Cigarette smoking has a negative impact on the skeletal system by reducing bone mass and increasing the risk of fractures through its direct or indirect effects on bone remodeling. Recent evidence shows that smoking causes an imbalance in bone turnover, making bone vulnerable to osteoporosis and fragility fractures. In addition, cigarette smoking is known to have deleterious effects on fracture healing, as a positive correlation has been shown between the daily number of cigarettes smoked and years of exposure to smoking, although the underlying mechanisms are not fully understood. Smoking is also known to cause several medical and surgical complications responsible for longer hospital stays and a consequent increase in resource consumption. Smoking cessation is, therefore, highly advisable to prevent the onset of metabolic bone disease. However, some of the consequences appear to continue for decades. Based on this evidence, the aim of our work was to assess the impact of smoking on the skeletal system, particularly bone fractures, and to identify the pathophysiological mechanisms responsible for the impairment of fracture healing. Because smoking represents a major public health problem, understanding the association between cigarette smoking and the occurrence of bone disease is necessary in order to identify potential new targets for intervention.

Introduction: Vertebral compression fractures (VCFs) are the most common complications in patients with poor bone quality: trabecular bone discontinuity, occurring with aging, leads to trabecular loosening, subsequent microcracks and vertebral collaps. Percutaneous vertebral augmentations as vertebroplasty and kyphoplasty are minimally invasive surgical procedures developed for the management of symptomatic VCFs not responding to medical treatment, but related complications are not uncommon. The aim of this international multicentric study was to assess the reduction of pain, complications and results of Vesselplasty, a new kyphoplasty procedure.

Material and Methods: From January 2006 to July 2008 we treated 327 VCFs in 264 patients, 193 women and 71 men (mean age 68 years). Procedures were managed by one or two C-arm fluoroscopic techniques. The highest level was D6 while more common were at the thoracolumbar junction. Patients were followed at 1, 6, 12 and 24 months using plain X-rays or reformatted CT images. Pain was evaluated with visual analog scale (VAS) and SF-36 assessed at baseline, after the procedure, and after 1, 6, 12 and 24 months. Data analysis was used Student-t test. All patients received antiosteoporosis medical treatment, pain medication, and physiotherapy.

Results: We always performed transpedicular minimally invasive approches using Vessel-X^® with low-viscosity bone cement mixed with calcium sulphate. The average amount of cement injected, for each vertebral body, was 5cc (range 3.5–7cc). The mean preoperative scores of 8.3 (VAS), 12.6 (SF-36 Bodily Pain) and 10.9 (SF-36 Physical Function) were improved to 2.3, 54.9 and 52.2, respectively (P< 0.001) at 1 month follow-up and 2.1, 65.7 and 59.4, respectively (P< 0.001) at 12 month follow-up. No case reported pedicular or intracanal leaks of cement. Intradiscal leakages occurred in 20 levels (6.1% of total) but asymptomatic. Another VCF, within the first year after operation, took place in 29 patients, but only in 9 cases (3.4% of total) was an adjacent level.

Conclusion and Discussion: Treatment of osteoporosis has made enormous advances in the past years, resulting in a wide range of options. Vesselplasty is a safe and effective minimally invasive procedure for pain relief associated with VCFs, and improves mobility and quality of life in these patients. Vesselplasty permits the interdigitation of bone filler materials into the surrounding trabecular bone: the double layers containers reduce the risk of leaks of cement and restore the vertebral height. We underline the importance of a global approach to the osteoporotic patients: the best treatment remains early diagnosis evaluating bone remodelling markers, lumbar and femoral DXA, thoraco-lumbar X-rays and risk fracture assessment to guarantee the most appropriated therapy as specific as possible.

The study describes the changes of condrocytes and extracellular matrix occurring in Hip OA. 16 femoral heads were included in the study.

Cartilage explants were removed from 3 anatomical sites over the surface of 14 OA and 2 non-OA patients. Cartilage sections were evaluated with histological (EE, Alcian Blu and Mallory-Azan stainings) and immuno-histochemichal (antibodies directed against fibronectin, tenascin, laminin, type I and type IV collagen, metallo-proteinase-1,-2,-7 and -7) analysis.

Histological analysis of cartilage of central and per-hipheral biopsies from patients with severe OA showed significant reduced number of chondrocytes in both superficial and middle zones. In the lower cartilage layer with severe structural lesions a cospicous number of cartilagineous repair-islands were noticed. Immunohistochemical analysis showed high levels of tenascin in all cartilage layers of byopses showing structural damages. Frequently we observed an altered distribution of fibronectin. Metalloproteinase-2 (constitutive) is present in all stages during coxarthritis. Metalloproteinase-9 (not constitutive) is expressed at the final stages suggesting an important late role. Obtained results show that metalloproteinases have a peculiar behaviour during coxarthritis vs. other pathologies. Costitutive metal-loproteinases have a fundamental role in extracellular matrix remodelling, MMP-2 especially.