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Evidence about the characterization of home workers in terms of both work-related outcomes and health issues is lacking. The purpose of this cross-sectional study was to examine the impact of home working on perceived job productivity and satisfaction, work-related stress, and musculoskeletal (MSK) issues. We included 51 mobile workers, collecting data about demographic characteristics, working experience, job productivity, and stress. Job satisfaction was assessed through the Utrecht Work Engagement Scale (UWES), while MSK pain was investigated by the Brief Pain Inventory (BPI) and Fear Avoidance Beliefs Questionnaire (FABQ). Moreover, a home workplace analysis had to be carried out according to current Italian regulations. Participants declared that they were less productive (39.2%) but less stressed (39.2%) and equally satisfied (51%) compared to the time of office working. Regarding MSK disorders, low back pain (LBP) was referred by 41.2% of home workers and neck pain by 23.5% of them. Neck pain worsened in 50% of home workers, while LBP did not exacerbate in 47.6% of cases. Home workers with MSK pain reported a lower job satisfaction. Depending on our data, the home environment seems to be not adequate in the mobile worker population, with an increased risk for mental health and MSK problems, particularly affecting the spine. Addressing these issues can significantly reduce risks for health, thus, improving job productivity and satisfaction and reducing cost.

Sclerostin, a protein encoded by the sclerostin (SOST) gene, is mostly expressed in osteocytes. First described in the pathogenesis of three disorders, sclerosteosis, van Buchem’s disease, and craniodiaphyseal dysplasia, sclerostin has been identified as an important regulator of bone homeostasis, controlling bone formation by osteoblasts through inhibition of the canonical Wnt signaling pathway. Recent studies have highlighted a hypothetical role of sclerostin in myogenesis, thus modulating the interaction between bone and muscle. This narrative review provides an overview of the clinical implications of sclerostin modulation on skeletal muscle mass and function, and bone metabolism. Improving knowledge about muscle–bone crosstalk may represent a turning point in the development of therapeutic strategies for musculoskeletal disorders, particularly osteosarcopenia.

Transient osteoporosis of the hip is a rare, temporary condition characterized by hip pain and functional limitations, which can significantly reduce the quality of life. Bone marrow edema of the proximal femur, identified through magnetic resonance imaging is the primary diagnostic feature of transient osteoporosis of the hip. While the exact cause of transient osteoporosis of the hip remains unclear, several potential pathophysiological mechanisms warrant further investigation to better understand this condition. In this case study, we present an unusual case of a patient with transient osteoporosis of the hip who was diagnosed with non-alcoholic fatty liver disease. A 42-year-old Caucasian man presented with left hip pain. After clinical and radiological evaluations, he was diagnosed with transient osteoporosis of the hip. Biochemical assessment revealed a persistent and isolated elevation of alanine aminotransferase. The patient underwent a treatment regimen involving 16 days of intramuscular neridronate along with physical therapy. At the 3- and 6-month follow-ups, he showed significant improvements in both clinical symptoms and radiological findings. In our study, we propose, for the first time, a potential association between liver disorders, specifically non-alcoholic fatty liver disease, and the onset of transient osteoporosis of the hip, exploring the possible pathophysiological mechanisms connecting these two conditions and discuss the rationale for both pharmacological and non-pharmacological treatments.

Bone fragility is the determinant of the increased risk of minimal trauma fracture and must be treated with a multimodal approach that includes pharmacological therapy, physical exercise, and adequate nutrition. Pharmacological therapy, to date based on the administration of antiresorptive drugs, such as bisphosphonates and denosumab, or osteoanabolic drugs, such as teriparatide and abaloparatide, has shown to be effective in reducing the risk of fracture in osteoporotic patients. In the context of the cellular and molecular mechanisms that regulate bone metabolism, the discovery of the Wnt signaling pathway and its role in bone tissue homeostasis has allowed the identification of sclerostin as an inhibitor of osteoblastic activity and simultaneously as a stimulator of osteoclastic activity. Therefore, the use of a monoclonal antibody, romosozumab, against this protein has been tested as a potential drug with a dual action, stimulating bone neo-apposition and inhibiting bone resorption. The efficacy of romosozumab has been demonstrated in numerous clinical trials against both placebo and other drugs commonly used in the treatment of patients affected by osteoporosis. The advantages of this drug lie above all in its rapid action which makes it particularly suitable in clinical situations where it is necessary to improve bone strength very quickly due to the imminent risk of fragility fracture. Clinical studies and guidelines suggest romosozumab as an initial drug in an ideal sequential approach from osteoanabolic to antiresorptive drugs. Some aspects of cardiovascular safety remain to be fully investigated, therefore its use in osteoporotic patients at high cardiovascular risk should be avoided until further data become available.

Background It has been suggested that overweight and obese individuals have an increased risk to develop vitamin D deficiency, commonly associated with poor muscle performance. The relationship among fat mass, vitamin D status, and skeletal muscle is still debated. Aims To evaluate the effects of the combination of hypovitaminosis D and overweight on muscle mass and strength, and physical performance in post-menopausal women. Methods In this cross-sectional study, we recruited post-menopausal women referring to a physiatric outpatient service for the management of osteoporosis over a 36-month period. We compared four groups: (1) normal weight with hypovitaminosis D; (2) overweight with normal serum 25(OH)D 3 ; (3) overweight with hypovitaminosis D; and (4) normal weight with normal serum 25(OH)D 3 (control group). Outcome measures were: appendicular lean mass-to-BMI ratio; hand grip strength; and short physical performance battery. Results We analysed 368 women (mean aged 67.2 ± 7.8 years): 95 normal weight with hypovitaminosis D, 90 overweight with normal levels of 25(OH)D 3 , 96 overweight with hypovitaminosis D, and 87 normal weight with normal levels of 25(OH)D 3 . Overweight women with hypovitaminosis D had a significant risk of reduced muscle mass (OR 5.70; p  < 0.001), strength (OR 12.05; p  < 0.001), and performance (OR 5.84; p  < 0.001) compared to controls. Normal weight women with hypovitaminosis D had only a greater risk of an impairment of muscle strength (OR 7.30; p  < 0.001) and performance (OR 3.16; p  < 0.001). Discussion According to our findings, both hypovitaminosis D and overweight should be investigated in post-menopausal women because of their negative effects on skeletal muscle mass and function. Conclusions This study demonstrated that hypovitaminosis D is associated to impaired muscle function and its combination with overweight might lead also to muscle wasting in a cohort of post-menopausal women.

Background Rotator cuff (RC) tendinopathy is a common shoulder pain condition. Extracorporeal shockwave therapy (ESWT) and hyaluronic acid peritendinous injection are viable treatment options for RC tendinopathy. The aim of this study is to evaluate the response in two different therapeutic rehabilitative approaches, the combined treatment ESWT plus hyaluronic acid injections (E + Hy) compared to ESWT alone (ESWT-al), in a cohort of patients with RC tendinopathy according to gender differences. Methods This is a retrospective longitudinal cohort study of patients with painful RC tendinopathy. Patients that had received a clinical evaluation, a shoulder ultra sound examination, as well as the Shoulder Pain and Disability Index (SPADI) questionnaire, and the Numerical Rating Scale (NRS) for pain at baseline, 1-month (T1) and 2-month follow-ups (T2) were included. Results Medical records of 53 patients were analyzed. In the comparison between baseline to T1 and similarly from baseline to T2, a statistically significant reduction has been reported in the NRS ( p  < 0.001) and in the SPADI ( p  < 0.001) in the entire study group. At T1, patients in the E + Hy compared to ESWT-al group, showed a slight but statistically significant reductions in both NRS and SPADI score, while these changes were more evident at T2 ( p  < 0.001). Interestingly, a gender dimorphism in NRS and in SPADI was found, with female patients that apparently responded better to the combined E + Hy compared to ESWT-al approach. Conclusion This retrospective cohort study suggests that the combination of ESWT plus HyA injections seems to be more effective than ESWT alone in RC tendinopathy in both genders. Moreover, in ESWT alone treatment, male patients reported better outcomes compared to females. However, further randomized controlled trials should be structured to confirm and enforce these conclusions.

Background: Choline is an essential micronutrient with a pivotal role in several metabolic pathways contributing to liver, neurological, and hematological homeostasis. Although choline is commonly administered to improve physical performance, its effects on muscle are still unclear. The aim of this scoping review is to analyze the role of choline on skeletal muscle in terms of biological effects and clinical implications. Methods: A technical expert panel (TEP) of 6 medical specialists with expertise in muscle physiology and skeletal muscle disorders performed the review following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) model. The TEP planned a research on PubMed selecting “choline” as MeSH (Medical Subject Headings) term adding to PubMed Search Builder the terms ”skeletal muscle” and “muscle striated”. TEP considered for eligibility articles published in the last 30 years, including original researches, particularly in vitro studies, and animal and clinical studies in the English language. Results: From the 1239 studies identified, TEP included 14 studies, 3 in vitro, 9 animal, and 2 clinical studies. Conclusions: Our scoping review elucidates and summarizes the crucial role of choline in modulating muscle fat metabolism, muscle proteins homeostasis, and the modulation of inflammation and autophagy.

Osteoporosis is a skeletal disorder characterized by decreased bone strength, which leads to an increased risk of developing fractures. Interestingly, this metabolic disorder is often related to sarcopenia, defined as decreased muscle mass, strength, and function. These two conditions appear to be closely connected, leading to a clinical condition named osteosarcopenia (OS). Aging may explain the link between muscle and bone loss through genetic, mechanical, endocrine, and nutritional factors. Further, aging increases the amount of adipose tissue, often due to sedentary behavior and unbalanced nutritional pattern, leading to a clinical condition defined as osteosarcopenic obesity, characterized by concurrent obesity, sarcopenia, and osteoporosis, where each condition exacerbates the others. Moreover, sarcopenia leads to decreased physical (PA) activity, worsening skeletal homeostasis, and creating a vicious cycle, which increases falls, fracture risk, and disability. This review underscores the importance of a systemic approach, focusing on nutritional therapy integrated with PA and, eventually, pharmacological interventions to efficiently manage (OS).

Background Physical exercise and nutrition seem to have a key role in the management of hip fracture patients. Aim To evaluate the impact of a 2-month rehabilitative protocol combined with dietetic counseling, with or without essential amino acid supplementation, on functioning in hip fracture patients. Methods In this pilot randomized controlled study, we recruited patients aged more than 65 years, at 3 months after hip fracture. We randomly assigned the participants into two groups (A and B). Both groups performed a physical exercise rehabilitative programme (five sessions of 40 min/week for 2 weeks, followed by a home-based exercise protocol) and received a dietetic counseling; only group A was supplemented with two sachets of 4 g/day of essential amino acids (Aminotrofic ® ). We evaluated at baseline and after 2 months of intervention (T 1 ): hand grip strength, Timed Up and Go, and Iowa Level of Assistance scale (ILOA). Results The 32 hip fracture patients (mean aged 79.03 ± 7.80 years) were allocated into two groups: group A ( n  = 16) and group B ( n  = 16). All the participants showed significant differences in all outcomes at T 1 ( p  < 0.017). Sarcopenic patients in group A ( n  = 10) showed statistically significant differences in all the primary outcomes at T 1 ( p  < 0.017), whereas sarcopenic patients in group B ( n  = 13) showed a significant reduction of ILOA only. In non-sarcopenic patients, we found no differences at T 1 in all outcome measures. Discussion Hip fractures are a complex multifactorial condition of the elderly that determines devastating effects on functioning and independence. Conclusion A multidisciplinary rehabilitative and nutritional intervention seems to be effective on functioning in hip fracture patients, in particular sarcopenic ones.

Musculoskeletal disorders are characterized by several impairments, including pain, affecting muscles, bones, joints and adjacent connective tissue, resulting in temporary or permanent functional limitations and disability. Musculoskeletal pain is particularly prevalent worldwide and greatly impacts the quality of life, social participation and economic burden. To date, several issues persist about the classification of musculoskeletal pain and its management strategies and resources. The treatment of musculoskeletal pain conditions is complex and often requires a multimodal approach, including pharmacological and non-pharmacological therapy that might be ineffective in many cases, resulting in poor patient satisfaction and controversial expectations about the potential benefits of available interventions. This manuscript provides an overview of unmet needs in managing musculoskeletal pain, particularly focusing on pharmacotherapeutic pitfalls in this context.