Dr. med. Yannis Dionyssiotis is specialized in Physical Medicine and Rehabilitation. He worked as Research Fellow in the Laboratory for Research of the Musculoskeletal System at the University of Athens, as Physiatrist in the Rehabilitation department of KAT Hospital in Athens and Head of Physical Medicine and Rehabilitation Department in Rhodes General Hospital in Greece. Currently, is the Medical Director of Rehabilitation Center Amyntæo, in Florina, Greece. Dr. med. Dionyssiotis has clinical experience as physiatrist including experience in a variety of clinical settings as clinician, researcher, clinical instructor and consultant. He also holds a Thesis in Osteoporosis and Metabolic Bone Diseases from National and Kapodistrian University of Athens. Dr. med. Dionyssiotis has an extensive list of professional presentations and publications in the areas of rehabilitation, and osteoporosis. He continues to work in Greece developing his research. He has served as reviewer for several international, pubmed and peer-reviewed journals. Dr med. Dionyssiotis is elected member of the board of International Society of Musculoskeletal & Neuronal Interactions (ISMNI) and has written books and papers for spinal cord injury and multiple sclerosis related bone impairment, physical exercise, spinal orthoses, jumping mechanography, vitamin D, falls and fractures. He is also editor of the online Rehabilitation magazine: www.medreha.com, http://publicationslist.org/y.dionyssiotis
Abstract: BACKGROUND: Interventions other than medications in the management of osteoporosis are often overlooked. The purpose of this study was to investigate the association of physical activity and calcium intake with bone parameters. METHODS: We measured the heel T-score and stiffness index (SI) in 1890 pre- and postmenopausal women by quantitative ultrasound (QUS) and assessed physical activity and dietary calcium intake by questionnaire. Participants were divided according to their weekly physical activity (sedentary, moderately active, systematically active) and daily calcium consumption (greater than or less than 800 mg/day). RESULTS: SI values were significantly different among premenopausal groups (p = 0.016) and between sedentary and systematically active postmenopausal women (p = 0.039). QUS T-scores in systematically active premenopausal women with daily calcium intake > 800 mg/day were significantly higher than those in all other activity groups (p < 0.05) independent of calcium consumption. CONCLUSIONS: Systematic physical activity and adequate dietary calcium intake are indicated for women as a means to maximize bone status benefits.
Abstract: The purpose of this study was to investigate and add reference data about the musculoskeletal system in women. The mechanography system of the Leonardo⢠platform (Novotec, Germany) was used to measure parameters of movement (velocity, force, power) in 176 healthy Greek women aged 20-79 years, separated according to age decade in six groups: group 1 (n = 12), 20-29 years; group 2 (n = 14), 30-39 years; group 3 (n = 33), 40-49 years; group 4 (n = 59), 50-59 years including 21 postmenopausal; group 5 (n = 31), 60-69 years including 12 postmenopausal; and group 6 (n = 27), 70-79 years all postmenopausal. This system measures forces applied to the plate over time, calculates through acceleration the vertical velocity of center of gravity and using force and velocity it calculates power of vertical movements. All women performed a counter-movement jump (brief squat before the jump) with freely moving arms. Weight was recorded on the platform before the jump and height was measured with a wall-mounted ruler. Body weight and body mass index were gradually increased; on the contrary height and all movement parameters except force (velocity, power) were statistically decreased during aging and after menopause.
Abstract: Osteoporotic vertebral fractures are associated with considerable reduction of quality of life, morbidity, and mortality. The management of patients with vertebral fractures should include treatment for osteoporosis and measures to reduce pain and improve mobility. This article provides information for management and rehabilitation of vertebral fractures based on clinical experience and literature.
Abstract: To investigate the influence of the neurological level of injury in bone mineral content (BMC) and mechanical properties, lean mass (LM), and fat mass (FM) among paraplegics with a similar duration of paralysis (DOP), we separated 30 paraplegics into group A (15 men, high-level paraplegia) and group B (15 men, low-level paraplegia) and compared them with group C (33 men, nondisabled). In all subjects, we measured stress-strain index (SSI) at 14% (SSI(2)) and 38% (SSI(3)) of the tibia length and the difference between them using peripheral quantitative computed tomography (XCT 3000 [Stratec Medizintechnik, Pforzheim, Germany]) and lower-limb BMC, LM, and FM (g) using whole-body dual-energy X-ray absorptiometry (Norland XR-36 [Norland Medical Systems, Inc; Fort Atkinson, Wisconsin]). Bone strength parameters, BMC, and LM were statistically decreased, but we found no difference in paraplegic FM compared with group C. We found a correlation between the DOP and the difference between SSI 3 and SSI 2 in group B (r = 0.53, p = 0.03 and r = 0.5, p = 0.04, respectively). We correlated DOP with FM in group A's lower limbs (r = 0.5, p = 0.05). Because of the nonsignificant DOP, the groups with paraplegia act differently in tibia mechanical properties and lower-limb body composition.
Abstract: Quantitative ultrasound (QUS) is considered a useful method in evaluating bone status. The aim of the present study was to establish the reference data for the QUS measurements of the calcaneus in a Greek population. We measured a QUS parameter, stiffness index (SI), at the right calcaneus in 1500 women using the Achilles express Ultrasonometer (GE Lunar, Madison, WI). Participants were divided into 7 groups according to their age with a 10-yr span in each group. A progressive decline was found in the SI values after the age of 39 yr in the current study. When the SI values were compared between the age groups, high statistically significant differences were obvious, especially between 20-29 and 50- to 59-yr age groups and 60-69 and 70- to 79-yr age groups (p < 0.0005). Additionally, in the Greek normal range (GNR), the SI values of those aged 60-69 and 70-79 yr were significantly higher (81.84+/-16.14 and 77.45+/-17.65, respectively) than those in the manufacturer's normal range (MNR; 75.84+/-16.14 and 69.10+/-17.65, p < 0.005, respectively). Using the manufacturer's values, significantly fewer women were classified as normal (48% vs 67.3%), although those with T-score < or =-2.5 were more (15.7%) compared with our Greek value (1.5%), and classification of subjects into risk-of-fracture categories was significantly different (kappa: 0.459, 66.2%, p < 0.0005). Multiple regression analysis showed that weight was the most significant predictor for SI in the age groups 30-39 (beta = 0.280, p < 0.05), 40-49, 60-69, and 70-79 yr (beta = 0.185, p < 0.005; beta = 0.329, p < 0.0005; beta = 0.494, p<0.0005, respectively). Using conventional categories of risk, we report a different classification of our subjects from those proposed by the manufacturer, supporting the concept that data specific to the Greek population are necessary.
Abstract: To investigate alterations in the body composition of paraplegic men, 31 complete paraplegic men thoracic (T)4-T 12 neurological level of injury, 16 with paraplegia above (high), and 15 below (low) thoracic 7, were compared with 33 able-bodied men. Whole body dual X-ray absorptiometry was used to estimate regional (arms, legs) and total body bone mineral density (g/cm(2)), lean, and fat mass (g).The influence of the neurological level of injury and the duration of paralysis in relation with the above parameters were also investigated. Body mass index, bone mineral density, and lean mass were significantly decreased (p < 0.0005) and fat mass was increased (p < 0.05) in the legs and total body composition in paraplegics. Bone mineral density was significantly lower in high paraplegics' arms compared with low paraplegics (p = 0.028). The correlation of body mass index with fat mass was statistically significant in all paraplegics and controls (r = 0.57, p = 0.001 and r = 0.73, p = 0.0001, respectively) and in low paraplegics (r = 0.72, p = 0.004). Legs' bone mineral density and arms' fat mass were correlated with the duration of paralysis in all paraplegics (r = -0.46, p = 0.009 and r = 0.43, p = 0.020, respectively) and in high paraplegics (r = 0.73, p = 0.001 and r = 0.55, p = 0.042, respectively). Total fat mass was correlated with the duration of paralysis in high paraplegics (r = 0.5, p = 0.05). These results suggest body composition changes in paraplegics.
Abstract: Falls are one of the most common geriatric problems threatening the independence of older persons. Elderly patients tend to fall more often and have a greater tendency to fracture their bones. Fractures occur particularly in osteoporotic people due to increased bone fragility, resulting in considerable reduction of quality of life, morbidity, and mortality. This article provides information for the rehabilitation of osteoporotic fractures pertaining to the rehabilitation of the fractured patient, based on personal experience and literature. It also outlines a suggested effective and efficient clinical strategy approach for preventing falls in individual patients.
Abstract: AIM: The effects of Spinal Cord Injury (SCI) on bone in paralyzed areas are well documented but there are few data for the importance of the level of injury in the decrease of mechanical strength in paralyzed legs. The aim of the present study was to describe bone loss of the separate compartments of trabecular and cortical bone in spinal cord injured men and to compare possible changes in mechanical properties of tibia with the neurological level of injury. MATERIALS AND METHODS: Fifty men were included in this study: 39 had complete SCI in chronic stage. As chronic stage, we considered paraplegia >1.5 years (yrs). Men were separated as follows: Group A (18 men, high paraplegia: Thoracic (T)4-T7 level, mean age: 33 yrs, duration of paralysis: 5.9 yrs) and group B (21 men, low paraplegia: T8-T12 level, mean age: 39 yrs, duration of paralysis: 5.6 yrs) in comparison with 11 healthy men as a control group (C) of similar age, height, and weight. None of the subjects was given bone acting drugs. The neurological profile of each patient was assessed according to the American Spinal Injury Association (ASIA). All subjects were measured by peripheral quantitative computed tomography (pQCT). Measurements were performed at the tibia with a Stratec XCT 3000 (Stratec Medizintechnik, Pforzheim, Germany) scanner. The distal end of the tibia was used as an anatomical marker. The bone parameters, bone mass density (BMD) trabecular, BMD total, BMD cortical, and cortical thickness have been measured at 4% and 38%, respectively, of the tibia length proximal to this point, and the periosteal and endocortical was measured at 14% of the tibia. We calculated stress strain index (SSI), a bone strength estimator derived from the section modulus, and the volumetric density of the cortical area at 14% (SSIPol2) and 38% (SSIPol3) of the tibia length proximal to the distal end of the tibia. RESULTS: In both groups A and B most bone mass parameters were statistically decreased in comparison with controls. In each group we calculated the median deltaSSI(3-2) (SSIPol3 - SSIPol2). In the paraplegic groups Spearman correlation coefficient between duration of paralysis and deltaSSI(3-2) was in group A: r=-0.178, p=N.S. and group B: r=0.534, p=0.027, respectively. CONCLUSION: Despite the similar paralytic effect on bone in all paraplegic patients in our study and because of the non-significant duration of paralysis between paraplegic groups (p=0.87), the two paraplegic groups act differently in mechanical properties of the tibia. In addition, group A patients in respect to the level of injury, are susceptible to autonomic dysreflexia as a result of the disruption of the autonomic nervous system pathways. These results suggest that neurogenic factors are influencing geometric bone parameters.
