FRAGILITY FRACTURES IN OLDER PERSONS WITH ALTERED THYROID FUNCTION

Gli ormoni tiroidei sono peptidi che svolgono molteplici e complesse funzioni nell\u2019organismo umano. Lo sche-letro \ue8 uno dei tessuti bersaglio degli ormoni tiroidei, ed una loro carenza o un loro eccesso ha importanti conseguenze sul tessuto osseo soprattutto nel periodo dello sviluppo e durante l\u2019invecchiamento. I disturbi a carico della tiroide si osservano con maggior frequenza nei soggetti in et\ue0 avanzata rispetto ai giovani. La tire-otossicosi \ue8 una causa nota di osteoporosi secondaria. L\u2019ipertiroidismo conclamato e l\u2019ipertiroidismo iatrogeno dovuto ad un eccesso nel dosaggio della terapia sostitutiva con ormoni tiroidei sono possibili cause di fratture ossee da fragilit\ue0. L\u2019ipertiroidismo subclinico da cause endogene o esogene si associa ad una riduzione della densit\ue0 minerale ossea (BMD), soprattutto a livello dell\u2019osso corticale nelle donne in et\ue0 avanzata. Il rischio di sviluppo di fratture da fragilit\ue0 sembra essere strettamente correlato al grado di soppressione dell\u2019ormone stimolante la tiroide (TSH) e alla presenza di altri fattori di rischio, inclusa l\u2019et\ue0 avanzata. Nelle persone anziane, l\u2019ipertiroidismo conclamato e l\u2019ipertiroidismo subclinico endogeno dovrebbero essere trattati al fine di ridurre il rischio di sviluppo di fratture da fragilit\ue0 e di fibrillazione atriale, e la mortalit\ue0 associata a tali patologie. Il rischio di fratture da fragilit\ue0 nei soggetti in et\ue0 avanzata, specialmente nelle donne nel periodo post-menopausale, che devono assumere dosaggi soppressivi di levotiroxina per il trattamento di un carcinoma della tiroide, pu\uf2 essere ridotto adottando una terapia a base di levotiroxina con la minima dose efficace e/o, se indicato, ag-giungendo una terapia con farmaci antiriassorbitivi o che favoriscano la formazione ossea. La terapia sostitu-tiva con levotiroxina nell\u2019ipotiroidismo conclamato dovrebbe essere regolarmente monitorata e aggiustata per evitare la soppressione dei livelli di TSH e il conseguente aumento del rischio di fratture da fragilit\ue0.Thyroid hormones are pleiotropic peptides with complex action on the human economy. The skeleton is a target tissue for thyroid hormone\u2019s action, which is illustrated by the consequences of thyroid hormone excess and deficiency during development and during aging. Thyroid disorders are more frequently observed in older than in younger persons. Thyrotoxicosis is an established cause of secondary osteoporosis. Overt hyper-thyroidism and iatrogenic hyperthyroidism due to over-replacement of thyroid hormone may result in fragility fractures. Endogenous or exogenous subclinical hyperthyroidism is associated with reduced bone density, especially in cortical bone in older women. Fragility fracture risk seems to be closely related to the degree of thyroid-stimulating hormone suppression and to other risk factors, including older age. Overt hyperthyroidism and endogenous subclinical hyperthyroidism in older persons should be treated to reduce the risk for fragility fractures, atrial fibrillation and related mortality risk. The risk for fragility fractures in older people, especially in postmenopausal women, taking suppressive doses of levothyroxine for thyroid cancer can be diminished by treatment with the minimal effective suppressive dose and in some cases, by adding an antiresorptive or bone forming therapy where indicated. Replacement therapy for overt hypothyroidism should be regularly adjusted to avoid TSH suppression and consequent increased risk of fragility fractures

MAGNESIUM AND TYPE 2 DIABETES: AN UPDATE

The link between magnesium (Mg) deficiency and type 2 diabetes mellitus is well known. Type 2 diabetes is frequently associated with both extracellular and intracellular Mg deficits. A chronic latent Mg deficit or an overt clinical hypomagnesaemia is common in subjects with type 2 diabetes, especially in those with poorly controlled glycemic profiles. Insulin and glucose are important regulators of Mg metabolism. Intracellular Mg plays a key role in regulating insulin action, insulin-mediated-glucose-uptake and vascular tone. Reduced intracellular Mg concentrations result in a defective tyrosine-kinase activity, postreceptorial impairment in insulin action and worsening of insulin resistance in diabetic patients. A low Mg intake and an increased Mg urinary loss appear the most important mechanisms that may favor Mg depletion in patients with type 2 diabetes. Low dietary Mg intake has been related to the development of type 2 diabetes and metabolic syndrome. Benefits of Mg supplementation on metabolic profile in diabetic subjects have been found in most, but not all clinical studies and larger prospective studies are needed to support the potential role of dietary Mg supplementation as a possible public health strategy in diabetes risk. The objective of this review is to revise current evidences on the mechanisms of Mg deficiency in diabetes mellitus type 2 and on the possible role of Mg supplementation in the prevention and management of the disease

Dietary Approaches and Supplements in the Prevention of Cognitive Decline and Alzheimer's Disease

Age-associated cognitive decline and dementia are conditions in which there is deterioration in memory, thinking, and behavior, with profound effects on the ability to perform everyday activities and well-being. Even if dementia mainly affects older persons, it is not a normal part of aging. Alzheimer's disease accounts for 60-75% of dementia cases. The number of persons affected will increase in the next decades in parallel with aging of the world population. Hence, unless some approach is found to reduce age-related deterioration of cognitive functions, health care costs will continue to rise exponentially. There is a wealth of epidemiological evidence supporting a relationship between diet and Alzheimer's disease, and suggesting that the risk of cognitive decline may be reduced by dietary interventions. It has been proposed that adopting a healthy diet and lifestyle that improves cardiovascular function may help delaying the onset of Alzheimer's disease due to its potential association with vascular disease. Several nutrients, dietary components, supplements and dietary patterns have been reported in relation to their association with cognition and with the development of cognitive decline and Alzheimer's disease. The possible effect of diet on the prevention of dementia is of tremendous scientific and general interest, because hitherto there is no definitive evidence of any effective pharmacological treatment for dementia. The aim of this review is to evaluate the evidence for the effects of some dietary components, supplements, and dietary patterns as neuroprotective, with potential to delay cognitive decline and the onset of dementia

L\u2019IPONATRIEMIA NELL\u2019ANZIANO: UNA PROBLEMATICA SEMPRE ATTUALE

Le alterazioni della concentrazione plasmatica del sodio rappresentano una delle disionie di pi\uf9 frequente riscontro nei pazienti ricoverati e che l\u2019incidenza e la prevalenza aumentano con l\u2019et\ue0. Molteplici fattori correlati all\u2019invecchiamento giocano un ruolo in tal senso; ad esempio, variazioni anatomiche e funzionali, modificazioni della composizione corporea, alterazioni dei meccanismi fisiologici che regolano il metabolismo e l\u2019omeostasi del sodio e dell\u2019acqua. L\u2019aumento dell\u2019incidenza di tali disturbi nella popolazione anziana rappresenta un chiaro esempio di come l\u2019invecchiamento \ue8 in grado di compromettere le capacit\ue0 di compenso, di adattamento e l\u2019omeostasi dell\u2019organismo.Alterations in the plasma concentration of sodium represent one of the most frequently ionic disorders in hospitalized patients. The incidence and prevalence of hyponatremia increase with age. Multiple factors related to aging play a role in this process: for example, anatomical and functional changes, body composition modifications, alterations of physiological mechanisms that regulate metabolism and homeostasis of sodium and water. The increased incidence of these disorders in the older population is a clear example of how aging can affect the ability of compensation, adaptation and homeostasis of the organism

LE IPERNATRIEMIE NELL\u2019ANZIANO

L\u2019pernatremia \ue8 caratterizzata da un deficit di acqua corporea totale rispetto al sodio ed \ue8 definita da una concentrazione plasmatica superiore a 145 mmol/L. L\u2019ipersodiemia nella popolazione geriatrica \ue8 un disturbo comune, associato ad una significativa morbilit\ue0 e mortalit\ue0. Le persone anziane sono predisposte a sviluppare ipernatriemia a causa di modificazioni fisiologiche legate all'et\ue0: ad esempio la diminuzione della sete, una ridotta capacit\ue0 di concentrazione delle urine e la diminuzione del contenuto di acqua corporea totale. I farmaci possono aumentare questa predisposizione. Nelle case di cura e di riposo, l\u2019ipernatremia e la disidratazione sono considerate prevenibili, per cui vengono ritenute indicatori di negligenza e di scarsa qualit\ue0 delle cure.Hypernatremia is characterized by a deficit of total body water relative to total body sodium and is defined by a sodium plasma concentration greater than 145 mmol/L. Hypernatremia in the geriatric population is a common disorder associated with significant morbidity and mortality. Older people are predisposed to developing hypernatremia because of age-related physiologic changes such as decreased thirst drive, impaired urinary concentrating ability, and reduced total body water. Medications may exacerbate this predisposition. In nursing home residents, hypernatremia and dehydration are considered preventable; hence, they are indicators of neglect and substandard care

ETHICS AND AGING: FOCUS ON LIVING WILL FOR PATIENTS WITH DEMENTIA

Today dementia certainly represents a public health priority with a huge global impact on wordwide population. However, clinical and social issues related to demen-tia have long been marginalized. The actual high prevalence of dementias requires also to face issues from a bioethical perspective, regarding how to deal with demented patient\u2019s disposition. There are currently no specific guide-lines on the national territory regarding whether to draw up a living will by a patient with dementia, neither about the informa-tive role of physicians during the progres-sive story of the disease

Wear Behavior of a Ni/Co Bilayer Coating by Physical Vapor Deposition on AISI 1045 Steel

Coatings by physical vapor deposition (PVD) have become highly relevant due to their wide range of applications and the rapid rate of coating formation. In this work, AISI steel 1045 was coated with two layers, Ni and Co using the PVD technique. Each coating was deposited with a thickness of 1 μm. After applying the coatings, a post-treatment was applied in an AC plasma reactor using a boron nitride blank in an Ar atmosphere at a pressure of 3 Torr, 0.3 A, and 460 V at 4, 8, and 12h. The post-treatment was characterized by optical emission spectroscopy (OES) in a range of 200-1100 nm. The main species observed by OES were Ar+, N2, N2+, and B+. The coatings on 1045 steel and posttreatment were characterized by scanning electron microscopy (SEM) and X-ray diffraction (XRD). Also, were subjected to tribological tests to analyze wear resistance, using the Pin-on-Disk technique. The coatings on steel 1045 present remarkably better wear properties than the uncoated 1045 steel, being the sample post-treated at 4h that showed a lower wear rate

Osteoporosi e diabete mellito. [Osteoporosis and diabetes]

Diabetes mellitus and osteoporosis are chronic diseases with an elevated and growing incidence in the elderly. Recent epidemiological studies have demonstrated an elevated risk of hip, humerus and foot fractures in elder diabetic subjects. While type 1 diabetes is generally associated with a mild reduction in bone mineral density (BMD), type 2 diabetes, more prevalent in old subjects, is frequently linked to a normal or high BMD. Studies on experimental models of diabetes have suggested an altered bone structure that may help to explain the elevated risk of fractures observed in these animals and may as well help to explain the paradox of an incremented risk of fractures in type 2 diabetic elderly in the presence of normal or elevated BMD. In addition, diabetic elderly have an increased risk of falls, consequent at least in part to a poor vision, peripheral neuropathy, and weaken muscular performance. Diabetes may affect bone tissue by different mechanisms including obesity, hyperinsulinemia, deposit of advanced glycosilation end products in collagen fibre, reduced circulating levels of IGF-1, hypercalciuria, renal function impairment, microangiopathy and chronic inflammation. A better understanding of these mechanisms may help implement the prevention of fractures in the growing population of mature diabetics