Joints/Tendons/Bone

Discussion in 'Steroid Forum' started by pauladrive, Aug 27, 2010.

  1. DBaller

    DBaller Member

    Awesome post Dr. Jim, thanks for sharing that knowledge. Would you recommend keeping the reps high while on cycle in order to keep the connective tissue healthy? (i.e. avoid heavy singles, triples, etc.)
     
  2. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    Arthroscopic Single-Row Repair of Massive Potentially Irreparable Postero-Superior Cuff Tear

    Thirty-two patients satisfied the inclusion criteria and were enrolled in the study. The mean age was 52 years (range 41–58, SD 7), and 23 (71.87%) were males and nine females. Of the 32 patients, 15 (46.87%) were ex-athletes of sports highly involving the shoulder girdle (bodybuilding, crossfit, mixed martial arts, baseball); eight of them (53.3, 25% of the whole study group) admitted anabolic steroid abuse in the past.

    The role of anabolic steroids, of which the use was admitted by eight patients, is unclear; from the tendon side, a hypertrophic muscle belly may predispose to tendon tear, and some particular exercises as military press, bench press, and snatch may injury the tendon. On the other side, recent studies by Gerber et al. [25, 26] evidenced that the use of nandrolone decanoate may prevent muscle atrophy and fatty degeneration after tendon release and tendon repair in a sheep model. In this specific case series, it is difficult to determine whether the abuse of these drugs may have favored the tear of the cuff, or on the other side, it has maintained functional the cuff muscles, as argued by Gerber et al. [25, 26]. Of course, for ethical reasons, a randomized trial cannot be performed, and probably, this will remain an unresolvable topic of discussion.


    Carbone S, Razzano C, Passaretti D, Mezzoprete R. Arthroscopic single-row repair of massive potentially irreparable postero-superior cuff tear. MUSCULOSKELETAL SURGERY 2018;102:13-9. Arthroscopic single-row repair of massive potentially irreparable postero-superior cuff tear

    Purpose - We retrospectively evaluated the results of complete repair of massive potentially irreparable postero-superior tears in a consecutive cohort of patients. With the increasing and widespread use of superior capsular reconstruction, a complete repair of the superior cuff, also if not functional, may be a valuable option for irreparable cuff lesions.

    Methods - A consecutive case series of massive potentially irreparable postero-superior cuff tears that underwent complete repair was included in the study. Irreparability of cuff tear was defined when on preoperative MRI images, a positive tangent sign, a Goutallier 3–4 stage of fatty infiltration, and an absent acromion–humeral distance were present. A single-row complete repair was performed using triple-loaded titanium suture anchors. Operative time was recorded, as well as intra- and postoperative complications.

    Patients were followed for 12 months post-op; they were clinically evaluated with the use of constant score (CS) and subjective shoulder value (SSV) at 3, 6, and 12 months; a 12-month postoperative ultrasound evaluation was obtained.

    Results - Thirty-two patients satisfying the inclusion criteria were enrolled. The mean age was 52 years (range 41–58). The repair was completed with a mean use of 2.4 triple-loaded suture anchors (range 2–4); the mean operative time was 70 min (range 45–90).

    The mean preoperative CS was 55 (range 45–75, SD 17), while the SSV was 40 (range 30–70, SD 22). At the final follow-up, the mean CS and SSV were 72 (range 62–85, SD 8) and 80 (range 60–90, SD 10) (p < 0.001 with respect to the preoperative scores), respectively.

    At the final follow-up, sonography showed a complete healing of the cuff in 20 cases (62.5%). No intra-operative complications occurred; at the final follow-up, five patients (15, 6%) were not satisfied of the results and asked for revision surgery.

    Conclusions - The complete repair of massive potentially irreparable rotator cuff tear in patients younger than 60 years old yielded good results at a short-term follow-up, with a sonographic re-tear rate of about 20%. Even if it is logical to consider a tendon with severe fatty degeneration as non-functional, the superior soft tissue reconstruction we achieved may have at least the same results of a superior capsular reconstruction, with obvious lower costs.
     
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  3. Dr JIM

    Dr JIM Member

    Lighten the load and the dose is my recommendation, w few exceptions.
     
  4. Max squat

    Max squat Junior Member

    Thanks for the info I’ve had issues with my rotator cuff and used BPC-157 from Blue sky and had some good results I’ve just started a EQ test cycle to gain some muscle but also to increase strength especially tendon strength in my shoulders hands knees I’m 44 so I need it everywhere. I got the gear from napsgear seems to be good stuff but just started so I’ll see what it does for me pinning wasn’t too bad I’m front loading the EQ at 600mg for the first two weeks then 400mg for ten weeks and the Test at a TRT dose of 200mg per week but may increase
    Current
    Squat 565
    Deadlift 505
    Bench 365
     
  5. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    [OA] Guzzoni V, Selistre-de-Araújo H, de Cássia Marqueti R. Tendon Remodeling in Response to Resistance Training, Anabolic Androgenic Steroids and Aging. Cells 2018;7. Tendon Remodeling in Response to Resistance Training, Anabolic Androgenic Steroids and Aging

    Exercise training (ET), anabolic androgenic steroids (AAS), and aging are potential factors that affect tendon homeostasis, particularly extracellular matrix (ECM) remodeling. The goal of this review is to aggregate findings regarding the effects of resistance training (RT), AAS, and aging on tendon homeostasis. Data were gathered from our studies regarding the impact of RT, AAS, and aging on the calcaneal tendon (CT) of rats.

    We demonstrated a series of detrimental effects of AAS and aging on functional and biomechanical parameters, including the volume density of blood vessel cells, adipose tissue cells, tendon calcification, collagen content, the regulation of the major proteins related to the metabolic/development processes of tendons, and ECM remodeling. Conversely, RT seems to mitigate age-related tendon dysfunction.

    Our results suggest that AAS combined with high-intensity RT exert harmful effects on ECM remodeling, and also instigate molecular and biomechanical adaptations in the CT. Moreover, we provide further information regarding the harmful effects of AAS on tendons at a transcriptional level, and demonstrate the beneficial effects of RT against the age-induced tendon adaptations of rats.

    Our studies might contribute in terms of clinical approaches in favor of the benefits of ET against tendinopathy conditions, and provide a warning on the harmful effects of the misuse of AAS on tendon development.
     
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  6. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    [No real good place for this, so ... Also, what did they expect. ]

    Horstman AMH, Backx EMP, Smeets JSJ, et al. Nandrolone decanoate administration does not attenuate muscle atrophy during a short period of disuse. PLOS ONE 2019;14:e0210823. Nandrolone decanoate administration does not attenuate muscle atrophy during a short period of disuse

    Background A few days of bed rest or immobilization following injury, disease, or surgery can lead to considerable loss of skeletal muscle mass and strength. It has been speculated that such short, successive periods of muscle disuse may be largely responsible for the age-related loss of muscle mass throughout the lifespan.

    Objective To assess whether a single intramuscular injection of nandrolone decanoate prior to immobilization can attenuate the loss of muscle mass and strength in vivo in humans.

    Design, setting and participants Thirty healthy (22 ± 1 years) men were subjected to 7 days of one-legged knee immobilization by means of a full leg cast with (NAD, n = 15) or without (CON, n = 15) prior intramuscular nandrolone decanoate injection (200 mg). Measures Before and immediately after immobilization, quadriceps muscle cross-sectional area (CSA) (by means of single-slice computed tomography (CT) scans of the upper leg) and one-legged knee extension strength (one-repetition maximum [1-RM]) were assessed for both legs. Furthermore, muscle biopsies from the immobilized leg were taken before and after immobilization to assess type I and type II muscle fiber cross-sectional area.

    Results Quadriceps muscle CSA decreased during immobilization in both CON and NAD (-6 ± 1% and -6 ± 1%, respectively; main effect of time P<0.01), with no differences between the groups (time × treatment interaction, P = 0.59). Leg muscle strength declined following immobilization (-6 ± 2% in CON and -7 ± 3% in NAD; main effect of time, P<0.05), with no differences between groups (time × treatment interaction, P = 0.55).

    Conclusions This is the first study to report that nandrolone decanoate administration does not preserve skeletal muscle mass and strength during a short period of leg immobilization in vivo in humans.
     
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  7. Kike

    Kike Junior Member

    thanks for that very beneficial read
     
  8. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    testosterone Replacement in Congenital Hypogonadotropic Hypogonadism Maintains Bone Density but Has Only Limited Osteoanabolic Effects

    BACKGROUND: Congenital hypogonadotropic hypogonadism (CHH) is a rare condition characterized by complete sex steroid deficiency. Therefore, CHH is a unique human model to study the impact of long-term testosterone replacement therapy (TRT) on bone.

    OBJECTIVE: In this single-center retrospective observational study, we assessed the long-term impact of TRT on femoral and lumbar bone mineral density (BMD) in adult CHH men.

    METHODS: A total of 25 patients with CHH were included. Femoral and lumbar BMD was assessed by dual-energy X-ray absorptiometry (DEXA) and reported as T-scores. In six patients (treatment-naive group), BMD was measured before start of TRT. The other 19 (pre-treated group) had received TRT for a median duration of 7 years (range 1-41 years) before first BMD measurement.

    RESULTS: Age at which TRT was started ranged from 12 to 57 years old. Median time between first and last DEXA scan was 11 years (range 2-28). At the first DEXA scan, 83% and 61% of CHH patients had lumbar and femoral osteopenia/osteoporosis, respectively.

    In the treatment-naive group, the increase in lumbar T-score was 2.19 +/- 0.13 (mean +/- SEM, p < 0.01 between first and last DEXA scan) and 1.47 +/- 0.29 at femoral level (p < 0.001). For the pre-treated group, the increase in lumbar and femoral T-score was 0.77 +/- 0.17 (p < 0.001) and 0.19 +/- 0.12 (p = 0.13), respectively.

    However, lumbar and femoral osteopenia/osteoporosis persisted in 61% and 48% of CHH patients even after several years of continuous TRT. Additionally, BMD clearly decreased in patients who interrupted TRT.

    CONCLUSION: Despite modest improvement after starting TRT, BMD remains in the osteopenic/osteoporotic range in most patients with CHH. However, prolonged TRT prevents further bone loss, both at lumbar and femoral level.

    Antonio L, Caerels S, Jardi F, Delaunay E, Vanderschueren D. Testosterone replacement in congenital hypogonadotropic hypogonadism maintains bone density but has only limited osteoanabolic effects. Andrology 2019. https://onlinelibrary.wiley.com/doi/abs/10.1111/andr.12604
     
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  9. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    Relationship Between Sex Steroids and Deterioration of Bone Microarchitecture

    In older men, low estrogen levels are associated with poor bone microarchitecture. Data on androgens are discordant. We studied the link between baseline sex steroid levels (total 17beta -estradiol [17betaE2], total testosterone [tT], calculated bioavailable 17betaE2 [bio-17betaE2] and apparent free testosterone concentration [AFTC]) and bone microarchitecture deterioration assessed prospectively in 820 older men followed up for 8 years. Bone microarchitecture was assessed by HR-pQCT (XtremeCT, SCANCO) at baseline, then after 4 and 8 years.

    · At both the skeletal sites, bone microarchitecture deterioration rate did not correlate with serum levels of tT and 17betaE2.

    · At the distal radius, cortical area (Ct.Ar) decreased more rapidly in the lowest vs. the highest AFTC quartile.

    · At the distal tibia, cortical thickness (Ct.Th) decreased and trabecular area (Tb.Ar) increased more rapidly in the highest vs. the lowest AFTC quartile.

    · At the tibia, bone mineral content (BMC), total volumetric bone mineral density (Tt.vBMD), Ct.Th and Ct.Ar decreased, whereas Tb.Ar increased faster in the lowest vs. the highest bio-17betaE2 quartile.

    In men who had both AFTC and bio-17betaE2 in the lowest quartile (high risk group), distal radius cortical vBMD (Ct.vBMD) decreased more rapidly compared to men who had both hormones in the three upper quartiles (reference group). At the distal tibia, Tt.vBMD, Ct.Th, Ct.Ar, Ct.vBMD decreased and Tb.Ar increased more rapidly in the high risk group vs. the reference group.

    In men receiving androgen deprivation therapy (ADT) for prostate cancer, BMC, Tt.vBMD, Ct.Th, Ct.Ar, and Ct.vBMD decreased, whereas Tb.Ar increased, more rapidly vs. men not receiving ADT at both the skeletal sites.

    Thus, in older men followed up prospectively, low levels of bio-17betaE2, and a smaller extent AFTC, are associated with accelerated cortical bone deterioration. Cortical bone deterioration was strongly accelerated in men receiving ADT who had very low levels of all sex steroids.

    Piot A, Chapurlat RD, Claustrat B, Szulc P. Relationship between sex steroids and deterioration of bone microarchitecture in older men: the prospective STRAMBO Study. Journal of bone and mineral research: the official journal of the American Society for Bone and Mineral Research 2019. https://onlinelibrary.wiley.com/doi/abs/10.1002/jbmr.3746
     
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  10. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    [GMAFB] Immunodeficiency as A Side Effect of Anabolic Androgenic Steroid Abuse: A Case of Necrotizing Myofasciitis

    Even if there are well-known consequences of anabolic androgenic steroid (AAS) abuse, their full pathway of action is still being investigated. In this context, the presented case report aims to discuss and provide evidence of unusual adverse effects linked to immunodeficiency in an AAS abuser.

    In fact, this kind of chronic complication, even if not usually considered, may lead sudden death. In this case a 31-year-old aesthetic weightlifter, who presented to the emergency department due to an accidental fall that resulted in left thigh trauma. This subsequently developed into left thigh necrotizing myofasciitis in the following few days. Although surgery and hyperbaric therapy were carried out, the man died. An autopsy with complete biological sampling for toxicological studies was performed.

    This case highlights the close relationship between AAS abuse and immunodeficiency and highlights it’s importance for further studies. However, it should be considered that of all the dangerous effects produced by AAS use, necrotizing fasciitis is not such an unusual consequence.

    Bertozzi G, Sessa F, Maglietta F, et al. Immunodeficiency as a side effect of anabolic androgenic steroid abuse: a case of necrotizing myofasciitis. Forensic Science, Medicine and Pathology 2019. Immunodeficiency as a side effect of anabolic androgenic steroid abuse: a case of necrotizing myofasciitis
     
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  11. skinnyman

    skinnyman Member


    This sounds really odd. Why didn't Evan Centopani, Dave Palumbo, Branch Warren, Calum etc. die when they fell and tore muscles?
     
  12. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    Ardeljan A, Menses Z, Neal B, Vakharia RM, Roche MW. Increased Medical Complications, Revisions, In-Hospital Lengths of Stay, and Cost in Patients With Hypogonadism Undergoing Primary Total Knee Arthroplasty. The Journal of Arthroplasty 2019. http://www.sciencedirect.com/science/article/pii/S0883540319307569

    Background Research Regarding The Impact Of Hypogonadism Following Primary Total Knee arthroplasty (TKA) is limited. Therefore, the purpose of the study was to investigate whether patients with hypogonadism undergoing primary TKA are at increased odds of:
    (1) medical complications;
    (2) revisions;
    (3) in-hospital lengths of stay (LOS); and
    (4) cost of care.

    Methods A Humana patient-population consisting of 8 million lives was retrospectively analyzed from 2007 to 2017 using International Classification of Disease, 9th Revision (ICD-9) codes. Patients were filtered by male sex and patients with hypogonadism were matched to controls in a 1:4 ratio according to age and medical comorbidities. The query yielded 8,393 patients with (n=1,681) and without (6,712) hypogonadism undergoing primary TKA.

    Primary outcomes analyzed included: medical complications, revision rates, in-hospital LOS, and cost of care. Logistic regression analysis was used to calculate odds ratios (OR) 90-day medical complications and 2-year revisions. Welch’s t-test was used to test for significance in LOS and cost of care between cohorts. A p-value less than 0.05 was considered statistically significant.

    Results Hypogonadal patients undergoing primary TKA were found to have increased incidence and odds (9.45 vs. 4.67%; OR: 2.12, p<0.0001) of developing 90-day medical complications. Hypogonadal patients undergoing primary TKA were found to have a greater incidence and odds (3.99 vs. 2.80%; OR: 1.89, p<0.0001) of 2-year revisions. Hypogonadal patients had a 6.11% longer LOS (3.47 days vs. 3.27 days, p=0.02) compared to controls, and incurred greater 90-day costs ($15,564.31 vs. $14,856.69, p=0.018) compared to controls.

    Conclusion This analysis of over 1,600 patients demonstrates that patients with hypogonadism undergoing primary TKA have greater odds of postoperative medical complications, revisions, increased LOS and cost of care.