To evaluate the effect of the presence of a vertebral fracture on balance and physical performance and its contribution to fall and fracture risk in patients with postmenopausal osteoporosis.

Ninety-five individuals with postmenopausal osteoporosis were included in this study. Patients were divided into 2 groups with a history of vertebral fracture (n = 45) and those without (n = 50). The control group consisted of patients without fractures while the study group was subdivided into 2 subgroups: single-level (n = 29) and multiple-level vertebral fractures (n = 16). None of the study participants had a history of non-vertebral fracture. All patients with a history of vertebral fracture were in the chronic phase without any complaints of pain. Thoracolumbar radiograph, computed static posturography, FRAX (fracture risk assessment tool) scores, DXA (Dual-energy x-ray absorptiometry) measurements, serum 25(OH)D values, tandem test, timed up and go test (TUG), Berg balance scale (BBS) were performed.

The probability of FRAX-major osteoporotic fracture, lumbar total T-score and TUG time were significantly higher and the BBS score was lower in the study group. The mean TUG time was 11.69 ± 3.81 s in the study group and 9.87 ± 2.57 s in the controls, while the mean BBS score was 52.73 ± 3.80 s in the study group and 55,28 ± 1,59 s in the control group (p < 0,005). The probability of FRAX-major osteoporotic fractures was significantly higher in patients with multiple level fractures compared to the patients with a single level fracture. There was also a moderately negative correlation between TUG and BBS, and between the BBS and fall index. The fall index was 43.73% ± 26.34% in the study group and 34.14 % ± 24.04% in the controls (p: 0.058).

This study showed that the presence of a vertebral fracture may have a negative impact on balance and physical performance, leading an increase in the risk of falls and fractures in patients with postmenopausal osteoporosis. The risk factors should be evaluated cautiously to prevent the patients from this vicious circle.

Nutrition plays a critical role in maintaining bone health and excessive secretion of growth hormone (GH) and insulin-like growth factor 1 (IGF-1), in patients with acromegaly has been associated with disrupting bone remodeling and increased risk of vertebral fractures. The aim of this study was to assess the dietary quality of patients with acromegaly and its impact on bone density, quality and fractures.

This is a cross-sectional, observational, controlled study which included individuals with acromegaly (AG) and matched controls by sex and age (CG). Food intake was evaluated by a food frequency questionnaire (FFQ) and dietary reference intakes (DRIs). Bone mineral density (BMD) and bone quality [trabecular bone score] (TBS) measured by dual-energy X-ray absorptiometry (DXA) and the history of past fractures captured by a questionnaire.

Eighty-two individuals were included, 41 in the AG (58.5 % women, mean age 55.9 ± 11.8 years; mean body mass index (BMI) 31.14 ± 5.16) and 41 in the CG (58.5 % women, 56.8 ± 14.3 years and mean BMI was 25.5 ± 3.3). The mean age at diagnosis of acromegaly was 43.7 ± 13.0 years and 63.4 % of AG had a controlled disease. In both groups, insufficient intake, compared to DRIs, of essential nutrients (fiber, omega-3 and 6, vitamins A and E) and minerals (magnesium, potassium, and calcium) was observed. Compared to the CG, the AG showed a higher intake of carbohydrates, trans fats, and certain micronutrients compared to the CG, p < 0.05 for all, similar BMD values, higher number of fractures (AG 0.63 ± 1.11 vs. CG 0.14 ± 0.43; p = 0.001) and poorer TBS (men AG 1.10 ± 0.43 vs. CG1.43 ± 0.09; p = 0.006; women AG 1.03 ± 0.54 vs. CG 1.35 ± 0.14; p = 0,009). In the AG fractures were negatively associated to flavones and vitamin A, and positively associated to IGF-1 levels (p < 0.05 for all). BMD and TBS were positively associated with different bioactive compounds (flavone, anthocyanin, beta-carotene and vitamin C), macronutrients and vitamins with anti-inflammatory activity.

individuals with acromegaly had low bone quality and higher prevalence of fractures despite adequate BMD associated to Inadequate intake of antioxidant and anti-inflammatory compounds, combined with excessive consumption of trans fats and poor-quality carbohydrate.

Teriparatide followed by antiresorptive therapy exhibits fracture reduction efficacy for up to 2 years, but it remains unclear if this leads to sustained increases in bone mineral density (BMD) and trabecular bone score (TBS), and if BMD correlates with fracture risk reduction.

In this multicenter cohort study, the effect of teriparatide administration for 18-24 months, followed by antiresorptive therapy, was assessed in patients partipicipating in a nationwide Swiss osteoporosis registry. BMD and TBS were measured up to 10 years before and after teriparatide initiation.

A total of 624 patients (87 % female, age 67 ± 13 years) were enrolled from May 2004 to December 2023. Among them, 198 (32 %) received no treatment prior to teriparatide, while 426 had received previous antiresorptive therapies (median duration 5.9 years [2.2, 8.0]). All patients underwent subsequent antiresorptive therapy, mainly with bisphosphonates and denosumab. The incidences of vertebral, hip, and any fractures were 0.96, 0.11, and 1.37, respectively, within 2 years prior to teriparatide initiation. The total hip T-score did not correlate with fracture reduction under teriparatide. After transitioning from teriparatide to an antiresorptive regimen, fracture incidence remained low and BMD was significantly higher for up to 5 years after teriparatide compared to the pre-treatment period (T-score + 0.876 for lumbar spine, p < 0.001; and + 0.112 for total hip, p < 0.005), while TBS increased by 0.047 (p < 0.001). Overall, significant improvement was observed in pretreated and treatment-naïve patients undergoing teriparatide treatment.

Teriparatide led to sustained lower incidences of vertebral, hip, and other fractures for up to 8 years after switching to antiresorptive agents in both pretreated and treatment-naïve patients. Additionally, BMD and TBS levels were significantly higher than those before teriparatide treatment. During teriparatide treatment, the total hip T-score did not correlate with fracture risk.

Understanding how age and sex affect spinopelvic sagittal alignment is important for preventing the progression of adult spinal deformity and optimizing treatment. Here, we analyzed sex differences in age-related changes in spinopelvic sagittal alignment and balance in a Japanese community. Healthy adults (210 men and 300 women) ranging in age from their 20-80 s who participated in a general population health examination were categorized into age groups by decade according to sex. The association between changes in sagittal spinal alignment and balance, vertebral fracture, bone mineral density, bioelectrical impedance analysis, handgrip strength, and gait speed was investigated. In women, we found increased thoracic kyphosis in the 60s and pelvic retroversion in the 70s. In men, slight changes in local sagittal alignment were observed with age. Multiple linear regression analyses revealed that sagittal balance was associated with both age and vertebral fractures in men but only with age in women. Age-related changes in spinopelvic sagittal alignment differed between men and women, with men exhibiting nonstructural changes and women experiencing structural changes. In men, both age and vertebral fracture contributed to sagittal imbalance, whereas in women, only aging was associated with sagittal imbalance.

SB16 is a proposed biosimilar to reference denosumab (DEN; brand name: Prolia).

This phase 3 randomized, double-blind, multicenter study evaluated the biosimilarity of SB16 to DEN in women with postmenopausal osteoporosis (NCT04664959).

The study included 457 postmenopausal osteoporosis patients who had a lumbar spine or total hip T-score between -2.5 and -4. Patients were randomized in a 1:1 ratio to receive either 60 mg of SB16 or DEN subcutaneously at month 0 and month 6. At month 12, patients were rerandomized to continue with the assigned treatment or switch from DEN to SB16 up to month 18. This report includes results up to month 12.

The primary endpoint was the percent change from baseline in lumbar spine bone mineral density (BMD) at month 12. Secondary endpoints including the percent change from baseline in BMD of the lumbar spine (except for month 12), total hip, and femoral neck; pharmacokinetic, pharmacodynamic (serum C-telopeptide of type I collagen, and procollagen type I N-terminal propeptide), safety, and immunogenicity profiles were measured up to month 12.

The least-squares mean differences in percent change from baseline in lumbar spine BMD at month 12 were 0.33% (90% CI, -0.25 to 0.91) in the full analysis set and 0.39% (95% CI, -0.36 to 1.13) in the per-protocol set; both within the predefined equivalence margin. The secondary endpoints were comparable between the 2 treatment groups.

The reported efficacy, pharmacokinetic, pharmacodynamic, safety, and immunogenicity data support the biosimilarity of SB16 to DEN.

BackgroundSAPHO syndrome can involve the spine, along with vertebral fractures (VFs), and demonstrates osteoporosis and sarcopenia. However, the relationship between musculoskeletal factors with VFs in SAPHO patients is unclear.PurposeTo quantify bone and muscle loss in SAPHO syndrome and identify the factors associated with VFs.Material and MethodsThe study included 35 patients and 70 age- and sex-matched controls. The bone mineral density (BMD) of the lumbar spine (LS), femoral neck (FN), total hip (TH), the age- and sex-specific T- and Z-scores, and trabecular bone score (TBS) were evaluated using dual-energy X-ray absorptiometry (DXA). Cross-sectional muscle area (CSMA), skeletal muscle radio-attenuation (SMRA), skeletal muscle index (SMI), and skeletal muscle gauge (SMG) were assessed at the T8, T10, and T12 levels based on chest CT scans. The related factors of VFs were analyzed through univariable and multivariable analyses. The diagnostic accuracy of the related factors in VFs was based on receiver operator characteristic (ROC) curves.ResultsCompared to controls, LS-BMD, FN-BMD, TH-BMD, corresponding T- and Z-scores, and TBS were significantly reduced in women, whereas LS-BMD, T- and Z-scores were significantly increased in men. CSMA, SMI, and SMG at the T8, T10, and T12 levels were significantly reduced in women. LS-BMD and SMG-T12 were independently associated with VFs, and their combination showed the highest diagnostic efficacy for VFs.ConclusionFemale SAPHO patients exhibited notable bone and muscle loss, along with bone microstructure damage. LS-BMD and SMG-T12 hold the potential to offer valuable insights for the management of VFs risk in SAPHO patients.

Pregnancy and lactation-associated osteoporosis (PLO) is a rare bone disorder with insufficient understanding on its pathogenesis and treatments. We retrospectively investigated 22 Chinese PLO patients diagnosed in our hospital. Whole exome sequencing was performed in 14 patients, and responses to bisphosphonates treatment were evaluated. The mean age of the patients was 30.8 ± 4.4 years. The mean number of vertebral fractures per patient was 4.0 ± 2.6. The bone mineral density (BMD) Z-scores were - 2.9 ± 0.9 at the lumbar spine (LS), - 1.7 ± 0.7 at the femoral neck, and - 1.8 ± 0.7 at the total hip. Trabecular bone score Z-score was - 2.2 ± 0.8. Genetic analysis identified relevant variants (RVs) in 11 of 14 patients, predominantly in LRP5, WNT1, and COL1A1/A2. Patients with RVs had significantly greater height loss (3.6 ± 2.1 cm vs. 0 cm, p = 0.028). All patients received bisphosphonate therapy, during which increases in BMD primarily at the LS were observed: 13.5 ± 8.8%, 17.8 ± 14.7%, 22.0 ± 17.0%, 27.0 ± 14.1% and 35.1 ± 18.5% at the 6-, 12-, 24-, 36-, and 48-month follow-ups. Patients with RVs demonstrated LS BMD percentage changes of 40.1 ± 22.1% (vs. no RVs group 26.2 ± 14.8%, p = 0.57) after 48-month follow-ups. In conclusion, our study highlights the significant clinical burden of PLO. Genetic RVs are prevalent in Chinese PLO patients. After bisphosphonate treatment, there is a significant increase in BMD, especially in LS. Patients with RVs have the potential of more robust therapeutic response.

Osteoporosis is a chronic, systemic skeletal disease characterized by decreased bone mass and microarchitectural deterioration, leading to increased fracture risk. In Slovakia, its prevalence is estimated at 6%, with substantial health, social, and economic burdens.

The Slovak national guideline provides an overview for the diagnosis, prevention, and treatment of osteoporosis in Slovakia, reflecting recent scientific advances and recommendations from international bodies.

The guidelines were developed by a multidisciplinary expert panel and officially adopted by the Ministry of Health of the Slovak Republic. They are based on current evidence and international standards, including FRAX, IOF, ISCD, and ESCEO recommendations.

Diagnosis involves clinical risk assessment, biochemical testing, and imaging-primarily DXA and trabecular bone score. FRAX with or without BMD enhances risk stratification. Osteoporosis is categorized as primary or secondary. Prevention strategies include lifestyle modification, calcium and vitamin D supplementation, and fall risk reduction. Pharmacologic treatment includes antiresorptive agents (bisphosphonates, denosumab, SERMs), osteoanabolic (teriparatide, romosozumab), and hormone therapy when indicated. Sequential treatment strategies are emphasized, particularly in high-risk individuals. Treatment monitoring includes bone turnover markers and periodic DXA.  CONCLUSIONS: The Slovak guidelines provide a comprehensive and pragmatic approach for the management of osteoporosis across all stages, emphasizing early diagnosis, personalized treatment, and long-term fracture prevention. They align with European and global best practices and support clinical decision-making across specialties.

BACKGROUNDSevere osteoporotic vertebral compression fracture (SOVCF) is frequently complicated by endplatedisc complex (EDC) injury. While percutaneous kyphoplasty (PKP) can offer rapid analgesia and facilitate early activity, it does not restore vertebral height and may result in intervertebral leakage and untreated EDC injury.OBJECTIVEThis study aimed to evaluate the clinical outcomes of percutaneous functional spinal unit cementoplasty (PFSUP) for SOVCF complicated by EDC injury and compare its clinical and imaging outcomes with PKP.METHODSThis was a retrospective case-control study. Patients with SOVCF complicated with EDC injury between January 1, 2018, and December 31, 2019, were recruited and assigned to the PKP group and PFSUP group based on their treatment procedures Back pain was evaluated using the visual analog scale (VAS) and daily life activities were assessed using the Oswestry disability index (ODI). X-rays were employed to observe the presence and location of cement leakage, as well as to measure the sagittal vertical axis (SVA) and local kyphosis angle (LKA). Loss of correction was calculated by subtracting the LKA after surgery from that at the final follow-up visit Subsequent vertebral fracture (SVF) was confirmed using the Genant semi-quantitative method and/or MRI.RESULTSA total of 64 patients were included in this study. Among them 41 cases were assigned to the PKP group (28 females, 74.8 years on average), while the remaining 23 cases were assigned to the PFSUP group (15 females, 76.3 years on average). All surgical interventions were successfully completed without major complications. Compared to the PKP group, the PFSUP group had longer operation time (70.28 ± 11.44 vs 44.5 ± 10.12, P< 0.001) higher frequencies of radiation exposure (97.6 ± 19.85 vs 38.6 ± 9.53, P< 0.001), and a lower cement leakage rate (26.1% vs. 41.5%, P< 0.001). One day after surgery and at the final follow-up the PFSUP group had lower VAS and ODI scores, as well as lower LKA and Sva values compared with the PKP group (all P< .001). At the final follow-up visit, the PFSUP group demonstrated a lower loss of correction (4.38 ± 2.71 vs. 10.19 ± 3.41 P< 0.001) and a lower SVF rate compared to the PKP group (21.7% vs. 31.7%, P< 0.001).CONCLUSIONPFSUP outperformed PKP in alleviating pain restoring and maintaining sagittal balance, and lowering the incidence of cement leakage and SVF for SOVCF with EDC injury However, PFSUP was associated with longer operation time and high radiation exposure frequencies.

Despite many studies on the prevalence of vertebral fractures (VFs), the VF prevalence at death in the Japanese population remains unclear.

We evaluated the VF prevalence at death in a Japanese cohort using autopsy imaging computed tomography (AiCT). We enrolled 365 cadavers (188 men, 177 women, mean age of 84.6 years) donated for anatomical dissection at Shimane University School of Medicine. The VFs were diagnosed using the semiquantitative technique of Genant from the first cervical vertebra to the fifth lumbar vertebra.

The overall VF prevalence was 69.6% (58.5%/81.4% in men/women), of which 46.0% (29.8%/63.3% in men/women) had thoracic VFs, and 58.1% (50.5%/66.1% in men/women) had lumbar VFs. The most frequent fracture site was lumbar spine 1 (L1) with 31.5% (22.9%/40.7% in men/women), followed by thoracic spine 12 (T12) with 31.0% (20.7%/41.8% in men/women). In terms of severity, 3.8% (4.8%/2.8% in men/women), 23.8% (27.1%/20.3% in men/women), and 41.9% (26.6%/58.2% in men/women) were Grades 1, 2, and 3. The VFs from T3 to L5 and of Grade 3 severity were significantly higher in women. VF and Grade 3 fractures were associated with a history of surgical intervention for femoral neck fractures. VFs were not associated with the following underlying causes of death: cancer, heart disease, senile death, cerebrovascular disease, pneumonia, and aspiration pneumonia.

The VF prevalence at death, assessed by AiCT in cadavers donated for anatomical dissection, was higher in both men and women compared with previous studies conducted on individuals aged ≥ 80 years in Japan.

Our study focused on predicting thoracolumbar osteoporotic vertebral fractures through radiomic analysis of non-fractured thoracic vertebrae using conventional chest CT. Four types of radiomics models were developed and showed acceptable prediction performance. Radiomics models incorporating both cortical-appendicular and trabecular bone may have superior performance compared to those using either feature set individually. The RAD score models based on thoracic vertebral combinations achieved comparable performance with lumbar bone mineral density (BMD) measurements.

To develop and validate radiomics models based on chest CT for predicting the risk of thoracolumbar osteoporotic vertebral fractures (OVFs).

A total of 494 patients (including 198 patients with thoracolumbar OVFs) who underwent conventional chest CT scans were included in this retrospective analysis and were divided into training set 1 (n = 334) and validation set 1 (n = 160). Radiomics features (RFs) were extracted from each thoracic vertebral level on chest CT images. Four types of radiomics models (trabecular RFs, cortical-appendicular RFs, mixed RFs, and RAD score) were constructed and compared. Additionally, RAD score models based on trabecular and cortical-appendicular bone of different vertebral combinations (T1-T6, T7-T12, and top 3 vertebrae) were performed, respectively. A subset of patients with available bone mineral density (BMD) data formed training set 2 (n = 199) and validation set 2 (n = 88). We combined RAD score of different vertebral combinations with lumbar BMD for predicting thoracolumbar OVFs, and further adjusted for age. Predictive performance was evaluated using the area under the receiver operating characteristic curve (AUC).

Among the radiomics models, the RAD score model based on trabecular and cortical-appendicular bone achieved highest AUC at the most vertebral levels. The RAD score model of top 3 (T5 + T8 + T10) vertebrae achieved higher AUC (0.813) than T7-T12 (AUC = 0.780) with a statistically significant difference (P = 0.02) and T1-T6 (AUC = 0.772) without a statistically significant difference (P = 0.062). Prior to adjusting for age, both RAD score models (AUCs 0.774-0.807) and RAD score + BMD models (AUCs 0.771-0.800) demonstrated slightly superior performance compared to BMD (AUC = 0.736) alone in predicting OVFs, although the differences were not statistically significant (P > 0.05). Following adjustment for age, our RAD score models, which utilized different vertebral combinations (AUCs 0.784-0.804), were found to be comparable to lumbar BMD (AUC = 0.785) in predicting OVFs (P > 0.05).

Radiomics analysis based on conventional chest CT can provide valuable information for predicting thoracolumbar OVFs. Radiomics models incorporating both cortical-appendicular and trabecular bone may have superior performance compared to those using either feature set alone. RAD score models based on thoracic vertebral combinations comparable performance compared to lumbar BMD highlights its clinical utility.

Parathyroid hormone controls calcium and phosphate metabolism. The latter is also regulated by both FGF23 and 1-25(OH)2VitaminD. The polymorphic variant c.716 C > T of the FGF23 gene was previously found to be associated with renal phosphate leak/nephrolithiasis. The aim of our research is to study the metabolism of phosphate in a cohort of patients with primary hyperparathyroidism (PHPT) and its impact on bone and kidney.

We have retrospectively compared a large sample of sporadic PHPT patients (339) with historical comparison cohort (HCC 503: Olivetti Study Group and Siena Osteoporosis Study). Moreover, in 51 PHPT patients, phosphate metabolism indexes were also revaluated at least 2 years after surgical cure. The variant c.716 C > T of the FGF23 gene was genotyped in patients and in a small sample of the control group.

In PHPT patients we found higher levels of serum calcium, PTH, alkaline phosphatase, beta-C-terminal telopeptide (CTx), urinary calcium, while serum phosphate, 25OH-VitaminD, maximal tubular renal phosphate reabsorption adjusted for glomerular filtration rate (TmPO4/GFR) were lower than what was found in HCC. In PHPT patients fibroblast growth factor 23 (FGF23) levels were higher than in controls. Patients with kidney stones carried the 716 T allele more frequently than patients without it (χ2 7.20, p = 0.027). In PHPT patients revaluated at least 2 years after surgery, we observed a significant reduction of 1-25(OH)2VitaminD and FGF23. According to the median of serum phosphate levels, PHPT patients were subdivided into two subgroups: ≤2.8 mg/dL and > 2.8 mg/dL. The lowest phosphate group had a significantly higher serum calcium, PTH, 1-25(OH)2VitaminD, urinary calcium and a higher prevalence of kidney stones than in the highest phosphate group. The rate of males in the lowest phosphate group was significantly higher than in the highest phosphate group.

Our study shows that the regulators of phosphate metabolism in PHPT patients are higher than controls and they significantly reduce after surgical cure. PHPT patients with low serum phosphate have a worse biochemical and clinical phenotype.

Kummell's disease (KD) is a long-term complication of vertebral compression fractures, resulting in vertebral collapse and kyphosis. Despite its clinical significance, the underlying mechanisms remain poorly understood.

To identify the predictive factors for the onset of KD and provide clinical insights for early screening and intervention in KD patients.

Retrospective study.

A total of 170 patients were included, comprising 66 with KD and 104 with old compression fractures.

Relevant clinical and imaging data were collected retrospectively. Spinal imaging indicators were also assessed.

We analyzed clinical data from patients admitted from May 2021 to April 2024 for vertebral compression fractures. Sixty-six diagnosed with KD based on clinical and imaging criteria were identified as the case group. The control group consisted of 104 patients with vertebral compression fractures who underwent conservative treatment and showed no signs of KD upon reexamination one year later. The clinical data included gender, age, bone mineral density (BMD), history of long-term smoking, alcohol abuse, hypertension, diabetes, coronary heart disease, osteoporosis, glucocorticoid use, previous vertebral compression fracture segment and vertebral compression ratio, Cobb angle, vertebral fracture morphology and disc degeneration grade. Independent predictive factors for KD were determined using multivariate binary logistic regression. Receiver operator characteristic (ROC) analysis and Kaplan-Meier plot were used to assess the diagnostic efficiency of parameters for predicting the occurrence of KD.

T-tests and Chi-square tests identified significant differences between groups in age, BMD, alcohol abuse, history of hypertension, history of diabetes, history of osteoporosis, history of glucocorticoid use, vertebral compression segment, Cobb angle, vertebral compression ratio, vertebral compression morphology, and disc degeneration grade between the two groups. Binary logistic regression revealed six independent predictors of KD: age, BMD, history of osteoporosis, vertebral compression rate, vertebral compression morphology, and disc degeneration grade. ROC demonstrated that age ≥ 70.5, BMD (T-score) ≤ - 3.65 and a vertebral compression ratio ≥ 29.9% were strongly correlated with KD (P < 0.001). Kaplan-Meier plot showed that most cases of KD occurred within one year after initial vertebral compression fractures, with significant differences in KD incidence observed across different disc degeneration grades (Log-rank test, P < 0.001).

The risk of developing KD is heightened in patients with the following predictive factors are present: (1) Age ≥ 70.5 years; (2) BMD (T-score) ≤ - 3.65; (3) History of osteoporosis; (4) Vertebral compression ratio ≥ 29.9%; (5) Wedge-shaped vertebral compression morphology; and (6) Grade III or higher disc degeneration. Early screening and regular follow-up of high-risk patients are recommended for timely preventive interventions.

Vertebral fragility fractures (VFFs) are the most common osteoporotic fracture, with significant associated morbidity, mortality, and risk of future fractures. Unfortunately, VFFs are frequently underdiagnosed and underreported. With this background, The Royal College of Radiologists (RCR), in collaboration with the Royal College of Physicians (RCP) and Royal Osteoporosis Society (ROS), undertook a UK-wide retrospective audit in 2019 to assess radiology reporting of incidental VFFs present on CT studies. The audit standards were not achieved; however, following a series of interventions, a re-audit in 2022 demonstrated generalized improvement in compliance with the audit parameters, in particular a 6-percentage point increase in moderate/severe VFFs reported. This article examines the potential benefits in terms of reductions in patient morbidity, mortality, and costs that could be expected if the improvements identified were translated to a national level, acknowledging and discussing other improvements that need to occur, with particular reference to onward referral pathways.

Patients with kidney failure have elevated fracture risk that remains high following kidney transplantation. This study aimed to assess whether dual-energy x-ray absorptiometry-derived advanced hip analysis (AHA) and the trabecular bone score (TBS) improve bone mineral density (BMD)-based post-transplant fracture prediction.

Patients receiving kidney-only or simultaneous pancreas-kidney (SPK) transplants underwent immediate post-transplant dual-energy x-ray absorptiometry to provide BMD, the TBS, and AHA parameters; femoral neck, calcar, and shaft cortical thickness (CTh), and femoral neck buckling ratio (BR), an index of structural instability. Patients received treatment to reduce post-transplant BMD loss, using an established risk algorithm. Hazard ratios were determined using Kaplan-Meier and Cox proportional hazard models.

Of 357 transplant recipients, 289 (83%) received a kidney-only transplant. There were 83 incident fractures over a median of 4.4 years (IQR: 2.5-5.5). Fracture was associated with type 1 diabetes mellitus (p < 0.001), former smoking (p = 0.006), lower 25-hydroxyvitamin D (p = 0.003), BMD at total proximal femur and neck of femur (p < 0.001) and spine (p = 0.008), lower CTh at the calcar (p = 0.005) and shaft (p = 0.023), higher BR (p = 0.016) and lower TBS (p = 0.047). Following multivariable adjustment, type 1 diabetes mellitus, 25-hydroxyvitamin D, smoking, and femoral neck BMD remained significant. Using the BMD-based risk algorithm, inclusion of the BR improved the model fit.

BMD, the TBS, and AHA parameters are associated with incident fracture in kidney-only and SPK transplant recipients. Pre-transplant smoking, lower 25-hydroxyvitamin D and BMD are potentially modifiable factors that could reduce post-transplant fracture risk.

Proximal femoral fractures are critically associated with increased risk of mortality and secondary fractures. Identifying prognosis predictors related to sagittal imbalance that are known to have negative impact on fracture risk and mortality is crucial. This study aimed to explore the relationship between various sagittal imbalance parameters and the prognosis of proximal femoral fractures to identify the most important prognostic indicators.

This multi-center prospective cohort study included patients with proximal femoral fractures treated surgically from April 2020 to March 2021. Spinal standing radiographs were obtained to measure various sagittal spine parameters. Postoperative follow-ups were conducted at 6, 12, 18, 24, and 36 months to assess mortality and secondary fracture rates and examine the predictors and their effects.

Among the 137 patients who underwent spinal standing radiographs, 22 died and 23 developed secondary fractures. Multivariate analyses identified the number of previous vertebral fractures and thoracolumbar kyphosis (TLK) as significant risk factors for mortality and secondary fractures. Survival analysis revealed that patients with TLK < 20° had significantly higher survival rates than those with TLK ≥ 20° (P = 0.002 and P < 0.001 for mortality and secondary fractures, respectively). In addition, serum albumin was associated with mortality, and the intake of sleeping pills and antidepressants was associated with secondary fractures.

TLK after surgery and the number of previous vertebral fractures affected both mortality and secondary fractures. When each risk factor, such as low serum albumin levels, intake of sleeping pills and antidepressants, was also considered, it was found that comprehensive postoperative care is essential.

Patient satisfaction with two teriparatide (TPTD) self-injection regimens [once-daily (1/D)-TPTD and twice-weekly (2/W)-TPTD] was compared in a randomized crossover study involving patients with osteoporosis at high fracture risk.

Questionnaires evaluated overall satisfaction, satisfaction with treatment effectiveness, satisfaction with utility of the self-injection device, and preference for a particular injection regimen after crossover. Quality of life (QOL), visual analogue scale pain scores, and bone mineral density (BMD) were also analyzed. Safety was evaluated based on the incidence and severity of adverse events (AEs).

The 1/D-TPTD and 2/W-TPTD groups comprised 180 (mean age: 75.9 ± 7.3 years) and 178 (75.4 ± 6.9 years) patients, respectively. After 26 weeks of treatment, the injection regimens were switched and treatment continued for another 26 weeks. Significantly higher persistence was observed in the 1/D-TPTD to 2/W-TPTD group (p = 0.032). No significant between-group differences in overall satisfaction scores or satisfaction with treatment were observed. Satisfaction with the utility of the injection device was significantly higher with the 2/W-TPTD regimen (p < 0.05); this regimen was preferred by 69.4% of patients after crossover (p < 0.001). A significant increase in BMD from baseline was observed at the lumbar vertebrae in both groups and at the hip area in the 1/D-TPTD to 2/W-TPTD group at 52 weeks (p < 0.05). Significant improvement in the QOL score was observed in both groups (p < 0.05). No serious AEs were reported.

Continuation of this study will further clarify patient satisfaction, treatment effects, and tolerability.

Although obesity is generally associated with increased bone mass, recent data have challenged its potential protective effect. Our study found that increased BMI showed beneficial effects on BMD in a non-linear way. However, individuals with obesity, especially women, were more likely to have vertebral fractures. There was a U-shaped relationship between BMI and the prevalent fractures.

To estimate the association of obesity with the prevalence of fractures in the Mainland Chinese population.

A total of 8251 individuals from the COPS cohort were enrolled in this cross-sectional study and grouped by BMI level. The Five-Repetition Sit-to-Stand Test (5R-STS) and the Sharpened Romberg test were used to evaluate the balance ability. Vertebral fractures (VFs) were confirmed by spine X-ray examination. Prevalent fractures were defined by a self-report questionnaire which happened in the recent 5 years. The restricted cubic spline (RCS) was used to explore the non-linear relationship. Multiple linear regression and multivariable logistic regression were conducted to adjust the covariates.

Obesity was correlated with a reduced bone turnover rate and increased BMD. Nevertheless, there were significant non-linear correlations between BMI and BMD, with a rapid increase and plateau at extremely high BMI levels (p for non-linear < 0.001 for all). Individuals with obesity were associated with a longer time of the 5R-STS and more likely to have a positive Sharpened Romberg test, especially in women. Compared with the normal weight group, the likelihood of prevalence of VFs and the prevalent fractures were significantly increased in the obesity group, independent of the Sharpened Romberg test and lumbar spine BMD (VFs: OR = 1.88 [95% CI 1.38-2.56]; prevalent fractures: OR = 2.18 [95% CI 1.39-3.41]). Per standard deviations (SD) increase in BMI was associated with 21% and 22% increase in the prevalence of VFs and prevalent fractures, respectively. Moreover, the prevalence of prevalent fractures also elevated in the low-weight individuals (OR = 2.62 [95% CI 1.34-4.75]), which indicated a U-shaped relationship between BMI and the prevalence of prevalent fractures.

Obesity was associated with higher BMD in a non-linear manner. However, BMI was positively associated with the prevalence of VFs, and there was a U-shaped relationship between BMI and the prevalent fractures.

Background/AimsData integrity in multicenter and longitudinal studies requires implementation of standardized reproducible methods throughout the data collection, analysis, and reporting process. This requirement is heightened when results are shared with participants that may influence health care decisions. A quality assurance plan provides a framework for ongoing monitoring and mitigation strategies when errors occur.MethodsThe Diabetes Control and Complications Trial (1983-1993) and its follow-up study, the Epidemiology of Diabetes Interventions and Complications (1994-present), have characterized risk factors and long-term complications in a type 1 diabetes cohort followed for over 40 years. An ancillary study to assess bone mineral density was implemented across 27 sites, using one of two dual x-ray absorptiometry scanner types. Centrally generated reports were distributed to participants by the sites. A query from a site about results that were incongruent with a single participant's clinical history prompted reevaluation of this scan, revealing a systematic error in the reading of hip scans from one of the two scanner types. A mitigation plan was implemented to correct and communicate the errors to ensure participant safety, particularly among those originally identified as having low bone mineral density scores for whom antiresorptive treatment may have been initiated based on these results.ResultsThe error in the analysis of hip scans from the identified scanner type resulted in lower bone mineral density scores in scans requiring manual deletion of the ischium bone. Hip scans with original T-score ≤ -2.5 (n = 84) acquired on either scanner were reviewed, and reanalyzed if the error was detected. Fourteen scans were susceptible to this error and reanalyzed: nine scans were reclassified from osteoporosis to low bone mineral density, one from low to normal bone mineral density, and four were unchanged. All errors occurred on one scanner type. An integrated communication and intervention plan was implemented. The nine participants whose scans were reclassified from osteoporosis to low bone mineral density were contacted; five were using antiresorptive treatment, all of whom had other risk factors for fracture beyond these scan results. Review of all hip scans with a T-score > -2.5 (n = 371) using this scanner type identified 27 additional hip scans that required reanalysis and potential reclassification: 1 scan was reclassified from osteoporosis to low bone mineral density, 11 from low to normal bone mineral density, and 15 were unchanged.ConclusionThe impact of an analysis error on participant safety, specifically when the initiation of unnecessary treatment may result, necessitated implementation of a coordinated communication and mitigation plan across all clinical centers to ensure consistent messaging and accurate results are provided to participants and their local care providers. This framework may serve as a resource for other clinical studies.

To determine the potential economic, morbidity and mortality impact of improvements in reporting of vertebral fragility fractures (VFFs) following a complete audit cycle. Six percent interval increase in reporting of moderate/severe VFFs results in an additional 890 hip fractures predicted in year one and a potential cost saving of £13,207,000.

To determine the potential economic, morbidity and mortality impact of improvements in reporting of vertebral fragility fractures (VFFs) following an initial UK-wide audit initiated by the Royal College of Radiologists (RCR), collaborating with the Royal Osteoporosis Society (ROS) and Royal College of Physicians (RCP) and subsequent re-audit in 2022.

Patient-specific and organisational questionnaires in 2019 and 2022 involved retrospective analysis of between 50 and 100 consecutive, non-traumatic CT studies which included the thoracolumbar spine where the spine was not the area of clinical interest in patients > 70 years. VFFs were recorded and the severity graded using the Genant reporting system. A series of UK-wide interventions were initiated between the audits. Results of the re-audit were evaluated using a bespoke ROS calculator to identify potential patient related and economic benefits from any improvements demonstrated.

Widespread improvements were evident between the two audits across all audit parameters, both patient-related and organisational. Notably, there was a 6% interval increase in reporting of moderate/severe VFFs (26 to 32%). Extrapolating from NHS England data, approximately 1.8 million non-trauma CT studies including the thoracolumbar spine for patients > 70 years were performed in the UK in 2022. The incidence of VFFs in the 2022 audit was found to be 21.7%. Using these figures and the 6% increase, the number of additional patients potentially diagnosed with a VFF equates to 23,420. Applying the ROS Benefits Calculator, in this cohort of 23,420 patients with no treatment, 890 hip fractures can be predicted in year one. With initiation of treatment, this figure falls to 328 patients (562 hip fractures prevented in year one), a potential cost saving of £13,207,000.

The 2022 national re-audit confirmed improvements in radiology diagnostic performance and practice in VFF reporting. Ongoing work is required to build on this improvement and to further embed best practice. To realise this potential, there will need to be significant and maintained investment in onward referral and treatment systems (fracture liaison services or equivalent). Increasing availability of artificial intelligence will significantly increase the diagnoses of these fractures.

To investigate the characteristics of spinal adverse events after non-operative treatment for spinal metastases with intermediate instability and to discuss clinical considerations when selecting non-operative treatment.

This study included 56 patients with spinal metastases who had Spinal Instability Neoplastic Scores (SINS) of 7-12 and who underwent radiotherapy and intensive rehabilitation without a bed rest period as initial treatment between 2020 and 2023. We evaluated progression of paralysis and changes in spinal alignment before treatment, within 1 month, 1 to 6 months, and more than 6 months after treatment.

Paralysis progressed within 1 month after treatment in 7 of 56 patients (12.5%). Pre-treatment paralysis and SINS ≥ 11 were significantly associated with progression of paralysis. Alignment changes occurred in 18 of 56 patients (32.1%), with a similar incidence in patients with SINS ≥ 11 and ≤ 10. Fifteen of 44 patients (34.1%) without pre-treatment paralysis had alignment changes, but 1 patient (2.3%) experienced progression of paralysis due to increased instability within 1 month. All 3 patients whose paralysis progressed despite no evidence of malignant spinal cord compression before or after treatment had SINS ≥ 11 and showed vertebral height reduction and kyphosis progression within 1 month.

Patients with pre-treatment paralysis and SINS ≥ 11 can progress to paralysis early; therefore, careful observation and imaging examinations are recommended early after treatment. If spinal alignment worsens, the treatment plan should be reconsidered, including restrictions of activity and surgical treatment.

Vertebral height loss of fractured vertebrae treated by percutaneous vertebral augmentation (PVA) for osteoporotic vertebral compression fracture (OVCFs) during follow-up had been reported. Mostly, vertebral height loss and its relevant terms (e.g., "recompression", "recollapse" and "refracture") were defined according to immediate postoperative vertebral height as the baseline in published studies. By contrast, vertebral height deterioration (VHD) was defined according to preoperative vertebral height as the baseline in the present study. The aim of the study was to reveal predictors for VHD in fractured vertebrae operated by percutaneous vertebroplasty (PVP), with a specific focus on surgical factors.

All patients with OVCFs treated by PVP between April 2016 and September 2018 were retrospectively reviewed. Patients were followed up for at least 12 months after procedure according to treatment protocol. VHD was defined as the presence of a decrease of vertebral height at final follow-up compared to preoperative. Clinical, radiological and surgical factors that might affect occurrence of VHD were assessed using univariate and multivariate analyses.

A total of 543 patients (females 80%, age 73.2 ± 8.1 years) with 681 fractured vertebrae who underwent PVP were enrolled. Mean follow-up time was 28.9 ± 13.4 months (range, 12-59 months). Incidence of VHD in fractured vertebrae was 48.9% (333/681). One clinical factor and four radiological factors, including fracture age (OR = 0.513, 95% CI 0.385-0.683, p = 0.000), fracture location (OR = 2.878, 95% CI 1.994-4.152, p = 0.000), fracture severity (OR = 0.521, 95% CI 0.386-0.703, p = 0.000), cortical defect on lateral wall (OR = 2.535, 95% CI 1.351-4.758, p = 0.004) and intravertebral cleft (OR = 2.362, 95% CI 1.488-3.750, p = 0.000), were independent predictors for VHD. However, all the surgical factors evaluated were not significant in final model analysis.

Surgical factors might play a negligible effect on VHD. VHD might be due to natural course of fracture/osteoporosis.

Glucocorticoid-induced osteoporosis (GIO) is the most common drug-induced osteoporosis. Early detection and treatment may decrease the fragility fractures. Several GIO guidelines exist, although they vary in recommended intervention thresholds for initiating pharmacologic treatment. This study aimed to evaluate the performance of intervention thresholds in treating GIO under various guidelines.

Rheumatic disease patients receiving ≥ 2.5 mg/day prednisolone or equivalent for longer than 3 months between January 2013 and 2023 were retrospectively reviewed. Patients who were previously treated with anti-osteoporotic medications or had other secondary causes of osteoporosis were excluded. Bone mineral density (BMD) and Thailand-specific FRAX with glucocorticoid adjustment (GC-FRAX) were recorded. The performances of different intervention thresholds from six GIO guidelines (ACR 2022, Belgian 2022, TOPF 2021, Korean 2018, Malaysian 2015, and Japanese 2023) were examined against the incidence of actual fragility fractures.

This study included 226 rheumatic patients, with a mean (SD) age of 62.9 (10.1) years. Most of the patients were female (88.9%). The average (SD) daily dose, cumulative dose, and duration of glucocorticoid use were 4.6 (10.6) mg/day, 9,223.4 (9,223.4) mg, and 58.3 (55.8) months, respectively. Diagnoses included rheumatoid arthritis (59.8%), systemic lupus erythematosus (22%), inflammatory myositis (4.7%), systemic sclerosis (4.7%), and others. The prevalence of major osteoporotic fractures and hip fractures was 14.2% and 0.9%, respectively. The ten-year probabilities of major osteoporotic and hip fractures (FRAX) with and without BMD were 12.6 ± 9.1, 5.4 ± 6, 10.7 ± 7.2, and 4.6 ± 4.8, respectively. The mean (SD) ten-year FRAX probabilities of major osteoporotic and hip fractures were 12.6% (9.1) and 5.4% (6) with the inclusion of BMD result, and 10.7% (7.2) and 4.6% (4.8) without the inclusion of the BMD result. The sensitivity, specificity and accuracy of the ACR 2022, Belgian 2022, TOPF 2021, Korean 2018, Malaysian 2015, and Japanese 2023 guidelines were 100%/ 3.1%/ 16.8%, 93.8%/ 14.4%/ 25.7%, 93.8%/ 43.8%/ 50.9%, 100%/ 17.5%/ 29.2%, 78.1%/ 62.9%/ 65% and 100%/ 24.2%/ 35%, respectively.

Among evaluated guidelines, ACR 2022, Korean 2018, and Japan 2023 had the highest sensitivity for GIO treatment, while Malaysian 2015 showed the highest specificity and accuracy. These findings can improve clinical decision-making in GIO management for rheumatic disease patients.

Although percutaneous kyphoplasty (PKP) is used to treat severe osteoporotic vertebral compression fractures (OVCF), the unsatisfactory effect of bone cement reduction and leakage is a concern. In recent years, the application of surgical robots in the field of orthopaedics has shown promising prospects. Since 2017, our hospital has used surgical robot-assisted PKP to treat severe OVCF.

One hundred and fifty-five old patients with severe OVCF who had undergone PKP were retrospectively analyzed and stratified into two groups: robot-assisted (n = 88) and fluoroscopy-assisted (n = 67). The surgical time, intraoperative radiation dose, surgical efficacy (analgesic effect and limb function), imaging evaluation (accuracy of puncture, distribution of bone cement, reduction of vertebral height, and rectification of Cobb angle), and leakage of bone cement were analyzed to evaluate the potential advantages of robot-assisted PKP in the treatment of severe OVCF.

There were significant differences in surgical time (P < 0.001), intraoperative radiation dose (P < 0.001), analgesic effect (P = 0.001), accuracy of puncture (P = 0.008), distribution (P = 0.013), and leakage of bone cement (P = 0.019) between the two groups. However, postoperative limb function (P = 0.612), reduction in vertebral height (P = 0.068), and rectification of the Cobb angle (P = 0.243) were similar in both groups.

The application of robot-assisted PKP for treating severe OVCF (Genant Grade III) can slightly shorten surgery time and significantly reduce intraoperative total radiation exposure for both patients and clinicians. Additionally, it improves puncture accuracy and reduces the cement leakage rate, ultimately achieving satisfactory pain relief. However, in terms of functional recovery, no significant differences were observed between the two approaches.

This review aims to overview factors contributing to TAO development and addresses the targeted diagnostic work-up and treatment management in adult thalassemic patients.

Osteoporosis management in Thalassemia is challenging because several factors contributing to its pathogenesis should be considered and controlled starting from child- hood. A multidisciplinary approach is crucial. Evidence concerning the efficacy of available anti-osteoporosis drugs in thalassemic patients is scarce. In this scenario, clinical experience and center resources often guide the treatment choice. More efforts should be made to share knowledge in this field in order to indicate specific treatment strategies for TAO management.

We performed a literature search in Pubmed from 1992 to March 2024 using the words Thalassemia and: osteoporosis, Bisphosphonates, Denosumab, Teriparatide, Romosozumab, hormone replacement therapy, growth hormone, hypogonadism, calcium, vitamin D, bone disease, sarcopenia. The search was limited to English literature including original studies, reviews, meta-analyses, case reports.

This study evaluated trabecular bone score (TBS) for assessing vertebral fractures and spinal deformity in children and adolescents with osteogenesis imperfecta (OI). TBS showed superior performance in identifying vertebral fractures compared to areal bone mineral density (aBMD), especially in patients without densitometric osteoporosis, suggesting its potential for monitoring vertebral fractures and spinal deformity risk.

TBS, derived from a textural greyscale analysis of lumbar spine dual-energy X-ray absorptiometry (DXA) images, offers a non-invasive and indirect evaluation of bone microarchitecture. This method potentially enhances the assessment of skeletal phenotypes beyond the scope of aBMD. We aim to explore the utility of TBS in assessing vertebral fractures and spinal deformity in children and adolescents with OI.

In this cross-sectional study, 153 children and adolescents with OI were enrolled. DXA was used to measure TBS and aBMD, and their Z-scores were calculated based on reference values for BMD and TBS in normal children and adolescents with the same age and sex. Lateral thoracolumbar films were used to evaluate vertebral fractures and calculate the spine deformity index (SDI). The accuracy of TBS and aBMD for identifying vertebral compression fractures (VCFs) was assessed using area under the curve (AUC).

TBS Z-score was negatively correlated with the age of children with OI (r =  - 0.435, P < 0.001) and was positively correlated to aBMD Z-score at the lumbar spine and femoral neck (both P < 0.01), even after adjusting for confounding factors. TBS Z-score was as effective as lumbar spine aBMD Z-score in discriminating VCFs (AUC, 0.667 vs 0.666, P > 0.05). Notably, in patients without densitometric osteoporosis, TBS Z-score demonstrated superior discriminative power for VCFs compared to lumbar spine aBMD Z-score (AUC, 0.719 vs 0.545, P < 0.05). In this population, only the TBS Z-score (r =  - 0.358, P < 0.05), rather than the lumbar spine aBMD Z-score, was negatively correlated with the SDI.

TBS has a close correlation with bone mineral density in children and adolescents with OI. In patients without densitometric osteoporosis, the Z-score of TBS is more effective than that of bone mineral density in assessing VCFs and spinal deformity, highlighting the potential of TBS in evaluating the risk of VCFs and monitoring the progression of spinal deformity.

To evaluate the impact of prior teriparatide (TPTD) treatment on the effectiveness of romosozumab (ROMO) in postmenopausal osteoporosis.

In this retrospective, case-controlled, multicenter study, 323 postmenopausal patients were initiated ROMO. Of these, 275 were treatment-naïve, and 48 were switched from TPTD, with uninterrupted ROMO treatment for 12 months. Propensity score matching was applied to ensure clinical comparability, yielding 44 patients in each group. Baseline characteristics included a mean age of 78.0 years, lumbar spine (LS) T-score of -3.6, and total hip (TH) T-score of -2.8. Bone mineral density (BMD) and serum bone turnover markers were evaluated over the 12-month period.

The increasing rate in the bone formation marker PINP was significantly greater in the treatment-naïve group compared to the TPTD-switched group throughout the 1-12 month period. Conversely, the reduction in the bone resorption marker TRACP-5b was similar between the groups, indicating a diminished anabolic window in the TPTD-switched group. After 12 months, the TPTD-switched group showed lower BMD gains in the LS (10.3 % vs. 17.3 %; P = 0.002) and TH (3.1 % vs. 7.8 %; P = 0.002) compared to the treatment-naïve group. Multiple regression analysis revealed positive associations between the 12-month percentage BMD increases (LS; β = 0.30; 95 % CI = 0.85-11.61; P = 0.024 / TH; β = 0.32; 95 % CI = 0.51-8.56; P = 0.028) and being treatment-naïve compared to prior TPTD treatment.

Prior TPTD treatment may attenuate the effectiveness of ROMO, potentially due to diminished bone formation activation.

Study DesignRetrospective cohort study.ObjectiveIn general, Multiple Myeloma (MM) patients are treated with systemic therapy including chemotherapy. Radiation therapy can have an important supportive role in the palliative management of MM-related osteolytic lesions. Our study aims to investigate the degree of radiation-induced remineralization in MM patients to gain a better understanding of its potential impact on bone mineral density and, consequently, fracture prevention. Our primary outcome measure was percent change in bone mineral density measured in Hounsfield Units (Δ% HU) between pre- and post-radiation measurements, compared to non-targeted vertebrae.MethodsWe included 119 patients with MM who underwent radiotherapy of the spine between January 2010 and June 2021 and who had a CT scan of the spine at baseline and between 3-24 months after radiation. A linear mixed effect model tested any differences in remineralization rate per month (βdifference) between targeted and non-targeted vertebrae.ResultsAnalyses of CT scans yielded 565 unique vertebrae (366 targeted and 199 non-targeted vertebrae). In both targeted and non-targeted vertebrae, there was an increase in bone density per month (βoverall = .04; P = .002) with the largest effect being between 9-18 months post-radiation. Radiation did not cause a greater increase in bone density per month compared to non-targeted vertebrae (βdifference = .67; P = .118).ConclusionOur results demonstrate that following radiation, bone density increased over time for both targeted and non-targeted vertebrae. However, no conclusive evidence was found that targeted vertebrae have a higher remineralization rate than non-targeted vertebrae in patients with MM.

This study compared TBS v4.0, which uses DXA-derived tissue thickness corrections, with TBS v3, which adjusts using BMI. TBS v4.0 improved soft tissue adjustments and maintained fracture risk prediction equivalence with TBS v3, enhancing applicability across diverse body compositions/phenotypes. Direct tissue thickness adjustment increases TBS's utility in osteoporosis assessment and management.

This study aimed to compare trabecular bone score (TBS) version 4.0, which uses direct tissue thickness correction via DXA measurements, with TBS version 3, which adjusts for soft tissues using body mass index (BMI). The objective was to assess the performance of TBS v4.0 compared to v3, for bone health evaluation and fracture risk assessment across diverse body compositions.

Data from the OsteoLaus cohort were analyzed. Associations between TBS, BMI, DXA-measured tissue thickness, visceral fat (VFAT), and android fat were examined using regression and correlation analyses. Machine learning, including Random Forest (RF) and SHapley Additive exPlanations (SHAP), explored TBS changes between versions. Five-year fracture risk was assessed using FRAX adjustment, and logistic regression.

TBS v3 correlated with BMI (r = 0.110, p < 0 .001), VFAT mass (r =  - 0.162, p < 0 .001), and soft tissue thickness (r =  - 0.165, p < 0.001). TBS v4.0 demonstrated weaker correlations with BMI (r =  - 0.057, p > 0.999), VFAT Mass (r =  - 0.067, p > 0.779), and soft tissue thickness (r =  - 0.114, p = 0.019). Differences between TBS versions were investigated with SHapley Additive exPlanations (SHAP) and explained by BMI, tissue thickness, VFAT, and gynoid fat. Logistic regression and Delong's test revealed no significant differences in vertebral fracture prediction between the two TBS versions (p = 0.564). FRAX adjustments were highly consistent between versions (r = 0.994, p < 0.001), with no evidence of calibration bias (p = 0.241).

TBS v4.0 enhances the adjustment for regional soft tissue effects and results suggest comparable vertebral fracture risk prediction to TBS v3. Explainable AI provided insights into the contributions of BMI, tissue thickness, visceral fat, and gynoid fat to the observed changes between TBS versions. Incorporating direct tissue thickness adjustment improves TBS applicability across diverse body sizes and compositions.

Long term glucocorticoid treatment in Duchenne Muscular Dystrophy (DMD) is associated with a high incidence of fragility fractures. This systematic review aims to assess the current evidence for pharmacological and non-pharmacological treatment for osteoporosis in children and adults with DMD.

Three online databases (Embase, Medline, Cochrane Library) were searched for studies that evaluated interventions for treatment or prevention of osteoporosis in DMD. Included studies had to report changes in bone mineral density (BMD) or bone mineral content (BMC) Z-scores or fracture incidence.

Nineteen studies were identified, including twelve that evaluated bisphosphonate, three evaluated testosterone (2 studies of the same patient group), one evaluated vitamin D/calcium, one teriparatide, and two evaluated vibration therapy. Only two randomised-controlled trials were found, one of intravenous bisphosphonate and one of vibration therapy. Changes in lumbar spine BMD ranged from -0.3 to +1.3 in studies of bisphosphonate and - 0.2 to 0.0 with vibration therapy, whereas this was +0.38 with testosterone and + 0.9 with vitamin D/calcium. There was limited information on impact on fracture in all studies. None of the pharmacological studies involved a fracture naïve group at baseline. In addition, none addressed a group of individuals over 18 years at baseline.

This systematic review provides evidence for the effectiveness of bisphosphonate therapy in improving bone density in children and adolescents with DMD. However, there is less information on the impact on fracture. The review did not find studies exclusively in those over 18 years old with DMD and limited information on non-bisphosphonate pharmacological agents.

Investigating vertebral fractures and brain structure, we found significant gray matter volume reductions in the right hippocampus, amygdala, and parahippocampal gyrus, especially in males. These findings emphasize the importance of integrating skeletal and neural health in osteoporosis management.

Vertebral fractures (VF) due to osteoporosis impact morbidity and quality of life in the elderly. The relationship between VF and changes in brain structure remains underexplored. This study aimed to investigate the association between VF and gray matter volume (GMV) reductions in specific brain regions and to explore potential sex differences.

Data from 1,751 participants (571 males, 1,180 females; mean age 64.9, range 18-97) in the fourth survey of the population-based Research on Osteoarthritis/Osteoporosis Against Disability study (2015-2016) were used. Participants were classified into those with and without VF (VF + and VF - groups) based on Genant's semiquantitative method, assessed by spine radiographs. Voxel-based morphometry was applied to MRI images to measure GMV, and a general linear model analysis was performed to compare GMV between groups, adjusting for age, sex, total brain volume, and Mini-Mental State Examination scores as covariates. Additionally, a two-way analysis of variance was conducted on the significant GMV cluster, with sex and VF presence as independent variables, to explore interaction effects.

The VF+ group consisted of 113 participants, while the VF- group included 1,638 participants. The analysis identified a significant cluster with reduced GMV in the VF + group compared to the VF - group. This cluster included the right hippocampus, right amygdala, and right parahippocampal gyrus. Further analysis revealed that males in the VF + group exhibited more pronounced GMV reductions in the significant cluster compared to females.

These findings suggest that VF is associated with significant reductions in brain regions critical for memory, emotional processing, and visuospatial memory, with more severe effects observed in males.

This exploratory study developed and evaluated an artificial intelligence (AI)-based algorithm for quantitative morphometry to assess vertebral body deformities indicative of fractures. To achieve this, 709 radiographs from 355 cases were utilized for algorithm development and performance evaluation. The proposed algorithm integrates a first-stage AI model to identify the positions of thoracic and lumber vertebral bodies in lateral radiographs and a second-stage AI model to annotate 6 landmarks for calculating vertebral body height ratios (C/A, C/P, and A/P). The first-stage AI model achieved a sensitivity of 97.6%, a precision of 95.1%, and an average false-positive ratio of 0.43 per image for vertebral body detection. In the second stage, the algorithm's performance was evaluated using an independent dataset of vertebrae annotated by 2 spine surgeons and 1 radiologist. The average landmark errors ranged from 2.9% to 3.3% on the X-axis and 2.9% to 4.0% on the Y-axis, with errors increasing in more severely collapsed vertebrae, particularly at central landmarks. Spearman's correlation coefficients were 0.519-0.589 for C/A, 0.558-0.647 for C/P, and 0.735-0.770 for A/P, comparable with correlations observed among human evaluators. Bland-Altman analysis revealed systematic bias in some cases, indicating that the algorithm underestimated anterior and central height collapse in deformed vertebrae. However, the mean differences and limits of agreement between the algorithm and external evaluators were similar to those among the evaluators. Additionally, the algorithm processed each image within 10 s. These findings suggest that the algorithm performs comparably with human evaluators, demonstrating sufficient accuracy for clinical use. The proposed approach has the potential to enhance patient care by being widely adopted in clinical settings.

Since the majority of vertebral compression fractures (VCFs) are asymptomatic, they often go undetected on opportunistic CT scans. To reduce rates of undiagnosed osteoporosis, we developed a deep learning (DL)-based algorithm using 2D/3D U-Nets convolutional neural networks to opportunistically screen for VCF on CT scans. This study aimed to evaluate the performance of the algorithm using external real-world data.

CT scans acquired for various indications other than a suspicion of VCF from January 2019 to August 2020 were retrospectively and consecutively collected. The algorithm was designed to label each vertebra, detect VCF, measure vertebral height loss (VHL) and calculate mean Hounsfield Units (mean HU) for vertebral bone attenuation. For the ground truth, two board-certified radiologists defined if VCF was present and performed the measurements. The algorithm analyzed the scans and the results were compared to the experts' assessments.

A total of 100 patients (mean age: 76.6 years ± 10.1[SD], 72% women) were evaluated. The overall labeling agreement was 94.9% (95%CI: 93.7%-95.9%). Regarding VHL, the 95% limits of agreement (LoA) between the algorithm and the radiologists was [-9.3, 8.6]; 94.1% of the differences lay within the radiologists' LoA and the intraclass correlation coefficient was 0.854 (95%CI: 0.822-0.881). For the mean HU, Pearson's correlation was 0.89 (95%CI: 0.84-0.92; p-value <0.0001). Finally, the algorithm's VCF screening sensitivity and specificity were 92.3% (95%CI: 81.5%-97.9%) and 91.7% (95%CI: 80.0%-97.7%), respectively.

This automated tool for screening and quantification of opportunistic VCF demonstrated high reliability and performance that may facilitate radiologists' task and improve opportunistic osteoporosis assessments.