potential effects of thermal treatment in patients affected by osteoporosis universitÀ di pisa...

POTENTIAL EFFECTS OF THERMAL TREATMENT IN PATIENTS AFFECTED BY OSTEOPOROSIS

POTENTIAL EFFECTS OF THERMAL TREATMENT IN PATIENTS AFFECTED BY OSTEOPOROSIS

UNIVERSITÀ DI PISA Facoltà di Medicina e Chirurgia Scuola di Specializzazione in Idrologia Medica

«EAST & WEST MEET IN CERVIA»7th - 10th October 2007Cervia, Ravenna (Italy)

60th GENERAL ASSEMBLYAND INTERNATIONAL SCIENTIFIC

CONGRESS OF THE WORLDFEDERATION OF HYDROTHERAPYAND CLIMATOTHERAPY (FEMTEC)

F. Russo

OSTEOPOROSIS

(already described 3.000 yrs ago)

AFTER THE WORLD WAR II THERE IS AN INCREASING SCIENTIFIC INTEREST TOWARDS THIS AND OTHER

DISEASES, THAT WILL BE MORE AND MORE RELEVANT, BECAUSE OF THE RISE IN LIFE EXPECTATION



OSTEOPOROSIS

ONE OF THE MAJOR PROBLEM OF PUBLIC HEALTH

75.OOO.OOO OF PATIENTS IN EU, US AND JAPAN

15 % RISK OF VERTEBRAL, WRIST, OR HIP FRACTURES



OSTEOPOROSIS

IS NOT A UNIQUE DISORDERBUT

A COMPLEX SYNDROME

Derived from latin, osteoporosis literally means porous bone, which involves both the mineraland the non-mineral components of bone

Osteoporosis is a disease characterized by low bone mass and structural deterioration of bone tissue, leading to bone fragility and an increased susceptibility to fractures (W.H.O.)



PRINCIPAL CAUSES OF DISABILITY

OSTEOPOROSIS AND FRACTURES

CARDIO- AND CEREBRO-VASCULAR DISEASES

DIABETESARTHRITIS

EYE AND EAR

COGNITIVE IMPAIRMENT



> 40 yrs OLD

BONE DENSITY DECREASE = PARAPHYSIOLOGICAL PHENOMENON

( OSTEOPENIA )

0.5 - 1 % per year

in men

1.5 - 2 % per year

in women



Decrease in bone deposition rate

No modification in bone absorption rate

AGEING

SIGNIFICANTLY MODIFY THE ACTIVITY OF BONE TISSUE



OSTEOPOROSIS

PRIMARY O.

SECONDARY O.

TYPE I

TYPE II

POSTMENOPAUSAL O.Associated to menopause and decrease in estrogen rates

SENILE O.It usually affects people older than 70 and is twice as common in women as in men

GENETIC DIS.ENDOCRINO-METABOLIC DIS. (Cushing S.)

CHRONIC RENAL INSUFFICIENCYGASTROINTESTINAL DIS.NEOPLASIACORTICOSTEROID ABUSEARTICULAR INFLAMMATORY DIS.PROLONGED INACTIVITY INSUFFICIENT NUTRITION

CLASSIFICATION



OSTEOPOROSIS TYPE IPOSTMENOPAUSAL O.

TYPE IISENILE O.

AGE

M/F

TYPE OF BONE LOSS

TYPE OF TURNOVER

FRACTURE SITE

PARATHYROID function

Ca ABSORPTION

hydroxylase activity

PRINCIPAL CAUSES

51 - 75

5 : 1

Trabeculare

Increased

Vertebral and distal radium

Reduced

Reduced

Secondary decrease

Menopause

> 70

2 : 1

Trabeculare and cortical

Not increased

Vertebral and femoral

Increased

Reduced

Primitive decrease

AgeingMAIN CHARACTERISTICS



OSTEOPOROSIS

70 %Genetic predisposition

MULTIFACTORIAL PATHOGENESIS

30 %Environmental influences



OSTEOPOROSIS

RISK FACTORS

WHITE RACEAGEINGPRECOCIOUS MENOPAUSEHISTERECTOMYINACTIVITYCORTICOSTEROIDS

PROBABLE RISK FACTORS

DECREASED WEIGHT/HEIGHT RATIOPOSITIVE ANAMNESIS FOR O.ALCOHOLLOW CALCIUM DIETSMOKEHIGH PROTEIN DIETCAFFEINE



OSTEOPOROSIS

CONVERSION OF SURRENALIC ANDROGENSIN ESTROGENS, IN ADIPOSE TISSUE

OBESITY

appears to be a protective factoragainst osteoporosis



OSTEOPOROSIS

MORE FREQUENT CONSEQUENCE

FRACTURES

VERTEBRAL COMPRESSION F.

FEMORAL NECK F.

RADIUS DISTAL COLLES F.



OSTEOPOROSIS

THE % OF THESE TYPES OF FRACTURES DRAMATICALLY INCREASES DEPENDING ON

THE BMD DECREASE

COMPLICANCES

> 50 YRS OLD

WOMEN 1 : 4MEN 1 : 8



OSTEOPOROSIS

COMPLICANCES

HIGH % OF VERTEBRAL FRACTURES, ASSOCIATED TO MENOPAUSE O.

10% women > 50 yrs old BONE LOSS

35-40% women > 65 yrs old 1 or more fractures

25% women > 60 yrs old vertebral compression

32% women > 65 yrs old femoral fractures

FOLLOWED BY INCREASED % OF WRIST/HIP FRACTURES, ASSOCIATED TO CONCOMITANT

SENILE OSTEOPOROSIS



HOW PREVENT & TREAT OSTEOPOROSIS?

Johnatan Adachi(McMaster University, Hamilton-Toronto Canada)

“TO MAINTAIN THE BONE MASS AND TO PREVENT THE BONE LOSS”



OSTEOPOROSIS

STRATEGIES FOR THE PATIENT(calcium administration, physical activity, etc.)

DRUGS STIMULATING THE BONE TISSUE FORMATION(anabolizant steroids, parathyroid hormone 1-34)

THERAPEUTICAL STRATEGIES

(J. Adachi)

DRUGS THAT INHIBIT BONE TISSUE REABSORPTION(estrogens, bisphosphonates)



OSTEOPOROSIS

THERAPEUTICAL STRATEGIES

(J. Adachi)

EARLY IDENTIFICATION OF PATIENTS(IN PARTICULAR, IN POST-MENOPAUSAL AGE)

BECAUSE ALSO IN PRESENCE OF A NORMAL BONE MASS

IT IS IMPORTANT TO MAINTAIN THE PEAK OF BONE MASS

PREVENTION

AN EFFECTIVE STRATEGY



WHY AND HOWCOULD BE USEFUL A STAY IN A SPA?



Spa treatment can modify the calciotrope metabolism

(reduction of osteocalcine levels and elevated calcitonin 90 days after the end of therapy)

Current Therapeutic Research

PROTOCOL OF THERMAL MEDICINEand

SCIENTIFIC MEETING

1st Congress on Calcium and Vitamin D in human life



OSTEOPOROSIS

THERMAL THERAPY

FANGOBALNEOTHERAPY

methods

Mud: thickness 5-10 cm and T 40°-47°

Duration: 15-20 min

Bath in thermal water: T 37°-40°

Bed: 30-50 min

12 sessions, with a rest of 1 day after the 6° session



OSTEOPOROSIS

SPA THERAPY

BMD ( +15 % )

urinary hydroxyproline levelsUNIVERSITÀ DI PISA

Facoltà di Medicina e Chirurgia Scuola di Specializzazione in Idrologia Medica


FANGOBALNEOTHERAPY

serum levels of osteocalcin (BGP) (> stimulation of osteoblastic activity)

OSTEOPOROSIS

SPA THERAPY

interleukin-1

TNF

prostaglandin E2

leukotriene B4

PRODUCTION OF OSTEOCLAST CELLS

BONE REABSORPTION



FANGOBALNEOTHERAPY

(Bellometti et al.)

THERMAL THERAPY, IN PARTICULAR IF ASSOCIATED TO PHYSICAL EXERCISE AND FOR LONG PERIODS CAN INDUCE AN ANABOLIC EFFECT



OSTEOPOROSIS

SPA THERAPY

FANGOBALNEOTHERAPY

THERMAL STRESS

Induces enzymes able to act on beta linked glucuronic acid, and hyaluronic acid metabolism

(hyaluronidase, beta-glucuronidase, N-acetil-beta-glucosaminidase )

Able to ‘re-organize’ tissues,considered in the past amorphous tissues



OSTEOPOROSIS

SPA THERAPY

in bone tissue: vascular trophism, consequent to the increase in ematic flux

optimization of cell nutrition, formation of new osteons,in particular, if associated to physical exercise (Arena, 2004)

or with appropriate pharmacological therapy (Cozzi, 1992)



FANGOBALNEOTHERAPY

THERMAL STRESS

OSTEOPOROSISLES THERMES

AN EDUCATIONAL MOMENT

in menopause women: Ca <400 mg/die = RISCHIO >

in menopause women: 1000-1500 mg/die(in normal subject: 800 mg/die)

CAN BE USEFUL TO DRINK MINERAL WATER RICH INCa (bicarbonate w.)

for ex.suggestions for a correct Ca assumption



OSTEOPOROSIS

SPA THERAPY

BENEFICIAL EFFECTS CAUSEDBY PHYSICOCHEMICAL PROPERTIES

OF THERMAL WATER, AND PHYSICAL ACTIVITY

a great number of articulations and muscles can be involved (during the thermal bath)

increase in muscle vascularization, myorelaxant effect,pain reduction, and consequent positive effects on rigidity,and muscle hypotrophy



LES THERMES

HYDROKINESITHERAPY

OSTEOPOROSIS

paper byG. Farchi

Ist.Sup.San.

HIGH SOCIO-ECONOMIC COSTS

consequences of the only fractural fractures

COMPARABLE PROBLEMS IN VERTEBRAL FRACTURES(50 % not diagnosed)

MORTALITY: 15-25 %

MOTORIAL DISABILITY THE YEAR AFTER THE FRACTURE: > 50 %

RECOVERY OF FUNCTIONS OF DAILY LIFE ACTIVITIES: < 30-40 %



OSTEOPOROSIS

paper byS. Maggi

CNR-Padova

SINCE 1998, UE HAS CONSIDERED THE FIGHT AGAINST OSTEOPOROSIS ONE OF THE MAJOR OBJECTIVES

FOR PUBLIC HEALTH

ITALY HAS THE HIGHER % OF OVER-65 YRS OLD OF EUROPE(18,3% in I vs. 15,7% in UK and 16,6% in G)

THERE IS AN INCREASE IN THE PREDICTED Nr OF FEMORAL FRACTURES(in European women, from 300.000 in 2000 to 800.000 in 2050 !)



HIGH SOCIO-ECONOMIC COSTS

OSTEOPOROSIS

LES THERMES

A PLACE TO

RELAX AND SOCIALIZE

PREVENTION AND THERAPY

But also



THANK YOU !

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