Tanja Janković

Background and Objectives: The Back Beliefs Questionnaire (BBQ) is a patient-reported outcome measure used to assess beliefs about back pain. This study aimed to cross-culturally adapt the BBQ into Serbian and evaluate the psychometric properties of the Serbian version (BBQ-Srb) in patients with chronic low back pain. Materials and Methods: A cross-sectional study involving cross-cultural adaptation and psychometric validation was conducted in 143 patients with chronic low back pain. The adaptation process included forward and backward translation, expert review, and pilot testing. Psychometric evaluation included assessment of floor and ceiling effects, internal consistency, test–retest reliability, measurement error, exploratory and confirmatory factor analyses, and construct validity testing using predefined hypotheses. Construct validity was examined through associations between BBQ-Srb scores and pain intensity, disability, pain catastrophizing, and work absenteeism. Results: The BBQ-Srb showed acceptable internal consistency, with Cronbach’s alpha of 0.728 and McDonald’s omega of 0.735. Total-score analyses were based on the preliminary exploratory 8-item BBQ-Srb version excluding BBQ13, whereas floor and ceiling effects were examined for the original 9-item scored BBQ-Srb version. Test–retest reliability was excellent (ICC = 0.916). Exploratory factor analysis suggested a predominantly one-factor structure, but the explained variance was modest. Confirmatory factor analysis of the 8-item version provided only partial support for unidimensionality, with marginal model fit and a low average variance extracted. The 8-item BBQ-Srb total score showed significant negative correlations with pain intensity, disability, and pain catastrophizing, confirming three of four predefined hypotheses. Conclusions: The BBQ-Srb demonstrated acceptable reliability and preliminary evidence of construct validity as a Serbian patient-reported outcome measure for assessing beliefs about back pain. However, structural validity was only partially supported, and the exploratory 8-item structure requires confirmation in larger, independent, and more diverse Serbian-speaking samples.

Background/Objectives: Osteoarthritis is a slowly evolving joint disorder defined by cartilage degradation, synovial inflammation, subchondral bone hardening, and the growth of osteophytes. Increasing evidence highlights the role of metabolic factors in osteoarthritis onset and progression. This study investigated the link between metabolic syndrome and the level of knee impairment in postmenopausal respondents suffering from knee osteoarthritis. Methods: A total of 200 participants aged 60–75 years with knee pain were enrolled in this observational cross-sectional study conducted between 2022 and 2023. The case group comprised 120 women with radiographically verified knee osteoarthritis (Kellgren–Lawrence grades II–IV), while 80 age-matched women without radiographic changes served as controls. Clinical and anthropometric measures, metabolic indicators, and radiographic findings were collected. Functional status was assessed using the Lower Extremity Functional Scale and the Lequesne Index. Results: The groups differed significantly with respect to the presence of metabolic syndrome, diastolic blood pressure, and fasting glucose level (p < 0.05). The metabolic syndrome showed modest but significant associations with radiographic knee damage (effect size 4.7%). After adjusting for smoking status and physical activity level, metabolic syndrome remained significantly associated with radiographic damage (effect sizes: 4.8 and 2.2%, respectively). Participants with osteoarthritis but without metabolic syndrome had better functional knee status compared to those with metabolic syndrome (p < 0.05). Conclusions: In postmenopausal women, metabolic syndrome is independently associated with radiographic knee damage and contributes to poorer functional outcomes in participants with knee osteoarthritis, underscoring its potential role as a modifiable risk factor.

Background and Objectives: Knee osteoarthritis (KOA) is a widespread chronic joint disease characterized by functional limitations and pain. Functioning restrictions exert a detrimental impact on societal integration, relationships, and psychological well-being, resulting in significant emotional distress in KOA patients. The objective of this study is to examine how various risk factors impact the emotional well-being of individuals with KOA. Materials and Methods: This prospective cross-sectional study involved 154 postmenopausal women treated at the Special Hospital for Rheumatic Diseases in Novi Sad, Serbia. The experimental group comprised 97 individuals with chronic knee pain and structural knee damage (Kellgren–Lawrence (KL) scale II-IV), while the control group had 53 individuals with chronic knee pain but no structural knee damage (KL scale 0-I). The collected data consisted of sociodemographic factors, general characteristics, associated diseases, and laboratory results. Adequate anthropometric measurements were conducted, and all subjects were required to complete the SF-36 RAND questionnaire. Results: The analysis identified several variables that independently influenced emotional well-being. These included pain intensity (beta (β) 0.21; 95% CI: 0.03–0.20; p < 0.01), social functioning (beta (β) 0.47; 95% CI: 0.23–0.43; p < 0.001), physical functioning (beta (β) 0.23; 95% CI: 0.04–0.21; p < 0.01), and education level (8–12 years: beta (β) 0.25; 95% CI: 1.47–9.41; p < 0.01; >12 years: beta (β) 0.27; 95% CI: 2.51–12.67; p < 0.01). However, the multivariate model revealed that only social functioning (beta (β) 0.57; 95% CI: 0.27–0.53; p < 0.001) and education level (8–12 years: beta (β) 0.21; 95% CI: 1.10–8.260; p < 0.05; >12 years: beta (β) 0.21; 95% CI: 1.18–10.30; p < 0.05) were significantly associated with emotional well-being in KOA patients. Conclusions: The findings of this study indicate that a reduced social functioning and a lower educational attainment are linked to a poorer emotional well-being among patients with KOA.

Tumor necrosis factor alpha (TNF-α), which enhances osteoclast activity and bone resorption, is one of the key inflammation mediators in rheumatoid arthritis (RA). The aim of this study was to assess the influence of yearlong TNF-α inhibitor application on bone metabolism. The study sample comprised 50 female patients with RA. Analyses involved the osteodensitometry measurements obtained using a “Lunar” type apparatus and the following biochemical markers from serum: procollagen type 1 N-terminal propeptide (P1NP), beta crosslaps C-terminal telopeptide of collagen type I (b-CTX) by ECLIA method, total and ionized calcium, phosphorus, alkaline phosphatase, parathyroid hormone and vitamin D. Analyses revealed changes in bone mineral density (BMD) at L1–L4 and the femoral neck, with the difference in mean BMD (g/cm²) not exceeding the threshold of statistical significance (p = 0.180; p = 0.502). Upon completion of 12-month therapy, a significant increase (p < 0.001) in P1NP was observed relative to b-CTX, with mean total calcium and phosphorus values following a decreasing trend, while vitamin D levels increased. These results suggest that yearlong application of TNF inhibitors has the capacity to positively impact bone metabolism, as indicated by an increase in bone-forming markers and relatively stable BMD (g/cm²).

Introduction. Elucidation of the pathogenetic mechanisms of osteoporosis has led to the development of new and effective drugs from the group of biological agents. Case report. In April 2018, a 64-year-old female patient was presented to the hospital due to low back pain. She was diagnosed with postmenopausal osteoporosis based on bone density scan score and a compression fracture of the L1 vertebral body revealed by X-ray. She was treated with a weekly bisphosphonate and supplementation with vitamin D and calcium. After one year, monthly bisphosphonate was introduced in therapy because of an inadequate response. In April 2020, the patient was treated for COVID-19 according to protocol, and during the treatment, bisphosphonate therapy was discontinued. After five months, she suffered a fracture of her left forearm. Due to the persistence of low mineral bone density, which was complicated by a new fracture, denosumab 60 mg subcutaneously once every six months was initiated with additional vitamin D and calcium supplementation. At six months follow-up, an increase in mineral bone density was verified, and after 12 months, the dual-energy x-ray absorptiometry score was within the osteopenia range. Laboratory findings showed a decrease in bone turnover markers. Conclusion. One-year administration of denosumab led to a significant increase in bone mineral density measured at the lumbar spine and neck of the femur, as well as changes in the levels of biochemical markers of bone synthesis and resorption, and reduced the risk of new fractures.

Introduction. Osteoporosis is a metabolic bone disease characterized by reduced bone mineral density and damage to the bone microarchitecture, which leads to bone fragility, thus increasing the risk of osteoporotic fractures. While different diagnostic methods can be employed for detecting bone mineral density decrement in a timely manner, dual energy X-ray absorptiometry remains the gold standard in research and clinical practice. Bone mineral density estimation methods. Osteoporosis can be diagnosed through conventional radiography, quantitative ultrasonography, quantitative computed tomography, and magnetic resonance. Nonetheless, dual energy X-ray absorptiometry is the gold standard in the diagnosis of osteoporosis on which further treatment and monitoring are based. The dual energy X-ray absorptiometry apparatus is equipped with the Fracture Risk Assessment Tool, which estimates the 10- year probability of a major fracture and hip fracture due to osteoporosis. The use and interpretation of osteoporosis diagnostic evaluation modalities is based on the International Society for Clinical Densitometry guidelines for diagnosing osteoporosis in adults and children. According to the International Society for Clinical Densitometry recommendations, the aforementioned quantitative visualization modalities should be used alongside laboratory analyses of bone metabolism markers to supplement diagnostics and monitor treatment efficacy in patients suffering from osteoporosis. Conclusion. Assessment of risk factors and early diagnosis are prerequisites for timely treatment and effective monitoring, which is necessary for arresting the progression of bone mineral density loss and preventing the occurrence of osteoporotic fractures.

Introduction. Horizontal therapy is the only electrotherapy modality for the treatment of osteoarthritis that has a simultaneous bioelectrical and biochemical, effect on deep and superficial joint tissues. The objective of this report was to provide evidence of efficacy of horizontal therapy in a patient suffering from lumbar spine osteoarthritis. Case report. A 70-year-old female patient was admitted to the hospital due to severe low back pain with radiating pain in both legs followed by tingling in left leg. The patient has had this painful condition since 2010. Physical examination revealed a reduction of the range of motion of the lumbar spine followed by spasm of the paraspinal musculature. Deep tendon reflexes of the lower limbs were 2+ bilaterally, except right patellar reflex which was absent. She had hypoesthesia in L4, L5 and S1 dermatome of the left leg and no motor deficits were noted. Radiographic evaluation showed multilevel degenerative changes of the lumbar spine. The patient was prescribed medication, physical and exercise therapy. She underwent horizontal therapy for lumbar spine with a frequency oscillating between 4357 and 12127 hertz. The patient had a total of 15 treatments, 5 per week and each lasted 30 minutes. Conclusion. In a patient with osteoarthritis of the spine, horizontal therapy has proved to be an effective modality of physical therapy leading to pain relief and functional improvement. Additional clinical research is needed for confirming its effectiveness on a larger sample, to define optimal parameters of the application and indication areas.