A Clinical Application of the Bone Structure Index

It has been recently estimated that about 30% of women and 20% of men over 50 will develop osteoporosis, a disease characterized by decreasing bone strength. Although low bone mineral density is generally associated with higher fracture risk, the spatial arrangement of the trabecular structure is a second key factor of bone resistance [1] and about 40-60% of the fractures affect people that can be considered at moderate risk on the basis of densitometry (DXA) assessment alone [2, 3]. Hence the need to develop innovative and low-cost diagnostic methods that can be used together with the consolidated systems. The recently introduced Bone Structure Index (BSI) gives an indication of the quality of the bone structure: it measures the weight-bearing capacity of the bone structure, evaluated from simulated application of loads on a virtual biopsy of the patient. The bone structure images are acquired by planar radiograms in the proximal epiphysis of the three central proximal phalanges of the non-dominant hand, a peripheral site of the human body [4-7]. In this work, we describe a recent application of the BSI in a clinical setting

Atrial natriuretic peptide predicts disease progression and digital ulcers development in systemic sclerosis patients

Aims: Systemic sclerosis (SSc) is an autoimmune disease characterized by micro/macrovascular damage due to the underlying fibrosis. Markers able to predict the progression of cardiovascular damage, including digital ulcers, in SSc are warranted. We aimed at characterizing the relevance of N-terminal proatrial natriuretic peptide (NT-proANP) and N-terminal probrain natriuretic peptide plasma levels in relation to cardiovascular damage and digital ulcers in a cohort of Italian SSc patients. Methods: Seventy patients were enrolled (64 women and six men; mean age 56.7 ± 14 years) with a disease duration of 11.1 ± 8.3 years. Clinical, instrumental (nailfold videocapillaroscopy, ECG, transthoracic echocardiography, pulmonary function test with diffusion lung CO), NT-proANP and N-terminal probrain natriuretic peptide plasma levels measurement were performed at baseline. The clinical follow-up lasted 24 months. The statistical approach used to achieve the study objectives included multivariate analysis, receiver operating characteristic curve, Kaplan-Meier and Cox regression analyses. Result: Both NT-proNPs levels correlated with systolic pulmonary arterial pressure, but only the NT-proANP level correlated with right heart dimension. Both NT-proNPs levels were higher in patients experiencing events at follow-up but only the NT-proANP level significantly predicted the progression of cardiovascular damage, including development of pulmonary arterial hypertension (PAH). NT-proANP levels were higher in patients with digital ulcers and strongly predicted their development. Conclusion: Our results show that the NT-proANP plasma level significantly correlates with disease progression such as new onset of PAH, worsening of pulmonary hypertension and development of digital ulcers in a cohort of SSc Italian patients. If future studies will confirm our findings, the plasma NT-proANP level could be used in clinical practice as a novel sensitive marker for PAH and digital ulcers development in SSc