Vertebroplasty or kyphoplasty is a safe and effective procedure to treat persistent pain and correct deformity for early mobilisation in an osteoporotic vertebral compression fracture. However, there is conflicting evidence supporting the unipedicular or bipedicular approach in terms of the outcomes and complications with a recent increase in literature and no meta-analysis in this decade. This review is aimed at providing insight into the comparison between unipedicular and bipedicular approaches for making clinical decisions.

Multiple databases were screened using the keywords: "kyphoplasty", "vertebroplasty", "unipedicular", "bipedicular", "osteoporotic fracture", and "compression fracture", and all the results were reviewed for inclusion of 20 articles and data analysis done to look for significant differences between the two approaches. The quality of the studies included is evaluated using MINORS criteria. This review is registered in the International Prospective Register of Systematic Reviews (PROSPERO) with ID: CRD4202511004028.

We found no significant difference between the two groups in terms of patient-related outcomes (Visual Analogue scale and Oswestry Disability Index), radiological outcomes (kyphotic angle correction or vertebral height restoration), complications (cement leakage or adjacent vertebral fractures), fluoroscopy frequency with significantly less operative time in the unipedicular group.

Vertebroplasty and kyphoplasty, irrespective of unipedicular or bipedicular approach, are effective procedures providing pain relief and adequate functional outcomes with comparable complications, with the unilateral approach taking less operative time. However, in a clinical setting, the approach of kyphoplasty or vertebroplasty should depend on a patient's condition, fracture type and symmetry, along with the levels affected.

This study introduces an ensemble framework that integrates Vision Transformer (ViT) and Convolutional Neural Networks (CNN) models to leverage their complementary strengths, generating visualized and decision-transparent recommendations for dual-energy X-ray absorptiometry (DXA) scans from chest low-dose computed tomography (LDCT).

The framework was developed using data from 321 individuals and validated with an independent test cohort of 186 individuals. It addresses two classification tasks: (1) distinguishing normal from abnormal bone mineral density (BMD) and (2) differentiating osteoporosis from non-osteoporosis. Three field-of-view (FOV) settings-fitFOV (entire vertebra), halfFOV (vertebral body only), and largeFOV (fitFOV + 20 %)-were analyzed to assess their impact on model performance. Model predictions were weighted and combined to enhance classification accuracy, and visualizations were generated to improve decision transparency. DXA scans were recommended for individuals classified as having abnormal BMD or osteoporosis.

The ensemble framework significantly outperformed individual models in both classification tasks (McNemar test, p < 0.001). In the development cohort, it achieved 91.6 % accuracy for task 1 with largeFOV (area under the receiver operating characteristic curve [AUROC]: 0.97) and 86.0 % accuracy for task 2 with fitFOV (AUROC: 0.94). In the test cohort, it demonstrated 86.6 % accuracy for task 1 (AUROC: 0.93) and 76.9 % accuracy for task 2 (AUROC: 0.99). DXA recommendation accuracy was 91.6 % and 87.1 % in the development and test cohorts, respectively, with notably high accuracy for osteoporosis detection (98.7 % and 100 %).

This combined ViT-CNN framework effectively assesses bone status from LDCT images, particularly when utilizing fitFOV and largeFOV settings. By visualizing classification confidence and vertebral abnormalities, the proposed framework enhances decision transparency and supports clinicians in making informed DXA recommendations following opportunistic osteoporosis screening.

Parathyroid hormone (PTH) increases bone mass and decreases fracture risk. However, the anabolic effects of PTH are limited to a period of approximately 24 months, motivating the need to maximize bone growth during this timeframe. Concurrent mechanical loading with weight-bearing exercise is synergistic with PTH treatment. We sought to determine if priming with PTH prior to initiating mechanical loading would enhance their synergistic effects. We pre-treated 10-week-old, female C57Bl/6J mice with either PTH or saline vehicle (VEH) for six weeks. We subsequently initiated cyclic tibial compression for either two or six weeks while continuing PTH or VEH treatment. We analyzed bone morphology in cortical and cancellous compartments of the proximal tibia. To further explore the effects of PTH and loading in cancellous bone, we measured bone cell presence and changes in bone morphology via histology, immunohistochemistry, and dynamic histomorphometry. Concurrent treatment with PTH enhanced load-induced increases in bone mass in cortical bone but blunted the effects of loading in cancellous bone. PTH pre-treatment further increased load-induced changes in cortical bone mass and rescued the load effects in cancellous bone, returning values to those of VEH-treated animals. Osteoclast populations decreased with loading, independent of PTH treatment. Active osteoblast populations increased with PTH pre-treatment but did not change with loading. Bone formation rate increased with PTH pre-treatment in the 2-week group but did not differ between treatment groups after 6-weeks. Collectively, pre-treating with PTH prior to mechanical loading primed the skeletal tissue and enhanced the anabolic response of concurrent treatment and loading.

This study examined the global burden of fractures, low bone mineral density (BMD), and high body mass index (BMI) across various age groups, periods, and cohorts, revealing significant health inequalities and the need for targeted interventions.

To analyze globally long-term trends in fractures, low BMD, and high BMI, and to examine effects of age, cohort, period, and health inequalities.

The estimated annual percentage change (EAPC) in age-standardized rates (ASR) of prevalence, Disability-Adjusted Life Years (DALYs) or Years Lived with Disability (YLDs) were utilized to estimate the trends, and health inequality indices were applied to assess the socioeconomic disparities, in 204 countries or territories from 1990 to 2021. The age-period-cohort model was used to assess the independent effects of age, period, and cohort.

From 1990 to 2021, fracture prevalence and the DALYs attributable to low BMD generally declined (EAPC for fracture prevalence: -0.53%; EAPC for DALYs attributable to low BMD: -0.90%), while the DALYs attributable to high BMI increased (EAPC: 0.66%). The disease burden attributable to fractures, low BMD, and high BMI generally increased with age. Globally, there was a pattern of rising and then declining risk of fractures and low BMD in successively younger birth cohorts, alongside an increasing risk of high BMI. Significant Socio-demographic Index (SDI)-related inequalities in burdens of fractures, low BMD, and high BMI were observed, with inequalities quantified by the slope index of inequality (SII) in 2021 showing values of 267, -53, and -119, respectively.

Global trends in burden of fractures, low BMD, and high BMI varied across different age groups, periods, cohorts, and varied SDI regions.

To examine the association between body mass index (BMI) categories and the fragility fractures in Thai men and to identify the most common anatomical sites of these fractures. We hypothesised that BMI is associated with the risk of fragility fractures in this population.

Retrospective observational study.

A tertiary care centre in eastern Thailand, based on data from Burapha University Hospital.

The study included 419 Thai men aged 40 years or older who underwent bone mineral density (BMD) assessment between 2014 and 2022. Participants were classified according to the presence or absence of documented fragility fractures. Exclusion criteria included pathological fractures, high-energy trauma and incomplete BMI or BMD data.

The primary outcome was the association between BMI categories and the risk of fragility fractures. The secondary outcome was the anatomical distribution of these fractures.

Among 419 participants, 147 (35.1%) had fragility fractures and 272 (64.9%) did not. Underweight men had significantly increased odds of fragility fractures (OR, 3.44; 95% CI, 1.03 to 11.47; p=0.044) and vertebral fractures (OR, 4.30; 95% CI, 1.36 to 13.58; p=0.013), compared with men of normal BMI. In contrast, overweight men had lower odds of overall fractures (OR, 0.50; 95% CI, 0.31 to 0.80; p=0.004) and vertebral fractures (OR, 0.48; 95% CI, 0.27 to 0.84; p=0.010). Among underweight participants, BMI was moderately positively correlated with BMD at the lumbar spine (r=0.607; p=0.028) and at the one-third radius (r=0.557; p=0.084).

Lower BMI was significantly associated with increased risk of fragility fractures, particularly vertebral fractures. These findings support prior evidence in Asian populations and reveal a fracture pattern, predominantly vertebral followed by hip fractures, which differs from those observed in predominantly Caucasian populations.

Hip fractures affect over 10 million people annually worldwide and are expected to increase with an ageing population, contributing significantly to morbidity, mortality, and healthcare costs. Hemiarthroplasty, a common treatment for displaced femoral neck fractures, accounts for more than half of hip fracture surgeries in older adults. However, the optimal surgical approach - anterior, lateral, or posterior - remains uncertain, with decisions often based on surgeon preference or institutional protocols.

To assess the effects of different surgical approaches for hemiarthroplasty in the treatment of hip fractures.

We searched CENTRAL, MEDLINE, Embase, and six other databases in November 2024. We also searched two trials registries, nine different conference proceedings, reference lists of included studies, and systematic reviews published within the last five years.

We included randomised controlled trials (RCTs) and quasi-RCTs in adults with hip fractures comparing different surgical approaches for hemiarthroplasty. We excluded studies of participants with high-energy hip fractures, fractures not associated with osteoporosis, or studies comparing hemiarthroplasty with total hip arthroplasty (THA).

We were interested in a primary core outcome set: activities of daily living (ADL), health-related quality-of-life (HRQoL), mobility or functional status, mortality, and pain. Our secondary outcomes were complications, operative details and postoperative care outcomes.

We used the Cochrane RoB 1 tool to assess risk of bias.

We performed meta-analyses using RevMan with a generic inverse-variance approach and random-effects models to calculate risk ratios (RRs), mean differences (MDs) or standardised mean differences (SMDs) with 95% confidence intervals (CIs). We used GRADE to determine the certainty of evidence.

We included 27 studies (23 RCTs, three quasi-RCTs, and one combined RCT/quasi-RCT) with a total of 3369 participants. The studies were conducted in Europe and Asia and published between 1981 and 2024. All studies but one focused on intracapsular fractures. The 'typical' included participant was a geriatric woman with an osteoporotic hip fracture treated with hip hemiarthroplasty who was ambulatory prior to injury and had a varying level of cognitive impairment at baseline.

All but three studies were at high risk of detection bias and had unclear/high risk of bias in at least one domain. We downgraded many outcomes for imprecision, and for risk of bias where sensitivity analysis indicated the estimate was influenced in size or direction by studies with limitations. Anterior versus posterior approaches (7 studies, 455 participants) There was no evidence of a difference in ADL (MD 0.08, 95% CI -0.55 to 0.71; 1 study, 89 participants), mortality (RR 1.0, 95% CI 0.41 to 2.44; 3 studies, 242 participants), or pain (SMD -0.12, 95% CI -0.42 to 0.18; 2 studies, 171 participants) at three-month follow-up, but evidence was of very low-certainty. We found low-certainty evidence of improved early ability to ambulate independently with anterior approach hemiarthroplasty (RR 1.64, 95% CI 1.15 to 2.34; 2 studies, 161 participants). However, no evidence of a difference in measured functional status was shown at three-month follow-up (SMD 0.06, 95% -0.25 to 0.37; 3 studies, 158 participants). No studies reported on early HRQoL. Anterior versus lateral approaches (6 studies, 641 participants) We found no evidence of a difference in ADL (MD 3.08, 95% CI -14.95 to 21.1; 2 studies, 140 participants), or pain (MD -0.29, 95% CI -0.92 to 0.33; 4 studies, 282 participants) at three-month follow-up, but the evidence is very uncertain. There was low-certainty evidence of improved functional status with anterior approach hemiarthroplasty (MD 1.17, 95% CI 0.03 to 2.30; 2 studies, 142 participants). However, this did not reach a clinically important difference. We found that Trendelenburg gait may be reduced slightly with anterior approach hemiarthroplasty at three-month follow-up (RR 0.13, 95% CI 0.04 to 0.40; 1 study, 94 participants). We are unsure of the effect on early HRQoL as no studies reported the outcome, or for early mortality as no events were reported, resulting in a non-estimable effect size. Lateral versus posterior approaches (11 studies, 1840 participants) There was no evidence of a difference in early ADL (MD 0.05, 95% CI -0.33 to 0.43; 1 study, 297 participants), HRQoL (MD -0.03, 95% CI -0.09 to 0.03; 2 studies, 529 participants), functional status (SMD 0.09, 95% CI -0.36 to 0.55; 5 studies, 494 participants), or pain (SMD -0.07, 95% CI -0.41 to 0.27; 6 studies, 752 participants), but evidence was very low-certainty. We found low-certainty evidence of little to no difference between lateral and posterior approaches in mortality (RR 0.88, 95% CI 0.56 to 1.39; 4 studies, 1417 participants).

For people undergoing hemiarthroplasty for intracapsular hip fracture, the evidence is very uncertain regarding the effect of surgical approach on activities of daily living and pain within four months. There is little to no evidence of a difference in health-related quality of life, functional status, or mortality between approaches. There is currently insufficient evidence to determine whether anterior, lateral, or posterior approaches are a more appropriate option for hemiarthroplasty for hip fracture with respect to these outcomes. Further research is needed to improve the certainty of evidence, requiring better-powered trials, adherence to reporting standards, prospective trial registration, involvement of experienced surgeons, and blinded outcome assessment to reduce bias. Ensuring the inclusion of the core outcome set for hip fractures and follow-up of at least four months in all RCTs remains essential.

This Cochrane review had no dedicated funding.

Registration: Prospero CRD42024498914 Previous version available at: https://doi.org/10.1002/14651858.CD001707.

This study presents an injectable nanocomposite hydrogel composed of hyaluronic acid, gelatin, and amine-functionalized mesoporous bioactive glass nanoparticles (AMBGs) for localized delivery of alendronate (ALN). Enzymatically cross-linked hyaluronic acid/gelatin hydrogels (HG) were prepared following the modification of hyaluronic acid and gelatin with tyramine. Nanocomposite hydrogels (HGB) were fabricated by incorporating varying concentrations of AMBGs into the HG hydrogel. Adding AMBGs significantly influenced the physical and biomechanical properties of the hydrogels. The hydrogel containing 0.5 % AMBGs (HGB-0.5 %) exhibited the highest compressive strength compared to the other formulations. The bioactivity and osteo-conductive properties of HGB-0.5 % hydrogel were confirmed by forming an apatite-like layer on the hydrogel surface after incubation in simulated body fluid and an ion release test. ALN was loaded into the HGB-0.5 % hydrogels with varying concentrations, and the biological activity of the resulting hydrogels was evaluated. All hydrogel groups supported the attachment and growth of the MC3T3-E1 cells cultured on hydrogels. Additionally, adding AMBGs to the hydrogels increased osteoblastic differentiation of MC3T3-E1 cells. Incorporating ALN into HGB-0.5 % hydrogels also decreased the differentiation of RAW 264.7 cells into osteoclasts. These results highlight the potential of ALN-loaded HGB-0.5 % hydrogels with osteo-induction, osteo-conduction, and anti-osteoclastogenesis properties for treating osteoporotic fractures.

Both liver fibrosis and osteoporosis share inflammatory pathways, with liver fibrosis potentially contributing to decreased bone mineral density (BMD). The rising prevalence of non-alcoholic fatty liver disease (NAFLD) and associated liver fibrosis, especially in older populations, may increase the risk of osteoporosis, but evidence remains inconclusive. This study aims to investigate the relationship between liver fibrosis and osteoporosis in individuals over 50 years old.

This cross-sectional study used data from the Bushehr Elderly Health Program (BEHP), a cohort of 2,000 participants aged 50 and older, selected through multistage stratified random sampling. BMD and trabecular bone score (TBS) measurements were assessed. The Fibrosis-4 (FIB-4) index, a surrogate marker for liver fibrosis, was also calculated to examine its association with these bone health indicators. Multiple linear regression was applied to assess the relationship between FIB-4 and lumbar, hip, femoral neck BMD, and TBS scores, while logistic regression was used to evaluate osteoporosis as the dependent variable.

A total of 1,959 participants with adequate data were included in our analysis. 538 participants had osteoporosis, 936 participants had osteopenia, and 485 participants had normal bone density. FIB-4 index was higher in osteoporotic groups (1.45 ± 0.90) than in osteopenic (1.26 ± 0.58, p < 0.001) and normal groups (1.17 ± 0.48, p < 0.001). After controlling for confounders, FIB-4 index was negatively associated with hip BMD (βmen=-0.0162; 95% CI: -0.0313, -0.0012 and βwomen=-0.0221; 95% CI: -0.0340, -0.0102), femoral neck BMD (βmen=-0.0216; 95% CI: -0.0356, -0.0076 and βwomen=-0.0233; 95% CI: -0.0342, 0.0124), and TBS (βmen=-0.0154; 95% CI: -0.0264, -0.0043 and βwomen=-0.0244; 95% CI: -0.0338, -0.0149) in both genders and with lumbar BMD in women (β=-0.0176; 95% CI: -0.0307, -0.0045). An increase in the FIB-4 index was associated with more than a twofold rise in the risk of developing osteoporosis in women (OR = 2.123; 95% CI: 1.503, 3.000; p < 0.001) and a 36% higher risk in men (OR = 1.366; 95% CI: 1.012, 1.844; p = 0.042).

Liver fibrosis is associated with decreased bone density and attenuated bone architecture. Elevated FIB-4 index has been identified as a risk factor for osteoporosis, indicating a potential link between liver fibrosis and deteriorating bone health.

This study aims to investigate incidence rates of acetabular, pelvic, and proximal femur fractures in The Netherlands over a 10-year period (2012-2022). With an aging population, understanding trends in these osteoporotic fractures is essential for improving patient outcomes and guiding healthcare strategies.

A retrospective cohort study was conducted using data from two national databases, forming a 'hospitalised' and an 'all patients' cohort. The study population included patients diagnosed with acetabular, pelvic, and proximal femur fractures in The Netherlands during the study period. Incidence rates were calculated per 100,000 person-years and linear regression was used to assess temporal trends. Age-adjustments were performed using Dutch population data from the Central Bureau of Statistics (CBS). Comparative analyses between the two cohorts were conducted to identify discrepancies.

A total of 283,991 patients were identified (12,020 acetabular, 70,595 pelvic and 201,376 proximal femur fractures). Of these patients, 159,563 were hospitalised (7123 acetabular, 24,192 pelvic, and 128,252 proximal femur fractures). Incidence rates of acetabular fractures increased by 26 % (hospitalised) and 98 % (all patients), while pelvic fractures showed stagnation in hospitalised patients (-0.13 %) but a 44 % rise in all patients. Proximal femur fractures increased by 5 % (hospitalised) and 15 % (all patients). Significant differences between the databases were noted across all fracture types.

The incidence of acetabular, pelvic, and proximal femur fractures has significantly increased in the last decade, most notably in acetabular and pelvic fractures. Furthermore, a shift toward out-patient treatment of acetabular and pelvic fractures was found. These findings highlight the need for improved fracture prevention and out-patient management strategies, while also underscoring the need for a nationwide registration for these injuries.

Bone mineral density (BMD) and height are highly heritable traits for which hundreds of genetic loci have been linked through genome wide association studies (GWAS). FUBP3 is a DNA and RNA binding protein best characterised as a transcriptional regulator of c-Myc, but little is known about its role in vivo. Single nucleotide polymorphisms in FUBP3 at the 9q34.11 locus have been associated with BMD, fracture and height in multiple GWAS, but FUBP3 has no previously established role in the skeleton. We analysed Fubp3-deficient mice to determine the consequence of FUBP3 deficiency in vivo. Mice lacking Fubp3 had reduced survival to adulthood and impaired skeletal growth. Bone mass was decreased, most strikingly in the vertebrae, with altered trabecular micro-architecture. Fubp3 deficient bones were also weak. These data provide the first functional demonstration that Fubp3 is required for normal skeletal growth and development and maintenance of adult bone structure and strength, indicating that FUBP3 contributes to the GWAS association of 9q34.11 with variation in height, BMD and fracture.

Postmenopausal osteoporosis poses a significant clinical challenge, as conventional therapies are often ineffective or poorly tolerated owing to adverse effects or underlying health conditions, underscoring the need for alternative treatments. This study investigated the anti-osteoporotic effects of a novel probiotic mixture combining Limosilactobacillus reuteri MGE 3301 (LR) and Weissella cibaria MGE 3110 (WC), which were selected for their anti-inflammatory properties and ability to modulate bone metabolism, in an ovariectomized rat model. Thirty-five female Wistar rats were randomly assigned to five groups: Sham, Ovariectomy (OVX), OVX with LR supplementation (OVX/LR), OVX with WC (OVX/WC), and OVX with a combination of LR and WC (OVX/LR/WC), under ARRIVE guidelines and ethical approval. Each probiotic group received 1 × 10⁹ CFU/mL/day for 16 weeks starting at 5 weeks post-OVX. Micro-computed tomography and histopathological analyses revealed that the OVX/LR/WC group had superior trabecular bone preservation compared with that in the OVX control group, with significant improvements in bone mineral density (+ 54.2%), bone volume fraction (+ 24.8%), trabecular thickness (+ 13.6%), and trabecular number (+ 20%), along with decreased trabecular separation (- 8.1%; p < 0.05). RT-qPCR analysis of bone marrow demonstrated that LR/WC suppressed osteoclastogenic mediators (RANKL: -1.35-fold; TNF-α: -2.5-fold; IL-6: -1.9-fold) while elevating osteoprotective osteoprotegerin expression (+ 3.14-fold; p < 0.05). Serum analysis showed reduced CTX-I (- 38.9%) and elevated calcium (+ 30.8%) levels in OVX/LR/WC versus OVX rats (p < 0.05), indicating suppressed bone resorption and enhanced mineral homeostasis. These findings indicate that LR/WC probiotic supplementation attenuates OVX-induced bone loss by modulating bone turnover markers and inflammatory cytokines. To our knowledge, this is the first study to assess the combined effects of LR and WC in an osteoporosis animal model, highlighting its potential as an adjunctive therapeutic candidate for osteoporosis. However, few notable imitations include undefined human dosing and the unassessed long-term safety of probiotics. Future clinical trials must validate the efficacy, elucidate mechanisms (e.g., gut-bone axis interactions), and assess safety in postmenopausal women to advance therapeutic applicability.

Diabetic osteoporosis (DOP) can cause abnormal brain neural activity, but its mechanism is still unclear. This study aims to further explore the abnormal functional connectivity between different brain regions based on the team's previous research.

Resting-state functional magnetic resonance imaging (rs-fMRI) data were obtained from 14 participants diagnosed with type 2 diabetes mellitus (T2DM) and osteoporosis. For comparison, data from 13 T2DM patients without osteoporosis were analyzed. The seed regions for functional connectivity (FC) analysis were chosen according to brain areas previously reported to exhibit abnormal regional homogeneity (ReHo).

DOP patients exhibited significantly decreased BMD, T-scores, MoCA scores, and osteocalcin (OC) levels compared to controls (p<0.05). FC analysis revealed: 1) Reduced connectivity between the left middle temporal gyrus (increased ReHo) and middle occipital gyrus; 2) Enhanced connectivity between the right angular gyrus (increased ReHo) and left Rolandic operculum; 3) Weakened the left precuneus (increased ReHo) and right superior/left middle frontal gyri. These alterations correlated with deficits in visual processing, working memory, and executive function.

Distinct FC reorganization in DOP patients reflects synergistic effects of metabolic and skeletal pathologies on neural networks, potentially mediating cognitive decline through visual pathway disruption and prefrontal-default mode network decoupling. The findings highlight neuroimaging biomarkers for metabolic bone disease-related cognitive disorders.

There has been sharp increase in the incidence of hip fractures (HFs) with the increasing aging globally. However, it remains ambiguous regarding the association between HF risk and sleep duration. This study intended to explore the association between sleep duration and HF risk among the older adults.

The study assessed a cohort of 7,540 participants aged at least 60 years old using data from the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2010, as well as from 2013 to 2014. Two distinct groups of HF and non-HF were constructed on the basis of their history of HFs. Based on the self-reported sleep duration through a structured questionnaire, multivariate logistic regression analyses were conducted to examine the relationship between sleep duration and HF risk. In addition, restricted cubic splines (RCS) were used to assess linearity. The receiver operating characteristic (ROC) curve was used to explore the threshold of sleep duration for HF risk.

HFs were found in 129 patients among the 7,540 participants over 60 years of age with mean age of 70.17 ± 7.1 years. Significant differences in sleep duration were observed between the HF and non-HF groups (7.73 ± 1.68 h vs. 7.11 ± 1.42 h; p = 0.006). The multivariate analysis was adjusted for sociodemographic, behavioral lifestyle, and comorbidities. A 1-h increase in sleep duration was associated with higher odds of having prior hip fractures in unadjusted models [odds ratio (OR) = 1.36; 1.11, 1.67; p = 0.004], minimally adjusted models (OR = 1.23; 1.03, 1.48; p = 0.025), second adjusted models (OR = 1.22; 1.02,1.45; p = 0.026) and fully adjusted models (OR = 1.22; 1.03,1.45; p = 0.026). The relationship remained consistent across all four models, indicating the correlation of a longer sleep duration with an elevated HF risk. RCS analysis revealed a statistically linear relationship between sleep duration and HF risk (p-nonlinear = 0.244, p-overall < 0.01). In addition, the identified threshold of sleep duration linked to HF risk was determined to be 7.5 h among the older adults (AUC = 0.611).

This study suggests an linear association between sleep duration and the risk of HFs. Further research is needed to validate these findings and more clearly identify the clinical relevance of this potential relationship.

The primary purpose was to assess the incidence and predictors for mortality in Chinese geriatric patients with perioperative transfusion following intertrochanteric fracture (IF) surgery. A total of 1260 patients who received perioperative transfusion following IF surgery between Jan. 2016 and Dec. 2018 were included. Data was performed to compare the mortality group and the survival group based on subgroup of follow-up time in univariate, and adjusted Cox regression analysis. Perioperative transfusion factors included total, pre-, intra-, and post-operation transfusion volume, and number of transfusions. In our study, the mortality rate was 0.87%, 1.6%, 2.9%, 7.0%, and 13.4% at 30-day, 3-month, 6-month, 1-year, and 2-year follow-up, respectively. Within 6-month follow-up, the adjusted Cox regression analysis revealed that a high American Society of Anesthesiologists (ASA) score, as well as an increase in volume and number of transfusions leading to rapidly increasing morbidity, were identified as risks with mortality. While advanced age and complications played important roles in mortality from 6-month follow-up. In the present study, a high ASA score, as well as the volume and number of transfusions, were identified as risk factors for mortality after IF surgery in Chinese geriatric patients within 6-month follow-up. However, age and severe complications contributed to mortality in 1- and 2-year follow-up.

Osteoporotic vertebral compression fractures (OVCFs) are common in older populations, and cause pain and kyphosis, impacting patient quality of life. This study aimed to determine the optimal timing of percutaneous vertebroplasty (PVP) for the treatment of OVCFs.

This retrospective cohort study included 120 older patients with OVCFs admitted to our hospital between January 2020 and December 2022. Patients were divided into three groups according to the timing of PVP surgery: Group A, within 7 days of the OVCF; Group B, 8-14 days after the OVCF; and Group C, 15-28 days after the OVCF. Preoperative and postoperative visual analog scale scores, the Oswestry Disability Index, vertebral height, Cobb angle, and complications were compared among the three groups.

PVP surgery within 7 days of the OVCF led to rapid pain relief and restoration of vertebral function; preoperative visual analog scale scores and the Oswestry Disability Index were significantly higher in this group compared with the other two groups, but no significant differences among the three groups were observed postoperatively. However, early surgery was also associated with a higher rate of bone cement leakage compared with the other two groups, whereas delayed PVP was associated with a greater incidence of deep vein thrombosis and urinary infections.

The timing of PVP surgery in the management of OVCFs impacts patient outcomes. Early surgical treatment may result in greater pain relief, improved vertebral function, and fewer complications, but patient-specific factors should be considered when determining the optimal surgical timing.

The study's objectives were to assess the sarcopenia prevalence in hip fracture patients admitted to a North African (Egyptian) level one specialized trauma unit and to evaluate factors associated with sarcopenia.

This was an analytic, cross-sectional study where patients who were admitted with low-energy hip fractures and managed surgically were included. Assessment was performed using the SARC-F questionnaire, InBody device assessments (skeletal muscle mass (SMM), Fat mass, nutritional status (total water, protein, and minerals)), handgrip strength, and body mass index (BMI). Sarcopenia was diagnosed based on the revised European Working Group on Sarcopenia in Older People criteria (EWGSOP2).

The patients' mean age was 68 ± 8.3 years; 51.9% were females. The mean SMM was 24 ± 4.5 kg, while the mean handgrip strength was 20.55 ± 7.66 kg, sum SARC-F score was normal in 115 (85.2%) patients and abnormal in 20 (14.8%). Based on the EWGSOP2 criteria, 23 (17%) patients had sarcopenia, and 112 (83%) did not. The two groups were comparable regarding age and sex (p = 0.907 and 0.623, respectively). Sarcopenic patients had significantly lower values in BMI (21.9 vs. 25.9 kg/m2, p < 0.001), SMM (14.8 vs. 23, p < 0.001), BMR (p < 0.001), Fat mass (18.8 vs. 24.3, p = 0.003), and handgrip strength (16 vs. 20 kg, p = 0.034), however the sum SARC-F score ≥ 4 points, was higher in sarcopenic group (30.4% vs. 11.6%, p = 0.046). SMM, BMR, and fat mass showed large effect sizes (≥ 5), while the handgrip strength showed a medium effect size (0.3). There was a significant negative correlation between patients' age and handgrip strength (r = -0.394, p < 0.001), and a significant positive correlation between BMI and the SMM (r = 0.210, p = 0.014). Univariate logistic regression analysis revealed that the patient's BMI, fat mass, total water, protein, minerals, and the sum of SARC-F were significantly associated with sarcopenia development. However, on multivariate logistic regression analysis, two factors kept a significant association: the protein levels as a marker of nutritional reserve (OR = 0.044, 95%CI = 0.008 to 0.235, P < 0.001) and the sum SARC-F ≥ 4 points as a proxy for functional decline (OR = 6.365, 95%CI = 1.272 to 31.854, P = 0.024).

The sarcopenia prevalence in our hip fracture patients was 17%, where BMI, fat mass, and nutritional status had a significant negative association; on the other hand, the sum of SARC-F (≥ 4 points) had a significant positive association. However, after multivariate analysis, only protein levels and the sum of SARC-F remained significantly associated with sarcopenia.

The discriminative accuracy of femoral strength was significantly higher than that of aBMD over 16 years of follow-up for classifying hip fractures and major osteoporotic fractures. The use of accurate thresholds, whether for aBMD or other imaging-based biomarkers, is crucial to improve sensitivity and identify high-risk older adults.

Areal bone mineral density (aBMD) is a surrogate for bone strength but has limited prognostic value. Finite element (FE)-derived femoral strength offers a biomechanical alternative to aBMD for fracture risk assessment, but its long-term predictive value remains unclear. This study compared the discriminatory accuracy of aBMD and femoral strength for hip (HFs) and major osteoporotic fractures (MOFs) over 16 years, accounting for mortality risk.

In the prospective Age Gene/Environment Susceptibility-Reykjavik (AGES-Reykjavik) Study, elderly participants underwent CT scans at entry and automated algorithms were used to compute aBMD and femoral strength. Time-dependent area under the receiver operating characteristic curves (AUC) was used to compare the predictive abilities of aBMD and femoral strength. Optimal cutoffs at the Youden's index were compared with the World Health Organization (WHO)-defined aBMD cutoffs at various time points.

The cohort comprised 4621 older adults (mean age 76 ± 5 years). Femoral strength had a significantly higher AUC than aBMD in identifying HFs (p < 0.05) from the 6th year in males and females, while their AUCs in predicting MOFs were similar. WHO-defined aBMD showed low sensitivity (17-52%) but high specificity (78-94%) for both HFs and MOFs. The sensitivity of optimal femoral strength was significantly higher than that of aBMD at comparable specificity by 5-19% for HFs and 2-10% for MOFs (p < 0.05).

Both image-based markers predict long-term fracture risk and enable opportunistic screening with existing CT scans. However, femoral strength demonstrates better discriminatory accuracy than aBMD. The low sensitivity of the WHO-defined aBMD demonstrates the necessity to revise current risk assessment criteria.

Background and Objectives: Hip fractures are a leading cause of morbidity in the elderly, often resulting in declining physical function, psychological distress, and diminished quality of life (QoL). This study aimed to evaluate changes in QoL among hip fracture patients preoperatively and postoperatively, comparing diverse patient subgroups to identify factors influencing recovery. Methods: We conducted a prospective longitudinal observational study at Victor Babeș University of Medicine and Pharmacy Timișoara, recruiting 77 adult patients admitted for surgical management of hip fractures between March 2023 and March 2025. Standardized questionnaires, including the Short Form-36 (SF-36), World Health Organization Quality of Life (WHOQOL-BREF), Hospital Anxiety and Depression Scale (HADS), and Generalized Anxiety Disorder-7 (GAD-7), were administered preoperatively and at 3 months postoperatively. Demographic, clinical, and surgical variables were also recorded. Results: Participants' mean age was 72.6 years (SD 8.1), with 57.1% female. Postoperative QoL scores (SF-36 Physical Function domain mean 52.7 ± 9.2) improved significantly compared to preoperative scores (44.8 ± 8.7, p = 0.012). WHOQOL-BREF physical and psychological domain scores similarly increased (p < 0.05). Anxiety and depression symptoms, as measured by HADS and GAD-7, decreased markedly postoperatively in most subgroups. Subgroup analyses revealed that patients undergoing total hip arthroplasty demonstrated more pronounced QoL improvements than those receiving partial hip replacement. Older patients (≥80 years) exhibited improvements but at a slower rate. Conclusions: Quality of life indicators show notable improvement following surgical treatment of hip fractures, underscoring the significance of timely orthopedic intervention and comprehensive perioperative care. Anxiety and depression levels also declined, highlighting the benefits of a structured follow-up. These findings may guide clinicians toward optimizing patient-centered recovery protocols and targeted interventions, particularly for older adults or those with high baseline anxiety and depression levels.

Background: This institutional, register-based analysis aimed to evaluate the feasibility of using CT-based sacral Hounsfield units (HUs) for assessing bone density in pelvic fragility fractures and to explore their potential correlation with DEXA measurements and osteological laboratory diagnostics. Methods: Patients aged > 80 years, admitted between 2003 and 2019 with pelvic ring fractures, were analyzed in this retrospective single-center study. CT scans were evaluated according to the classification of fragility fractures of the pelvis (FFPs), which guided treatment decisions (conservative or surgical). The diagnosis of a fragility fracture was based on both fracture morphology and patient history, including the presence of low-energy trauma. Bone health was assessed using standardized laboratory diagnostics including serum calcium, phosphate, alkaline phosphatase, and 25(OH)-vitamin D, in addition to DEXA scans and CT-derived Hounsfield units. Vitamin D levels and bone density evaluations were analyzed to identify possible correlations among these factors and with fracture patterns. Results: A total of 456 patients (mean age 87.3 years, 79.6% female) were included. The CT-based FFP classification identified Type II as the most common fracture type (66.7%). Conservative treatment was the predominant approach (84.9%). Serum 25(OH)-vitamin D deficiency was observed in 62.7% of the patients, while osteopenia and osteoporosis were found in 34.3% and 46.5% of cases, respectively. HU values at S1 showed significant correlation with femoral neck T-scores, highlighting the utility of CT scans for bone density assessment. Conclusions: This study emphasizes the complementary roles of CT-derived HU values and DEXA T-scores in evaluating bone quality and fracture severity in geriatric patients with FFP. While DEXA remains the gold standard, CT imaging offers valuable early insights, supporting the timely initiation of osteoporosis therapy. Given the high prevalence of fragility fractures in this age group, early CT-based screening may facilitate earlier initiation of osteoporosis-specific therapy, including anabolic agents where indicated. Further research is needed to explore the relationships between vitamin D levels, bone density assessments, and fracture types.

Osteoporosis is a globally affecting bone disease characterized by reduced bone mineral density, in which women are more insidious to the disease. It accounts for 8.9 million fractures annually, and about 50% of repeated hip fractures cause permanent disabilities. With the knowledge of determinants and pathology, various FDA-approved drugs and therapies are available for the management of the disease, but the challenges associated with those therapies lead to the adoption of nanotechnology in osteoporosis management. The nanosystems developed for the management of osteoporosis are nanogenerators, nanobubbles, microneedles, nanogels, implantable delivery systems, nanoparticles, nanofibrous scaffolds, and nanocements that probably address the current challenges related to the diagnosis and cure. In view of targeted accumulation of the cargo, various moieties assisted the nanocarrier system for selective distribution to bone, and the development of different types of nanotechnology-based delivery systems has been briefed in this review.

The Dual-energy X-ray absorptiometry (DXA) scan is considered the current gold standard for the estimation of bone mineral density (BMD). Normative BMD data for the generation of T scores is based on data pertaining to young Caucasian white women from the NHANES-III study. However, there have been reports of significant ethnic variations in the normal BMD values, which could under/over-diagnose osteoporosis. The Indian Council of Medical Research (ICMR) has given the normative BMD data for Indians. Our study compares machine-generated T-scores (Tstd) based on Caucasian BMD reference data with calculated T-scores based on ICMR reference data (TICMR).

ETHNICA was a retrospective study involving 1144 individuals who underwent DXA study (Hologic®) at our centre. 835 females and 309 males aged between 18 and 95 were included. A total of 3420 BMD values at bilateral hips and L1-L4 levels of spine were analysed. The age distribution differed from that of the NHANES-III and ICMR reference dataset, which primarily includes younger individuals (20-29 years) as it was done to standardize T score. Gender-specific ICMR BMD and standard deviation (SD) for each site were used to calculate TICMR. This was compared with Hologic-generated Tstd, and the differences were analysed.

The prevalence of osteoporosis was significantly lower using ICMR data compared to NHANES-III data, with a greater reduction seen in males (16.8 to 7.1%) than in females (26.6 to 18%). Similarly, a larger increase in individuals classified with normal BMD was seen in males (59.5 to 76.1%) compared to females (41.2 to 59.6%).

We conclude that if we use NHANES-III BMD reference data, there is a significant overdiagnosis of osteoporosis and osteopenia in India. We recommend the adoption of representative regional reference standards for the diagnosis.

Ankle fractures, ranking as one of the very common osteoporotic fractures, pose a substantial socioeconomic burden. We aimed to investigate the incidence of elderly ankle fractures, refracture risks, and mortality rates in South Korea.

Utilizing the Korean National Health Insurance Service (NHIS) registry from January 2006 to December 2022, individuals over 50 years with ankle fractures were identified. Osteoporotic ankle fractures were defined using admission diagnoses, procedural codes, and cast-related codes. Incidence rates, refracture rates, and one-year mortality rates were analyzed with standardization adjusted for gender and age distribution.

From 2006 to 2022, annual ankle fracture incidence rose from 193.90 to 278.83 per 100,000 person-years. Women exhibited 1.93 times higher incidence than men, with a notable increase in women. Most common in ages 60 to 69, ankle fracture rates increased until 2019 and after 2020 but decreased between 2019 and 2020. The one-year ankle refracture rates and osteoporotic refracture rates increased from 3.55% and 4.56% in 2007 to 9.32% and 10.37% in 2021, respectively. The one-year mortality rate after ankle fractures decreased from 2.10% in 2007 to 1.49% in 2021.

This study offers insights into the epidemiology of osteoporotic ankle fractures in South Korea, revealing increasing incidence, gender differences, age-related patterns, and trends in refracture and mortality rates over the study period. This study examines the incidence, refracture risk, and mortality of osteoporotic ankle fractures in South Korea using a nationwide dataset (2006-2022). The incidence of ankle fractures increased significantly, especially in women, and refracture rates also rose, highlighting an unmet need for better osteoporosis management.

Osteoporosis, a multifaceted metabolic bone disease, is becoming increasingly prevalent and poses a significant burden on global healthcare systems. Given the limitations of traditional treatments such as pharmacotherapy, tissue engineering has emerged as a promising alternative for osteoporosis management. This review begins by exploring the pathogenesis of osteoporosis, with a focus on the abnormal metabolic, cellular, and molecular signalling microenvironments that drive the disease. We also examine commonly used clinical diagnostic techniques, discussing their strengths and limitations. Notably, this review evaluates various advanced tissue engineering strategies for osteoporosis treatment. Delivery systems, including injectable hydrogels and nanomaterials, are detailed alongside bone tissue engineering materials such as bioactive ceramics, bone cements, and polymers. Additionally, biologically active substances, including exosomes and cytokines, and emerging therapies that leverage small-molecule drugs are explored. Through a comprehensive analysis of the advantages and limitations of current biomaterials and therapeutic approaches, this review provides insights into future directions for tissue engineering-based solutions. By synthesizing current advancements, it aims to inspire innovative perspectives for the clinical management of osteoporosis.

Osteoporosis is the most common skeletal disease worldwide, characterized by low bone mineral density, resulting in weaker bones, and an increased risk of fragility fractures. The maintenance of bone mass relies on the precise balance between bone synthesis and resorption. The close relationship between the immune and skeletal systems, called "osteoimmunology", was coined to identify these overlapping "scientific worlds", and its function resides in the evaluation of the mutual effects of the skeletal and immune systems at the molecular and cellular levels, in both physiological and pathological states. Lipids play an essential role in skeletal metabolism and bone health. Indeed, bone marrow and its skeletal components demand a dramatic amount of daily energy to control hematopoietic turnover, acquire and maintain bone mass, and actively being involved in whole-body metabolism. Statins, the main therapeutic agents in lowering plasma cholesterol levels, are able to promote osteoblastogenesis and inhibit osteoclastogenesis. This review is meant to provide an updated overview of the pathophysiology of bone remodelling cycle, focusing on the interplay between bone, immune system and lipids. Novel therapeutic strategies for the management of osteoporosis are also discussed.

Osteoporotic vertebral compression fractures (OVCFs) frequently occur in older adults. Appropriate surgical treatment of these fractures is still not well understood. This study sought to evaluate the therapeutic effectiveness of percutaneous curved kyphoplasty (PCKP) compared to percutaneous kyphoplasty (PKP) for OVCFs.

This study retrospectively analyzed 68 OVCF patients who underwent surgeries from July 2021 to June 2022 in Sheyang County People's Hospital. Patients were categorized into two groups based on surgical procedure (PCKP group = 35 patients, PKP group = 33 patients). Surgery duration, amount of x-ray imaging sessions conducted intraoperatively, bone cement injection dose, and outflow rate were compared between the two groups. Visual analogue scale (VAS), anterior vertebral height (AVH), and Cobb angle were measured at 1 week and 12 months after surgery.

Compared with the PKP group, the amount of intraoperative x-ray imaging sessions (P<0.05) and bone cement outflow rate (P<0.05) were noticeably reduced in the PCKP group. The results identified no variation between groups in cement injection dose (P>0.05). No meaningful statistical variation was found in VAS scores (P>0.05), anterior border height of the injured vertebra (P>0.05), or Cobb angle (P>0.05) between two groups at 1 week and 12 months.

This research suggests both PKP and PCKP are efficient and secure for pain relief, restoring vertebral body height, and correcting the Cobb angle. However, PCKP has advantages in reducing surgery duration, amount of intraoperative x-ray imaging sessions, and bone cement outflow rate. [Orthopedics. 202x;4x(x):xx-xx.].

The purpose of this study is to conduct a meta-analysis to evaluate the diagnostic performance of current radiomics models for diagnosing osteoporosis, as well as to assess the methodology and reporting quality of these radiomics studies.

According to PRISMA guidelines, four databases including MEDLINE, Web of Science, Embase and the Cochrane Library were searched systematically to select relevant studies published before July 18, 2024. The articles that used radiomics models for diagnosing osteoporosis were considered eligible. The Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool and radiomics quality score (RQS) were used to assess the quality of included studies. The pooled diagnostic odds ratio (DOR), sensitivity, specificity, area under the summary receiver operator characteristic curve (AUC) were calculated to estimated diagnostic efficiency of pooled model.

A total of 25 studies were included, of which 24 provided usable data that were utilized for the meta-analysis, including 1553 patients with osteoporosis and 2200 patients without osteoporosis. The mean RQS score of included studies was 11.48 ± 4.92, with an adherence rate of 31.89%. The pooled DOR, sensitivity and specificity for model to diagnose osteoporosis were 81.72 (95% CI: 51.08 - 130.73), 0.90 (95% CI: 0.87-0.93) and 0.90 (95% CI: 0.87-0.93), respectively. The AUC was 0.96, indicating a high diagnostic capability. Subgroup analysis revealed that the use of different imaging modalities to construct radiomics models might be one source of heterogeneity. Radiomics models built using CT images and deep learning algorithms demonstrated higher diagnostic accuracy for osteoporosis.

Radiomics models for the diagnosis of osteoporosis have high diagnostic efficacy. In the future, radiomics models for diagnosing osteoporosis will be an efficient instrument to assist clinical doctors in screening osteoporosis patients. However, relevant guidelines should be followed strictly to improve the quality of radiomics studies.

Osteoporosis, a chronic metabolic bone disease, increases the predisposition to fragility fractures and is associated with considerable morbidity, high health care cost as well as mortality. An elevation in the rate of incident fragility fractures will be observed proportional with the increase in the number of older people worldwide. Severe osteoporosis is currently defined as having a bone density determined by dual-energy X-ray absorptiometry that is more than 2.5 standard deviations (SD) below the young adult mean with one or more past fractures due to osteoporosis. Nutrition, physical activity and adequate vitamin D are essential for optimal bone strength throughout life. Hormone (oestrogen/sex steroid) status is also a major determinant of bone health. This review explores mechanisms involved in bone homeostasis, followed by the assessment and management of severe osteoporosis, including an overview of several treatment options in older people that range from anti-resorptive to anabolic therapies.

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.

To evaluate short-segment fixation (SSF), with or without advanced osteotomy, for treating thoracolumbar kyphosis caused by osteoporotic vertebral compression fractures (OVCFs).

This retrospective analysis included 28 patients with thoracolumbar kyphosis caused by OVCFs who underwent SSF at our hospital between 2017 and 2022. The change in the Cobb angle between standing and supine positions was measured to establish whether an advanced osteotomy was necessary. Bone mineral density (T-score) and related hematologic bone metabolism markers were recorded to assess the patient's osteoporosis status. The Cobb angle and sagittal plane parameters were measured before and after surgery to determine the orthopedic outcomes, and function was assessed using a visual analog scale and the Oswestry Disability Index.

A total of 28 patients successfully underwent SSF with or without advanced osteotomy, with no serious complications. The mean follow-up period was 29 ± 3 months. The Cobb angle decreased significantly, from 45° ± 6° before surgery to 11° ± 3° at the last follow-up (P < 0.05). The visual analog scale scores and Oswestry Disability Index at the last follow-up were significantly improved compared with those before surgery (P < 0.05). Five patients developed low back pain within 6 months of surgery (proximal junctional kyphosis in 4 patients and internal fixation fractures in 1 patient), and 2 of these patients underwent a second surgery. In the long-term follow-up, 2 patients had proximal junctional kyphosis/distal junctional kyphosis after the re-trauma. The 21 remaining patients maintained good internal fixation at the last follow-up, with no broken screws or rods, loosening, or displacement.

SSF, with or without advanced osteotomy, is an effective treatment for thoracolumbar kyphosis caused by OVCFs, achieving good orthopedic outcomes and improving the quality of life of patients. Continuous standardized anti-osteoporosis treatment is essential for long-term recovery.

The prevalence of osteoporosis (OP) on a global scale is significantly elevated that causes life threatening issues. The potential of groundbreaking biomolecular therapeutics in the field of OP is highly encouraging. The administration of biomolecular agents has the potential to mitigate the process of bone demineralization while concurrently augmenting the regenerative capacity of bone tissue, thereby facilitating a personalized therapeutic approach. Biomolecules-based therapies showed promising results in term of bone mass protection and restoration in OP.

We summarized the recent biomolecular therapies with notable progress in clinical, demonstrating the potential to transform illness management. These treatments frequently utilize different biomolecule based strategies. Biomolecular therapeutics has a targeted character, which results in heightened specificity and less off-target effects, ultimately leading to increased patient outcomes. These aspects have the capacity to greatly enhance the management of OP, thus resulting in a major enhancement in the quality of life encountered by individuals affected by this condition.

Fractures of the vertebral column, encompassing various spinal injuries, represent a significant public health burden worldwide. These injuries can lead to long-term disability, reduced quality of life, and substantial healthcare costs.

We utilized comprehensive data sources from the Global Health Data Exchange (GHDx). The study employed the incidence, prevalence, and years lived with disability (YLDs) metric to quantify the burden. First, numbers and age-standardized rates (ASRs) of incidence, prevalence, and YLDs were assessed globally and by sub-types including sex, age, socio-demographic index (SDI) regions, Global Burden of Disease Study (GBD) regions, and countries in 2021. Furthermore, the temporal trend of the disease burden was explored by the linear regression model from 1990 to 2021. The cluster analysis was used to evaluate the changing pattern of related disease burden across GBD regions. Finally, the age-period-cohort (APC) model were used to predict the future disease burden in the next 25 years.

Exposure to fracture of vertebral column contributed to 7,497,446 incidence, 5,371,438 prevalence, and 545,923 YLDs globally in 2021. The disease burden was higher in males than in females. And it was higher in older adults. High SDI regions were high-risk areas. From 1990 to 2021, the number of cases showed the increasing trend, and the ASRs showed the decreasing trend. The predicted results showed that the number of cases for both genders would still increase from 2022 to 2046.

Our findings highlight the substantial and growing global burden of vertebral column fractures, with significant variations across regions and countries. Targeted interventions to address modifiable risk factors, such as osteoporosis and falls, are essential to mitigate the burden.

Background and Objectives: Osteoporosis is a common chronic condition after menopause that increases the risk of fractures. In South Korea, the prevalence of osteoporosis among adults aged 50 and older is 22.4%, with 94.4% of treated patients being women, highlighting its significant impact on postmenopausal health. In this study, we examine the sales trends of osteoporosis medications in Korea from 2018 to 2023 to understand current usage patterns and market dynamics. Materials and Methods: This study is a retrospective analysis based on pre-recorded sales data from Intercontinental Marketing Services (IMS). Data covering a five-year period (2018-2023) were analyzed to examine the sales trends of osteoporosis medications, including bisphosphonates, selective estrogen receptor modulators (SERMs), parathyroid hormone analogs, denosumab, romosozumab, and others. Romosozumab, approved in November 2019, was included in the analysis. Given the nature of this study, no direct patient data or clinical interventions were involved. Results: The total market size for osteoporosis medications in South Korea reached USD 285.42 million in 2023, reflecting a 15.3% increase from 2022. Bisphosphonates, previously the dominant therapy, experienced an 11% decline in market share over five years. Meanwhile, denosumab, a receptor activator of the nuclear factor-κB ligand inhibitor, showed a remarkable growth rate of 957.6% from 2018 to 2023, surpassing bisphosphonates in their market share. Romosozumab, a newly introduced anabolic agent, accounted for 7.4% of the market, with sales increasing by 59% in 2023. Conclusions: This analysis revealed major shifts in treatment preferences, with newer drugs like denosumab and romosozumab gaining prominence over traditional bisphosphonates. These trends highlight the increasing clinical adoption of anabolic agents for high-risk patients and the impact of expanded reimbursement policies on osteoporosis management. Given the increasing use of advanced therapies, it is essential to monitor treatment access, patient adherence, and long-term clinical outcomes. Understanding these sales trends can aid healthcare professionals and policymakers in optimizing osteoporosis treatment strategies and ensuring better patient care.

Osteoarthritis (OA) is a common joint disease that poses a significant public health burden, particularly in older adults. Despite research on its impact, the role of bone mineral density (BMD) in OA prognosis remains underexplored. This study investigates the association between BMD, measured using dual-energy X-ray absorptiometry (DXA), and all-cause mortality in individuals with OA using data from the National Health and Nutrition Examination Survey (NHANES).

This retrospective cohort study utilized NHANES data from 1999 to 2018, including participants aged 20 years and older (n = 55,081). After excluding individuals with missing BMD or mortality data, 1,573 participants diagnosed with OA were analyzed.

The multivariate-adjusted hazard ratio (HR) for BMD and all-cause mortality was 0.344 (0.153, 0.774), indicating a protective effect of higher BMD. We observed an L-shaped relationship between BMD and mortality: a 1-unit decrease in BMD was associated with a 97.3% increased HR for mortality when BMD was below 1.216 g/cm² (HR 0.027, 95% CI 0.010-0.069). No significant association was found for higher BMD levels (HR 4.490, 95% CI 0.431-46.754). In age-stratified analysis, a significant association was found in both those under and over 50 years old.

This study reveals an L-shaped association between BMD and all-cause mortality in individuals aged 20 and older with OA, underscoring the importance of maintaining bone health in this population. These findings highlight BMD as a prognostic marker and suggest that monitoring BMD could improve clinical outcomes for OA patients.

Not applicable.

To evaluate the association between a thoracolumbar fascia injury (TLFI) and the development of residual back pain (RBP) following percutaneous vertebral augmentation (PVA).

Osteoporotic vertebral compression fractures (OVCF) commonly affect elderly individuals and those with osteoporosis, leading to pain and limited mobility. Percutaneous vertebral augmentation provides immediate pain relief and stabilization of the fractures. However, some patients experience residual pain after the treatment. Although recent studies have suggested a potential association, the role of TLFI in RBP remains inconclusive. The aim of this meta-analysis was to evaluate this association.

A thorough search was performed across the PubMed, Medline, Embase, Web of Science, and Cochrane Library databases from inception to 31 December 2024 to identify studies examining the link between TLFI and RBP following PVA. A random-effects model was used to combine the outcome data to account for the potential heterogeneity among the included studies.

This meta-analysis included 13 studies with a total of 4,542 participants and a TLFI incidence rate of 28%. Univariate analysis indicated that patients with a TLFI were significantly more likely to develop RBP compared to those without a TLFI, with an odds ratio (OR) of 4.19 (95% CI: 2.49 to 7.05, I² = 76.9%). The sensitivity analysis identified two studies as significant influential outliers that contributed to the majority of the observed heterogeneity. Excluding these studies resulted in an OR of 4.62 (95% CI: 3.61 to 5.92, I² = 0%). The multivariate analysis confirmed a strong association between TLFI and RBP after adjusting for confounders and other risk factors, with an OR of 4.57 (95% CI: 3.28 to 6.37, I² = 81.5%). The sensitivity analysis identified three studies as significant influential outliers, and excluding them resulted in an OR of 4.79 (95% CI: 3.76 to 6.11, I² = 0%) with no heterogeneity. This finding further confirms the association with a more homogenous overall effect estimate.

The pooled effect size of both univariate and multivariate analyses consistently demonstrated that a TLFI significantly increased the risk of developing RBP after PVA regardless of other related risk factors. Recognizing fascia injury as a potential source of postoperative pain in clinical practice could enhance the care of these patients and mitigate postoperative pain.

Background/Objectives: Proximal femur fractures are common in the older population and are related to bone quality. Our work evaluates bone parameters from pelvic anteroposterior (AP) radiographs in patients with trochanteric and sub-capital fractures to determine if there are predictive morphology parameters for each fracture type. Methods: Data from 237 medical records were extracted from patients who arrived at our hospital with trochanteric and sub-capital femoral fractures. Descriptive data and radiological evaluation of the calcar-to-canal ratio (CCR), cortical thickness index (CTI), and Dorr classification were measured by two observers and statistically evaluated. Results: A total of 202 patients were found to be eligible for the study. The mean patient age was 81.41 ± 7.27 years old. The mean age of the trochanteric group was significantly higher than that of the sub-capital group (p = 0.005). There were no statistically significant differences in gender and comorbidities. The CCR showed significance, but the CTI and Dorr classification did not show a significant difference (p = 0.001, p = 0.78, and p = 0.98). A high degree of reliability was shown for all measurements. The ICC for CTI and CCR was p = 0.791 and p = 0.770 (p < 0.001), and Cronbach's alpha was 0.815 and 0.796, respectively. Logistic regression was found to be significant in predicting 60.4% of correct forecasts with an odds ratio of 0.011 and 95% confidence interval (p = 0.001). For CTI, the correct forecasting rate was 48%, with an odds ratio of 0.615 (p = 0.78). Conclusions: We found that, out of the measured parameters, the CCR stood out as important, showing that higher CCR levels are linked to an increased likelihood of trochanteric fractures.

To develop an artificial intelligence (AI) system capable of classifying and segmenting femoral fractures. To compare its performance against existing state-of-the-art methods.

This Institutional Review Board (IRB)-approved retrospective study did not require informed consent. 10,308 hip x-rays from 2618 patients were retrieved from the hospital PACS. 986 were randomly selected for annotation and randomly split into training, validation, and test sets at the patient level. Two radiologists segmented and classified femoral fractures based on their location (femoral neck, pertrochanteric region, or subtrochanteric region) and grade, using the Evans and Garden scales for neck and pertrochanteric regions, respectively. A YOLOv8 segmentation convolutional neural network (CNN) was trained to generate fracture masks and indicate their class and grade. Classification CNNs were trained in the same dataset for method comparison.

On the test set, YOLOv8 achieved a Dice coefficient of 0.77 (95% CI: 0.56-0.98) for segmenting fractures, an accuracy of 86.2% (95% CI: 80.77-90.55) for classification and grading, and an AUC of 0.981 (95% CI: 0.965-0.997) for fracture detection. These metrics are on par with or exceed those of previously published AI methods, demonstrating the efficacy of our approach.

The high accuracy and AUC values demonstrate the potential of the proposed neural network as a reliable tool in clinical settings. Further, it is the first to provide a precise segmentation of femoral fractures, as indicated by the Dice scores, which may enhance interpretability. A formal evaluation is planned to further assess its clinical applicability.

The proposed system offers high granularity in fracture classification and is the first to segment femoral fractures, ensuring interpretability.

We present the first AI method that segments and grades femoral fractures. The method classifies fractures with fracture location and type. High accuracy and interpretability promise utility in clinical practice.

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.

Recent studies suggest that metabolic factors, such as fasting blood glucose (FBG), may significantly affect bone health, influencing the risk and severity of osteoporotic fractures (OPFs). This study examined the association between FBG levels and bone turnover markers (BTMs) in patients hospitalized for OPFs requiring surgical intervention.

A retrospective cross-sectional analysis was conducted on 888 patients treated for OPFs at Kunshan Hospital affiliated with Jiangsu University from November 2018 to August 2023. Serum levels of FBG, procollagen type 1 N-terminal propeptide (P1NP), and β-C-terminal telopeptide of type I collagen (β-CTX) were measured, with FBG serving as an independent variable, and P1NP and β-CTX as outcome variables. Patients were stratified into tertiles based on FBG levels, and multiple regression models were adjusted for confounding variables, including age, gender, BMI, and clinical parameters. Non-linear relationships and threshold effects were analyzed.

Adjusted regression models identified a negative association between FBG and BTMs. For each 1 mmol/L increase in FBG, β-CTX levels decreased by 0.02 ng/mL (95% CI: -0.04 to -0.01; p < 0.01), and P1NP levels decreased by 2.91 ng/mL (95% CI: -4.38 to -1.45; p < 0.01). Non-linear relationships were observed, with an inflection point at 7.93 mmol/L for both markers. Below this threshold, higher FBG levels were associated with a steeper decline in BTMs.

FBG levels exhibit a negative non-linear association with P1NP and β-CTX in patients with OPFs. Elevated FBG levels may adversely affect BTMs, potentially contributing to the progression of osteoporosis (OP). These findings underscore the importance of glycemic control in managing bone health among patients with OPFs.

This study evaluates the role of ChatGPT in osteoporosis management, demonstrating 91% diagnostic accuracy and significantly faster response times compared to clinicians. The findings highlight the potential for artificial intelligence (AI) to revolutionize clinical decision-making while emphasizing the critical need for professional oversight to ensure patient safety and comprehensive care.

Osteoporosis is a progressive skeletal disease that is characterized by increased bone fragility and an increased risk of fracture. Early diagnosis and effective treatment can significantly reduce healthcare costs; however, limited access to clinical expertise represents a significant challenge to patient care. This study evaluates the diagnostic and treatment recommendations provided by natural language processing (NLP)-based AI models for osteoporosis management and compares them with those of healthcare professionals.

A multicenter, cross-sectional study was conducted with the creation of 100 real scenarios from 206 patients with a diagnosis of osteoporosis. The data pertaining to bone mineral density (BMD) and the clinical parameters were subjected to analysis using ChatGPT-4.0. Thereafter, the recommendations proffered by this software were compared to those of five independent physiatrists. A statistical validation of the model's accuracy was conducted through the use of categorical distribution analysis.

ChatGPT exhibited a high degree of diagnostic accuracy, with 91% of responses being entirely accurate. It provided recommendations for both pharmacological and non-pharmacological interventions that were consistent with current clinical guidelines. Nevertheless, 8% of the responses were reported as incomplete. Furthermore, ChatGPT was able to produce diagnoses and treatment recommendations at a significantly faster rate than clinicians, while the mean answer time is 5.4 ± 2.45 min in clinicians and 2.3 ± 0.76 min in ChatGPT (p < 0.001).

These findings highlight the potential of AI tools like ChatGPT to improve efficiency in clinical decision-making while underscoring the necessity of collaboration with healthcare professionals to guarantee comprehensive patient care.

The intricate relationship between human health and gut microecology has emerged as a central theme in contemporary medical research. Postmenopausal osteoporosis, primarily driven by estrogen deficiency, remains a major health concern. Traditional Chinese herbal medicines have attracted significant interest for their promising role in osteoporosis treatment.

The effects of Isaria felina, derived from Cordyceps sinensis, on postmenopausal osteoporosis in rats are the focus of this study. Adult female Sprague-Dawley rats were categorized into control, postmenopausal osteoporosis (OVX), and Isaria felina-treated (IF+OVX) groups. Following a 12-week treatment period, various analyses, including micro-CT, histological assessments, 16S rDNA sequencing, untargeted metabolomics, flow cytometry, and ELISA, were performed.

Micro-CT and histological assessments indicated significant improvements in bone loss and obesity control in OVX rats treated with Isaria felina. 16S rDNA sequencing revealed that Isaria felina corrected gut microbiota dysbiosis, particularly in the Bacteroides and Ruminococcus genera. Untargeted metabolomics highlighted alterations in nucleotide and lipid metabolism. Flow cytometry and ELISA analyses demonstrated that Isaria felina modulated the Th17/Treg immune balance, resulting in reduced levels of inflammatory cytokines IL-17 and TNF-α.

These findings indicate that Isaria felina mitigates bone loss in postmenopausal osteoporosis through modulation of gut microbiota and immune responses, underscoring its potential as a therapeutic agent for osteoporosis treatment.

Longitudinal data quantifying fracture rates beyond 80 years are lacking. Over 5 years, hospitalised fracture incidences increased by 85% in Māori and 73% in non-Māori octogenarians. However, while fracture-related hospital nights increased by 107% in non-Māori, they remained stable for Māori. Hospitalised fracture risk increases markedly with 5 years of advanced ageing.

Fractures become increasingly common in people beyond 80 years, the most serious resulting in hospitalisation. This study examines longitudinal changes in hospitalised fractures in octogenarians.

Hospital discharge records from a cohort study of Māori aged 80-90 years and non-Māori turning 85 years (LiLACS NZ) were used to determine the incidence of hospitalised fractures for 5 years before and 5 years after enrolment.

Records were available for 378 Māori (aged 82.6 ± 2.8 years; mean ± SD) and 498 non-Māori (84.6 ± 0.5 years). In the 5 years prior to enrolment, 22 (5.8%) Māori and 43 (8.6%) non-Māori were hospitalised at least once for fracture, and 29 (7.7%) Māori and 62 (12.4%) non-Māori sustained hospitalised fractures in the 5 years following enrolment. Hospitalised fracture incidences were 1270/100,000 person-years in Māori and 2048/100,000 person-years in non-Māori before enrolment, increasing to 2345 (P = 0.02) and 3541 (P = 0.002) /100,000 person-years in the subsequent 5 years, respectively. Pelvis/femoral fractures accounted for almost half (47%) of fractures. Fracture-related hospital nights increased 107% in non-Māori (P < 0.0001), but remained stable for Māori, from before to after enrolment. Following enrolment, 21% of hospital nights spent by non-Māori women were fracture-related.

In octogenarians, hospitalised fracture risk increased markedly with 5 years of ageing, almost doubling fracture-related hospitalisation time in non-Māori but having little effect on time spent in hospital for Māori. Projections of fracture burden in advanced age need to consider rapidly changing risk with small increases in age and differences between demographic groups.