Persons with type 2 diabetes have increased fracture risk that existing fracture risk assessment tools underestimate.

Identify fracture predictors in persons with type 2 diabetes and overweight or obesity, considering traditional and diabetes-related risk factors.

This is a secondary analysis of a multicenter US study, the Look AHEAD: Action for Health in Diabetes randomized clinical trial, with randomization from 2001 to 2004 and fracture follow-up until 2015. Participants were men and women 45 to 75 years old with type 2 diabetes and body mass index ≥ 25 kg/m2. Potential fracture predictors ascertained at randomization included traditional and diabetes-related risk factors (diabetes duration, diabetic neuropathy, antidiabetic medication use, hemoglobin A1c, and renal function). Total hip bone mineral density (BMD) was measured in a subcohort. Primary outcome was all incident clinical fractures, ascertained by self-report and centrally adjudicated with medical records review.

Over a median 12.2-year follow-up, 649 of the 4703 participants experienced at least one clinical fracture. Thiazolidinedione use (hazard ratio [HR] 1.22; 95% CI, 1.02-1.46) and insulin use (HR 1.34, 95% CI, 1.08-1.66) were significant diabetes-related predictors of all clinical fractures. When measured in a subcohort (n = 1285), total hip BMD was the strongest modifiable predictor of all clinical fractures (per 1 SD = 0.1 g/cm2 increase, HR 0.47; 95% CI, 0.39-0.58).

Thiazolidinedione and insulin use predict clinical fracture in middle-aged and older persons with type 2 diabetes and overweight or obesity. Evaluating BMD is advisable if these medications are prescribed. Fracture risk prediction tools may consider including thiazolidinedione and insulin use to refine prediction in this population.

Early identification of osteoporosis promotes timely treatment. This retrospective study demonstrated that bone cortical percentage (2MCP) measured on hand X-ray in patients with inflammatory arthritis correlates significantly with bone density, fracture risk and fracture incidence. Routine hand X-ray 2MCP reporting could support identification of patients at risk of osteoporotic fractures.

Effective osteoporotic screening facilitates earlier identification and treatment of patients at risk. Bone mineral density (BMD) alone has limited sensitivity and may not always be available. This study aimed to show whether radiographic second metacarpal cortical thickness percentage (2MCP) correlates with BMD and fracture incidence.

This retrospective cohort study measured 2MCP in 230 patients with inflammatory arthropathies who underwent both DXA and hand radiograph within 6 months. BMD, FRAX and fracture history was gathered.

2MCP correlated with femoral neck BMD (p < 0.001), T-scores (p < 0.001), FRAX (p < 0.001) and major and all osteoporotic fracture incidence (p < 0.001) across all patient groups. 2MCP ≤ 55% was 88% sensitive and 51% specific in identifying patients with osteoporotic BMD (AUC 0.7893). 2MCP ≤ 65% and ≤ 73% were 100% sensitive for osteoporotic and osteopenic BMD respectively, whilst ≤ 30% and ≤ 39% were 100% specific. 2MCP ≤ 59% demonstrated 92% sensitivity for all low-impact fractures and 2MCP ≤ 56% was 87% sensitive for major osteoporotic fracture (MOF). 2MCP showed superior sensitivity and specificity to osteopenic femoral neck T-score for predicting MOF incidence (AUC 0.7009 and 0.6590). Combining 2MCP with T-score parameters enhanced sensitivity to 94.6% for MOF up to 2 years beyond the hand radiograph.

2MCP presents a fast, inexpensive adjunct to evaluate fracture risk. This technology may enhance BMD sensitivity in predicting MOF and improve global bone health assessment accessibility. 2MCP automation and routine inclusion in hand radiographs could optimise early awareness and diagnosis of patients at risk of osteoporosis and fractures.

Background: Patients with myasthenia gravis (MG) are susceptible to fractures due to glucocorticoid (GC) use and disease-related functional impairment affecting activities of daily living (ADL). The Fracture Risk Assessment Tool (FRAX®) estimates fracture probability but does not incorporate disease-specific functional status. We investigated whether combining FRAX® with the Myasthenia Gravis Activities of Daily Living (MG-ADL) scale improves fracture risk stratification in MG patients. Methods: This single-center prospective cohort study followed 53 MG patients for 10 years (2012-2022) at Toho University Ohashi Medical Center, Japan. Patients were categorized into four groups based on baseline FRAX® probability (calculated with bone mineral density [BMD]) and MG-ADL scores using median splits: high FRAX®/high MG-ADL (HH), high FRAX®/low MG-ADL (HL), low FRAX®/high MG-ADL (LH), and low FRAX®/low MG-ADL (LL). The primary outcome was incident major osteoporotic fracture (MOF). Results: Over 10 years, nine MOFs occurred: seven in the HH group (43.8%), two in the HL group (16.7%), and none in the LH or LL groups. Fracture-free survival differed significantly among the groups (log-rank p < 0.001), with the HH group exhibiting the lowest survival rate. Baseline characteristics, including age, disease duration, MG severity scores, BMD, and FRAX® scores, differed significantly among groups. Specific MG-ADL items reflecting greater impairment (impairment of ability to arise from a chair, double vision, and ptosis) were significantly more pronounced in the HH group at baseline. Conclusions: Combining baseline FRAX® scores with the MG-ADL assessment effectively stratifies long-term MOF risk in patients with MG. Individuals with both high FRAX® and high MG-ADL represent a particularly high-risk subgroup. This dual-assessment approach may improve the identification of patients requiring targeted preventive interventions.

This study presents an innovative ensemble machine learning model integrating genomic and clinical data to enhance the prediction of major osteoporotic fractures in older men. The Super Learner (SL) model achieved superior performance (AUC = 0.76, accuracy = 95.6%, sensitivity = 94.5%, specificity = 96.1%) compared to individual models. Ensemble machine learning improves fracture prediction accuracy, demonstrating the potential for personalized osteoporosis management.

Existing fracture risk models have limitations in their accuracy and in integrating genomic data. This study developed and validated an innovative ensemble machine learning (ML) model that combines multiple algorithms and integrates clinical, lifestyle, skeletal, and genomic data to enhance prediction for major osteoporotic fractures (MOF) in older men.

This study analyzed data from 5130 participants in the Osteoporotic Fractures in Men cohort Study. The model incorporated 1103 individual genome-wide significant variants and conventional risk factors of MOF. The participants were randomly divided into training (80%) and testing (20%) sets. Seven ML algorithms were combined using the SL ensemble method with tenfold cross-validation MOF prediction. Model performance was evaluated on the testing set using the area under the curve (AUC), the area under the precision-recall curve, calibration, accuracy, sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and reclassification metrics. SL model performances were evaluated by comparison with baseline models and subgroup analyses by race.

The SL model demonstrated the best performance with an AUC of 0.76, accuracy of 95.6%, sensitivity of 94.5%, specificity of 96.1%, NPV of 95.1%, and PPV of 94.7%. Among the individual ML, gradient boosting performed optimally. The SL model outperformed baseline models, and it also achieved accuracies of 93.1% for Whites and 91.6% for Minorities, outperforming single ML in subgroup analysis.

The ensemble learning approach significantly improved fracture prediction accuracy and model performance compared to individual ML. Integrating genomic and phenotypic data via the SL approach represents a promising advancement for personalized osteoporosis management.

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.

People with rheumatoid arthritis (RA) are at increased risk of osteoporosis. The Australian Rheumatology Association RA Clinical Care Standard recommends fracture risk assessment at RA diagnosis and as clinically indicated.

The aim of this study was to evaluate the use of dual-energy X-ray absorptiometry (DEXA) for osteoporosis screening among Australian patients with early RA enrolled in the Australian Rheumatology Association Database (ARAD). We also aimed to assess the dispensing patterns of anti-osteoporotic medications in this population.

ARAD participants aged ≥18 years with a RA diagnosis from 2011 onwards and linked 2011-2023 Medicare Benefits Schedule and Pharmaceutical Benefits Scheme data were included (n = 306). Time to first DEXA and anti-osteoporotic medication dispensing was assessed using Kaplan-Meier failure functions and multivariable Cox regression. Covariates included age, sex, BMI, alcohol use, smoking and glucocorticoid use.

The median time to first DEXA was 3 years (IQR 0, 10) following RA diagnosis. Predictors for DEXA included female sex (HR 1.6, 95% CI 1.1, 2.4), age ≥50 (HR 2.6, 95% CI 1.8, 3.9) and glucocorticoid use (HR 1.7, 95% CI 1.3, 2.4). DEXA was less likely with BMI ≥25 (HR 0.68, 95% CI 0.48, 0.96). By 8 years after RA diagnosis, 25% of participants received anti-osteoporotic medication, predicted by age ≥50 (HR 6.7, 95% CI 2.1, 21.4) and glucocorticoid use (HR 2.8, 95% CI 1.5, 5.0).

Our findings reveal delays and variability in osteoporosis screening for individuals with RA, despite higher fracture risk. Screening practices were influenced by age, glucocorticoid use and BMI, with significant gaps, particularly after diagnosis. These gaps highlight the need for standardised screening protocols to ensure timely DEXA scans and treatment, ultimately improving osteoporosis management and reducing fracture burden.

Background/Objectives: Osteoporosis is prevalent in the elderly and increases fracture risk. Bone density is commonly assessed using dual-energy X-ray absorptiometry (DEXA). The femoral cortical thickness index (CTI) also provides indirect information for osteoporosis. It remains unclear whether there are intra-individual differences and if a correlation to fracture risk of the CTI in fractured femora results due to fracture related malrotation during X-rays. The aim of this study was to investigate the individual bilateral CTI in patients with proximal femoral fractures. Methods: A retrospective analysis of 200 surgically treated patients (100 trochanteric, 100 femoral neck fractures) was performed. Measurements included the bilateral CTI at 10 and 15 cm below the lesser trochanter. Analysis of the correlation of those examinations, in comparison to the contralateral CTI at 15 cm, and correlation of the CTI with the body mass index (BMI) and age was performed. Results: Results showed significant differences (p < 0.001) in bilateral CTIs for both fracture types at 15 cm with a strong inter-rater reliability (ICC > 0.9). There was no significant correlation between age and CTI, as well as BMI and CTI in both cohorts (p > 0.1). Sex-specific subgroup analyses revealed that females exhibited significant differences in CTI between fractured and non-fractured sides (p < 0.001). Conclusions: In conclusion, CTI, and the modified CTI at 15 cm below the lesser trochanter in fractured proximal femora, is lower compared to the non-fractured side. The femoral CTI could help in daily clinical routines and circumstances, where more detailed risk prediction tools are lacking.

This 10-year study of 5000 + adults aged 50-84 found 20% experienced non-vertebral fractures. Higher risk was linked to female sex, older age, European ethnicity, lower education, living alone, alcohol use, prior falls/fractures, osteoporosis, arthritis, and antidepressants. Targeting modifiable factors (living arrangements, alcohol, antidepressants) could reduce fracture burden cost-effectively in older adults.

Although there has been extensive research on non-vertebral fractures, their risk factors remain incompletely understood. This study aimed to examine risk factors associated with non-vertebral fractures through a longitudinal examination of a community-dwelling cohort.

This was a follow-up of participants recruited from family practices into a randomized trial of vitamin D supplementation and interviewed between 2011 and 2012, with follow-up until 2022. The outcome was the first non-vertebral fracture during the follow-up period, as identified from hospital events and insurance claims for fractures. Candidate risk factors were selected using a domain-based approach, and Cox models were employed to estimate adjusted hazard ratios (HRs).

The analysis comprised 5108 participants aged 50-84 years. Of these, 83% were of European/other ethnicity. A substantial proportion reported living with non-family members or living alone (20.5%), engaging in daily drinking (21.6%), or using antidepressants (11.9%). Over a median 10-year follow-up, 1016 participants (20%) experienced non-vertebral fractures. In the multivariable model, several factors were related to higher risk of non-vertebral fracture, including females (HR = 1.53), aged 80-84 years (HR = 1.47), European/other ethnicity, primary school education (HR = 1.65), living with non-family members (HR = 1.47) or living alone (HR = 1.29), daily alcohol drinking (HR = 1.51), history of falls (HR = 1.59) or fractures (HR = 1.43), osteoporosis (HR = 1.95), and arthritis (HR = 1.20), and dispensing of antidepressants (HR = 1.52) and antiarrhythmic medications (HR = 1.51).

Non-vertebral fractures are prevalent among older adults, with several prevalent and potentially modifiable risk factors identified, such as living situation, drinking habits, and antidepressant dispensing. Further exploration of these factors' causality and the implementation of public health interventions targeting them, could yield significant benefits and cost-effectively reduce the burden of fractures.

This study was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12611000402943).

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.

The main aim of the current study was to compare the effects of two strength training modalities (hypertrophy vs. contrast training) on bone health parameters, physical performance and quality of life in a group of subjects aged 60 and above with low skeletal muscle mass index (SMI). 45 older adults voluntarily participated in this study, but only 41 (22 women and 19 men) completed it. The participants were assigned to 3 different groups: control group (CG; n = 15), contrast training group (CTG; n = 13) and hypertrophy training group (HTG; n = 13). The duration of the training protocol was six months. The experimental groups performed two sessions of strength training per week; the duration of each session was forty-five minutes. Several measurements (which included anthropometrics, body composition, bone parameters, maximal strength parameters, physical performance parameters, fracture risk and quality of life) were performed in the three groups before and after the six-month training period. The different measurements of the protocol were carried out under the same conditions with identical materials and investigators for all the participants and for each approach. The current study has demonstrated that the two training modalities show common benefits such as improving maximal strength, physical performance and quality of life parameters but have no significant effects on bone mineral density (BMD) and bone mineral content (BMC). The influence of training was marked more for improving maximal strength and reducing fracture risk for the contrast training group (who performs movements at high speed) compared to the hypertrophy training group (who performs movements at spontaneous speed). In conclusion, this study shows that both resistance training programs are effective in improving maximal strength, physical performance and quality of life in older adults with low SMI. However, this 6-month intervention was not sufficient to significantly increase BMC nor BMD values in this population.

The triglyceride-glucose (TyG) index, a recognized marker for insulin resistance, holds potential implications for skeletal health. However, its relationship with fragility fractures remains uncertain. We aimed to elucidate the association between the TyG index and fragility fractures in the general US population.

Cross-sectional data of 25,082 participants were obtained from the National Health and Nutrition Examination Survey. The association between the TyG index and fragility fractures was investigated using univariate and weighted multivariate logistic regression as well as restricted cubic spline (RCS) regression models. The least absolute shrinkage and selection operator regression with ten-fold cross-validation was employed to identify key variables, leading to the development of a nomogram model. Calibration and receiver operating characteristic curves were utilized to evaluate the model's validity.

The overall prevalence of fragility fractures among participants was 1.10%. After adjusting for confounders, the TyG index exhibited a robust association with the risk of fragility fractures (odds ratio, 1.94; 95% confidence interval, 1.31-2.88; P < 0.001). RCS regression demonstrated a positive linear relationship between the TyG index and fragility fractures. The predictive nomogram, incorporating the TyG index and other clinical factors, demonstrated favorable predictive performance (consistency index = 0.901).

Elevated TyG index levels were significantly correlated with the risk of fragility fractures in the general US population. These findings suggest that the TyG index may serve as a predictive marker for fragility fractures, underscoring the importance of early intervention and improved fracture risk assessment tools in clinical practice.

This study aimed to develop and validate a novel web-based calculator using machine learning algorithms to predict fragility fracture risk in People living with HIV (PLWH), who face increased morbidity and mortality from such fractures.

We retrospectively analyzed clinical data from Beijing Ditan Hospital orthopedic department between 2015 and September 2023. The dataset included 1045 patients (2015-2021) for training and 450 patients (2021-September 2023) for external testing. Feature selection was performed using multivariable logistic regression, LASSO, Boruta, and RFE-RF. Six machine learning models (logistic regression, decision trees, SVM, KNN, random forest, and XGBoost) were trained with 10-fold cross-validation and hyperparameter tuning. Model performance was assessed with ROC curves, Decision Curve Analysis, and other metrics. The optimal model was integrated into an online risk assessment calculator.

The XGBoost model showed the highest predictive performance, with key features including age, smoking, fall history, TDF use, HIV viral load, vitamin D, hemoglobin, albumin, CD4 count, and lumbar spine BMD. It achieved an ROC-AUC of 0.984 (95% CI: 0.977-0.99) in the training set and 0.979 (95% CI: 0.965-0.992) in the external test set. Decision Curve Analysis indicated clinical utility across various threshold probabilities, with calibration curves showing high concordance between predicted and observed risks. SHAP values explained individual risk profiles. The XGBoostpowered web calculator (https://sydtliubo.shinyapps.io/cls2shiny/) enables clinicians and patients to assess fragility fracture risk in PLWH.

We developed a web-based risk assessment tool using the XGBoost algorithm for predicting fragility fractures in HIV-positive patients. This tool, with its high accuracy and interpretability, aids in fracture risk stratification and management, potentially reducing the burden of fragility fractures in the HIV population.

For younger postmenopausal women, clinical guidelines recommend using osteoporosis risk prediction tools to identify candidates with low bone mineral density (BMD). However, the performance of these tools is not well quantified.

To examine the performance of Osteoporosis Risk Assessment Instrument (ORAI) and Osteoporosis Index of Risk (OSIRIS), compared with Osteoporosis Self-Assessment Tool (OST), in identifying the presence of osteoporotic BMD in younger postmenopausal women.

This cross-sectional study used data from the Women's Health Initiative Bone Density Substudy, which was conducted at 3 clinical centers in Tucson and Phoenix, Arizona; Pittsburgh, Pennsylvania; and Birmingham, Alabama. Participants were healthy postmenopausal women aged 50 to 64 years with BMD measurements evaluated using the 3 risk prediction tools: OSIRIS, ORAI, and OST. Risk factors and other participant characteristics were compared across osteoporosis status. Data were collected from October 1993 to December 1998 and analyzed between September 23, 2023, and April 10, 2024.

The primary exposures were OSIRIS, ORAI, and OST risk scores.

Primary outcome was osteoporosis defined by BMD T score of -2.5 or lower at 1 or more of 3 anatomical locations: femoral neck, total hip, and/or lumbar spine. The tools were evaluated via area under the receiver operating characteristic curve (AUC) at published score cutoffs and at alternate cutoffs.

Among 6067 included participants (mean [SD] age at baseline, 57.7 [4.1] years), the prevalence of osteoporosis was 14.1% (n = 857) at any 1 of 3 anatomical sites. AUC for identifying osteoporosis at any site was 0.633 (95% CI, 0.633-0.634) for OSIRIS, 0.663 (95% CI, 0.663-0.664) for ORAI, and 0.654 (95% CI, 0.654-0.655) for OST.

In this cross-sectional study, 3 guideline-recommended osteoporosis risk assessment tools had fair to moderate discrimination in identifying osteoporosis defined by lowest BMD at any 1 of 3 skeletal sites. Screening is essential to reducing individual and societal burden of osteoporosis and related fractures, and this study showed a gap in identifying younger postmenopausal women using common clinical risk factors.

In Parkinson's disease (PD), the propensity to fall and the higher risk of osteoporosis converge yielding a high fracture risk. Updated National Osteoporosis Guideline Group (NOGG) guidance recommends that PD should trigger a risk assessment, for example using the FRAX tool, yet clinical pathways remain sub-optimal. To address this, we generated an algorithm for the assessment and management of bone health specifically in PD.

Within the Proactive and Integrated Management and Empowerment in Parkinson's Disease randomised controlled trial (PRIME-UK RCT), bone-health metrics were collected, and all participants were offered a dual X-ray absorptiometry scan. The FRAX tool was used to obtain the 10-year probability of hip and major osteoporotic fracture (MOF), and the resulting NOGG risk-category recorded. Probabilities were recalculated including femoral-neck bone mineral density (FN-BMD) and/or with numeric adjustment for recurrent falls, and results compared.

Among 182 people with parkinsonism (mean age 73.8 years, 65% male, median disease duration 5 years), 28% reported a prior fragility fracture, and 40.7% recurrent falls over the previous year. 28.6% had MOF above NOGG intervention thresholds (IT); whilst 12.1% had a FN-BMD T-Score ≤ -2.5. Recalculation of FRAX with FN-BMD (n = 182) reduced fracture MOF and hip fracture probabilities; 12 (6.6%) deescalated below the IT, and 16 (8.8%) moved above the IT.

This 2024 BONE-PARK algorithm is informed by both the latest NOGG Guidelines and novel findings in a 'real-world' population. The algorithm will aid bone health assessment for people with PD.

Some current prostate cancer (PCa) treatment regimens are known to have adverse effects on bone, for example androgen deprivation therapy (ADT), and on cardiovascular health, for example ADT and antiandrogen therapy. Strengthened recommendations for the practical assessment and management of bone and cardiovascular health in men with PCa are needed. This review aims to provide practical guidance for healthcare providers along the continuum of patient care on the management of bone and cardiovascular health in men with PCa undergoing ADT and antiandrogen therapy based on real-world evidence. Evidence was identified by searching PubMed for publications that reported the effects of PCa treatment on bone or cardiovascular health in a real-world setting and were published between January 2017 and August 2023. Review articles were excluded. The evidence identified indicates that ADT decreases bone mineral density (BMD) and increases the risk of osteoporosis and fractures. Bone-protecting agents (BPAs) are effective at improving bone health in patients undergoing ADT and antiandrogen therapy at all stages of the PCa pathway. Despite this, the use and timing of initiation of BPAs are variable. Furthermore, real-world studies have confirmed an association between ADT and cardiovascular risk. As survival outcomes improve, maintenance of bone and cardiovascular health is increasingly important in men with PCa. Risk is a continuous variable that must be assessed throughout the continuum of PCa treatment. Therefore, all men starting ADT should be assessed for bone and cardiovascular risk. Lifestyle adjustments, dietary supplementation and pharmacological intervention may be advised.

Bone anabolic treatment has been shown to be superior to oral bisphosphonates, especially in osteoporosis patients with a very high fracture-risk. The current German osteoporosis guideline classifies the very high 3-year fracture-risk based upon a novel fracture-risk model. As age is a severe risk-factor, we examined the distribution and associations to geriatric assessment parameters of the very high-risk group in a well-characterized cohort of community-dwelling geriatric patients.

Analyses were based on 166 patients (mean age 82 ± 6 years) taken from MUSAR (MUnich SArcopenia Registry). Fracture-risk was calculated as described in the current German guideline. Thereupon, patients were allocated to the low-/moderate (<5 %), high- (5-10 %) or very high-risk group (>10 %). Associations of geriatric assessment parameters with the group allocation to the fracture-risk group were evaluated by covariate-adjusted linear regression analysis.

>80 % of the study population were at an increased fracture-risk. Besides, >50 % were allocated to the very high-risk group. Patients in the very high-risk group showed limitations in all physical performance tests (short physical performance battery (SPPB), gaitspeed, handgrip strength and chair rise test). Also, polypharmacy and a risk for malnutrition (from mini nutritional assessment short form (MNA-SF)), were present. All parameters showed significant associations with group allocation to very high-risk group.

Most of the geriatric patients are at a very high-risk for osteoporotic fractures. Also, this group presented several limitations in the comprehensive geriatric assessment highlighting the vulnerability of this group. Clinicians need to reinforce fracture-risk assessment and familiarize with treatment options.

Hereditary neuromuscular disorders (NMD) are associated with compromised bone health and elevated fracture risk, though data are largely lacking.

This study aimed to assess the prevalence and risk factors of fractures in hereditary NMD.

We conducted a retrospective study in a cohort of adult patients with diverse hereditary NMD, using data from electronic medical records.

Among 469 patients, 505 fractures were recorded, with 5.5% of patients experiencing a fracture within the past year. In the 10 years preceding study inclusion, 31.1% of all patients sustained at least one fracture. The fracture rate was 47.3/1000 patient-years. Fracture incidence was highest in the second decade of life and the first five years after symptom onset. Fracture recurrence occurred in 25.6% over the next two years. Fractures were most prevalent in patients with Duchenne muscular dystrophy, myotonic dystrophy type 1/2, and spinal muscular atrophy. Patients with Vignos scale 5-6 had the highest fracture risk. Major osteoporotic fractures accounted for 28.6%, and 71.3% were caused by low-energy trauma. Long-term complications of a fracture were present in 44.2%, with 9.0% losing ambulation. Osteoporosis was confirmed in 47.5% of DXA scans. In patients with a normal DXA scan, 66.7% experienced a subsequent fracture. Hip T-scores declined with increasing Vignos scale (r = -0.27, p = 0.001). Fracture risk factors included glucocorticoid use, alcohol abuse, recent falls, and previous emergency visits for falls (all p < 0.05).

This cohort exhibited a high prevalence of fractures and osteoporosis, emphasizing the need for regular bone health assessment and fracture prevention in hereditary NMD patients.

Polymorphisms within the collagen 1 alpha 1 gene (COLIA1) have been shown to be associated with bone mineral density (BMD). This study aimed to test the hypothesis that COLIA1 polymorphisms are associated with bone loss and fragility fractures.

The study involved 809 postmenopausal women aged 60 years and above in the Dubbo Osteoporosis Epidemiology Study who had COLIA1 genotypes and at least two BMD measurements over a 30-year period. BMD at the lumbar spine (LSBMD) and femoral neck (FNBMD) was measured biennially by dual-energy X-ray absorptiometry (GE-Lunar Prodigy). Fragility fracture has been ascertained by X-ray reports between 1990 and 2020. The G-> T polymorphism at the Sp1-binding site in the COLIA1 gene (rs1800012) was determined by the PCR-based method, and coded as GG, GT, and TT.

Women homozygous for the minor allele (TT) tended to have greater bone loss (-0.72%/year) than those with GT (-0.58%/year) or GG (-0.56%/year) though the difference did not achieve statistical significance (P = 0.84). Women of the TT genotype were associated with a two-fold greater risk of any fracture (adjusted hazard ratio: 2.21; 95%CI 1.42-3.46) and almost fourfold greater risk of hip fracture (3.78; 1.83-7.82) than those with either GG or GT genotype.

Polymorphisms at the Sp1 site in the COLIA1 gene are associated with fracture risk, independent of bone loss.

Parkinson's disease (PD) is the fastest-growing neurological disorder globally. Defining features include tremor, muscular rigidity, bradykinesia, and postural instability, which in combination with nonmotor symptoms such as cognitive impairment and orthostatic hypotension increase the risk of falls. Along with low bone mineral density, fracture risk is high in PD.

The aims were to identify and appraise clinical practice guidelines, consensus statements, and treatment algorithms containing recommendations for bone health in people with PD (PwP).

We systematically searched 4 electroninc databases (MEDLINE, Embase, Emcare, and Web of Science) (n = 78), in addition to the websites of organizations, societies, and professional bodies focused on PD or osteoporosis (n = 28), up to April 22, 2024.

After duplicate removal, screening, and full-text review, 6 records were included. Included records were appraised using the AGREE II (Appraisal of Guidelines for Research and Evaluation) tool. All records recognized bone health as a concern in PD, yet recommendations for fracture-risk screening were inconsistent. Two of six records grouped PD under the broad category of neurological diseases. The acceptability and tolerance of anti-osteoporosis medications in PwP was discussed only in 1 record, which incorporated national osteoporosis guidelines into a PD-specific treatment algorithm.

This review highlights that despite the documented high fracture rates of PwP, health professionals do not always have adequate resources to support them when considering how to manage osteoporosis. Osteoporosis screening and management needs to be incorporated into PD treatment guidelines, and equally providing specific recommendations for PwP related to bone health in national osteoporosis guidelines should be a priority given the high burden of fracture in the patient population.

This study aimed to investigate the risk factors and predictive value of vertebral Hounsfield units (HUs) for vertebral compression fracture (VCF) development in gastric cancer (GC) patients who received adjuvant radiotherapy (RT).

We retrospectively analyzed the data of 271 patients with non-metastatic GC who received adjuvant RT between 2010 and 2020. The vertebral bodies from 9th thoracic (T9) to 2nd lumbar (L2) were contoured in computed tomographies used for RT planning, and V30, V35, V40, mean doses, and HUs of vertebrae were documented. We conducted univariate and multivariate analyses to identify the risk factors for VCF development.

The median follow-up time was 35.7 months. VCF developed in 23 patients (8.5%) in a median of 30.6 months (range, 3.4 to 117.3) after the end of RT. In total, 37 vertebrae were fractured, with 14 located in T12, nine in L1, seven in T11, four in L2, and three in T10. Older age, female sex, non-smoking status, and lower median vertebrae HUs were significantly associated with VCF in the univariate analysis. In the multivariate analysis, lower median HUs of T12 vertebrae (odds ratio, 0.965; 95% confidence interval, 0.942 to 0.989; p = 0.004) remained significant. The optimal cut-off value for T12 HU was 205.1, with an area under the receiver operating characteristic curve of 0.765, sensitivity of 85.7%, and specificity of 65%.

The lower median HU value of T12 vertebrae is a significant and independent risk factor for VCF development in GC patients who received adjuvant RT. HUs values serve as a simple and reliable predictor of VCF development in this population.

Identifying osteoporosis in geriatric populations is essential for fragility fracture prevention. While dual-energy X-ray absorptiometry (DXA) remains the gold standard for diagnosing osteoporosis, its availability and cost for mass screening are limited. This study aims to determine an effective fracture risk assessment tool (FRAX) cut-off value for screening osteoporosis in the Thai geriatric population. The demographic data, FRAX hip fracture (HF), major osteoporotic fracture (MOF), and Bone mineral density (BMD) of community-dwelling Thai adults aged ≥ 60 years, conducted between March 2021 to August 2022 were analyzed. Osteoporosis is defined as a BMD T-score ≤ - 2.5. The accuracy of FRAX in identifying osteoporosis was assessed using the area under the receiver operating characteristic curve (AUC). Among 2991 participants (average age 69.2 ± 6.5 years), the discriminative ability was acceptable for both FRAX hip fracture (HF) (AUC = 0.75) and major osteoporotic fracture (MOF) (AUC = 0.72). A cut-off value of 1.5 for FRAX HF and 4.5 for FRAX MOF demonstrated excellent sensitivity (90.4%) and a high negative predictive value (89.7%) in osteoporosis detection. This study identifies FRAX cut-off values that can effectively screen for high-risk osteoporosis in the Thai geriatric population and suggests that FRAX could be a valuable tool for initial osteoporosis screening in Thai seniors.

A surrogate FRAX® model for Mongolia has been constructed using age- and sex-specific hip fracture rates for mainland China and age- and sex-specific mortality rates from Mongolia.

FRAX models are frequently requested for countries with little or no data on the incidence of hip fracture. In such circumstances, the development of a surrogate FRAX model is recommended based on country-specific mortality data but using fracture data from a country, usually within the region, where fracture rates are considered to be representative of the index country.

This report describes the development and characteristics of a surrogate FRAX model for Mongolia.

The FRAX model used the ethnic-specific incidence of hip fracture in mainland China, combined with the death risk for Mongolia in 2015-2019. Intervention thresholds were developed based on fracture probabilities equivalent to women with a prior fragility fracture, and their impact was assessed in a referral cohort comprising men at age 50 and above and postmenopausal women. The number of hip fractures in 2015 and 2050 was estimated based on United Nations' predicted changes in population demography.

The surrogate model gave similar hip fracture probabilities to estimates from China. Age-dependent intervention thresholds for a major osteoporotic fracture ranged from a 10-year probability of 2.4% at the age of 40 years to 13.7% at the age of 90 years. In the cohort of those eligible for assessment, 46% of men and 36% of women were eligible for treatment because of a prior fracture. Based on intervention thresholds, a further 0.5% of men and 7.0% of women would be eligible for treatment. It was estimated that 440 hip fractures arose in 2015 in individuals aged 50 years and older in Mongolia, with a predicted 4.3-fold increase expected by 2050, when 1896 hip fractures are expected nationally.

The surrogate FRAX model for Mongolia provides an opportunity to determine fracture probability within the Mongolian population and help guide decisions about treatment.

Background & objectives Mineral bone disease commonly occurs in individuals with chronic kidney disease (CKD) and increases fracture risk due to deficiency in bone quality and quantity. The FRAX score attempts to estimate fracture risk better. The primary aim of this study was to evaluate the prediction and correlation of fracture risk with different stages of CKD. Methods This was a correlational study. Data were collected from 95 individuals at different stages of CKD using non-probability consecutive sampling. The clinical and laboratory parameters were compared with the FRAX score in all CKD patients. Results A total of 95 CKD patients with a mean age of 51.42±9.95 yr were selected. Of these, 66.3 per cent between 40-55 yr, 25.3 per cent were 56-70 yr, and 8.4 per cent were ≥70 yr. There were 62 (65.3%) males and 33 (34.7%) females, and more than half (60%) were from rural areas. Age (P<0.001), occupation (P<0.005), and area of residence (P<0.003) showed a significant association with the FRAX score for major osteoporotic fracture risk. The FRAX score for predicting hip fracture risk showed a significant association with factors such as age, occupation, and area of residence, with P values of <0.001, 0.003, and 0.031, respectively. Additionally, the FRAX score for assessing the risk of major osteoporotic fractures demonstrated a significant association with various stages of CKD (P=0.018). Similarly, for hip fracture, there was a significant increase in the risk between stage III and V CKD patients (P=0.038). Interpretation & conclusions Based on the study findings it was found that the FRAX score was significantly associated with different stages of CKD, both for major osteoporotic as well as hip fracture risk.

At present, primary hyperparathyroidism is most often discovered in an asymptomatic patient, but can sometimes be revealed by a renal or bone complications. In all cases, a full work-up is recommended, with assessment of renal function (glomerular filtration rate), 24-hour calciuria, screening for risk factors for lithiasis, and renal and urinary tract imaging (ultrasound or CT scan) to look for stones or nephrocalcinosis. Bone densitometry, with measurements of the spine, femur and radius, is the recommended reference test for demineralization. Standard X-rays of the spine or other imaging techniques are recommended for the detection of asymptomatic vertebral fracture. Neurocognitive manifestations, reduced quality of life or cardiovascular manifestations should not be routinely screened for, as they are not currently consensual criteria for surgical indications.

The aim of this study was to develop and validate a novel computed tomography (CT)-based fracture risk assessment model (FRCT) specifically tailored for patients suffering from chronic obstructive pulmonary disease (COPD).

We conducted a retrospective analysis encompassing a cohort of 284 COPD patients, extracting data on demographics, clinical profiles, pulmonary function tests, and CT-based bone quantification metrics. The Boruta feature selection algorithm was employed to identify key variables for model construction, resulting in a user-friendly nomogram.

Our analysis revealed that 37.32% of the patients suffered fragility fractures post-follow-up. The FRCT model, integrating age, cancellous bone volume, average cancellous bone density, high-density lipoprotein levels, and prior fracture incidence, demonstrated superior predictive accuracy over the conventional fracture risk assessment tool (FRAX), with a C-index of 0.773 in the training group and 0.797 in the validation group. Calibration assessments via the Hosmer-Lemeshow test confirmed the model's excellent fit, and decision curve analysis underscored the FRCT model's substantial positive net benefit.

The FRCT model, leveraging opportunistic CT screening, offers a highly accurate and personalized approach to fracture risk prediction in COPD patients, surpassing the capabilities of existing tools. This model is poised to become an indispensable asset for clinicians in managing osteoporotic fracture risks within the COPD population.

Dialysis patients have high rates of fracture morbidity, but evidence on optimal management strategies for osteoporosis is scarce.

To determine the risk for cardiovascular events and fracture prevention effects with denosumab compared with oral bisphosphonates in dialysis-dependent patients.

An observational study that attempts to emulate a target trial.

A Japanese administrative claims database (April 2014 to October 2022).

Adults aged 50 years or older who have initiated denosumab or oral bisphosphonates for osteoporosis in dialysis-dependent patients.

The safety outcome was major adverse cardiac events (MACE). The effectiveness outcome was a composite of all fractures. Follow-up was 3 years.

A total of 1032 patients were identified (658 denosumab users and 374 oral bisphosphonate users). Overall average age was 74.5 years, and 62.9% were women. The weighted 3-year risk difference for MACE was 8.2% (95% CI, -0.2% to 16.7%), with a weighted 3-year risk ratio of 1.36 (CI, 0.99 to 1.87). The weighted 3-year risk difference for composite fractures was -5.3% (CI, -11.3% to -0.6%), and the weighted 3-year risk ratio was 0.55 (CI, 0.28 to 0.93).

Lack of clinical data on kidney or osteoporosis disease severity and cardiovascular or other metabolic risk with residual confounding. Safety outcomes did not include kidney end points.

It was estimated that, compared with oral bisphosphonates, denosumab lowered the risk for fractures by 45% and increased the risk for MACE by 36%. The estimates, however, are imprecise and need to be confirmed in future studies.

None.

Using the UK Clinical Practice Research Datalink, our cohort study matched 237,297 individuals with hearing loss (HL) to 829,431 without HL. The study found an 8-10% higher risk of major osteoporotic fracture in individuals with HL compared to those without. Additionally, within the HL cohort, we identified risk factors for potential inclusion in fracture risk models.

Assess association between hearing loss (HL) and major osteoporotic fracture (MOF; spine, wrist/forearm, shoulder/proximal humerus, hip) in individuals aged ≥ 60 years, and risk factors for MOF in individuals with HL.

From the UK Clinical Practice Research Datalink, our cohort study matched individuals aged ≥ 60 years diagnosed with HL (READ/ICD-10 codes; 01January2001-31December2021; index event), without secondary osteoporosis causes, with up to five individuals without HL (birth, index year, sex, general practice). Incidence rates and Cox proportional hazard ratios (HL vs. no HL; stratified by low/high fracture risk) were calculated for MOF and hip fracture; multivariate logistic regression assessed risk factors for MOF and hip fracture (HL cohort).

A total of 237,297 individuals with HL matched to 829,431 without HL, with a median age of 74 and 72 years, respectively. Compared with those without HL, individuals with HL had greater frailty (severe electronic frailty index, 5.9% vs. 2.7%), higher incidence of prior falls (14.1% vs. 10.6%), longer mean follow-up with higher incidence of MOF and hip fractures (5.1 vs. 4.4 years, 20.1 and 5.32 vs. 16.58 and 4.54 per 1000 person-years, respectively) and higher risk of MOF and hip fracture (adjusted HR, 1.10 and 1.08, respectively). Significant risk factors for MOF and hip fracture included age ≥ 70 years, fracture history, falls, osteoporosis diagnosis, chronic obstructive pulmonary disorder and cardiovascular disease (HL cohort).

In individuals with HL, we observed an 8-10% higher risk of MOF and hip fracture versus individuals without HL and identified risk factors for potential inclusion in fracture risk models.

Rural communities face healthcare challenges. This study assessed a multicomponent intervention to improve hospital visits and anti-osteoporosis medication (AOM) treatment rates. A total of 567 patients were randomized into three groups. Results showed significant improvements in hospital attendance and AOM treatment in intervention groups compared to usual care group.

Rural communities face limited healthcare access, financial constraints, and transportation barriers leading to health disparities. This study examined interventions that reduced health disparities in increasing the outpatient attendance and treatment rate of anti-osteoporosis medication (AOM), while identifying factors contributing to therapy refusal in rural communities.

A total of 567 patients were randomized at the community level into three groups: multicomponent integrated care (MIC), osteoporosis care only (OC), and usual care (UC). Fracture Risk Assessment Tool and dual-energy X-ray absorptiometry scans were used to evaluate the osteoporosis and osteoporotic fracture risk. High- and moderate-risk patients were advised to pursue further hospital-based assessments and treatment. Both the MIC and OC groups received five interventions to address rural barriers, including specialist access, disease education, overcoming transportation barriers, peer support, and dedicated case managers. However, UC excluded transportation assistance, peer support, and case management. Outcomes measured included outpatient attendance, AOM treatment rates, and factors affecting hospital assessment refusal, analyzed via multivariable logistic modeling.

In the MIC group, 73.3% of patients attended the outpatient clinic and 58.6% received AOM. In the OC group, 81% patients attended and 69.3% received AOM. Conversely, in the UC group, only 4.1% attended and received AOM. Significant differences in attendance and AOM rates were found between the MIC and UC groups and between the OC and UC groups (p < .001 for both). Common barriers included beliefs that treatment was unnecessary and lack of hospital access. Risk factors hindering outpatient attendance include male sex, low education, low budget, multiple disabilities, and osteopenia diagnosis.

Addressing transportation barriers and implementing dedicated case management are crucial for improving healthcare access among rural patients.

ClinicalTrials.gov NCT05104034.

Gaucher disease is a rare lysosomal storage disorder characterized by the accumulation of glucocerebroside lipids within multiple organs due to a deficiency of the lysosomal enzyme (acid β-glucosidase). It is an inherited autosomal recessive disease. The onset of symptoms can vary depending on disease type and severity, with milder forms presenting in adulthood. The main clinical manifestations include cytopenia, splenomegaly, hepatomegaly, and bone lesions. GD is characterized by several bone manifestations, such as osteopenia/osteoporosis, focal lytic or sclerotic lesions, osteonecrosis acute or chronic bone pain, Erlenmeyer flask deformity, and subchondral joint collapse with secondary degenerative arthritis. In 70-100% of patients affected by Gaucher disease type 1, clinical or radiographic evidence of bone disease occurs. Among bone complications, osteoporosis is very common, but its etiopathogenesis in GD is not completely clear. Results deriving from experimental studies support the hypothesis that there is an aberrant activity of both osteoclasts and osteoblasts due to several factors, resulting in impaired bone turnover. Bone complications represent the main cause of pain, disability, and reduced quality of life in these patients. Therefore, there is a need to enhance awareness among physicians on the skeletal manifestations throughout life of GD patients, in order to improve diagnosis and management of bone complications. In particular, this narrative review focuses on risk of bone fragility in GD, etiopathogenetic hypotheses, epidemiological data, diagnosis, monitoring, and treatment of osteoporosis in patients suffering from Gaucher disease, specifying the challenges not yet addressed.

Bone mineral density (BMD) is a major predictor of osteoporotic fractures, and previous studies have reported the effects of mitochondrial dysfunction and lifestyle on BMD, respectively. However, their interaction effects on BMD are still unclear.

We aimed to investigate the possible interaction of mitochondrial DNA (mtDNA) and common lifestyles contributing to osteoporosis.

Our analysis included 119 120 white participants (Nfemale = 65 949 and Nmale = 53 171) from the UK Biobank with heel BMD phenotype data. A generalized linear regression model of PLINK was performed to assess the interaction effects of mtDNA and 5 life environmental factors on heel BMD, including smoking, drinking, physical activity, dietary diversity score, and vitamin D. In addition, we also performed linear regression analysis for total body BMD. Finally, we assessed the potential causal relationships between mtDNA copy number (mtDNA-CN) and life environmental factors using Mendelian randomization (MR) analysis.

Our study identified 4 mtDNA loci showing suggestive evidence of heel BMD, such as m.16356T>C (MT-DLOOP; P = 1.50 × 10-3) in total samples. Multiple candidate mtDNA × lifestyle interactions were also detected for heel BMD, such as MT-ND2 × physical activity (P = 2.88 × 10-3) in total samples and MT-ND1 × smoking (P = 8.54 × 10-4) in males. Notably, MT-CYB was a common candidate mtDNA loci for heel BMD to interact with 5 life environmental factors. Multivariable MR analysis indicated a causal effect of physical activity on heel BMD when mtDNA-CN was considered (P = 1.13 × 10-3).

Our study suggests the candidate interaction between mtDNA and lifestyles on heel BMD, providing novel clues for exploring the pathogenesis of osteoporosis.

To describe diagnostic approaches and management strategies for patients with primary hyperparathyroidism (PHPT) and recent fracture in England.

We developed a survey based on a patient at high fracture risk and a new diagnosis of probable PHPT. The survey was circulated among 50 secondary care professionals identified by the Society for Endocrinology Calcium and Bone special interest group. Descriptive statistics, combinatorial, and thematic analyses were employed.

In the patient with hyperparathyroidism and a recent fracture, 54% of respondents favoured a 24-hour urinary calcium: creatinine clearance ratio, with 85% opting to do so after correcting vitamin D levels. Thirty-two percent (16/50) preferred the spot urinary calcium:creatinine clearance ratio, as a random test (56%, n = 9/16). Ninety-six percent of the respondents agreed they would include a fracture risk assessment in their management plan. Eighty-five percent of the respondents selected dual-energy X-ray absorptiometry scans of the lumbar spine, total hip, and femoral neck as the most popular choice. Before initiating antiosteoporotic medications (AOMs), 94% of the respondents preferred correcting vitamin D levels with diverse regimens. IV zoledronate acid was the preferred AOM, and 58% (n = 29/50) supported cinacalcet usage if the patient was ineligible for parathyroid surgery, while 26% (n = 13/50) opposed cinacalcet use entirely. No significant correlation was found between status as an endocrinology consultant or working in a tertiary care hospital and these management preferences.

This study of National Health Service medical staff identified highly-varied clinical practices in managing PHPT in the setting of high fracture risk, highlighting the need for pragmatic guidelines and wider education.

A lifetime of successive bone remodeling events leads to trabeculae which are composed of a patchwork of bone structural units (BSUs) called hemi-osteons or trabecular packets. Traditionally, only intact surface BSUs have been studied, which are those that have been created most recently. Accordingly, the complex changes in the size and distribution of BSU throughout the trabeculae have been overlooked. In this study, the BSUs within the trabeculae of the second lumbar vertebrae were manually traced, using ImageJ software, in osteopontin immunostained sections of eight young women (aged 19-38 yr) and eight older women (aged 69-96 yr). A series of BSU profile properties including area, width, length, and perimeter were quantified, along with properties of each trabecular profile such as the number of BSU and cement line length. The relationships between these properties and age, as well as selected trabecular microstructural properties assessed with microcomputed tomography, and bone strength assessed on the neighboring third lumbar vertebrae, were investigated. The median BSU profile length and perimeter decreased with age, while the median BSU profile area and width was unchanged. Moreover, age was associated with an increase in the number of BSU profiles and cement line length per trabecular profile area. However, changes in BSU profile geometry, the number of BSU profiles, and the cement line length per trabecular profile were strongly correlated with trabecular bone volume fraction, structure model index, and bone strength. Further research is needed to understand how these changes in BSU properties affect the mechanical and failure properties of trabecular bone.

The prevalence of AAC in patients attending a Fracture Liaison Service is 27.6%. Prevalent vertebral fractures were associated with AAC, but not with severe AAC in patients without CVD. Fracture location and BMD were not related to AAC or severe AAC.

Abdominal aortic calcification (AAC) is associated with an increased risk of cardiovascular disease (CVD), osteoporosis and fractures. We aimed to analyze the prevalence and severity of AAC and to assess whether index fracture location, bone mineral density (BMD) and prevalent VFs are associated with AAC in patients with a recent fracture.

Cross-sectional cohort study of patients with a recent clinical fracture (aged 50-90 years) attending the FLS. Patients received a BMD measurement and lateral spine imaging using Dual-energy X-ray absorptiometry. AAC prevalence was assessed using the AAC-24 score and categorized as none, moderate (AAC-24 1-4) and severe (AAC-24 ≥ 5). Multivariate logistic regression analyses were performed to study the association between risk factors and AAC presence/ severity.

AAC was present in 478 (27.6%) of 1731 patients of whom 207 (43.3%) had moderate and 271 (56.7%) severe AAC. The presence of AAC was associated with age, BMI, smoking, history of CVD and prevalent grade 2 or 3 VFs, but index fracture location and BMD were not associated with AAC or severe AAC. In patients with AAC (n =  318) without a history of CVD, there was no association between index fracture location and BMD. In that subgroup, severe AAC was not associated with prevalent VFs.

In FLS patients, the prevalence of AAC and severe AAC was 27.6% and 15.7%. Index fracture location and BMD were not associated with AAC or severe AAC. Prevalent VFs were associated with AAC, but not with severe AAC in the subgroup of patients without CVD.

FRAX uses clinical risk factors, with or without BMD, to calculate 10-year fracture risk. RA is a risk factor for osteoporotic fracture and a FRAX input variable. FRAX predates the current era of RA treatment. We examined how well FRAX predicts fracture in contemporary RA patients.

Administrative data from patients receiving BMD testing were linked to the Manitoba Population Health Research Data Repository. Observed cumulative 10-year major osteoporotic fracture (MOF) probability was compared with FRAX-predicted 10-year MOF probability with BMD for assessing calibration. MOF risk stratification was assessed using Cox regression.

RA patients (n = 2099, 208 with incident MOF) and non-RA patients (n = 2099, with 165 incident MOF) were identified. For RA patients, FRAX-predicted 10-year risk was 13.2% and observed 10-year MOF risk was 13.2% (95% CI 11.6, 15.1). The slope of the calibration plot was 0.67 (95% CI 0.53, 0.81) in those with RA vs 0.98 (95% CI 0.61, 1.34) in non-RA patients. Risk was overestimated in RA patients with high FRAX scores (>20%), but FRAX was well calibrated in other groups. FRAX stratified risk in those with and without RA [hazard ratio (HR) 1.52 (95% CI 1.25, 1.72) vs 2.00 (95% CI 1.73, 2.31)], with slightly better performance in the latter (P for interaction = 0.004).

FRAX predicts fracture risk in contemporary RA patients but may slightly overestimate risk in those already at high predicted risk. Thus the current FRAX tool continues to be appropriate for fracture risk assessment in RA patients.

Hip fracture (HF) is one of the most prevalent orthopedic conditions among the elderly, with falls being the primary risk factor for HF. With the surge of aged population, China is facing great challenges from HF and falls. However, a comprehensive long-term observation of risk factors affecting HF and falls and their association are little reported at a national level.

The longitudinal cohort was established using the China Health and Retirement Longitudinal Study (CHARLS) data from 2011 to 2018. The incidence density and multi-risk-stratified lifetime risk (up to 90 years of age) of falls and HF were studied at index ages of 50, 60, and 70, as well as the lifetime risk stratified by six regions in China, based on the modified Kaplan-Meier method with Statistical Analysis System (SAS).

This study identified 17 705 subjects aged 50-89. The incidence density of falls was 65.07 and 47.53 per 1000 person-years in women and men, respectively. The incidence density of HF was also higher in women at 5.58 per 1000 person-years than in men at 4.88. By age 50, the lifetime risk of experiencing a HF was 18.58 % for women and 13.72 % for men. Vision and hearing abilities were significantly related to the lifetime risk of both falls and HF. Obesity-related factors presented age-relevant relationships with lifelong risks. Lack of naps, poor lower limb strength, and physical capabilities were indicative of HF risk. The north-western region of China had the lowest lifetime risk of falls but highest risk of HF, while other regions showed a consistent trend between falls and HF.

The aging population worldwide faces a considerable risk of falls and HF. Several risk factors were identified in this study using a Chinese population, relating to disease history, lifestyle habits, health status and physical function, and the risks differed among six regions in China. Future precautionary management programs, as well as patient self-awareness are necessary for improving the prevention of falls and HF to reduce their incidence in the aging population.

With the greatest aged population worldwide, China faces the unparalleled challenge on public health. The study poses the lifetime risk of hip fracture and falls stratified by multiple risk factors in people from 45 to 90 in a national scale, which would shed a light on the early and continuous prevention of such injury.

To explore the hypothesis that knee osteoarthritis patients with osteoporosis represent a sub-cohort with different disease characteristics and origin of symptoms. Men and women in the Osteoarthritis Initiative (OAI) at visit 5 (36 months) were examined for osteoporosis (N = 1483) using DXA (T-score at femoral neck ≤ -2.5), use of bisphosphonates, or having experienced a fracture. Those with and without osteoporosis were compared by subchondral bone quality, bone marrow lesion (BML) properties, and cartilage thickness from MRI, with general linear modeling. Relationships between symptoms (12 months later) and each of cartilage or subchondral bone features were examined conditional on osteoporosis status. Overall, 15.2% of 1246 participants (825 women, 658 men, mean age: 64.4 ± 8.9yrs, BMI: 30.1 ± 4.9 kg/m2) with knee OA likely had osteoporosis and showed lower medial and lateral subchondral bone density, smaller trabecular number and larger trabecular separation (all p < 0.01) compared to those without. Cartilage thickness appeared lower in this group (p = 0.04) but only by a small amount. Knee symptoms correlated with both BML properties and cartilage thickness; the latter but not the former being moderated by osteoporosis status. Those with osteoporosis showed no relationship between cartilage and knee symptoms, but demonstrated bone-related associations with symptoms. Osteoporosis affects the pattern of subchondral bone and cartilage properties in individuals with knee osteoarthritis. Knee symptoms in this subgroup likely originates in bone instead of cartilage. Osteoporosis screening may help identify knee osteoarthritis patients at further risk of subchondral bone damage leading to pain.

New evidence has emerged on pleiotropic properties of Statins (St), that would be potentially beneficial in the treatment of osteoporosis (OP)

Our objective was to study the effect of St on bone mineral density (BMD) in postmenopausal women.

This is a cross-sectional, analytical study, that analyze postmenopausal women with hypercholesterolemia who received treatment with St for at least 6 months, and as a control group (CG), postmenopausal women who did not receive St assisted in two rheumatology services in the city of Córdoba from August 2014 to September 2018.

202 postmenopausal women received St and 203 constituted the CG. The average age, weight and BMI were 62.54 years, 69.60 kg and 27.13 in the St group vs 58.58 years, 65.70 kg and 26.83 in the control group (p= 0.0001, p= 0.01, p=ns respectively). Lumbar, femoral neck and total hip BMD were statistically higher in patients who received St than in controls (-0.87 vs -1.74 p=0.00, - 1.15 vs 1.56 p= 0.00 and - 0.33 vs - 0.75 p= 0.01). Regarding the time of St treatment, a significant difference was found only in relation to BMD and lumbar spine between the groups of 6 to 12 months and those that received between 12 and 36 months. No relationship was found between BMD and the different types of St received.

Treatment with St could improve BMD in hypercholesterolemic postmenopausal women who takes these drugs.