Maria Luisa Brandi

University of Florence, Florens, Tuscany, Italy

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Publications (685)2146.36 Total impact

  • Luisella Cianferotti · Maria Luisa Brandi ·
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    ABSTRACT: Non-surgical, inherited hypoparathyroidism consists of a group of heterogeneous disorders characterized by hypocalcemia and hyperphosphatemia resulting from inadequate PTH synthesis, secretion, or action. Hypoparathyroidism may present as the sole manifestation or in combination with additional features. Until 20 years ago they were mainly referred to as idiopathic hypoparathyroidism, since genetic tests were not available. In the last two decades, the molecular basis of many of the isolated and familial forms of the disease has been unraveled and accurate and targeted cytogenetic/genetic analyses are now available to better classify and consequently improve clinical management. In parallel, mouse models of the corresponding diseases have been generated, helping to define and dissect in vivo the newly identified molecular pathways. The identification of genes important for parathyroid development, differentiation and function and the steadily growing research in this field have shed light on new regulators of mineral metabolism.
    The Parathyroids, 12/2015: pages 719-736; , ISBN: 9780123971661
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    ABSTRACT: Primary hyperparathyroidism is a common endocrine disease that has undergone a series of changes in its clinical presentation over the past 60 years. The form of primary hyperparathyroidism (PHPT) that is seen most often in countries where biochemical screening is routine is described as “asymptomatic” because these individuals do not have classical signs and symptoms that are typically associated with hypercalcemia or high levels of parathyroid hormone. Four international workshops on the management of this form of PHPT have been held: 1991, 2002, 2008, and 2013. In this chapter, we present the results of the 2013 conference that led to a revision of the 2008 guidelines. It constitutes an update of evidence-based information about diagnostics, clinical features, and management of this disease. The conference also highlighted areas for which research is needed to clarify issues that remain uncertain or controversial.
    The Parathyroids, 12/2015: pages 489-497; , ISBN: 9780123971661
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    ABSTRACT: Bone tissue engineering is an emerging field, representing one of the most exciting challenges for scientists and clinicians. The possibility of combining mesenchymal stem cells and scaffolds to create engineered tissues has brought attention to a large variety of biomaterials in combination with osteoprogenitor cells able to promote and regenerate bone tissue. Human adipose tissue is officially recognized as an easily accessible source of mesenchymal stem cells (AMSCs), a significant factor for use in tissue regenerative medicine. In this study, we analyze the behavior of a clonal finite cell line derived from human adipose tissue seeded on poly( ε -caprolactone) (PCL) film, prepared by solvent casting. PCL polymer is chosen for its good biocompatibility, biodegradability, and mechanical properties. We observe that AMSCs are able to adhere to the biomaterial and remain viable for the entire experimental period. Moreover, we show that the proliferation process and osteogenic activity of AMSCs are maintained on the biofilm, demonstrating that the selected biomaterial ensures cell colonization and the development of an extracellular mineralized matrix. The results of this study highlight that AMSCs and PCL film can be used as a suitable model to support regeneration of new bone for future tissue engineering strategies.
    11/2015; 2015(3):1-12. DOI:10.1155/2015/323571
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    ABSTRACT: Dairy products provide a package of essential nutrients that is difficult to obtain in low-dairy or dairy-free diets, and for many people it is not possible to achieve recommended daily calcium intakes with a dairy-free diet. Despite the established benefits for bone health, some people avoid dairy in their diet due to beliefs that dairy may be detrimental to health, especially in those with weight management issues, lactose intolerance, osteoarthritis, rheumatoid arthritis, or trying to avoid cardiovascular disease. This review provides information for health professionals to enable them to help their patients make informed decisions about consuming dairy products as part of a balanced diet. There may be a weak association between dairy consumption and a possible small weight reduction, with decreases in fat mass and waist circumference and increases in lean body mass. Lactose intolerant individuals may not need to completely eliminate dairy products from their diet, as both yogurt and hard cheese are well tolerated. Among people with arthritis, there is no evidence for a benefit to avoid dairy consumption. Dairy products do not increase the risk of cardiovascular disease, particularly if low fat. Intake of up to three servings of dairy products per day appears to be safe and may confer a favourable benefit with regard to bone health.
    Calcified Tissue International 10/2015; DOI:10.1007/s00223-015-0062-x · 3.27 Impact Factor
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    ABSTRACT: Primary hyperparathyroidism (HPT) is the most common endocrinopathy in Multiple Endocrine Neoplasia type 1 (MEN1) syndrome. Supernumerary and/or ectopic parathyroid glands, potentially causes of persistent or recurrent HPT after surgery, have been previously described. However, this is the first ever described case of ectopic parathyroid gland localized in the aortopulmunary window causing HPT in MEN1. After a consistent concordant pre-operative imaging assessment the patient, a 16 years old male affected by a severe hypercalcemia, underwent surgery. The parathyroid was found very deeply near the tracheal bifurcation, hidden by the aortic arch itself and for this reason not visible at the beginning of the dissection but only after being identified by palpation for its typical consistence. The intraoperative PTH decreased at normal level 10 min after removal of the ectopic gland. The patient remained with normal value of calcemia and PTH during the 10 months of follow-up.
    Familial Cancer 09/2015; DOI:10.1007/s10689-015-9840-x · 1.98 Impact Factor
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    ABSTRACT: Development of tools to be used for in vivo bone tissue regeneration focuses on cellular models and differentiation processes. In searching for all the optimal sources, adipose tissue-derived mesenchymal stem cells (hADSCs or preadipocytes) are able to differentiate into osteoblasts with analogous characteristics to bone marrow mesenchymal stem cells, producing alkaline phosphatase (ALP), collagen, osteocalcin, and calcified nodules, mainly composed of hydroxyapatite (HA). The possibility to influence bone differentiation of stem cells encompasses local and systemic methods, including the use of drugs administered systemically. Among the latter, strontium ranelate (SR) represents an interesting compound, acting as an uncoupling factor that stimulates bone formation and inhibits bone resorption. The aim of our study was to evaluate the in vitro effects of a wide range of strontium (Sr 2+ ) concentrations on proliferation, ALP activity, and mineralization of a novel finite clonal hADSCs cell line, named PA20-h5. Sr 2+ promoted PA20-h5 cell proliferation while inducing the increase of ALP activity and gene expression as well as HA production during in vitro osteoinduction. These findings indicate a role for Sr 2+ in supporting bone regeneration during the process of skeletal repair in general, and, more specifically, when cell therapies are applied.
    Stem cell International 08/2015; 2015(5):1-12. DOI:10.1155/2015/871863 · 2.81 Impact Factor
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    ABSTRACT: Primary hyperparathyroidism is the main endocrinopathy associated with Multiple Endocrine Neoplasia type 1 syndrome. Cinacalcet is a calcimimetic agent licensed for the treatment of secondary hyperparathyroidism in patients with end-stage renal disease, and for the reduction of marked hypercalcemia in patients with parathyroid carcinoma and sporadic hyperparathyroidism requiring surgery but for whom parathyroidectomy is contraindicated. It may provide a medical alternative for the management of primary hyperparathyroidism in subjects affected by Multiple Endocrine Neoplasia type 1. In this longitudinal, intervention study, 33 MEN1 patients had been enrolled, 10 males and 23 females with a mean age of 40 ± 11.9 years, range 20-63. Primary hyperparathyroidism was the first clinical manifestation in 12 patients. All subjects commenced with Cinacalcet 30 mg/day, 22 patients starting therapy with calcimimetics as an alternative to surgery, and 11 patients opting for the medication after the onset of persistent post-surgical primary hyperparathyroidism. Duration of follow-up was 12 months. The results of this study show significant reductions in serum calcium. The changes in hormonal secretions of pituitary and gastroenteropancreatic glands were not significant, demonstrating the overall safety of this drug in this disease. Cinacalcet has been well tolerated by 28 patients, whereas five individuals complained of heartburn and grade 1 nausea, which did not prevent the completion of the study. In conclusion, Cinacalcet has resulted to be well tolerated and safe in patients with MEN1 syndrome and the calcium homeostasis was stabilized.
    Endocrine 07/2015; DOI:10.1007/s12020-015-0696-5 · 3.88 Impact Factor
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    ABSTRACT: Osteoporosis is as a very complex multi-factorial pathogenesis; thereby any doctor facing a case of osteoporosis must be very careful. Diagnostic procedures are complex and include careful monitoring of the history of patient, physical examination and some laboratory analysis. In this study, 201 patients aged between 50 and 95 years were selected from 4872 patients consulting orthopedic clinics. This group (201 patients: 168 women, 33 men) showed evidence of osteoporosis: BMD DXA with reduced bone
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    ABSTRACT: Parathyroid hormone (PTH) is important in the assessment of calcium metabolism disorders. However, there are few data regarding PTH levels in childhood and adolescence. The aim of this study was to determine PTH levels in a large group of healthy children and adolescents. We retrospectively evaluated PTH levels in 1,580 healthy Caucasian children and adolescents (849 females, 731 males, aged 2.0-17.2 years) with 25-hydroxyvitamin D [25(OH)D] levels ≥30 ng/ml. All subjects with genetic, endocrine, hepatic, renal, or other known diseases were excluded. The serum intact PTH concentration (median and inter-quartile range) was 23.00 (15.00-31.60) pg/ml. In our population, the mean 25(OH)D value was 34.27 ± 4.12 ng/ml. The median PTH concentration in boys was 23.00 (15.00-32.00) pg/ml, whereas in girls it was 23.10 (15.00-31.10) pg/ml. However, in girls, PTH levels significantly increased in the age group of 8.1-10.0 years compared to the age group of 2.1-4.0 years (p < 0.0001), whereas in boys it significantly increased in the age groups of 10.1-12.0 years (p < 0.0001) and 12.1-14.0 years (p < 0.0001), leading to the hypothesis of a relationship between PTH level and pubertal and bone growth spurts. PTH levels in healthy children and adolescents covered a narrower range than the adult values. Obtaining reference values of PTH in childhood and adolescence could aid in the estimation of appropriate values of bone metabolites. © 2015 S. Karger AG, Basel.
    Hormone Research in Paediatrics 06/2015; 84(2). DOI:10.1159/000432399 · 1.57 Impact Factor
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    ABSTRACT: Commonly, health behaviour theories have been applied to single behaviours, giving insights into specific behaviours but providing little knowledge on how individuals pursue an overall healthy lifestyle. In the context of diet and physical activity, we investigated the extent to which cross-behaviour cognitions, namely transfer cognitions and compensatory health beliefs, contribute to single behaviour theory. A total of 767 participants from two European regions (i.e., Germany n = 351, southern Europe n = 416) completed online questionnaires on physical activity and healthy dietary behaviour, behaviour-specific cognitions (i.e., self-efficacy, outcome expectancies, risk perception, intention, action planning, action control), as well as cross-behaviour cognitions, namely transfer cognitions and compensatory health beliefs. Nested path models were specified to investigate the importance of cross-behaviour cognitions over and above behaviour-specific predictors of physical activity and healthy nutrition. Across both health behaviours, transfer cognitions were positively associated with intention and self-regulatory strategies. Compensatory health beliefs were negatively associated with intention. Action planning and action control mediated the effect of intentions on behaviour. Cross-behaviour cognitions contribute to single behaviour theory and may explain how individuals regulate more than one health behaviour. Statement of contribution What is already known on this subject? Cross-behaviour cognitions are related to a healthy lifestyle. Compensatory health beliefs hinder the adoption of a healthy lifestyle. Transfer cognitions encourage the engagement in a healthy lifestyle. What does this study add? Transfer cognitions were positively associated with intentions, action planning, and action control over and above behaviour-specific cognitions. Compensatory health beliefs were related to intentions only. Both facilitating and debilitating cross-behaviour cognitions need to be studied within a unified multiple behaviour research framework. © 2015 The British Psychological Society.
    British Journal of Health Psychology 06/2015; 20(4). DOI:10.1111/bjhp.12144 · 2.70 Impact Factor
  • L Cianferotti · A R Gomes · S Fabbri · A Tanini · M L Brandi ·
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    ABSTRACT: The calcium-sensing receptor (CaSR), a key player in the maintenance of calcium homeostasis, can influence bone modeling and remodeling by directly acting on bone cells, as demonstrated by in vivo and in vitro evidence. The modulation of CaSR signaling can play a role in bone anabolism. The calcium-sensing receptor (CaSR) is a key player in the maintenance of calcium homeostasis through the regulation of PTH secretion and calcium homeostasis, thus indirectly influencing bone metabolism. In addition to this role, in vitro and in vivo evidence points to direct effects of CaSR in bone modeling and remodeling. In addition, the activation of the CaSR is one of the anabolic mechanisms implicated in the action of strontium ranelate, to reduce fracture risk. This review is based upon the acquisition of data from a PubMed enquiry using the terms "calcium sensing receptor," "CaSR" AND "bone remodeling," "bone modeling," "bone turnover," "osteoblast," "osteoclast," "osteocyte," "chondrocyte," "bone marrow," "calcilytics," "calcimimetics," "strontium," "osteoporosis," "skeletal homeostasis," and "bone metabolism." A fully functional CaSR is expressed in osteoblasts and osteoclasts, so that these cells are able to sense changes in the extracellular calcium and as a result modulate their behavior. CaSR agonists (calcimimetics) or antagonists (calcilytics) have the potential to indirectly influence skeletal homeostasis through the modulation of PTH secretion by the parathyroid glands. The bone anabolic effect of strontium ranelate, a divalent cation used as a treatment for postmenopausal and male osteoporosis, might be explained, at least in part, by the activation of CaSR in bone cells. Calcium released in the bone microenvironment during remodeling is a major factor in regulating bone cells. Osteoblast and osteoclast proliferation, differentiation, and apoptosis are influenced by local extracellular calcium concentration. Thus, the calcium-sensing properties of skeletal cells can be exploited in order to modulate bone turnover and can explain the bone anabolic effects of agents developed and employed to revert osteoporosis.
    Osteoporosis International 06/2015; 26(8). DOI:10.1007/s00198-015-3203-1 · 4.17 Impact Factor
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    ABSTRACT: Osteoarthritis (OA), a disease affecting different patient phenotypes, appears as an optimal candidate for personalized healthcare. The aim of the discussions of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) working group was to explore the value of markers of different sources in defining different phenotypes of patients with OA. The ESCEO organized a series of meetings to explore the possibility of identifying patients who would most benefit from treatment for OA, on the basis of recent data and expert opinion. In the first meeting, patient phenotypes were identified according to the number of affected joints, biomechanical factors, and the presence of lesions in the subchondral bone. In the second meeting, summarized in the present article, the working group explored other markers involved in OA. Profiles of patients may be defined according to their level of pain, functional limitation, and presence of coexistent chronic conditions including frailty status. A considerable amount of data suggests that magnetic resonance imaging may also assist in delineating different phenotypes of patients with OA. Among multiple biochemical biomarkers identified, none is sufficiently validated and recognized to identify patients who should be treated. Considerable efforts are also being made to identify genetic and epigenetic factors involved in OA, but results are still limited. The many potential biomarkers that could be used as potential stratifiers are promising, but more research is needed to characterize and qualify the existing biomarkers and to identify new candidates.
    06/2015; 32(7). DOI:10.1007/s40266-015-0276-7
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    DESCRIPTION: The Tuscany Region was the first Italian Region to initiate a program for the prevention of hip fractures in over 65 year old. The T.A.R.Ge.T. project “Appropriate treatment of geriatric re-fractures in Tuscany” (Trattamento Appropriato delle Rifratture Geriatriche in Toscana), which is still on-going, includes a preliminary phase (2009-2010) for baseline analysis and education of the participating centers and a 4-year- prospective phase (2011-2014). The monitoring system is performed horizontally analyzing 5 different flows: SDO (Performance Hospitalization), SPF (Pharmaceutical Distribution Dataset), FED (Direct Distribution Dataset), SAA (Registry of Patients), SPA (Specialized Outpatient) flows. In this review will be shown some of the most important results of analyzes of the retrospective phase. Between 2006 and 2011 only 26% of hip fractured patients has being treated with anti-osteoporotic drugs. The percentage of treatment increases 10% after the second fracture. Until 2011 there wasn’t in Tuscany a prevention program of bone fragility; patients were treated with specific treatment only in severe cases: this phenomenon implies that mortality and re-fracture are higher on treated patients than in patients who did not have any kind of treatment. The treated patients are the most severe and therefore they have a higher risk of death and re-fracture. .
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    ABSTRACT: This article reports a taxonomic classification of rare skeletal diseases based on metabolic phenotypes. It was prepared by The Skeletal Rare Diseases Working Group of the International Osteoporosis Foundation (IOF) and includes 116 OMIM phenotypes with 86 affected genes. Rare skeletal metabolic diseases comprise a group of diseases commonly associated with severe clinical consequences. In recent years, the description of the clinical phenotypes and radiographic features of several genetic bone disorders was paralleled by the discovery of key molecular pathways involved in the regulation of bone and mineral metabolism. Including this information in the description and classification of rare skeletal diseases may improve the recognition and management of affected patients. IOF recognized this need and formed a Skeletal Rare Diseases Working Group (SRD-WG) of basic and clinical scientists who developed a taxonomy of rare skeletal diseases based on their metabolic pathogenesis. This taxonomy of rare genetic metabolic bone disorders (RGMBDs) comprises 116 OMIM phenotypes, with 86 affected genes related to bone and mineral homeostasis. The diseases were divided into four major groups, namely, disorders due to altered osteoclast, osteoblast, or osteocyte activity; disorders due to altered bone matrix proteins; disorders due to altered bone microenvironmental regulators; and disorders due to deranged calciotropic hormonal activity. This article provides the first comprehensive taxonomy of rare metabolic skeletal diseases based on deranged metabolic activity. This classification will help in the development of common and shared diagnostic and therapeutic pathways for these patients and also in the creation of international registries of rare skeletal diseases, the first step for the development of genetic tests based on next generation sequencing and for performing large intervention trials to assess efficacy of orphan drugs.
    Osteoporosis International 06/2015; 26(10). DOI:10.1007/s00198-015-3188-9 · 4.17 Impact Factor
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    L Cianferotti · S Parri · G Gronchi · C Rizzuti · C Fossi · D M Black · M L Brandi ·
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    ABSTRACT: Scientific interest in vitamin D has greatly risen during the last 10 years. The analysis of the changes in vitamin D prescriptions and related costs in a regional prescription dataset has revealed a profound increase in the period 2006-2013. Further studies on cost-effectiveness of such increase in vitamin D supplementation are needed. The aim of this study was to analyze the changes in population-based prescription patterns of vitamin D supplements in the general population in an Italian regional setting during an 8-year period (2006-2013). Data have been retrieved from the database of reimbursed prescriptions of the Region of Tuscany containing all of the medical reimbursements for the whole regional population (total of 3,619,872 and 3,692,828 inhabitants in 2006 and 2013, respectively). Data referring to adult population (age 20-90+ years) have been considered for this analysis (3,033,530 in 2006 and 3,066,741 in 2013). Two different flows (pharmaceutical distribution dataset and general data flow) were taken into account, using the ATC5 coding system for vitamin D supplements alone or in combination with calcium or alendronate. The number of boxes dispensed was retrieved, the number of patients receiving a specific treatment was calculated, and a cost analysis was performed. An upsurge in the prescriptions of vitamin D compounds was disclosed, mainly sustained by a 75.3-fold increase in cholecalciferol, in all age groups and both sexes. This occurred in parallel to a 4.3-fold rise in prescriptions of oral alendronate in combination with cholecalciferol, a slight decrease in dispensed alendronate alone, and a modest increase in the prescription of the combination of calcium salts and cholecalciferol, and calcium alone. The total cost for reimbursement by the Regional Health System for vitamin D-related compounds rose from 3,242,100 euros in 2006 to 8,155,778 in 2013. The huge increase in vitamin D prescriptions and related costs in the last decade, as revealed by the analysis of a regional pharmaceutical dataset, reflects the increased awareness of the possible consequences of a poor vitamin D status. Further studies on cost-effectiveness of such increase in vitamin D supplementation are needed.
    Osteoporosis International 06/2015; 26(11). DOI:10.1007/s00198-015-3187-x · 4.17 Impact Factor
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    ABSTRACT: Hypophosphatemic rickets (HR) is a rare disease that includes a group of hereditary and sporadic conditions characterized by renal phosphate loss associated with normal to low vitamin D serum concentration. The most common form is the X-linked hypophosphatemic rickets, with an incidence of 1: 20000. Several mutations have recently been identified in PHEX, FGF23, DMP1 and ENPP1 genes in patients with HR. Moreover, in vitro and in vivo studies suggested an involvement of MEPE for defective mineralization in HR. The present case series describes the clinical features and the analysis of genes implicated in HR in a cohort of 26 Italian HR patients. All patients were analyzed for PHEX and FGF23 genes by direct sequencing. When no mutations were detected, Multiplex Ligation-dependent Probe Amplification (MLPA) analysis was performed. The negative patients were screened for DMP1, MEPE and ENPP1 genes by direct sequencing. Twenty-two patients (84%) harbored mutations in PHEX gene. In particular, we detected 19 different mutations, 15 of which were novel. One patient presented a novel splice variation in ENPP1 gene while no alterations were identified in FGF23, DMP1 and MEPE genes. The genetic study of the families showed that 11 patients (55%) had de novo mutations. Clinical presentation and disease severity did not show an evident correlation between the mutation type. This report represents the first large familial study performed on Italian patients. It confirms that mutations in PHEX are the most frequent cause of HR. Furthermore, the variety of clinical manifestations identified in our HR patients underlines the extreme clinical and genetic heterogeneity of this disease. Copyright © 2015. Published by Elsevier Inc.
    Bone 06/2015; 79. DOI:10.1016/j.bone.2015.05.040 · 3.97 Impact Factor
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    ABSTRACT: Background JIA is the most common chronic arthritis of childhood. Vitamin D is a potential immuno-modulator in many conditions, including autoimmune diseases. Its influence in JIA is still unclear. Specific polymorphisms of vitamin D receptor gene (VDR) have recently been associated with different biologic responses to vitamin D itself. Objectives 90 Italian children, adolescents and young adults with poli- or oligoarticular onset of JIA were studied. VDR polymorphisms were analysed by PCR-based sequencing (CDX2 in the promoter region) and PCR-based enzymatic digestions (FokI in exon 2, BsmI and ApaI in intron 8, and TaqI in exon 9) in the genomic DNA from blood of patients. 2221 healthy Italian unrelated individuals have been used as controls for VDR polymorphism frequencies. Distribution of VDR polymorphisms has been evaluated in patients vs controls, in patients with active and inactive disease, and in patients with poli- or oligoarticular JIA. Methods The distribution of FokI, BsmI, and TaqI polymorphisms did not show any significant difference between subjects with JIA and controls. Conversely, significant statistical differences in the distribution of CDX2 and ApaI genotypes were found, respectively with the CDX2 GG genotype (Yates-corrected chi-square 6.56; Odds ratio=1.80; p=0.0104) and the TT ApaI genotype (Yates-corrected chi-square 20.97; Odds ratio=2.67; p=0.0000), both more frequent in JIA than in controls. Also the G allele of CDX2 (Yates-corrected chi-square 6.12; Odds ratio=1.60; p=0.0134) and the T allele of ApaI (Yates-corrected chi-square 19.69; Odds ratio=2.05; p=0.0000) was more frequent in JIA. No statistical differences were found for all the analysed VDR polymorphisms, between the poliarticular vs oligoarticular forms. No significant association was found between VDR polymorphisms and active or inactive forms of JIA, neither with osteopenic or normal bone mineral density status. Conclusions Pathogenetic mechanisms influencing the predisposition to JIA are poorly elucidated and autoimmune dysfunctions are strongly suspected. This genetic study found a significantly higher frequency of the GG genotype of VDR CDX2 polymorphism and TT genotype of VDR ApaI polymorphism in patients with JIA. The CDX2 polymorphism is located in the promoter region of the VDR gene and has been associated with VDR mRNA expression, while the ApaI polymorphism has been associated with the stability of VDR mRNA. Therefore, we can speculate that CDX2 GG genotype and ApaI TT genotype can both influence the expression of the VDR protein, presumably resulting in a reduced receptor activity with subsequent decreased response to vitamin D and potential immunity deregulation, favouring the development of JIA. Conversely, VDR polymorphisms seem not to have any influence for patients' active or non-active status, both for the oligoarticular and poliarticular form of the disease. Disclosure of Interest None declared
    Annals of the Rheumatic Diseases 06/2015; 74(Suppl 2):1224.3-1225. DOI:10.1136/annrheumdis-2015-eular.5804 · 10.38 Impact Factor

  • Annals of the Rheumatic Diseases 06/2015; 74(Suppl 2):529.2-530. DOI:10.1136/annrheumdis-2015-eular.1097 · 10.38 Impact Factor
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    ABSTRACT: A care gap exists between the health care needs of older persons with fragility fractures and the therapeutic answers they receive. The Fracture Prevention Service (FPS), a tailored in-hospital model of care, may effectively bridge the osteoporosis care gap for hip-fractured older persons. The purpose of this study was to evaluate the efficacy of the FPS in targeting persons at high risk of future fracture and to improve their adherence to treatment. This was a prospective observational study conducted in a teaching hospital with traumatology and geriatric units, and had a pre-intervention and post-intervention phase. The records of 172 participants were evaluated in the pre-intervention phase, while data from 210 participants were gathered in the post-intervention phase. All participants underwent telephone follow-up at 12 months after hospital discharge. The participants were patients aged ≥65 years admitted to the orthopedic acute ward who underwent surgical repair of a proximal femoral fracture. A multidisciplinary integrated model of care was established. Dedicated pathways were implemented in clinical practice to optimize the identification of high-risk persons, improve their evaluation through bone mineral density testing and blood examinations, and initiate an appropriate treatment for secondary prevention of falls and fragility fractures. Compared with the pre-intervention phase, more hip-fractured persons received bone mineral density testing (47.62% versus 14.53%, P<0.0001), specific pharmacological treatments (48.51% versus 17.16%, P<0.0001), and an appointment for evaluation at a fall and fracture clinic (52.48% versus 2.37%, P<0.0001) in the post-intervention phase. Independent of some confounders, implementation of the FPS was positively associated with recommendations for secondary fracture prevention at discharge (P<0.0001) and with 1-year adherence to pharmacological treatment (P<0.0001). The FPS is an effective multidisciplinary integrated model of care to optimize identification of older persons at highest risk for fragility fracture, to improve their clinical management, and to increase adherence to prescriptions.
    Clinical Interventions in Aging 06/2015; 10:1035-1042. DOI:10.2147/CIA.S76695 · 2.08 Impact Factor
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    ABSTRACT: Several compounds are produced along the complex pathways of vitamin D3 metabolism, and synthetic analogs have been generated to improve kinetics and/or vitamin D receptor activation. These metabolites display different chemical properties with respect to the parental or native vitamin D3, i.e., cholecalciferol, which has been, so far, the supplement most employed in the treatment of vitamin D inadequacy. Hydrophilic properties of vitamin D3 derivatives facilitate their intestinal absorption and their manageability in the case of intoxication because of the shorter half-life. Calcidiol is a more hydrophilic compound than parental vitamin D3. Active vitamin D analogs, capable of binding the vitamin D receptor evoking vitamin D-related biological effects, are mandatorily employed in hypoparathyroidism and kidney failure with impaired 1α-hydroxylation. They have been shown to increase BMD, supposedly ameliorating calcium absorption and/or directly affecting bone cells, although their use in these conditions is jeopardized by the development of hypercalciuria and mild hypercalcemia. Further studies are needed to assess their overall safety and effectiveness in the long-term and new intermittent regimens, especially when combined with the most effective antifracture agents.
    Endocrine 05/2015; 50(1). DOI:10.1007/s12020-015-0606-x · 3.88 Impact Factor

Publication Stats

15k Citations
2,146.36 Total Impact Points


  • 1982-2015
    • University of Florence
      • • Dipartimento di Chirurgia e Medicina Traslazionale (DCMT)
      • • Dipartimento di Scienze Biomediche, Sperimentali e Cliniche
      Florens, Tuscany, Italy
  • 2014
    • Euro Mediterranean Scientific and Biomedical Institute
      Brindisi, Apulia, Italy
  • 2013
    • Misericordia of Florence
      Florens, Tuscany, Italy
  • 2012
    • Santa Maria del Pozzo
      Napoli, Campania, Italy
  • 2006-2010
    • Azienda Ospedaliero Universitaria Careggi
      • Department of Internal Medicine
      Florens, Tuscany, Italy
    • Erasmus MC
      • Department of Internal Medicine
      Rotterdam, South Holland, Netherlands
  • 2007
    • Università di Pisa
      • Department of Clinical and Experimental Medicine
      Pisa, Tuscany, Italy
  • 2002
    • Università Vita-Salute San Raffaele
      Milano, Lombardy, Italy
  • 1993-1998
    • Università degli studi di Parma
      • Dipartimento di Scienze Chirurgiche
      Parma, Emilia-Romagna, Italy
  • 1996
    • Università degli Studi di Siena
      • Department of Medicine, Surgery and Neuroscience
      Siena, Tuscany, Italy
  • 1995
    • William Harvey Research Institute
      Londinium, England, United Kingdom
    • University of Bologna
      Bolonia, Emilia-Romagna, Italy
  • 1994
    • University of Catania
      Catania, Sicily, Italy
  • 1987-1993
    • National Institutes of Health
      • • Branch of Metabolic Diseases Branch (MDB)
      • • Branch of Surgery
      • • Laboratory of Genetics (LG)
      베서스다, Maryland, United States
  • 1992
    • CRO Centro di Riferimento Oncologico di Aviano
      Aviano, Friuli Venezia Giulia, Italy
  • 1986-1989
    • The National Institute of Diabetes and Digestive and Kidney Diseases
      Maryland, United States
    • Northern Inyo Hospital
      BIH, California, United States