Accurately evaluating bone mineral density (BMD) in patients with unilateral hip osteoarthritis (OA) is crucial for diagnosing osteoporosis and selecting implants for hip arthroplasty. Our goal was to measure the BMD differences between sides, examine contributing factors, and identify the optimal side for BMD assessment in these patients.

We analyzed 108 women with unilateral hip OA. Bilateral hip BMD was assessed automatically through quantitative CT (QCT) utilizing a validated, deep-learning-based approach. We evaluated BMD variations between the OA and healthy hips across total, neck, and distal regions. To determine their contributions, we analyzed factors, including patient demographics, Crowe classification, Bombelli classification, knee OA status, hip functional score, and gluteal muscle volume and density. Furthermore, we examined how side-to-side BMD differences influenced osteoporosis diagnosis using T-scores based on QCT.

The average BMD on the OA side was 6.9 % lower in the total region, 14.5 % higher in the neck region, and 9.4 % lower in the distal region than on the healthy side. Contributing factors to the reduced BMD in the OA hip included younger age, Bombelli classification (atrophic type), and significant gluteal muscle atrophy. Diagnoses from the OA side revealed lower sensitivity (61 %) than those from the healthy side (88 %).

Analysis on one side alone yields a more precise osteoporosis diagnosis from the healthy side. Nonetheless, bilateral BMD assessment remains crucial, particularly in younger individuals and those with atrophic OA types. Although based on QCT, our findings support bilateral analysis by dual-energy X-ray absorptiometry for these patients.

The focus of this study was to assess the diagnostic effectiveness of 99mTc-MDP single-photon emission computed tomography/computed tomography (SPECT/CT) in pinpointing medication-related osteonecrosis of the jaw (MRONJ).

We gathered a total of 39 patients who were suspected of having MRONJ and displayed radionuclide concentration in the jaws on whole-body bone scans. These patients were subjected to simultaneous SPECT/CT fusion imaging of the jaws during delayed imaging. A consistent team of nuclear medicine physicians and oral and maxillofacial surgeons carried out diagnostic evaluations using SPECT/CT image analysis and dental specialist examinations, and the diagnoses were documented.

Based on the SPECT/CT image analysis and dental specialist examination outcomes, we calculated the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of 99mTc-MDP SPECT/CT in diagnosing suspected MRONJ. Further, we enumerated the number and proportion of patients at each stage.

Our findings suggest that 99mTc-MDP SPECT/CT demonstrates high diagnostic precision in patients suspected of MRONJ who display radionuclide concentration in the jaw on whole-body bone scans. Moreover, it proves beneficial in identifying the early stages of MRONJ.

The aim of this study was to compare the radiological outcome of patients with distal radius fractures stabilized with a volar plate using either locking screws or pegs.

For this retrospective study all adult patients that received volar plating of a distal radius fracture at a trauma center between 06/2019 and 06/2022 were eligible for inclusion. Only patients who received an implant allowing both locking pegs and screws were included. Primary outcome was radiological loss of reduction at the 6-week and at the 12-month follow-up. Secondary outcomes were duration of surgery, implant removal, fracture union and complications.

Fourty-nine patients treated with pegs and 39 with screws were included. Patient demographics were comparable, however there were more complex fractures in the peg group. There was no significant difference in the occurrence of radiological loss of reduction between the groups at 6 weeks or 12 months (p = 1). Patients treated with pegs were more frequently operated upon by experienced surgeons while screws were more often used by more junior staff. The duration of surgery was longer for patients who received screws (p = 0.003). Union was achieved in all fractures for which a 12-month x-ray was available. There was no significant difference in implant removal rate or other complications.

Regarding secondary loss of reduction both locking pegs and screws show similar results. Considering the potential benefits of pegs, such as the smooth surface which may reduce the risk of joint penetration, pegs are a viable alternative to screws.

Erythropoietic protoporphyria (EPP) is a rare inherited metabolic disease, causing lifelong painful phototoxic reactions, minimal sunlight exposure, and vitamin D deficiency. Previous studies reported a high osteoporosis prevalence in EPP patients.

To identify those at risk for low bone mineral density (BMD) and assess which factors, including treatment with cholecalciferol and afamelanotide, improve BMD in EPP.

A longitudinal ambispective single-center cohort study. Data from patient files and two-time questionnaires from adult patients with EPP who underwent at least one dual-energy x-ray absorptiometry (DXA) scan between 2012 and 2023 were used.

BMD is low in EPP patients, with 82.7% of the 139 patients having a Z-score below 0 SD at baseline. Low BMD classified as osteopenia was found in 39.5%, and osteoporosis in 15.3%. There were 50 osteoporosis-related fractures in 34.2% of patients. Aging (odds ratio [OR] 1.08; CI, 1.03-1.12), persistent vitamin D deficiency (OR 1.11; 95% CI, 1.00-1.23) and a low body mass index (OR 0.91; 95% CI, 0.82-0.99) increased the odds of low BMD. Patients with a vitamin D deficiency (OR 5.51; 95% CI, 1.69-17.92) and no cholecalciferol at baseline (OR 0.22; 95% CI, 0.04-1.34) had the highest odds of improving their BMD. Afamelanotide did not improve BMD.

25-hydroxyvitamin D (25(OH)D) status plays a crucial role in both preventing low BMD and improving BMD. EPP is a natural model for lack of sunlight exposure and vitamin D deficiency, underlining the importance of lifelong adequate vitamin D status for bone health in the general population.

Endocrinopathies are frequently the initial presentation of histiocytic neoplasms, which are rare hematologic disorders affecting multiple organ systems. Langerhans cell histiocytosis and Erdheim-Chester disease are 2 such disorders known to infiltrate the hypothalamus and/or pituitary gland, leading to arginine vasopressin deficiency (AVP-D) and anterior pituitary dysfunction (APD) in 20% to 30% of cases, often as the first manifestation. Conversely, histiocytic disorders account for a notable proportion (10-15%) of all pituitary stalk lesions. The diagnosis of histiocytoses is often delayed in such cases due to the nonspecific presentation of endocrinopathies and pituitary involvement. Consequently, endocrinologists are at the frontline and uniquely positioned to achieve early diagnosis by recognizing the varied nonendocrine features of these disorders. This article provides an overview of the endocrine manifestations of histiocytic disorders and presents a simplified algorithm to guide the diagnostic workup in cases presenting with "idiopathic" AVP-D or APD. Such cases should be evaluated for histiocytic neoplasms with additional imaging studies and biopsies of suspected disease sites. If no disease site beyond the pituitary is identified, the risks and benefits of a pituitary stalk lesion biopsy must be carefully considered. While treatments of histiocytic neoplasms are highly efficacious, endocrinopathies are considered permanent and require long-term hormone replacement. It remains unclear whether early diagnosis and novel targeted therapies can reverse these endocrine disorders. Therefore, the role of the endocrinologist role is critical in the diagnosis and management of these rare diseases.

Bone marrow edema syndrome (BMES), transient osteoporosis of the hip (TOH), and regional migratory osteoporosis (RMO), along with numerous variants of these terms, are used inconsistently to describe spontaneous pain, typically in the lower extremity, accompanied by bone marrow edema on MRI and/or bone demineralization. In the present review, we aimed to determine whether these designations represent distinct conditions or varying manifestations of a shared pathology. We employed a scoping review methodology, following a preregistered protocol, utilizing a comprehensive systematic search of electronic databases. Eligible publications reported on patients designated with BMES, TOH, RMO, or related terms. A total of 2924 patients, across 561 studies, were included. Data extraction focused on demographics, clinical features and imaging results. Descriptive statistics and meta-analytic methods were used to synthesize the data. Our results show that patients described by terms related to bone marrow edema syndrome, or transient or migratory osteoporosis, displayed similar demographic and clinical profiles. Our findings strongly suggest that these various designations refer to the same clinical entity. Bone marrow edema syndrome appears to be the most suitable term to describe this condition, facilitating a more standardized approach to future diagnosis, management and research.

Metabolic Score for Visceral Fat (METS-VF) is commonly used as an indicator for assessing visceral fat metabolism. However, the relationship between METS-VF, Bone Mineral Density (BMD), and osteoporosis remains unclear in the American population.

This study utilized cross-sectional data from the National Health and Nutrition Examination Survey (NHANES), including participants aged 20 years and older, from the survey cycles conducted between 2005 and 2010, 2013-2014, and 2017-2018. Multivariable weighted linear regression and logistic regression analyses were first applied to investigate the associations between the METS-VF, femoral BMD, and osteoporosis. In addition, subgroup interaction analyses were performed to evaluate the robustness of these associations. To address potential non-linear relationships, restricted cubic spline regression was employed. All statistical analyses were conducted using R software version 4.3.3. P values were two-tailed, with P < 0.05 considered statistically significant.

After adjusting for all covariates, the positive correlations between METS-VF and BMD measurements at all sites remained statistically significant (p < 0.001 & p for trend < 0.001). Multivariable logistic regression analysis indicated that, after adjusting for covariates related to osteoporosis, each one-unit increase in METS-VF was associated with a 63.1% reduction in the risk of developing osteoporosis. Moreover, the direction of the associations between METS-VF and both BMD and osteoporosis remained consistent across all subgroups, while restricted cubic spline (RCS) analyses suggested nonlinear relationships. The 5.82-7.35 METS-VF range yielded a mean 51.9% osteoporosis risk reduction (sustained ≥ 30% peak efficacy in 66.7% of participants).

METS-VF demonstrated a nonlinear positive association with BMD and a nonlinear inverse relationship with osteoporosis risk. Future studies should establish optimal biological thresholds of METS-VF for skeletal health.

Not applicable.

Osteoporosis screening should be systematic in the group of over 50-year-old females with a radius fracture. We tested a phantom combined with machine learning model and studied osteoporosis-related variables. This machine learning model for screening osteoporosis using plain radiographs requires further investigation in larger cohorts to assess its potential as a replacement for DXA measurements in settings where DXA is not available.

The main purpose of this study was to improve osteoporosis screening, especially in post-menopausal patients with fragility wrist fractures. The secondary objective was to increase understanding of the connection between osteoporosis and aging, as well as other risk factors.

We collected data on 83 females > 50 years old with a distal radius fracture treated at Oulu University Hospital in 2019-2020. The data included basic patient information, WHO FRAX tool, blood tests, X-ray imaging of the fractured wrist, and DXA scanning of the non-fractured forearm, both hips, and the lumbar spine. Machine learning was used in combination with a custom phantom.

Eighty-five percent of the study population had osteopenia or osteoporosis. Only 28.4% of patients had increased bone resorption activity measured by ICTP values. Total radius BMD correlated with other osteoporosis-related variables (age r =  - 0.494, BMI r = 0.273, FRAX osteoporotic fracture risk r =  - 0.419, FRAX hip fracture risk r =  - 0.433, hip BMD r = 0.435, and lumbar spine BMD r = 0.645), but the ultra distal (UD) radius BMD did not. Our custom phantom combined with a machine learning model showed potential for screening osteoporosis, with the class-wise accuracies for "Osteoporotic vs. osteopenic & normal bone" of 76% and 75%, respectively.

We suggest osteoporosis screening for all females over 50 years old with wrist fractures. We found that the total radius BMD correlates with the central BMD. Due to the limited sample size in the phantom and machine learning parts of the study, further research is needed to make a clinically useful tool for screening osteoporosis.

To evaluate the effectiveness of Jintiange capsules (JTG) in relieving pain in patients with primary osteoporosis (POP).

A systematic review of the literature was conducted through seven databases, including PubMed, Web of Science, Cochrane Library, Embase, Chinese National Knowledge Infrastructure, Wanfang Database and SinoMed, from inception to October 2023. The control group was given conventional anti-osteoporosis drug therapy such as Alfacalcidol soft capsules, Alendronate sodium tablets, Caltrate D3, etc. The experimental group was treated with JTG alone or in combination with JTG on the basis of the drugs used in the control group. The primary outcome measure was the visual analog scale (VAS). Stata SE-64 software was used to conduct meta-analyses of the final included studies.

A total of 2916 participants were included in 21 articles. The results of meta-analysis showed that JTG relieved pain (WMD: -2.51; 95% CI: -3.30, -1.71; p < 0.05), improved the bone mineral density (BMD) of femoral neck (WMD: 0.83; 95% CI: 0.33, 1.33; p < 0.05) and lumbar (WMD: 1.14; 95% CI: 0.67, 1.62; p < 0.05), improved oswestry disability index (ODI) (WMD: -1.79; 95% CI: -3.05, -0.54; p < 0.05), enhanced timed up and go test (TUG) (WMD: -2.61; 95% CI: -4.60, -0.62; p < 0.05) and decreased fracture incidence (WMD: 0.37; 95% CI: 0.15, 0.93; p < 0.05).

In terms of relieving pain, improving BMD, improving activity function, and improving gait and preventing fracture, JTG is a good choice for patients with osteoporosis (OP).

To systematically evaluate the efficacy and safety of acupuncture as an adjuvant therapy for osteoporosis (OP) through a comprehensive synthesis of recent randomized controlled trial (RCT) evidence.

A systematic literature search was conducted across PubMed, Web of Science, CNKI, and Wanfang databases (2014 - 2024) to identify RCTs investigating acupuncture combined with conventional therapy for OP. Study quality was appraised using the Cochrane Risk of Bias tool, and meta-analyses were performed using RevMan 5.4 and Stata 15.0, with subgroup analyses stratified by intervention type, population characteristics, and treatment duration.

28 RCTs (n=2,758) were included. Meta-analysis revealed acupuncture significantly enhanced bone mineral density (BMD) versus controls: total (SMD = 0.47, p = 0.03), femoral neck (MD = 0.05, p = 0.01), lumbar spine (SMD = 0.40, p < 0.001), Ward's triangle (MD = 0.07, p = 0.02), and hip (SMD = 0.55, p < 0.001), with particularly marked improvements in the postmenopausal osteoporosis subgroup. Acupuncture demonstrated significant improvements in treatment efficacy, biochemical markers, pain scores, and symptom assessments, while reducing adverse events. Warm needle moxibustion outperformed controls in femoral neck (MD = 0.07, p = 0.002) and hip BMD (SMD = 0.87, p < 0.001), while electroacupuncture significantly elevated serum calcium (MD = 0.18, p = 0.02). Short-term interventions (≤ 3 months) demonstrated optimal efficacy.

Acupuncture demonstrates efficacy and safety as an OP adjuvant therapy. Current evidence is limited by regional bias and methodological heterogeneity. Multicenter, large-sample RCTs are needed to standardize protocols and validate long-term therapeutic efficacy.

https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024499354.

Dietary calcium supplements can prevent osteoporosis, and our previous investigation demonstrated a notable increase in duodenal calcium absorption due to the impact of estrogen. The decrease of estrogen level in postmenopausal women is significantly associated with an increased incidence of osteoporosis. In this study, we further investigated the role of estrogen regulating duodenal calcium absorption in osteoporosis and elucidated its underlying molecular mechanism. We recruited ten young women in the prefollicular stage and ten menopausal women for the study. Furthermore, we performed trials on mice, as well as human duodenal epithelial cells and SCBN cells. The measurement of calcium absorption in the duodenum of mice was conducted through single-pass perfusion in vivo. We used a calcium imaging system to evaluate calcium absorption in SCBN cells. The bone mineral density was measured using small animal computed tomography and a bone densitometer. Furthermore, The expression levels of calcium transport proteins, namely plasma membrane calcium pump (PMCA1b) and transient receptor potential cation channel (TRPV6), were evaluated using western blot analysis. Compared to young women, postmenopausal women exhibited significant reductions in estrogen levels, bone mineral density, and the expression of PMCA1b and TRPV6 in duodenal mucosal tissues (P < 0.05). A positive correlation was also observed between estrogen levels, the expression of PMCA1b and TRPV6, and bone mineral density (P < 0.05). The estrogen levels, the expression of PMCA1b and TRPV6 in the duodenal mucosa, calcium absorptions, and bone mineral density were observed to be decreased in ovariectomized mice based on in vivo animal experiments (P < 0.05). However, estrogen upplementation can enhance duodenal calcium absorptions and ameliorate osteoporosis in ovariectomized mice, with its primary mechanism of action being the regulation of PMCA1b expression and function (P < 0.05). The findings from SCBN cells further confirm that estrogen enhances duodenal calcium absorption through the effect of ERβ on PMCA1b. Estrogen enhances the expression and functionality of PMCA1b in duodenal mucosal cells via ERβ, promoting duodenal calcium absorption and ameliorating postmenopausal osteoporosis.

Hip fractures in elderly women pose significant healthcare challenges. Promoting walking for exercise as a cost-effective intervention may help reduce the risk of fractures in this population.

This study aimed to examine the relationship between walking and hip fracture risk among women aged 65 years and older.

A 20-year prospective study (1986-2006) included 9704 women from the Study of Osteoporotic Fractures (SOF) in the USA. Participants were followed biennially, and walking exposure was assessed by the number of city blocks walked for exercise, routine activity, and total blocks walked daily. Cox regression models with time-varying covariates assessed associations, with competing risks addressed using Fine and Gray models. Penalized splines were used to explore dose-response relationships.

In total, 1419 hip fractures were identified through the study period. The mean and median follow-up times for hip fractures or censoring were 15.0 and 15.8 years in the walking for exercise group, vs. 13.2 and 13.7 years in the not walking for exercise group. The hip fracture incidence rate was 10.0 cases per 1000 person-years (py) in the walking for exercise group compared to 10.9 per 1000 py in the not walking for exercise group. All-cause mortality was 37.1 per 1000 py in the walking for exercise group compared to 46.4 per 1000 py in the not walking for exercise group. Adjusted models showed that walking for exercise significantly reduced hip fracture risk (HR, 0.864; 95% CI, 0.762-0.980; P = 0.0230), with each additional block walked for exercise reducing risk (HR per block, 0.986; 95% CI, 0.978-0.995; P = 0.0022). Walking for routine activities showed no significant association. Spline analysis indicated walking 16 blocks (≈3200 steps) daily significantly lowered hip fracture risk.

Walking for exercise is linked to a reduced risk of hip fractures in elderly women. Walking the equivalent of 16 blocks or more (> 3200 steps) per day might be an effective way to reduce the risk of hip fractures in this vulnerable population.

This cross-sectional study investigated the association between appendicular skeletal muscle mass-to-visceral fat area ratio (SVR), bone mineral density (BMD), and osteoporosis in U.S. adults using NHANES data.

Data from the 2013-2014 and 2017-2018 NHANES cycles were analyzed. Multivariable regression models assessed associations between SVR, BMD, and osteoporosis, adjusting for demographic, lifestyle, metabolic, and comorbidity variables. Generalized Additive Models with smooth curve fitting and likelihood ratio tests evaluated model fit. Subgroup analyses explored effect modifications.

The study included 2325 individuals with a mean age of 50.66 ± 5.55 years. In fully adjusted models, the highest SVR tertile was associated with a 0.05 g/cm2 higher BMD (β = 0.05, 95 % CI: 0.03-0.08, P = 0.002) and 57 % lower odds of osteoporosis (OR = 0.43, 95 % CI: 0.24-0.78, P = 0.028) than the lowest tertile. As a continuous variable, SVR remained significantly associated with BMD (β = 0.03, 95 % CI: 0.02-0.04, P = 0.002) and osteoporosis (OR = 0.67, 95 % CI: 0.50-0.91, P = 0.033). Stronger associations were found in individuals with diabetes (β = 0.09, 95 % CI: 0.06-0.12, P < 0.01) and BMI ≥ 30 (β = 0.07, 95 % CI: 0.05-0.09, P < 0.01).

Higher SVR was significantly associated with increased BMD and lower odds of osteoporosis, suggesting its potential as a marker for bone health assessment. However, the cross-sectional design limits causal inference. Further longitudinal and mechanistic studies are warranted to confirm these findings and explore clinical applicability.

Our aim was to determine serum C-terminal telopeptide of type I collagen (sCTX) thresholds for predicting the minimal risk of medication-related osteonecrosis of the jaw (MRONJ) in patients undergoing anti-resorptive therapy prior to oral surgery.

A systematic literature search was conducted in MEDLINE, EMBase, and the Cochrane Library up to September 2023 for case-control, prospective and retrospective studies that assessed sCTX levels in patients exposed to anti-resorptive drugs who underwent oral surgery. We extracted data using a predetermined form. We performed an original percentile meta-analysis method, following PRISMA-DTA guidelines and descriptive analysis to identify the threshold associated with the lowest risk while assessing the overall result of the 95th, 97.5th and 99th percentiles with a random-effect model with weighting by DerSimonian and Laird (RStudio software [v. 4.2.0]).

Seven studies involving 1281 patients were included. Most patients (96%) were treated for osteoporosis, predominantly with oral bisphosphonates (94.5%). Individual data were available for 58 patients. In the entire population of patients who experienced MRONJ after oral surgery (n = 113), the 95th, 97.5th and 99th percentiles of sCTX were 338.0 pg/mL [95%CI: 190,3; 485,7], 401.9 pg/mL [95%CI: 191,3; 612,6], and 458.0 pg/mL [95%CI: 190,4; 725,6], respectively. Among those treated with oral bisphosphonates for osteoporosis (n = 38), the sCTX 95th, 97.5th and 99th percentiles were 185.3 pg/mL [95%CI: 131,3; 239,3] 187.4 pg/mL [95%CI: 133,9; 240,8] and 188.6 pg/mL [95%CI: 135,4; 241,9], respectively. The determination of these same percentiles with individual data analysis yielded similar results, i.e., 202.0, 257.0 and 260.0 pg/mL.

This pioneering meta-analysis assesses the risk of MRONJ by analyzing sCTX levels in patients undergoing oral surgery while exposed to antiresorptive drugs. Among patients receiving oral bisphosphonate therapy for osteoporosis, a sCTX threshold of 260 pg/mL is linked to an extremely low risk of MRONJ occurrence, surpassing the 99th percentile. Conversely, for patients undergoing treatment for cancer-related conditions, sCTX levels do not reliably serve as a biomarker for identifying this risk.

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

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

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

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

Bone regeneration processes are associated with a systemic skeletal change in bone quality, increasing the risk of fragility fractures. This condition may be aggravated in osteoporotic patients due to their limited osteogenic capacity. This work evaluates the impairment of the bone quality in osteoporotic sheep during a bone regeneration process. It provides a deeper understanding about the complex multiscale dynamics of bone mineral density, microstructure and chemical composition across different bone tissues, locations and time points.

Osteoporosis was induced in fifteen Merino sheep. A critical-size defect was then created in the sheep's right hind metatarsus and subsequently regenerated using distraction osteogenesis. The animals were randomly sacrificed during bone regeneration, either on days 40 or 100 after surgery. Computed tomography, micro-computed tomography and chemical composition analyses were conducted on different bone tissues (cortical, trabecular and woven) at several skeletal locations (the operated metatarsus, the contralateral one and the iliac crest) to assess the individual bone quality changes relative to the non-osteoporotic time point.

After osteoporosis induction, the trabecular tissue experienced a 6.4% reduction in the bone mineral density, while no significant changes were reported in cortical tissue quality. During bone regeneration, the operated bone increased significantly the woven ossification whilst the cortical mineral density decreased by 18.7%. Simultaneously, an early deterioration in the microstructure and chemical composition of the trabecular bone was observed in the iliac crest, persisting over time in non-operated trabecular regions.

Osteoporosis causes uneven degradation to trabecular tissue quality across different bone locations. Furthermore, the bone regeneration process via bone transport in osteoporotic subjects leads to a systemic skeletal disorder that further impairs the bone quality, surpassing the damage caused by osteoporosis alone. This impairment appears to be intensified by the pre-existing osteoporotic condition.

Osteoporosis is a chronic metabolic bone disease characterized by progressive bone loss and structural deterioration, increasing fracture risk and morbidity. As the global population ages, its incidence is rising, underscoring the urgent need for more effective prevention and treatment strategies.

This review synthesizes the latest evidence and guidelines from leading international societies, establishing a contemporary framework for osteoporosis pharmacotherapy. It emphasizes best practices and explores future directions in treatment optimization and fracture prevention.

To optimize outcomes, enhancing early detection, refining treatment strategies, and prioritizing patient-centered care are essential. Improving diagnosis through increased use of bone mineral density (BMD) assessments and identifying secondary causes are critical steps to addressing underdiagnosis, particularly in men. Pharmacotherapies play a vital role in management; while bisphosphonates serve as a cost-effective first-line treatment, denosumab and anabolic agents like Teriparatide and romosozumab are essential alternatives for high-risk patients. Future directions in osteoporosis management emphasize advancing treatment strategies through novel drug targets and innovative delivery systems, alongside personalized medicine approaches considering individual genetic and comorbidity profiles. Enhanced adherence strategies and further research into combination therapies and monitoring tools are crucial for improving prevention and treatment outcomes, ultimately reducing the fragility fracture burden worldwide.

Osteoporosis is a common chronic bone metabolism disorder characterized by decreased bone mass and reduced bone density in the bone tissue. Osteoporosis can lead to increased fragility of the skeleton, making it prone to brittle fractures. Osteoclasts are macrophage-like cells derived from hematopoietic stem cells, and their excessive activity in bone resorption leads to lower bone formation than absorption during bone remodeling, which is one of the important factors inducing osteoporosis. Therefore, how to inhibit osteoclast formation and reducing bone loss is an important direction for treating osteoporosis. Sophoraflavanone G, derived from Sophora flavescens Alt and Rhizoma Drynariae, is a flavonoid compound with various biological activities. However, there have been few studies on osteoporosis and osteoclasts so far. Therefore, we hypothesize that genistein G can inhibit osteoclast differentiation, alleviate bone loss phenomenon, and conduct in vitro and in vivo experiments for research and verification purposes.

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 compromises bone strength, making bone more susceptible to fractures. Decreased bone density heightens susceptibility to femoral neck fractures. The study investigated the impact of bone density on implant performance across three categories of bone quality: healthy, osteopenic, and osteoporotic. The effectiveness of three commonly used implant types (Femoral Neck System, Dynamic Condylar Screw, and Dynamic Hip Screw, where later two equipped with an anti-rotational screw) was evaluated through finite element analysis for treating Pauwels type III fracture. The bone geometry and material properties were based on a subject-specific CT data. The density and Young's modulus of bone elements were adjusted to simulate osteopenic and osteoporotic bone. FE models were developed and the peak loading values for normal walking and stair climbing conditions were considered. Stability and performance of the implant were assessed using bone strain, implant stress, deformation and rotation of the femoral head, micromotion at the interfaces, strain shielding, and risk of implant cut-out. Except for DCS with AR-screw and FNS implants under stair climbing conditions in weaker bone qualities, the implant stress remained within the yield limit of Ti-alloy. The comprehensive assessment identified DHS2 as the preferred implant option for treating such fractures, even in poor bone quality. The risk of cut-out risk was up to 3.9% higher in DCS2 and 6.3% higher in FNS implanted models than in DHS2. The effect of change in bone quality was comparatively less in DHS2 implants than the other two types.

Postmenopausal women are at an increased risk of bone density reduction, with multiple factors implicated, including folate, a B vitamin whose impact on bone health is gaining attention. The purpose of this research was to examine the association between red blood cell (RBC) folate levels and lumbar bone mineral density (BMD) in postmenopausal women.

We performed a cross-sectional study to investigate the association between postmenopausal women's lumbar BMD and RBC folate levels, using the data from the 2009-2018 National Health and Nutrition Examination Survey (NHANES). Participants were categorized into quartiles based on RBC folate levels (Q1-Q4). Univariate and multivariate regression models assessed the association between RBC folate levels and lumbar BMD, with threshold effect analysis performed.

A total of 1315 postmenopausal women were included. RBC folate levels were positively associated with lumbar BMD. The trend analysis across the quartiles of RBC folate indicated a statistically significant trend in all models (P for trend: Model 1 = 0.020; Model 2 = 0.015; Model 3 = 0.037), suggesting that higher RBC folate levels are associated with increased lumbar BMD. In the unadjusted model 1, a 10 nmol/L increase in RBC folate was associated with a 0.0002 g/cm² increase in lumbar BMD (P=0.002509). The correlation was still significant (P=0.0006) even after age and race were taken into account (model 2). Further adjustment for multiple variables (model 3) showed a 0.0002 g/cm² increase in lumbar BMD per 10 nmol/L increase in RBC folate (P=0.0212). Threshold effect analysis revealed a breakpoint at 92.4 nmol/dL, suggesting a nonlinear relationship between RBC folate levels and lumbar BMD.

Postmenopausal women's RBC folate levels had a positive association with their lumbar BMD. Maintaining appropriate RBC folate levels may help preserve bone density and offer a fresh approach to avoiding osteoporosis in postmenopausal women.

Hip fractures are one of the most serious forms of osteoporotic fractures. Osteosarcopenia is a growing geriatric giant with increased risk of falls, fractures, disability and mortality. The objective of this cross-sectional study was to determine the prevalence and risk factors of osteosarcopenia amongst hip fracture patients.

All patients received a dual energy x-ray absorptiometry (DXA) scan for diagnosis of osteopenia and osteoporosis. For sarcopenia assessment, patients received a bioimpedance analysis (BIA) measurement, handgrip strength and 5-time chair stand test. Osteosarcopenia was defined with the presence of osteopenia/osteoporosis and sarcopenia. Risk factors for osteosarcopenia were analysed using logistic regression.

A total of 342 hip fracture patients (n = 342) were recruited. Sarcopenia was present in 286 hip fracture patients (83.6%). 335 hip fracture patients (97.95%) had osteopenia/osteoporosis. Osteosarcopenia was present in 281 hip fracture patients (82.2%). For osteosarcopenia, patients with body mass index (BMI) < 23 kg/m2 were 4.33 (2.35 to 7.95; p < 0.001) times more likely to have osteosarcopenia regardless of age and gender. Males were 3.24 (1.38 to 7.58; p = 0.007) more likely to have osteosarcopenia regardless of age and BMI group.

Our study had shown a very high prevalence of osteosarcopenia amongst hip fracture patients, especially in male patients, and identified associated risk and protective factors. Given the potential clinical implications, we would recommend that in addition to bone mineral density assessment, routine sarcopenia assessment should also be incorporated into Fracture Liaison Services. Further research should be conducted on optimal body weight and BMI, and as to why male patients have more likelihood of sarcopenia.

We examined vertebral fracture (VF) prevalence, incidence, and treatment among 1488 older adults. VF prevalence and incidence were higher in women, older participants, and those with low bone density. In addition to VFs being underdiagnosed (only 20.7% of VFs clinically recognized), treatment rates were low, underscoring the need for improved screening and management.

To estimate prevalence and incidence of osteoporotic VFs and VF progressions overall and by sex, age, and bone status and to describe the proportion of participants with VFs in reporting osteoporosis (OP) medication use.

This observational analysis of the DO-HEALTH trial, a three-year, randomized, controlled trial among community-dwelling adults age ≥ 70 years, includes a subsample of participants recruited at four study sites equipped with DXA machines. Prevalence and incidence rates (IR) of VFs and VF progressions were described overall and by subgroups of sex, age, and bone status. Incidence of VFs which were clinically recognized was also estimated. Further, we estimated the proportion of participants on OP medication.

A total of 1488 participants were included (mean age 74.9 years, 63.1% women, 77.0% had osteopenia or osteoporosis). One hundred forty-four (9.7%) participants had at least one radiographic VF at baseline and of those 19.4% participants reported OP medication use. Over the three-year follow-up, 50 participants sustained 58 new radiographic VFs (IR 1.4, 95% CI 1.1, 1.9). Of the 58 radiographic VFs, only 12 (20.7%) were clinically recognized. Furthermore, 31 participants sustained 35 VF progressions (N = 157; IR 7.7, 95% CI 5.5, 10.7). Prevalence and incidence were significantly higher in women, in older participants and those with osteopenia or osteoporosis compared to those with normal bone density.

This study suggests a high prevalence and incidence of VFs in community-dwelling European older adults. Underdiagnosis may be even more prevalent than previously observed, and treatment rates were low.

Digital voice assistants (DVAs) are feasible for delivering a digital health intervention designed to improve osteoporosis self-management in postmenopausal women with osteoporosis. However, the DVA intervention did not improve anti-osteoporosis drug adherence, nor did it enhance osteoporosis knowledge or attitudes in this population.

To determine feasibility and effectiveness of a digital voice assistant (DVA) intervention for improving anti-osteoporosis medication adherence, and osteoporosis knowledge and attitudes, in postmenopausal women with osteoporosis.

This 12-month single-blinded, randomised controlled trial included 50 postmenopausal women with osteoporosis randomised to DVA (N = 25) or control (N = 25) for 6 months, followed by a 6-month follow-up period. DVA participants received an Amazon Alexa device that delivered osteoporosis education videos, medication reminders and interactive quizzes. Control participants received emails with links to osteoporosis information. Anti-osteoporosis medication possession ratio (MPR; acceptable adherence defined as ≥ 0.8) was determined using Pharmaceutical Benefits Schedule data. Osteoporosis knowledge was measured using the Osteoporosis Knowledge Assessment Tool (OKAT) and medication attitudes were measured using the Adherence Evaluation of Osteoporosis Treatment (ADEOS-12) questionnaire.

The mean ± SD age of participants was 64.3 ± 6.1 years and 6-month DVA intervention adherence (number of DVA sessions accessed) was 79.5% (95%CI: 73.9, 84.9). The proportion of participants with acceptable 12-month MPRs was similar between groups (control: 86.4% [95%CI: 77.0, 93.6]; DVA: 95.0% [95%CI: 88.4, 100.0], P = 0.34). Mean OKAT scores improved in both groups after both 6- and 12 months, but there were no significance between groups. Changes in mean ADEOS-12 scores did not differ between baseline and 6 months in DVA compared to control (0.61 [95%CI: - 0.80, 2.03]) but worsened post-intervention from 6 to 12 months (net difference: - 1.42 [95%CI: - 2.80, - 0.06]).

This DVA-delivered intervention achieved good adherence but did not improve medication adherence, osteoporosis knowledge, or attitudes compared with control. Future studies should target populations with poor adherence to anti-osteoporosis medication.

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.

To compare and analyze the clinical effects of acupuncture-related therapies for postmenopausal osteoporosis (PMOP) and propose the optimal scheme, we utilized a network meta-analysis to evaluate the therapeutic effects of various commonly used acupuncture methods for PMOP.

Randomized controlled trials of acupuncture-related therapies for PMOP were searched in eight databases (PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, China Science and Technology Journal Database, China Biomedical Literature Database, and Wanfang database) from January 1, 2002 to December 31, 2023. Our primary outcomes included overall clinical effectiveness rate, bone mineral density (BMD), and visual analog scale scores (VAS). The secondary outcome is adverse events. The entire process of literature screening and data analysis was conducted by 2 independent investigators.

A total of 30 studies with 2,342 participants provided data suitable for analysis. We compared six interventions: manual acupuncture, electroacupuncture, acupoint catgut embedding, moxibustion, acupoint application, and warm acupuncture. The results of the network meta-analysis revealed that, when compared to conventional Western medication (CWM), multiple acupuncture therapies had a greater impact on the overall clinical effectiveness rate. Electroacupuncture combined with CWM demonstrated superior clinical effectiveness and lumbar spine BMD improvement. Moxibustion with CWM ranked highest for femoral neck BMD, while warm acupuncture showed optimal effects on Ward's triangle and trochanter BMD. Acupoint catgut embedding provided the greatest pain reduction. The most prevalent minor adverse effects included hematoma, discomfort, and scorching.

The results suggest that several acupuncture-related therapies, either alone or in conjunction with CWM, outperform CWM alone and may be regarded as an alternative or supplementary therapy to PMOP, though higher-quality trials are needed.

Osteoporosis (OP) is characterized by degraded bone microstructure, loss of bone mass and increased risk of fragility fractures. Currently, T-score determined by dual-energy X-ray absorptiometry (DEXA) measurements has been regarded as the gold standard for the diagnosis of osteoporosis. However, multiple factors have indicated that the T-score is insufficient to identify individuals with osteoporosis at a potentially high risk of fracture, or accurately detect those who require treatment, or continuously monitor the risk of re-fracture and clinical outcomes after treatment. This review covers publications in a range of ten years and comprehensively summarizes the studies in laboratory-based biomarkers for osteoporotic fractures (OF), aiming to provide physicians and surgeons with an update of clinical research in identification, verification and application of these tools, and to provide useful information for the design of future clinical studies.

It was found that bone formation markers (such as PINP, BGP, ECM1 and SOST), bone resorption markers (such as β-CTX, TRAcP5b, osteocalcin, RANKL, RANKL/OPG ratio, and t-PINP/β-CTX), hormonal biomarkers (such as IGF- 1, PTH, leptin, adiponectin and AMH), indicators of inflammation and oxidative stress (SII, IL- 6, LTL, FlOP_360, FlOP_400, and GGT), microRNAs (such as miR- 21, miR- 320a- 3p, miR- 491 - 5p, miR- 485 - 3p, miR- 19b- 1- 5p, miR- 203a, miR- 31 - 5p, miR- 502 - 3p, miR- 4739, miR- 497, miR- 19b, and miR- 107), other biomarkers (SAF-AGEs and glycine), adipocytokines (irisin and Omentin- 1), senescence biomarkers (RDW), and lncRNAs (MIAT) may be useful biomarkers for clinical practice. Further validation of these biomarkers and a better understanding of the underlying molecular mechanisms may help in the development and application of these biomarkers for risk prediction of OF, differential diagnosis among OP, OF and healthy individuals, as well as post-operative monitoring of re-fracture risk and treatment outcomes.

Postmenopausal osteoporosis (PMO) increases the risk of fragility fractures (FF), leading to disability, higher mortality, and elevated healthcare costs. Despite available treatments, osteoporosis (OP) remains undertreated, especially in women over 50 years at high risk for FF. Real-world data on OP care in Spain are limited. This study aims to assess the OP treatment gap, healthcare resource utilisation (HCRU), and costs among Spanish women following a first FF or PMO diagnosis.

This retrospective study used data from the BIG-PAC® administrative database on women aged ≥ 50 years with a first FF (cohort 1) or newly diagnosed PMO (cohort 2) between 2014 and 2018. Patients were followed for 2 years after the index event. The primary outcome was the proportion of women not prescribed OP medication within 6 months after the index event (treatment gap). Secondary outcomes included fracture incidence, mortality, HCRU, and costs.

The study included 22,142 women: 3190 in cohort 1 and 18,952 in cohort 2. The OP treatment gap was higher in cohort 1 vs cohort 2 (41.5% vs 23.6%). In cohort 1, 59.2% were diagnosed with PMO after the first FF, with 88% experiencing subsequent fracture(s). OP treatment persistence decreased over time in both cohorts. Fracture rates were lower in women prescribed OP treatment vs those who were not (8.35 vs 13.8 per 1000 patient-years) and in those who showed 24-month-persistence and 12-month adherence to treatment vs those who did not (8.98 and 7.66 vs 10.79 and 10.76). The 2-year mean cost per patient was higher in cohort 1 (€10,601) than in cohort 2 (€1659), with the highest costs incurred for hip (€15,833) and vertebral (€10,593) fractures.

This study highlights a significant treatment gap in Spanish women aged ≥ 50 with a first FF or newly diagnosed PMO. Costs are particularly high for those with a first FF, especially for hip or vertebral fractures. Improving treatment adherence could reduce fracture risk, healthcare costs, and resource utilisation.

Osteoporosis has become a global public health concern making prevention and treatment essential to reduce severe consequences for individuals and health systems. This systematic review with meta-analysis aimed to determine the effects of combined protein and exercise interventions compared to (a) exercise alone and (b) protein alone on bone mineral content (BMC) or density (BMD) in middle-aged and older adults.

We systematically searched Medline, CINAHL, CENTRAL, Web of Science, and SPORTDiscus until 24th January 2023. Pairwise random-effects meta-analyses were performed to calculate weighted mean differences (WMD) with 95% confidence intervals (95% CI). We evaluated risk of bias (Cochrane RoB2) and certainty of evidence (CoE; GRADE). If pooling was not possible, the results were summarized descriptively.

For the comparison of combined protein supplementation and exercise vs. exercise alone, no meta-analysis for BMD (2 RCTs) was possible. For BMC, little to no intervention effect was found (WMD 0.03 kg; 95% CI - 0.00 to 0.05; 4 RCTs; IG = 97/CG = 98; I2 = 58.4%). In a sensitivity analysis, restricted to combined milk-protein supplementation and exercise, the result remained similar (0.01 kg; 95% CI - 0.01 to 0.03; 4 RCTs; IG = 71/CG = 71; I2 = 0.0%; low CoE). For the comparison of combined protein and exercise interventions vs. protein alone, no RCT on BMC was identified; the results on total or regional BMD (2 RCTs) were inconclusive.

Based on our findings, no robust conclusions can be drawn on whether combining protein and exercise interventions is more beneficial for bone health than one component alone. Sufficiently powered studies with longer duration are required to clarify these questions (CRD42022334026).

Osteoporosis is a chronic systemic skeletal disease that can benefit from patient-led self-care behaviors. The purpose of this meta-synthesis is to summarize the knowledge about the experiences in self-care behaviors, according to Riegel's middle-range theory of self-care, of patients affected by osteoporosis. A systematic review of the literature and a meta-synthesis of the results were performed to identify qualitative and mixed-method studies through database research conducted on six databases until June 2023 that identified 27 articles. Three dimensions of self-care were recognized within the articles: 'maintenance' was the most reported, mostly associated with therapy adherence; 'monitoring', predominantly related to instrumental test; and, 'management', mainly related to the management of symptoms. A cross-cutting topic that emerges and has been shown to be relevant is that of the relationship with health professionals.

Bone densitometry and fracture risk algorithms have proved scarce reliability for fractures risk estimation in patients with diabetic osteopathy. Calcaneal quantitative ultrasound (QUS) is a noninvasive, low-cost technique already acknowledged for fracture risk assessment in patients with primary osteoporosis. Nevertheless, there is limited evidence on the role of QUS in patients with diabetes mellitus (DM). The aim of our study was to evaluate whether calcaneal QUS may effectively estimate long-term risk of fragility fractures in a group of patients with DM.

We conducted a retrospective study including 300 patients with type 1 (T1DM) or type 2 DM (T2DM) who underwent calcaneal QUS evaluation in 2013. Information about clinical fragility fractures, DM characteristics, and QUS parameters (broadband ultrasound attenuation, BUA; speed of sound, SOS; stiffness index, SI) were collected through electronic medical records. Ten years later, the patients were asked to participate to an interview about clinical fragility fractures occurring within the decade 2013-2023.

At baseline, thirty-nine patients (13%) presented with at least one fragility fracture at any site. Fractured patients showed significantly lower QUS parameters than non-fractured (p < 0.0001), both in T1DM (n = 106) and in T2DM (n = 194). In 2023, 231 patients (132 with T2DM and 99 with T1DM) participated to the follow-up interview; 31 patients (13%) referred the occurrence a new clinical fragility fracture, and 14 patients (6%) a major osteoporotic fractures (MOF). Among QUS parameters, BUA was significantly associated to the occurrence of new MOF over 10-years in T2DM (p < 0.01), but not in T1DM.

Calcaneal QUS may represent an effective tool in assessment of fracture risk among patients with T2DM.

Osteoporosis, characterized by reduced bone mineral density and increased fracture risk, poses a significant health challenge, particularly for aging populations. Systemic treatments often lead to adverse side effects, emphasizing the need for localized solutions. This study introduces a 3D-printed polycaprolactone (PCL) scaffold embedded with strontium-substituted mesoporous bioactive glass nanoparticles (Sr-MBGNPs) and icariin (ICN) for the targeted regeneration of osteoporotic bone. The scaffold was characterized using scanning electron microscopy (SEM), energy-dispersive spectroscopy (EDS), ion release studies, and cellular assays, which confirmed its dual functionality in both enhancing osteoblast proliferation and differentiation and inhibiting osteoclastogenesis. The optimized Sr-MBGNP concentration ensured sustained ion release, superior hydrophilicity, and bioactivity without compromising scaffold integrity. Additionally, e-jet printing provided high precision and uniform pore sizes conducive to cellular activity. This novel scaffold platform demonstrates a promising localized treatment strategy, reducing systemic side effects while improving fixation stability. The innovative integration of Sr-MBGNPs and ICN highlights its potential to revolutionize osteoporosis therapy by promoting bone regeneration and mitigating bone resorption.

Rare genetic variants in genes previously described to be involved in bone monogenic disorders were identified in postmenopausal women split into two groups according to extreme bone mineral density (BMD) values and lumbar spine Z-scores. A pathogenic variant in COL1A2 gene found in a woman with low BMD highlights the overlap between osteogenesis imperfecta and osteoporosis, which may share their genetic etiology. Other variants were not clearly associated with the extreme BMD, suggesting that there is little contribution of rare variants to postmenopausal osteoporosis.

We aimed to evaluate whether extreme values of bone mineral density (BMD) in a population-based cohort of postmenopausal women (BARCOS) could be determined by rare genetic variants in genes related to monogenic bone disorders.

A panel of 127 genes related to different skeletal phenotypes was designed. Massive sequencing by targeted capture of these genes was performed in 104 DNA samples from those women of the BARCOS cohort that exhibited the highest (HZ group) and lowest (LZ group) LS Z-scores, ranging from + 0.70 to + 3.80 and from - 2.35 to - 4.26, respectively. 5'UTR, 3'UTR, splice region, missense, nonsense, and short indel variants with MAF < 0.01 were annotated with CADD version 1.6 and considered in the analysis.

After filtering those variants with CADD > 25 and present only in one of the groups (either LZ or HZ), six variants were detected, most of which (5/6) were in the LZ group in TCIRG1, COL1A2, SEC24D, LRP4, and ANO5 genes, while only one, in the LMNA gene, was in the HZ group. According to the ClinVar database, the COL1A2 variant, causative of a recessive form of osteogenesis imperfecta, is described as pathogenic, while the other variants are considered of uncertain significance (VUS).

The variant identified in COL1A2 in a woman from the LZ group highlights the genetic overlap between monogenic diseases such as osteogenesis imperfecta and complex diseases like osteoporosis. However, the other variants were not clearly associated with the extreme BMD, suggesting that there is little contribution of rare variants to postmenopausal osteoporosis.

Background/Objectives: Radiofrequency echographic multispectrometry (REMS) technology has emerged as a promising alternative for osteoporosis diagnosis. This non-ionising, portable and accessible method enables early detection of osteoporosis in primary healthcare settings. The aim of this study was to assess the effectiveness of REMS in evaluating osteoporosis within primary healthcare. Methods: Bone mineral density was assessed in 86 participants trough 172 scans of the lumbar spine and femur, using REMS technology in two Portuguese primary healthcare units in Guarda. Results: In the lumbar spine evaluation, 51.2% of the participants had osteopenia and 31.4% osteoporosis; in the femur evaluation, 43.0% had osteopenia and 34.9% osteoporosis. The data indicated a significant prevalence of bone fragility. The bone mineral density estimated by radiofrequency echographic multispectrometry showed good agreement with the clinical diagnosis, suggesting that this technology is effective in the early detection of osteoporosis. Conclusions: Bone densitometry using REMS method, performed by a radiographer in primary healthcare settings, offers a viable and innovative alternative for the effective detection of osteoporosis and osteopenia.

Assessing scientific literature about prevalence of periapical lesions in individuals with osteoporosis in comparison to those without osteoporosis. Systematic searches were conducted up to November 24th, 2023 in Cochrane Library, EMBASE, MEDLINE/PubMed, SCOPUS, Web of Science and Grey Literature Reports databases. Only observational studies were included. The ROBINS-E tool, a revised Cochrane instrument for assessing bias in nonrandomized exposure studies, was employed. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool was utilized to evaluate the certainty of the evidence. From 484 studies, three were included. One of them was categorized as having an exceptionally high risk of bias, while two were deemed to have certain concerns. Two studies reported that osteoporotic patients may have more chances to present a periapical lesion compared to non-osteoporotic patients. One study reported no differences between groups. The GRADE analysis indicated a markedly low level of certainty in the evidence. The present review indicates that osteoporotic patients may present more periapical lesions compared to non-osteoporotic patients. This statement should be cautiously interpreted and further well-designed studies are needed. (EEJ-2023-09-123).

Osteoporosis, the most common bone disorder, profoundly impacts women's health, especially during postmenopausal phases. Characterised by diminished bone mineral density (BMD), it increases the risk of fractures, affecting mobility, quality of life, and potentially mortality. The present review analyses the intricate interactions among physiological alterations, diseases, and medications that lead to bone mineral density reduction in women. It underscores the importance of gynaecologists in the prevention, diagnosis, and management of osteoporosis via early risk assessment, suitable hormone treatment, and lifestyle modifications. Essential considerations encompass the categorisation of osteoporosis into primary (age-related) and secondary (attributable to diseases or pharmacological treatments) types, with particular emphasis on predisposing conditions such as premature menopause, hormone deficits, and cancer therapies. The significance of diagnostic instruments such as DXA and novel methodologies like trabecular bone score and quantitative ultrasonography is emphasised for precise evaluation and surveillance. The review also addresses nutritional methods, physical exercise, and pharmaceutical interventions, including hormone replacement therapy (HRT), selective oestrogen receptor modulators (SERMs), and other anti-resorptive drugs, to preserve bone health. This review highlights the important role of gynaecologists in maintaining women's bone health, promoting a proactive strategy to avert osteoporosis-related complications and enhance long-term results.

We performed a systematic review and meta-analysis of observational studies aimed at investigating the prevalence of osteoporosis and osteoporotic fractures in subjects affected by systemic vasculitides (SVs) as well as to explore their risk of osteoporosis and osteoporotic fractures when compared to healthy controls.

Scopus, Web of Science and PubMed were systematically searched from inception to February 2024 for observational studies investigating the prevalence of osteoporosis and fragility fractures in adults with SVs. In addition, when available, we assessed the odd ratios (OR) of prevalent osteoporosis and fragility fractures amongst subjects with SVs vs. healthy controls. Data from eligible studies were extracted, and meta-analysis was performed using a random effects model to obtain ORs with 95% confidence intervals (CIs). Subgroup analyses and meta-regressions were also performed. This study was registered in Open Science Framework (DOI: https://doi.org/10.17605/OSF.IO/3G7RJ).

Forty studies with 23,358 individuals affected by SVs were included. The overall prevalence of osteoporosis and fragility fractures in the SV patients were respectively 14.64% (95%CI 12.21-18.89), and 17.08% (95%CI 11.42-24.78). The ORs for osteoporosis and fragility fractures in SV patients when compared with healthy controls were 2.92 (95%CI 1.72-4.98) and 2.39 (95%CI 1.34-4.26) respectively. The univariable meta-regression analysis showed a significant association between cumulative glucocorticoids' dosage (total grams) and risk of prevalent osteoporosis (estimate = 0.0995, R2 = 0.24, p=0.0194).

SVs are associated with an increased risk for osteoporosis and fragility fractures, suggesting that active vigilance and pre-emptive screening are recommended.

https://archive.org/details/osf-registrations-3g7rj-v1.