recommend conservative or surgical treatment accordingly. These scores have not been revised lately and there is a great concern that this improvement in survival of lung cancer patients is not reflected in the calculated scores. This is a review of the literature concerning the accuracy and validity of the current metastatic spine surgery scores in relation to lung cancer derived spinal metastases. Broad consensus exists about the need to revise the current scores and develop new ones specifically for lung cancer.

The purpose of the current review article was to explore to what extent the literature supports cemented or cementless total hip arthroplasty (THA) in osteoporotic patients., in terms of Harris Hip Score, periprosthetic bone loss, periprosthetic fractures, prosthesis subsidence and revision rate. A literature search was performed in PubMed and Cochrane databases to identify articles with purpose to investigate the aforementioned parameters after the use of cemented or cementless THA in patients with osteoporosis or Dorr type C bone, which is typically seen in those patients. Twenty studies were included in the review. Among them, there were two studies which compared cemented with cementless THA in osteoporotic patients and found better outcomes after cemented fixation. The remaining studies investigated only the outcomes of cementless THA in patients with osteoporosis or Dorr type C bone. Most of those studies showed satisfactory outcomes and suggested that cementless THA may not be contraindicated for those patients. The major issue concerning cementless THA was the relatively high rate of periprosthetic fractures. Three studies investigated the use of anti-osteoporotic medication in osteoporotic patients who underwent cementless THA and found positive outcomes. In conclusion, the role of cemented and cementless THA in the case of osteoporosis or Dorr type C bone needs to be further clarified with more comparative studies.

The present review aims at evaluating the usefulness and accuracy of the various panoramic morphometric indicators for the diagnosis of osteopenia and/or osteoporosis. We have based our review on literature meta-analyses concerning the sensitivity and specificity of panoramic radiography, as well as how this can be compared to more systemic methodologies, such as X-Ray and Dual-energy X-Ray Absorptiometry (DXA). A literature review was performed using the PubMed database, including studies that used the methodology if clinical trials and reviews. The main outcome measures including clinical manifestations and radiographic findings were also reported. Panoramic radiograph, pantomogram, is an X-Ray based radiogram that allows radiographic imaging in two dimensions; of the teeth, jaws, sinuses and other anatomical elements from the cervix and above, as well as from the nasal cavity and below. Osteopenia is an abnormal condition, in which bone density is reduced requiring further investigation, both clinically and radiographically. Failure to treat osteopenia in a timely manner, turns into a more chronic and harmful condition, namely osteoporosis. Finally, we discuss the approaches through which these cases can be diagnosed and treated and how panoramic radiography can be used as a diagnostic tool.

Osteoporosis is the most frequent bone disease, and it is considered to be a major burden for public health. Current trends show that osteoporosis rates increase all around the world, proving that osteoporosis is becoming a global socio-economic problem. Dual-energy X-ray absorptiometry (DXA) is an established method for the diagnosis of osteoporosis, treatment monitoring, and fracture risk assessment. Recent advances in DXA technologies have improved the accuracy and repeatability of the measurements and results of this method. However, there is a chance of BMD measurement and interpretation errors that may result in a non-accurate diagnosis or even inappropriate management of the patients. The errors that may happen in the installation and maintenance of the equipment involved in the examination, as well as the inadequate knowledge and lack of experience of the Radiology Technologist are considered as malpractice and may lead to misdiagnosis. This study aims to highlight the role of the radiologic technologist in the detection of the least significant change (LSC) in the DXA method, as well as the identification of possible errors in this diagnostic examination, to improve the quality and accuracy of diagnosis and provide better guidance of the patients.

Hip fracture constitutes a significant health concern especially for older adults. The incidence of hip fractures varies among countries, but it is estimated that globally, around 18% of women and 6% of men will be affected. Despite a gradual decrease in age-standardized incidence in several countries, the overall increase in the ageing population will lead to an expected rise in the number of hip fractures. This review provides an overview of hip fractures in European countries focuses on the most recent epidemiological data on hip fracture.

Osteoporosis is a significant predisposing factor for fragility fractures of the distal radius. The disorder is characterized by a significant and long-standing imbalance between bone formation and absorption, resulting in a gradual reduction in bone mass that worsens with age. This narrative review aims to present recent data regarding the effect of osteoporosis on the pathogenesis and healing of distal radius fragility fractures. Although research on this topic is limited, current studies suggest that during the osteopenia or osteoporosis stage, both trabecular and cortical bone undergo quantitative and qualitative changes. As a result, a weak cortex shell surrounds the trabecular bone compartment which exhibits significant deterioration of its microarchitecture, with cortical bone being the most critical factor in resisting distal radius fractures in the early stages of osteopenia. Concerning fracture healing, and based on limited published data, it is believed that osteoporosis does not have a significant impact on the progression of fracture healing in distal radius fractures, although there appears to be a tendency towards a potential negative effect. The treating physician must consider the unique characteristics of osteoporotic bone, including reduced healing ability and relatively lower functional requirements of patients. Balancing these factors is crucial in determining an appropriate treatment plan.

Fibromyalgia (FM) is a condition associated with chronic musculoskeletal pain, fatigue, joint rigidity, sleep interruption, depression and cerebral dysfunction. It is a complicated syndrome with not well-known pathogenesis and only clinical diagnosis at the present. Osteoporosis, however, is described as a skeletal disease, which main characteristics are: (1) reduced strength of the bone which is associated with the loss of skeletal mass and (2) micro-architectural deterioration of the bones, without clinical symptoms-except when fractures occur. In recent years, few studies have addressed the relation between fibromyalgia and osteoporosis. Most studies show that fibromyalgia may lead to an increased possibility of osteoporosis due to low levels of exercise because of the chronic pain. In addition, when Vitamin D levels are measured in patients with firbromyalgia syndrome it seems to be lower than general population. However, results of studies of the bone mineral density (BMD) of these patients are conflicted. In this short review article, we provide current knowledge on the relationship between fibromyalgia and osteoporosis, and in addition we discuss the association between fibromyalgia syndrome (FMS) and low bone mineral mass as shown in previously published papers including for systemic reviews and meta-analysis on these subjects.

Objectives: Idiopathic Congenital Talipes Equino Varus (CTEV), commonly referred to as Clubfoot, is a complex musculoskeletal deformity affecting infants. The Ponseti technique, a gold standard approach, has emerged as an effective treatment. This study aims to evaluate the clinical and sonographic outcomes of percutaneous Achilles tendon tenotomy in children with idiopathic clubfoot who underwent the Ponseti procedure. Methods: A prospective study was conducted at the JIPMER Department of Orthopaedics, involving 41 feet with residual equinus deformity following Ponseti treatment. Infants with idiopathic clubfoot were included. Clinical and sonographic evaluations were performed, percutaneous Achilles tendon tenotomy was performed. Parameters were measured, Data were statistically analyzed using Kolmogorov-Smirnov tests, paired t-tests, ANOVA, and correlation analysis. Results: 29 infants (41 feet), primarily boys (89.7%) were studied. Following percutaneous tenotomy, clinical improvement was observed, with a mean increase in dorsiflexion of 20-25 degrees. Sonographic parameters showed significant improvement in tibio calcaneal distance, talocalcaneal divergence, and metaphyseal-talocalcaneal angle post-tenotomy (p<0.05). Positive correlations were found between clinical and sonographic improvements. Conclusion: Clinical improvement of hindfoot deformity following percutaneous Achilles tendon tenotomy in idiopathic clubfeet correlates with the sonological improvement of talo calcaneal, tibio calcaneal angles and tibio calcaneal distance.