Estimating prevalence of osteoporosis: examples from industrialized countries

FABP4 inhibition suppresses bone resorption and protects against postmenopausal osteoporosis in ovariectomized mice

Postmenopausal osteoporosis (PMOP) is a condition in women caused by estrogen deficiency, characterized by reduced bone mass and increased fracture risk. Fatty acid-binding protein 4 (FABP4), a lipid-binding protein involved in metabolism and inflammation, has emerged as a key regulator in metabolic disorders and bone resorption; however, its direct role in PMOP remains unclear. Here, we show that serum FABP4 levels in PMOP patients negatively correlate with bone mineral density, a trend also observed in ovariectomized mice. FABP4 promotes osteoclast formation and bone resorption without affecting osteoblast differentiation. The FABP4 inhibitor BMS309403 suppresses osteoclast differentiation by modulating calcium signaling and inhibiting the Ca2+-Calcineurin-NFATc1 pathway. Oral BMS309403 increases bone mineral density in ovariectomized mice, though less effectively than alendronate. Notably, bone-targeted delivery of BMS309403 achieves comparable efficacy to alendronate. In this work, we demonstrate that FABP4 is a critical mediator in PMOP and that its inhibition offers a promising therapeutic strategy.

Analysis of the association between mixed exposure to multiple metals and comorbidity of hypertension and abnormal bone mass: Baseline data from the Chinese multi-ethnic cohort study (CMEC)

Comorbidity represents an increasingly significant public health challenge. While numerous studies have confirmed the association between metals and both hypertension and osteopenia, the relationship between the multi-faceted effects of mixed metal exposure and the comorbidity of hypertension with abnormal bone mass, as well as age-specific associations, remains unclear. This study utilized baseline data from the China Multi-Ethnic Cohort Study, investigating 9870 Chinese ethnic minorities (Dong and Miao) aged 30-79 years. We measured 17 urinary metal levels using inductively coupled plasma mass spectrometry. The study employed Least Absolute Shrinkage and Selection Operator (LASSO) penalized regression and Bayesian Kernel Machine Regression (BKMR) models to explore the association between urinary metals and comorbidity of hypertension and abnormal bone mass risk. In single-metal models, urinary nickel and zinc levels showed positive correlations with hypertension-related bone mass reduction risk, with ORs and 95 % CIs of 1.23 (1.01, 1.50) and 1.56 (1.27, 1.90), respectively. LASSO regression identified 11 urinary metals (aluminum, cobalt, chromium, copper, iron, manganese, lithium, lead, strontium, vanadium, and zinc) associated with hypertension and abnormal bone mass comorbidity. These selected metals were incorporated into subsequent analyses. BKMR analysis revealed an overall negative effect of metal mixtures on hypertension and abnormal bone mass comorbidity when all metals were fixed at their 50th percentiles. Vanadium and lithium showed negative correlations with the comorbidity. In subgroup analyses, age-stratified groups demonstrated consistent overall negative effects of metal mixtures on the comorbidity. Notably, in individuals over 60 years old, aluminum additionally exhibited a negative association alongside vanadium. Interactions were observed among metals in mixed exposures. Increasing urinary aluminum concentrations attenuated the negative correlation between manganese and hypertension-bone mass abnormality comorbidity. Similarly, increasing manganese concentrations weakened the positive association between urinary zinc and the comorbidity. In individuals under 60 years old, consistent with the general population, increasing urinary aluminum concentrations at P50 levels of other metals diminished the protective effect of manganese against hypertension-bone mass abnormality comorbidity. Interactions were identified between aluminum and lithium, and between manganese and zinc. This study provides substantial evidence linking mixed urinary metal exposure to hypertension and bone mass comorbidity, exploring the multifaceted effects of mixed metal exposure. These findings contribute to a deeper understanding of the role of metal exposure in chronic disease comorbidity, offering a scientific foundation and new directions for preventing and controlling hypertension and bone mass comorbidity, as well as informing public health policy formulation from an environmental metal perspective.

Heritability of bone mineral density among Japanese women: A twin study

BACKGROUND

Osteoporosis is a major risk factor for fractures among the older population. Despite osteoporosis being a significant concern in super-aged societies such as Japan, the heritability of bone mineral density within the Japanese populace remains unexplored. Therefore, we conducted a twin study among Japanese women to determine the extent of genetic and environmental influences on bone mineral density.

METHODS

The bone area ratio of 298 healthy, female Japanese twins (comprising 149 pairs, 136 monozygotic and 13 dizygotic twin pairs) registered in the Osaka University Twin Registry was measured using quantitative ultrasound. Classical twin analysis was employed to ascertain the heritability of bone mineral density.

RESULTS

The heritability of bone mineral density for the entire cohort was 0.51 (95 % confidence interval 0.38-0.63). For the women younger than 50 years, the effects of menopause were adjusted, and the best-fit model was also found to be the additive genetics and unique environment (AE) model, with a heritability estimate of 0.53 (95 % confidence interval 0.34-0.72).

CONCLUSIONS

Compared with women from other countries, Japanese women appear to have a lower heritability of bone mineral density. Consequently, environmental factors may exert a larger influence on osteoporosis among Japanese women than among women of other races and ethnicities.

Correlation between occupational hazard exposure and abnormal bone mineral density in steelworkers

OBJECTIVES

To investigate the relationships between abnormal bone mineral density (BMD) and exposure to single or combined occupational hazards in steelworkers by analyzing the correlations between various occupational hazards (night-shift work, high temperature, dust and noise) and abnormal BMD with both a single-risk score model (SRSM) and a hybrid-risk score model (HRSM).

METHODS

Participants were selected from a cross-sectional study called "Cohort Study on the Health Effects of the Occupational Population in the Beijing-Tianjin-Hebei Region". A total of 6816 participants were recruited for this study. Night-shift work and high temperature, dust and noise exposure were considered occupational hazards and were analyzed separately and in combination (coexposure). The health risk factor score and partial regression coefficient were used to establish an SRSM and an HRSM.

RESULTS

The rate of abnormal BMD in steelworkers was 27.6% (28.0% in males and 23.3% in females). Logistic regression revealed that, compared with that of individuals with 0 cumulative days of night-shift work, the risk of abnormal BMD for individuals with various amounts of night-shift work was as follows: ~927.20 days (OR = 1.40, 95% CI: 1.15 ~ 1.72), ~ 1772.02 days (OR = 1.45, 95% CI: 1.19 ~ 1.77), and ≥ 2573.50 days (OR = 1.55, 95% CI: 1.27 ~ 1.89). Compared with that of the cumulative exposure to high temperatures in the 0 °C·y group, the risk of abnormal BMD in the other groups was as follows: 667.49~°C·y (OR = 1.34, 95% CI: 1.06 ~ 1.71) and ≥ 790.30 °C·y (OR = 1.32, 95% CI: 1.03 ~ 1.69). Compared with that of the cumulative amount of dust exposure in the 0 mg/m3·y group, the risk of abnormal BMD for the other groups was as follows: 30.42 ~ mg/m³·y (OR = 1.23, 95% CI: 1.02 ~ 1.49) and ≥ 40.17 mg/m³·y (OR = 1.37, 95% CI: 1.14 ~ 1.65). Compared with that of the cumulative amount of noise exposure in the 0 dB(A)·y group, the risk of abnormal BMD for the other groups was as follows: ≥1707.47 dB(A)·y (OR = 1.17, 95% CI: 1.00 ~ 1.40). When an SRSM was used, compared with that in the control group (score < 0.42), the risk of abnormal BMD in the other groups was as follows: ~0.42 (OR = 1.24, 95% CI: 1.03 ~ 1.19), ~ 0.72 (OR = 1.51, 95% CI: 1.24 ~ 1.83), and ≥ 0.97 (OR = 2.11, 95% CI: 1.71 ~ 2.60). When an HRSM was used, compared with that of the reference group (score < 0.360), the risk of abnormal BMD for the other groups was as follows: ~0.360 (OR = 1.26, 95% CI: 1.05 ~ 1.52), ~ 0.576 (OR = 1.43, 95% CI: 1.18 ~ 1.74), and ≥ 0.779 (OR = 2.08, 95% CI: 1.70 ~ 2.55).

CONCLUSIONS

(1) Night-shift work and high temperature and dust exposure may contribute to abnormal BMD in steelworkers. (2) The higher the corresponding risk score of occupational hazard coexposure is, the greater the risk of abnormal BMD in steelworkers. When workers are exposed to multiple occupational hazards at the same time, coexposure models could reveal the relationships between occupational hazard exposure and abnormal BMD in steelworkers more accurately.

Systematic review and meta-analysis of the effects of blood flow restriction training on bone health in older adults

While low-intensity blood flow restriction (LI-BFR) training has recently been shown to improve bone health, there remains limited evidence regarding its impact on older adults. This meta-analysis aimed to quantitatively identify the effects of LI-BFR training on bone mineral density (BMD) and bone biomarkers compared with conventional resistance training programs. Studies were identified through searches of four databases: PubMed, Scopus, SPORTDiscus, and Web of Science. R packages were utilized for this meta-analysis. The results indicated that compared to low-intensity (LI) training, LI-BFR significantly increased BMD (ES = 0.25, 95% Confidence Interval [CI]: [0.08, 0.41], p < 0.01), osteotropic hormones (i.e., GH, ES = 1.18, 95%CI: [0.66, 1.70]), p < 0.001; IGF-1, ES = 0.89, 95% CI: [0.44, 1.33], p < 0.001), but resulted in a smaller increase in bone resorption markers (i.e., CTX, ES = -0.77, 95%CI: [-1.16, -0.37], p < 0.001). LI-BFR training demonstrated similar effects on BMD improvement as high-intensity (HI) resistance training (ES = -0.1, 95%CI: [-0.66, 0.41], p = 0.64). Furthermore, sex and training frequency moderated the secretion of osteotropic hormones (male vs. female: IGF-1, 0.51 vs. 1.64, p < 0.01; ≤ 3 times per week vs. > 3 times per week: GH, 1.62 vs. 0.68, p < 0.01, and IGF-1, 1.13 vs. 0.39, p < 0.05). In conclusion, LI-BFR training shows promise for enhancing bone health in older adults, offering benefits comparable to HI training.

Hounsfield units predict vertebral compression fractures in gastric cancer survivors after adjuvant irradiation

PURPOSE

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSION

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

Osteoporosis in Primary Care: An Analysis of Family Physicians' Knowledge, Attitudes, and Practices in Bahrain

BACKGROUND

Osteoporosis is a metabolic bone disease characterized by progressive loss of bone density. Osteoporotic fractures account for the significant morbidity and mortality of osteoporosis. Preventing and treating osteoporosis and its complications by proper screening and management will significantly improve prognosis and quality of life. Primary healthcare physicians play an important role in the primary prevention of chronic diseases. To that effect, we sought to assess the knowledge, attitude, and practices on the subject of osteoporosis among family physicians in Bahrain in order to identify the level of awareness in primary care centers.

METHODOLOGY

A cross-sectional study was conducted among family physicians working in primary healthcare centers across the Kingdom of Bahrain. Study participants were asked to complete an online revised osteoporosis knowledge test questionnaire. Data were collected and analyzed using IBM SPSS Statistics for Windows, Version 25 (Released 2017; IBM Corp., Armonk, New York).

RESULTS

A total of 210 family physicians participated in this study. More than half of the participants had not received any structured education on osteoporosis or professional development sessions in the past five years (65.7%). Electronic resources were the most utilized type of resource for osteoporosis (73.8%, n=155). The overall mean score for knowledge was 57.2%. Participants strongly agreed that patient education is crucial for disease prevention (72.7%). The three questions that received the highest percentage of neutral responses were related to the ability to screen for osteoporosis in at-risk populations, the ability to correctly diagnose osteoporosis, and effectively manage a patient with osteoporosis in the clinic (34.3%, 36.7%, and 37.1%, respectively). When analyzing the data of practice questions, it was evident that the most used method for diagnosing osteoporosis among primary care physicians was the dual-energy X-ray absorptiometry scan (79%), while the least utilized method was the calculation of an osteoporosis score (14.8%).

CONCLUSION

Our research demonstrated average levels of knowledge on osteoporosis among family physicians in Bahrain. There is also a deficiency in receiving formal updated training. The results highlight several specific deficiencies in both osteoporosis-related knowledge and clinical practice. Therefore, we suggest the need for a well-developed national screening and awareness program to increase screening practices and enhance knowledge about osteoporosis in primary healthcare.

The epidemiology of fifth metatarsal fracture surgeries in Japan using nationwide hospital claim database

BACKGROUND

A fifth metatarsal fracture is a common condition with various causes. The epidemiology of this condition is well established in certain populations such as athletes, and people from Western countries, but not in Japan. We aimed to study the epidemiology of fifth metatarsal fracture surgeries in Japan among various age groups from school age to elderly and hypothesized that they are more common in older Japanese patients.

METHODS

Data was collected from the Japanese Diagnosis Procedure Combination inpatient database, which is a nationwide database containing discharge abstracts and administrative claims data from over 1500 hospitals in Japan. Patients hospitalized with a primary diagnosis of metatarsal fracture and who underwent open reduction and internal fixation between April 1, 2010, and March 31, 2021 were analyzed.

RESULTS

Overall, a total of 2044 participants, with an average age of 17.93 years and a BMI of 22.63, were included in the analysis. Males exhibited a unimodal distribution, with a peak occurring during their late teens, while females displayed a bimodal distribution, with a peak at the age of 50. Additionally, the incidence of these injuries among both males and females peaked during high school, particularly at the age of 17 years.

CONCLUSIONS

The higher prevalence of fifth metatarsal fracture surgeries in elderly females and school age population was observed. This high prevalence may require fracture prevention and early screening. Further studies including patients who undergo conservative treatment are needed.

LEVELS OF EVIDENCE

III.

The Role of Copper Intake in Bone Health: A Quantitative Analysis in Postmenopausal Spanish Women

(1) Background: Copper is a crucial trace element which is vital to growth and development and is especially important in bone health. Copper intake is now the focus of much broader research beyond its associations with nail growth, looking at copper's potential in contributing to bone integrity to prevent a high risk of osteoporosis as well. (2) Methods: This study included postmenopausal women from a larger longitudinal study conducted between 2019 and 2022. Bone health was assessed using three quantitative techniques: heel QUS, DXA and pQCT. Copper intake was evaluated using a 131-item, 7-day food frequency questionnaire. Data from these assessments were used to analyze the relationship between copper intake and bone health. (3) Results: In the unadjusted multiple linear regression model, associations were found between copper intake levels and both BUA (dB/MHz) and pQCT cortical + subcortical density (mg/cm3), with copper intake acting as a negative predictor in both instances. However, these associations lost statistical significance after adjusting for participant age and weight. No further associations were identified for the other parameters assessed. (4) We conclude that our study does not reveal an association between copper intake and bone health in postmenopausal Spanish women.

Analysis of the association between mixed exposure to multiple metals and comorbidity of osteopenia or osteoporosis: baseline data from the Chinese Multi-Ethnic Cohort study (CMEC)

Both osteoporosis and metal exposure are well-recognized public health concerns globally, particularly in the aging population. However, studies investigating the relationship between metal exposure and bone health conditions such as osteopenia and osteoporosis have either produced inconsistent results or are scarce, especially among the ethnic minorities in China. Herein, we correlated single-metal and metal mixture exposure with osteopenia and osteoporosis using a log-binomial regression model and quantile g-computation. In total, 9,206 ethnic Chinese individuals (Dong and Miao) aged 30-79 years were investigated in this study utilizing the baseline data from the Chinese multi-ethnic cohort study. In the single-metal exposure model, urinary concentrations of arsenic (As), cadmium (Cd), chromium (Cr), iron(Fe), mercury(Hg), and manganese (Mn) were positively associated with of osteopenia, whereas those of cobalt(Co) and zinc(Zn) concentrations were negatively associated. Additionally, urinary As, Cd, Cr, and Mn concentrations were positively associated with osteoporosis, whereas that of vanadium(V) was negatively associated. Furthermore, Quantile g-computation results indicated that metal mixture exposure was positively associated with both osteopenia and osteoporosis. Altogether, these findings suggest that simultaneous exposure to multiple metals can affect bone health, providing a theoretical basis for further studies on underlying complex mechanisms.

Effects of resistance training on microcirculation of bone tissue and bone turnover markers in postmenopausal women with osteopenia or osteoporosis: A systematic review

After menopause, there is an imbalance between bone formation and resorption activity, which could lead to postmenopausal osteopenia or osteoporosis. Resistance training (RT) can induce mechanical stress on bone which is necessary for bone remodeling and angiogenic-osteogenic response. This systematic review aims to assess the effects of RT on bone microcirculation and bone turnover markers (BTMs) in postmenopausal women with osteopenia or osteoporosis. We conducted a comprehensive search for related studies published up to April 2023 to identify eligible articles. Out of 316 articles identified, the full texts of 69 articles were screened. There is not any study which consider the effect of resistance exercises on bone microcirculation in PMOP women, but four articles aseess the effect of RT on BTMs and were reviewed. The quality of the articles was assessed by using the Physiotherapy Evidence Database (PEDro) scale. In one study, after 6- and 12 -months RT, bone formation and bone resorption biomarkers decreased not significantly. According to another study, bone formation and resorption biomarkers increased significantly after 3-months RT. Two other studies reported increases in biomarkers of bone formation along with decreases of biomarkers in bone resorption after 6-months of RT, but these were not significant. However, these results suggest that RT had some beneficial effects on BTMs but it is not an effective tool for modifying BTMs in women with osteoporosis or osteopenia. This may be due to the site-specific skeletal stimulation that RT provides. In addition considering the effect of RT on microcirculation of bone are important . So, there is a need for further, high-quality studies in this field.

Differences in Body Composition, Bone Density, and Tibial Microarchitecture in Division I Female Athletes Participating in Different Impact Loading Sports

Sport participation affects body composition and bone health, but the association between sport, body composition, and bone health in female athletes is complex. We compared areal bone mineral density (aBMD, DXA) and tibial volumetric bone mineral density (vBMD), geometry, microarchitecture, and estimated strength (HR-pQCT) in cross-country runners (n = 22), gymnasts (n = 23) and lacrosse players (n = 35), and investigated associations of total body lean mass (TBLM), team, and their interaction with tibial bone outcomes. Total body (TB), total hip (TH), femoral neck (FN), and lumbar spine (LS) aBMD were higher in gymnasts than runners (p < 0.001); FN and LS aBMD were higher in gymnasts than lacrosse players (p ≤ 0.045); and TB, TH, FN, and LS aBMD were higher in lacrosse players than runners (p ≤ 0.013). At the distal tibial metaphysis, total area (Tt.Ar) was higher in gymnasts than runners (p = 0.004); cortical area and thickness (Ct.Ar, Ct.Th) were higher in lacrosse players than runners (p ≤ 0.044); trabecular separation (Tb.Sp) was higher in runners than gymnasts (p = 0.031); and failure load was higher in both gymnasts and lacrosse players than runners (p ≤ 0.012). At the tibial diaphysis, Tt.Ar, Ct.Ar, cortical perimeter (Ct.Pm), and failure load were higher in gymnasts than runners (p ≤ 0.040). In multiple linear regression analyses, TBLM was significantly associated with metaphyseal failure load (ß = 0.30, p = 0.042), and diaphyseal Tt.Ar and Ct.Pm (ß = 6.17, p = 0.003; ß = 0.59, p = 0.010). Bone health can vary among different sport types and is associated with TBLM, which may be a modifiable factor to maintain or improve bone health.

Alendronate for the primary and secondary prevention of osteoporotic fractures in postmenopausal women

RATIONALE

Osteoporosis is an abnormal reduction in bone mass and bone deterioration, leading to increased fracture risk. Alendronate belongs to the bisphosphonate class of drugs, which inhibit bone resorption by interfering with the activity of osteoclasts (bone cells that break down bone tissue). This is an update of a Cochrane review first published in 2008.

OBJECTIVES

To assess the benefits and harms of alendronate in the primary and secondary prevention of osteoporotic fractures in postmenopausal women at lower and higher risk of fracture, respectively.

SEARCH METHODS

We searched Evidence-Based Medicine Reviews (which includes CENTRAL), MEDLINE, Embase, two trial registers, drug approval agency websites, and the bibliographies of relevant systematic reviews to identify the studies included in this review. The latest search date was 01 February 2023. We imposed no restrictions on language, date, form of publication, or reported outcomes.

ELIGIBILITY CRITERIA

We included only randomized controlled trials that assessed the effects of alendronate on postmenopausal women. Targeted participants must have received at least one year of alendronate. We classified a study as secondary prevention if its population met one or more of the following hierarchical criteria: a diagnosis of osteoporosis, a history of vertebral fractures, a low bone mineral density T-score (-2.5 or lower), and 75 years old or older. If a study population met none of those criteria, we classified it as a primary prevention study.

OUTCOMES

Our major outcomes were clinical vertebral, non-vertebral, hip, and wrist fractures, withdrawals due to adverse events, and serious adverse events.

RISK OF BIAS

We used the Cochrane risk of bias 1 tool.

SYNTHESIS METHODS

We used standard methodological procedures expected by Cochrane. Based on the previous review experience, in which the clinical and methodological characteristics in the primary and secondary prevention studies were homogeneous, we used a fixed-effect model for meta-analysis and estimated effects using the risk ratio (RR) for dichotomous outcomes. Our base case analyses included all eligible placebo-controlled studies with usable data. We selected the data available for the longest treatment period. We consider a relative change exceeding 15% as clinically important.

INCLUDED STUDIES

We included 119 studies, of which 102 studies provided data for quantitative synthesis. Of these, we classified 34 studies (15,188 participants) as primary prevention and 68 studies (29,577 participants) as secondary prevention. We had concerns about risks of bias in most studies. Selection bias was the most frequently overlooked domain, with only 20 studies (19%) describing appropriate methods for both sequence generation and allocation concealment. Eight studies (8%) were at low risk of bias in all seven domains.

SYNTHESIS OF RESULTS

The base case analyses included 16 primary prevention studies (one to five years in length; 10,057 women) and 20 secondary prevention studies (one to three years in length; 7375 women) which compared alendronate 10 mg/day (or 70 mg/week) to placebo, no treatment, or both. Indirectness, imprecision, and risk of bias emerged as the main factors contributing to the downgrading of the certainty of the evidence. For primary prevention, alendronate may lead to a clinically important reduction in clinical vertebral fractures (16/1190 in the alendronate group versus 24/926 in the placebo group; RR 0.45, 95% confidence interval [CI] 0.25 to 0.84; absolute risk reduction [ARR] 1.4% fewer, 95% CI 1.9% fewer to 0.4% fewer; low-certainty evidence) and non-vertebral fractures (RR 0.83, 95% CI 0.72 to 0.97; ARR 1.6% fewer, 95% CI 2.6% fewer to 0.3% fewer; low-certainty evidence). However, clinically important differences were not observed for the following outcomes: hip fractures (RR 0.76, 95% CI 0.43 to 1.32; ARR 0.2% fewer, 95% CI 0.4% fewer to 0.2% more; low-certainty evidence); wrist fractures (RR 1.12, 95% CI 0.84 to 1.49; ARR 0.3% more, 95% CI 0.4% fewer to 1.1% more; low-certainty evidence); withdrawals due to adverse events (RR 1.03, 95% CI 0.89 to 1.18; ARR 0.2% more, 95% CI 0.9% fewer to 1.5% more; low-certainty evidence); and serious adverse events (RR 1.08, 95% CI 0.82 to 1.43; ARR 0.5% more, 95% CI 1.2% fewer to 2.8% more; low-certainty evidence). For secondary prevention, alendronate probably results in a clinically important reduction in clinical vertebral fractures (24/1114 in the alendronate group versus 51/1055 in the placebo group; RR 0.45, 95% CI 0.28 to 0.73; ARR 2.7% fewer, 95% CI 3.5% fewer to 1.3% fewer; moderate-certainty evidence). It may lead to a clinically important reduction in non-vertebral fractures (RR 0.80, 95% CI 0.64 to 0.99; ARR 2.8% fewer, 95% CI 5.1% fewer to 0.1% fewer; low-certainty evidence); hip fractures (RR 0.49, 95% CI 0.25 to 0.96; ARR 1.0% fewer, 95% CI 1.5% fewer to 0.1% fewer; low-certainty evidence); wrist fractures (RR 0.54, 95% CI 0.33 to 0.90; ARR 1.8% fewer, 95% CI 2.6% fewer to 0.4% fewer; low-certainty evidence); and serious adverse events (RR 0.75, 95% CI 0.59 to 0.96; ARR 3.5% fewer, 95% CI 5.8% fewer to 0.6% fewer; low-certainty evidence). However, the effects of alendronate for withdrawals due to adverse events are uncertain (RR 0.95, 95% CI 0.78 to 1.16; ARR 0.4% fewer, 95% CI 1.7% fewer to 1.3% more; very low-certainty evidence). Furthermore, the updated evidence for the safety risks of alendronate suggests that, irrespective of participants' risk of fracture, alendronate may lead to little or no difference for gastrointestinal adverse events. Zero incidents of osteonecrosis of the jaw and atypical femoral fracture were observed.

AUTHORS' CONCLUSIONS

For primary prevention, compared to placebo, alendronate 10 mg/day may reduce clinical vertebral and non-vertebral fractures, but it might make little or no difference to hip and wrist fractures, withdrawals due to adverse events, and serious adverse events. For secondary prevention, alendronate probably reduces clinical vertebral fractures, and may reduce non-vertebral, hip, and wrist fractures, and serious adverse events, compared to placebo. The evidence is very uncertain about the effect of alendronate on withdrawals due to adverse events.

FUNDING

This Cochrane review had no dedicated funding.

REGISTRATION

This review is an update of the previous review (DOI: 10.1002/14651858.CD001155).

The relationship between non-HDL-C/HDL-C ratio and bone mineral density: an NHANES study

Background

The non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) is a newly developed lipid parameter. However, the current research has only explored the relationship with lumbar spine bone mineral density, lacking studies on bone mineral density at other sites, total body bone mineral density, and an analysis of risk factors. This study aims to determine the potential association between NHHR and lumbar BMD, increase awareness of the impact of lipid levels on bone health.

Methods

By utilizing data from the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2018, we conducted univariate and generalized linear models (GLMs) analysis, stratified analysis, threshold effect analysis, smooth curve fitting and stratified analysis to investigate the association between NHHR and BMD. NHHR levels were categorized into tertiles (low, medium, and high) based on their distribution among the study population.

Results

The study included 8,671participants, studies have shown, the ratio of non-high-density lipoprotein to high-density lipoprotein (NHHR) exhibits a stratified correlation with bone mineral density (BMD). In the BMI subgroup, NHHR is significantly negatively correlated with BMD at multiple sites in the low-to-middle BMI group (BMI <25 kg/m2), while no significant correlation is found in the high BMI group (BMI ≥30 kg/m2). In the gender subgroup, NHHR has a more pronounced effect on male BMD, mainly reflected in the reduction of lumbar spine and total body BMD. In the age subgroup, the negative correlation between NHHR and BMD is strongest in the younger group (18-30 years), gradually weakening in the middle-aged (31-44 years) and older groups (45-59 years). Further analysis suggests that dyslipidemia may influence bone metabolism through pathways such as inflammation and oxidative stress.

Conclusion

The effect of NHHR on bone mineral density (BMD) varies by BMI, gender, and age. This study suggests that controlling NHHR levels may be a potential intervention target for bone health management, particularly for individuals with low-to-middle BMI, males, and younger populations. These findings offer a new perspective on the relationship between lipid metabolism and bone metabolism and provide scientific evidence for the development of personalized osteoporosis prevention and treatment strategies.

Prune extract prevents disuse osteoporosis by inhibiting the decrease in osteoblast-related gene expression in sciatic-denervated rats

In sedentary modern society, disuse osteoporosis is a health issue. Here, we investigate whether prune extract prevents disuse osteoporosis in rats. After feeding a control diet or 10% (wt/wt) prune extract-containing diet for 14 ‍days, we performed sham operation in the left leg and sciatic denervation in the right leg to induce disuse osteoporosis in rats. The rats were fed the same diet prior to surgery for 7 days. The rats fed a control diet before sham operation on both legs were set as the control group, and those with sciatic denervation in the right leg fed a control diet or prune extract containing diet were set as the denervation with control diet and denervation with prune extract diet groups, respectively. Femoral bone volume/tissue volume, trabecular number, and trabecular thickness were reduced in the right leg of denervation with control diet group; however, this reduction was not observed in the denervation with prune extract diet group. Similar results were obtained for mRNA levels of osteoblast-related genes, such as osteocalcin. Overall, prune extract inhibited bone loss by preventing the decrease in osteoblast-related gene expression in disuse osteoporosis, thus showing to improve the bone metabolism and quality of life.

Dynamic transcriptome analysis of osteal macrophages identifies a distinct subset with senescence features in experimental osteoporosis

Given the potential fundamental function of osteal macrophages in bone pathophysiology, we study here their precise function in experimental osteoporosis. Gene profiling of osteal macrophages from ovariectomized mice demonstrated the upregulation of genes that were involved in oxidative stress, cell senescence, and apoptotic process. A single-cell RNA-Seq analysis revealed that osteal macrophages were heterogeneously clustered into 6 subsets that expressed proliferative, inflammatory, antiinflammatory, and efferocytosis gene signatures. Importantly, postmenopausal mice exhibited an increase in subset 3 that showed a typical gene signature of cell senescence and inflammation. These findings suggest that the decreased production of estrogen due to postmenopausal condition altered the osteal macrophage subsets, resulting in a shift toward cell senescence and inflammatory conditions in the bone microenvironment. Furthermore, adoptive macrophage transfer onto calvarial bone was performed, and mice that received oxidatively stressed macrophages exhibited greater osteolytic lesions than control macrophages, suggesting the role of these cells in the development of inflammaging in the bone microenvironment. Consistently, depletion of senescent cells and the oxidatively stressed macrophage subset alleviated the excessive bone loss in postmenopausal mice. Our data provided insight into the pathogenesis of osteoporosis and shed light on a therapeutic approach for the treatment or prevention of postmenopausal osteoporosis.

Current status and dilemmas of osteoporosis screening tools: A narrative review

OBJECTIVE

This review aims to explore the strengths and dilemmas of existing osteoporosis screening tools and suggest possible ways of optimization, in addition to exploring the potential of AI-integrated X-ray imaging in osteoporosis screening, especially its ability to improve accuracy and applicability to different populations. To break through the dilemma of low accessibility, poor clinical translation, complexity of use, and apparent limitations of screening results of existing osteoporosis screening tools.

DATA SOURCES

A comprehensive literature search was performed using PubMed, Web of Science, and CNKI databases. The search included articles published between 2000 and 2023, focusing on studies evaluating osteoporosis screening tools, Artificial intelligence applications in medical imaging, and implementing AI technologies in clinical settings.

STUDY SELECTION

The Osteoporosis Risk Assessment Tool for Asians (OSTA), the Simple Calculated Osteoporosis Risk Estimator (SCORE), age, body size, one or no estrogen ever (ABONE), and the Osteoporosis Risk Index (OSIRIS) are the six commonly used screening tools for osteoporosis that are discussed in this review. In addition, the performance of AI-integrated imaging systems is explored in light of relevant research advances in Artificial intelligence in osteoporosis screening. Studies of the use of these tools in different populations and their advantages and disadvantages were included in the selection criteria.

RESULTS

The results highlight that AI-integrated X-ray imaging technologies offer significant improvements over traditional osteoporosis screening tools. Artificial intelligence systems demonstrated higher accuracy by incorporating complex clinical data and providing personalized assessments for diverse populations. The studies showed that AI-driven imaging could enhance sensitivity and specificity, particularly in detecting early-stage bone density loss in patients with complex clinical profiles. The findings also suggest that Artificial intelligence technologies have the potential to be effectively applied in resource-limited settings through the use of mobile devices and remote diagnostics.

CONCLUSIONS

AI-integrated X-ray imaging technology significantly advances osteoporosis screening, offering more accurate and adaptable solutions than traditional tools. Its ability to incorporate complex clinical data and apply it across various demographic groups makes it particularly promising in diverse and resource-limited environments. Further research is needed to explore the full potential of AI in enhancing screening accessibility and effectiveness, particularly in underserved populations.

Titanium Surface Synergy: Strontium Incorporation and Controlled Disorder Nanotopography Optimize Osteoinduction

Osteoporotic fractures and arthritis represent a major socioeconomic health burden. Fragility fracture fixation and joint replacement are often undertaken using titanium (Ti) or Ti alloy implants. Ideally these should induce bone formation and reduce osteoclast formation. Nanoscale topographies are potent inducers of osteogenesis, and strontium (Sr) has both osteogenic and antiosteoclastic effects. We incorporated strontium into a titanium surface with an osteogenic disordered nanoscale topography. The surface comprises 120 nm diameter, 100 nm deep pits in a near-square order with deliberate offset from the center pit position up to ±50 nm, providing a pattern with an average center-center pit spacing of 300 nm (called near-square 50, NSQ50). Several surfaces were assessed, including NSQ50 alone, strontium incorporated alone, and combined, compared with control surfaces. We assessed the surfaces using a human bone marrow stromal cell (BMSC)/ bone marrow hematopoietic cell (BHSC) coculture capable of osteogenesis and osteoclastogenesis. The samples eluted Sr over long-term culture, and uptake of Sr was better with eluted Sr than with Sr added to the culture media. The NSQ50 pattern in Ti was osteogenic, and addition of Sr elution increased osteogenesis further for both flat and NSQ50 samples. Interestingly, BMSCs on all Ti samples did not secrete the receptor activator of nuclear factor kappa-Β ligand (RANKL) or macrophage colony-stimulating factor (M-CSF) while secreting osteoprotegrin (OPG) at high levels. This meant that no osteoclast formation was observed on any Ti surface. Therefore, using Sr-incorporated nanotopographical imprinting, we generated highly osteogenic Ti surfaces that inhibited osteoclast formation.

Characteristics of falls in Japanese community-dwelling older adults

OBJECTIVE

Understanding the characteristics of falls among older adults is necessary to prevent them. These characteristics include questions such as when (month and time), where (places), who (age), what (injury), why (trigger), and how (direction) the falls occur. The objective of this study was to identify the characteristics of falls in individuals aged 65-74 years (young-old), 75-84 years (old-old), and ≥85 years (oldest-old).

METHODS

We conducted an observational mail survey among community-dwelling older adults in Japan and collected detailed information on the incidence of falls over the past 3 years. The month, time, location, trigger, direction, and resulting trauma of each fall were analyzed and compared across the different age groups (young-old, old-old, and oldest-old).

RESULTS

A total of 1695 falls among 1074 community-dwelling older adults were analyzed in this study. Falls were frequent during May and October as well as during the winter season from December to February, especially between 10:00 a.m. and 11:00 a.m. These fall characteristics were consistent across all the age groups. There was a higher incidence of outdoor falls among relatively young older adults, which were typically caused by tripping or slipping. However, as one progresses with age, there is a higher incidence of falls indoors, typically due to loss of balance or leg entrapment. Approximately 60% of older fallers experience some form of injury due to falls, with fractures considered the most serious, occurring in ≈10% of all falls.

CONCLUSION

We clarified the characteristics of falls including the "when, where, who, what, why, and how" of the fall. A future challenge is to use this valuable information to develop effective fall prevention programs for older populations worldwide. Geriatr Gerontol Int 2024; 24: 1181-1188.

Bone loss and fracture in people with multiple sclerosis: A systematic review and meta-analysis

BACKGROUND

People with multiple sclerosis (PwMS) exhibit reduced bone mineral density (BMD) across several anatomical regions. Studies have indicated that PwMS are at a heightened risk of fractures due to decreased BMD and increased prevalence of osteopenia and osteoporosis. This study aimed to investigate the prevalence and risk of osteopenia, osteoporosis, and fracture among PwMS.

METHODS

Relevant studies were identified through comprehensive searches of databases (PubMed/MEDLINE, Scopus, Embase, and Web of Science) from January 1, 2000, to January 21, 2024. R software version 4.4.0 and random-effects models were employed to estimate the pooled prevalence, odds ratio (OR), and risk ratio (RR) of osteopenia, osteoporosis, and fracture among PwMS, along with their respective 95 % confidence intervals (CIs).

RESULTS

From a total of 2039 articles, 51 studies with 1,503,785 PwMS met our inclusion criteria. The pooled prevalence of osteopenia, osteoporosis, and overall fracture among PwMS was 41.41 % (95 % CI: 36.14% to 46.69 %, I2=97 %), 14.21 % (95 % CI: 10.75 % to 17.68 %, I2=99 %), and 12.84 % (95 % CI: 8.49 % to 17.19 %, I2 = 100 %), respectively. The likelihood of osteopenia (OR=2.02, 95 % CI: 1.46 to 2.8, p-value<0.01, I2=17 %) and osteoporosis (OR=1.71, 95 % CI: 1.27 to 2.31, p-value<0.01, I2=74 %), as well as the probability of overall fracture (RR=1.86, 95 % CI: 1.61 to 2.14, p-value<0.01, I2=74 %) were significantly higher in PwMS than healthy controls (HCs).

CONCLUSION

PwMS were at a substantially increased risk of developing osteopenia (2-fold), osteoporosis (1.7-fold), and overall fractures (1.9-fold). Well-designed studies are needed to explore these associations further.

Disparities in Osteoporosis Prevention and Care: Understanding Gender, Racial, and Ethnic Dynamics

PURPOSE

Osteoporosis, the most prevalent metabolic bone disease, significantly impacts global public health by increasing fracture risks, particularly among post-menopausal women and the elderly. Osteoporosis is characterized by decreased bone mineral density (BMD) and deterioration of bone tissue, which leads to enhanced fragility. The disease is predominantly diagnosed using dual X-ray absorptiometry (DXA) and is significantly influenced by demographic factors such as age and hormonal changes. This chapter delves into the condition's complex nature, emphasizing the pervasive gender and racial disparities in its screening, diagnosis, and treatment.

RECENT FINDINGS

Recent findings highlight a substantial gap in the management of osteoporosis, with many individuals remaining under-screened and under-treated. Factors contributing to this include the asymptomatic early stages of the disease, lack of awareness, economic barriers, and inconsistent screening practices, especially in under-resourced areas. These challenges are compounded by disparities that affect different genders and races unevenly, influencing both the prevalence of the disease and the likelihood of receiving adequate healthcare services. The summary of this chapter underscores the urgent need for targeted strategies to overcome these barriers and improve health equity in osteoporosis care. Proposed strategies include enhancing public and healthcare provider awareness of osteoporosis, broadening access to diagnostic screenings, and integrating personalized treatment approaches. These efforts aim to align with global health objectives to mitigate the impacts of osteoporosis and ensure equitable health outcomes across all demographic groups.

Efficacy and safety of odanacatib in the treatment of postmenopausal women with osteoporosis: a meta-analysis

BACKGROUND

Osteoporosis, a systemic skeletal disease, seriously affects the quality of life in postmenopausal women. As one type of cathepsin K (CatK) inhibitor, odanacatib (ODN) is a fresh medication for osteoporosis. Considering the potential of ODN, we further examined the effect and safety of ODN for postmenopausal osteoporosis (PMOP) with a meta-analysis.

METHODS

PubMed, EMBASE, Cochrane Library, and Web of Science were searched for eligible studies from inception to December 29th, 2023. After that, we conducted a comprehensive meta-analysis following PRISMA guidelines. Risk of bias was meticulously investigated with the Cochrane Collaboration's tool. Efficacy was assessed with bone mineral density (BMD) at different sites (lumbar spine, trochanter, radius, femoral neck) and biomarkers of bone turnover (P1NP, uNTx/Cr, s-CTx, BSAP). Safety was evaluated by analyzing total, serious, other, and skin adverse events (AEs).

RESULTS

Four random clinical trials (RCTs) were involved in our research. All trials were rated as having high quality and met the eligibility criteria. In the current research, ODN was found to elevate BMD at lumbar spine, femoral neck, total hip, trochanter and forearm, while it decreased the levels of serum C-telopeptides of type I collagen (s-CTx) as well as urinary N-telopeptide/creatinine ratio (uNTx/Cr). No significant differences were observed in AEs between the ODN group and the control group.

CONCLUSIONS

ODN is a promising alternative for the treatment of PMOP on account of its excellent efficacy and credible safety. Unclear links between ODN and cardiovascular AEs require further research to clarify.

Diversity of the diet is correlated with osteoporosis in post-menopausal women: an Iranian case-control study

Background

Proper nutrition is a crucial factor in preventing osteoporosis, a significant pathological cause linked to skeletal weakness; this study investigated the relationship between dietary diversity score and food group diversity score with osteoporosis in postmenopausal women.

Methods

This case-control study was conducted on 378 menopausal women aged 45-85 in Tehran, Iran. The age-matching method to control the confounding effect of age was used. The method of dual-energy X-ray absorptiometry (DXA) was used for assessing the bone mineral density of lumbar vertebrae and femoral neck. The bone mass status was evaluated with WHO criteria. All subjects were divided into the osteoporosis group and the non-osteoporosis group according to their T-score. A convenience sampling method was utilized to select the participants, which included two groups: case (n = 189) and control (n = 189). Data was collected using demographic and anthropometric information questionnaires, a valid 147 item food frequency questionnaire, and a physical activity questionnaire. Statistical analyses were conducted using SPSS-26, and p-values less than 0.05 were deemed to be statistically significant.

Results

The results indicated significant differences in weight, body mass index, physical activity, smoking, and alcohol use between the two groups. The mean ± standard deviation of dietary diversity score (DDS) was lower in participants with osteoporosis (case) (3.31 ± 1.26) than in control (4.64 ± 1.33) (p < 0.001). The mean ± standard deviation of diversity score of cereals, fruits, and vegetables in the osteoporosis group (respectively: 0.71 ± 0.21, 0.94 ± 0.76, and 0.45 ± 0.44) was less than the control group (respectively: 0.80 ± 0.21, 1.64 ± 0.55 and 0.87 ± 0.42) (p < 0.001). After adjusting the confounding variables, the risk of osteoporosis had an inverse relationship with the diversity score of vegetable (OR = 0.16; 95%CI: 0.07-0.35), bread and cereal (OR = 0.21; 95% CI: 0.05-0.87) and fruit (OR = 0.35; 95%CI: 0.22-0.56) (p < 0.05). Nevertheless, no discernible correlation was seen between the tertiles of DDS, dairy and meat diversity score, and osteoporosis.

Conclusion

We found a correlation between the diversity score of fruits, vegetables, and grains and osteoporosis. However, there is no significant correlation between the DDS triads and the diversity score of dairy products and meats with osteoporosis.

The Impact of Depression on Detrimental Changes in Bone Microstructure in Female Mice

Background

Several clinical studies have examined the connection between depression and bone loss, but the cause-and-effect relationship between the two conditions, especially in animal models, is not well-studied.

Methods

A total of 32 female mice were, randomly divided into control group (CON, n=19) and depression group (DEP, n=13). The mice in the DEP group were subjected to 21 consecutive days of restraint stress, following depressive-like behaviors were assessment. The femurs were collected using Micro-Computed Tomography (μCT) and histochemical staining. In parallel, levels of serotonin-related proteins in the brain were measured using Western blot analysis, and sex hormone profiles were determined through liquid chromatography-mass spectrometry/mass spectrometry (LC-MS/MS).

Results

The mice in the DEP group exhibited clear signs of depressive-like behaviors and an increase in serotonin transporter levels (t=-2.435, P< 0.05). In comparison to the CON mice, the DEP mice showed a decrease in bone mineral density (t =3.741, P< 0.05), bone surface area density (t =8.009, P<0.01), percent bone volume (t =4.293, P< 0.05), trabecular number (t =5.844, P<0.01), and connected density (t =11.000, P< 0.05). Additionally, there was an increase in trabecular separation (t =-7.436, P<0.01) in DEP mice. Furthermore, the DEP mice displayed a significant reduction in serum estrogen levels (t =4.340, P< 0.05) and changes in its metabolite (t =-3.325, P< 0.05), while the levels of androgens remained unchanged.

Conclusion

The restraint stress not only led to the development of depressive-like behaviors but also disrupted the estrogen metabolism pathway, resulting in damage to bone mass and microstructure in female mice. These findings suggest that stress-induced depression may pose a risk for bone loss in female mice by altering estrogen metabolism pathways.

Comparison of the clinical effect of unilateral transverse process extrapedicular and bilateral transpedicular percutaneous kyphoplasty for thoracolumbar osteoporotic vertebral compression fracture

Background

Osteoporosis vertebral compression fractures (OVCF) are common with the aging process. This study aimed to compare the effects of unilateral transverse process extrapedicular (UEPKP) and bilateral transpedicular percutaneous kyphoplasty (BTPKP) for patients with thoracolumbar OVCF.

Methods

Data from 136 patients with OVCF treated with single-level PKP in our hospital between May 2019 and April 2021 were studied. Patients were grouped based on surgical procedure: there were 62 patients in the UEPKP group and 74 in the BTPKP group. All clinical and radiological data were collected from medical records. Clinical outcomes, including visual analog scale (VAS), Oswestry Disability Index (ODI), and Japanese Orthopaedic Association (JOA) scores of the lumbar spine, were evaluated preoperatively, postoperatively, and at the follow-up visit. The radiological evaluations (anterior vertebral height rate and local kyphosis angle) and complications were also collected.

Results

All patients had successfully improved after surgery. In the UEPKP group, patients showed a significantly shorter operating time and lower fluoroscopy frequency than patients in the BTPKP group (p < 0.05). However, a significantly better distribution score and cement volume were found in the BTPKP group (p < 0.05). The UEPKP group achieved a significantly better VAS score (0.6 ± 0.5 vs. 0.9 ± 0.8) and ODI (24.7 ± 3.1 vs. 27.5 ± 1.8) at the final follow-up visit than the BTPKP group (p < 0.05). The UEPKP group showed significantly worse radiological outcomes (anterior height rate and local kyphosis angle) at the 6- and 12-month follow-ups (p < 0.05). As for complications, the UEPKP group showed significantly fewer facet joint violations and intraspinal leakages (p < 0.05).

Conclusion

UEPKP could be a safe and effective alternative procedure for patients with thoracolumbar osteoporotic vertebral compression fracture, which possesses an apparent advantage in reducing intraspinal leakage and facet joint violation over BTPKP.

Prevalence of postmenopausal osteoporosis in Morocco: a systematic review and meta-analysis

INTRODUCTION

This systematic review and meta-analysis was conducted as part of the update of Moroccan recommendations for the management of postmenopausal osteoporosis. Its aim was to estimate the prevalence of postmenopausal osteoporosis in Morocco, based on available bibliographic data.

METHODS

We conducted a systematic search of the Medline/PubMed, Scopus, and Embase databases to identify articles published between January 2000 and January 2024. We included all observational studies reporting the prevalence of osteoporosis in postmenopausal women in Morocco. Two reviewers independently contributed to the study selection and data extraction. We assessed the risk of bias in the included studies using the Joanna Briggs Institute tool. Statistical analyses were performed using Stata with the Freeman-Tukey double arcsine transformation. Heterogeneity was assessed using the I2 test statistic. Meta-regression analysis was used to investigate the effect of the date on the prevalence. Publication bias was assessed by DOI plots and the LFK index.

RESULTS

An electronic search found a total of 161 citations from the databases. After excluding the irrelevant articles, 17 eligible studies were included. This meta-analysis included 5097 postmenopausal women. The pooled prevalence of postmenopausal osteoporosis was 32% (95% CI 28-36). Heterogeneity was statistically significant (I2 = 89.67%). There was no significant difference between subgroup analyses performed by risk of bias and sample size. The prevalence rate was significantly higher in 2006-2012 (36%; 95% CI 31-42; I2 = 88.7%; p < 0.001) than in 2013-2019 (27%; 95% CI 22-32; I2 = 85.9%; p < 0.001). Meta-regression showed that the prevalence of osteoporosis decreases very slightly (0.016% per year). This decrease becomes nonsignificant if only studies with a low risk of bias are included in the meta-regression (coefficient - 7.77, p = 0.667, I2 0%). No publication bias was detected in this meta-analysis.

CONCLUSION

Our results indicate that postmenopausal osteoporosis is prevalent in Morocco, which is a developing country; however, the prevalence of this disease is aligned with that of industrialized countries.

Independent and combined associations of dietary antioxidant intake with bone mineral density and risk of osteoporosis among elderly population in United States

BACKGROUND

The influence of dietary antioxidant intake on the occurrence and progression of osteoporosis may be significant. However, to date, evidence on the link between combined effect of dietary antioxidants on bone mineral density (BMD) level and risk of osteoporosis is limited. We aimed to assess the independent and combined association of dietary antioxidant intake with BMD level and risk of osteoporosis among elderly population in United States through analysis of data in the National Health and Nutrition Examination Survey.

METHODS

The dietary antioxidant intake was assessed based on six antioxidants, including vitamin A, vitamin C, vitamin E, zinc, selenium, and total carotenoid. A composite dietary antioxidant index (CDAI) was used to evaluate the combined exposure of dietary antioxidant intake.

RESULTS

A total of 5618 participants were included. Higher dietary vitamin A, vitamin C, vitamin E, zinc, selenium, and total carotenoid, were positively associated with BMD level. Compared with participants in the first quartile, those in the higher quartile of vitamin E (Q4: OR 0.652; 95% CI 0.463-0.918), zinc (Q4: OR 0.581; 95% CI 0.408-0.826), and selenium (Q3: OR 0.673; 95% CI 0.503-0.899) were associated with decreased risk of overall osteoporosis. Furthermore, compared to those in the first quartile, participants in the highest quartile of CDAI were associated with increased total femur (β 0.019; 95% CI 0.007-0.032), femur neck (β 0.020; 95% CI 0.009-0.032), trochanter (β 0.012; 95% CI 0.001-0.023), and intertrochanter BMD level (β 0.022; 95% CI 0.007-0.037); participants in the highest quartile of CDAI were associated with decreased risk of overall osteoporosis (OR 0.536; 95% CI 0.376-0.763). Furthermore, the associations of CDAI with the BMD level and osteoporosis risk were more significant among female participants.

CONCLUSION

Our study provides evidence that a combination of dietary antioxidants intake was associated increased BMD level and decreased osteoporosis risk.

The single point insulin sensitivity estimator (SPISE) is associated with bone health in Arab adults

BACKGROUND

The Single Point Insulin Sensitivity Estimator (SPISE) index is a surrogate marker for insulin sensitivity. Given the emerging role of bone as an active endocrine organ, its associations with non-invasive measures of extra-skeletal functions such as insulin sensitivity warrant investigation.

AIMS

This study aimed to explore the relationship between the SPISE index and Bone Mineral Density (BMD) in an adult population.

METHODS

Data from a total of 1270 Arab adults (84% females, mean age 56.7 ± 8.1 years) from the Osteoporosis Registry Database of the Chair for Biomarkers of Chronic Diseases in King Saud University, Riyadh, Saudi Arabia was used in this study. T-scores and SPISE were calculated. Regression models were used to determine associations between SPISE and bone health indices.

RESULTS

The low BMD group (N = 853; T-score <-1.0) had significantly higher SPISE values than those with normal BMD (N = 417; T-score - 1.0 and above) (4.6 ± 1.3 vs. 4.3 ± 1.2, p < 0.001). Multivariate linear regression, adjusted for covariates, confirmed a significant inverse association between SPISE and BMD for all participants (β=-0.22, p < 0.001), as well as both groups [normal BMD (β = -0.10, p = 0.02) and low BMD groups (β = -0.15, p < 0.001)]. SPISE, family history of T2DM, and history of fractures collectively account for 17% of the variances perceived in T-score for all participants (p < 0.001).

CONCLUSIONS

A significant inverse association between the SPISE index and BMD was observed in adults, suggesting a link between BMD and extra-skeletal health. Underlying mechanisms need to be investigated prospectively using BMD as secondary outcomes in lifestyle modification programs.

Gamified Exercise with Kinect: Can Kinect-Based Virtual Reality Training Improve Physical Performance and Quality of Life in Postmenopausal Women with Osteopenia? A Randomized Controlled Trial

BACKGROUND

Osteopenia, caused by estrogen deficiency in postmenopausal women (PMW), lowers Bone Mineral Density (BMD) and increases bone fragility. It affects about half of older women's social and physical health. PMW experience pain and disability, impacting their health-related Quality of Life (QoL) and function. This study aimed to determine the effects of Kinect-based Virtual Reality Training (VRT) on physical performance and QoL in PMW with osteopenia.

METHODOLOGY

The study was a prospective, two-arm, parallel-design, randomized controlled trial. Fifty-two participants were recruited in the trial, with 26 randomly assigned to each group. The experimental group received Kinect-based VRT thrice a week for 24 weeks, each lasting 45 min. Both groups were directed to participate in a 30-min walk outside every day. Physical performance was measured by the Time Up and Go Test (TUG), Functional Reach Test (FRT), Five Times Sit to Stand Test (FTSST), Modified Sit and Reach Test (MSRT), Dynamic Hand Grip Strength (DHGS), Non-Dynamic Hand Grip Strength (NDHGS), BORG Score and Dyspnea Index. Escala de Calidad de vida Osteoporosis (ECOS-16) questionnaire measured QoL. Both physical performance and QoL measures were assessed at baseline, after 12 weeks, and after 24 weeks. Data were analyzed on SPSS 25.

RESULTS

The mean age of the PMW participants was 58.00 ± 5.52 years. In within-group comparison, all outcome variables (TUG, FRT, FTSST, MSRT, DHGS, NDHGS, BORG Score, Dyspnea, and ECOS-16) showed significant improvements (p < 0.001) from baseline at both the 12th and 24th weeks and between baseline and the 24th week in the experimental group. In the control group, all outcome variables except FRT (12th week to 24th week) showed statistically significant improvements (p < 0.001) from baseline at both the 12th and 24th weeks and between baseline and the 24th week. In between-group comparison, the experimental group demonstrated more significant improvements in most outcome variables at all points than the control group (p < 0.001), indicating the positive additional effects of Kinect-based VRT.

CONCLUSION

The study concludes that physical performance and QoL measures were improved in both the experimental and control groups. However, in the group comparison, these variables showed better results in the experimental group. Thus, Kinect-based VRT is an alternative and feasible intervention to improve physical performance and QoL in PMW with osteopenia. This novel approach may be widely applicable in upcoming studies, considering the increasing interest in virtual reality-based therapy for rehabilitation.

Translation and cross-cultural adaptation of Osteoporosis Knowledge Assessment Tool (OKAT) for Chinese populations in Australia

The increased prevalence of osteoporosis among Chinese-speaking communities in Australia deemed it necessary to have a culturally appropriate tool for assessing knowledge. This study describes the cultural adaption of the validated Osteoporosis Knowledge Assessment Tool (OKAT). The adapted tool is readable and understandable for diverse Chinese-speaking communities.

PURPOSE

With an expected increasing prevalence of osteoporosis among Chinese-speaking communities in Australia, a cross-culturally adapted questionnaire is necessary to assess knowledge levels among the group. We aimed to cross-culturally adapt the Osteoporosis Knowledge Assessment Tool (OKAT) questionnaire for Chinese-speaking populations in Australia.

METHODS

Cross-cultural adaptation guidelines were employed to culturally adapt the OKAT to simplified Chinese. This involved translation, revision, retroversion, and expert discussion before finalizing the Chinese version of OKAT. The participants were recruited through convenience sampling from a cohort of Chinese-speaking populations who attended a bone health promotion program. The adapted questionnaire was piloted with Chinese-speaking communities in the Greater Western Sydney area for face and content validity. The adapted questionnaire was compared with the original version for response agreement using Cohen's kappa goodness of fit. The face validity of the adapted tool was analysed through a binary scale rating for readability and understandability.

RESULTS

The cross-culturally adapted version of OKAT has a 71.8% total response agreement with the original version of OKAT. The cross-culturally adapted OKAT yielded higher total scores than the translated version. The cross-culturally adapted tool had a good face and content validity.

CONCLUSION

The cross-culturally adapted version of OKAT improves the overall readability and understandability of the questionnaire among Chinese-speaking populations in Australia.

Survey on Actual Management of Osteoporosis with the Japanese Medical Data Vision Database in Elderly Patients Undergoing Spinal Fusion

Background: No actual data on spinal fusion and management of osteoporosis in Japan have been reported. The aim of the survey was to investigate pre- and post-operative management of osteoporosis, including testing and prescription, in elderly patients undergoing spinal fusion in Japan. Methods: Medical data on patients aged 65 years or older undergoing spinal fusion from April 2018 to March 2022 were extracted from the medical data vision (MDV) database containing health insurance claims data from Japanese acute care hospitals to investigate fusion area, pre- and post-operative osteoporosis tests (bone mineral density and osteoporosis markers), prescriptions of osteoporosis medications, and other information. Results: The analysis set consisted of 26,959 patients. Annual pre-operative BMD testing rates and osteoporosis markers testing rates were higher than the post-operative rates without significant annual changes. The post-operative prescription rate of osteoporosis medications throughout the target period was approximately two times higher than the preoperative rate. The drug with highest pre- and post-operative prescription rates was teriparatide (TPTD) followed by bisphosphonates, showing that the prescription rate of TPTD proportionally increased with the length of fusion area. Conclusions: It was suggested that patients aged 65 years or older undergoing spinal fusion might receive insufficient osteoporosis tests. Despite no trend in the testing rate with the length of fusion area, some tendency was observed in the selection of osteoporosis medications. In patients with osteoporosis undergoing spinal fusion, early examination, diagnosis, and therapeutic intervention may improve the prognoses, and solid testing and prescriptions are therefore expected.

Clusters from chronic conditions in the Danish adult population

Multimorbidity, the presence of 2 or more chronic conditions in a person at the same time, is an increasing public health concern, which affects individuals through reduced health related quality of life, and society through increased need for healthcare services. Yet the structure of chronic conditions in individuals with multimorbidity, viewed as a population, is largely unmapped. We use algorithmic diagnoses and the K-means algorithm to cluster the entire 2015 Danish multimorbidity population into 5 clusters. The study introduces the concept of rim data as an additional tool for determining the number of clusters. We label the 5 clusters the Allergies, Chronic Heart Conditions, Diabetes, Hypercholesterolemia, and Musculoskeletal and Psychiatric Conditions clusters, and demonstrate that for 99.32% of the population, the cluster allocation can be determined from the diagnoses of 4-5 conditions. Clusters are characterized through most prevalent conditions, absent conditions, over- or under-represented conditions, and co-occurrence of conditions. Clusters are further characterized through socioeconomic variables and healthcare service utilizations. Additionally, geographical variations throughout Denmark are studied at the regional and municipality level. We find that subdivision into municipality levels suggests that the Allergies cluster frequency is positively associated with socioeconomic status, while the subdivision suggests that frequencies for clusters Diabetes and Hypercholesterolemia are negatively correlated with socioeconomic status. We detect no indication of association to socioeconomic status for the Chronic Heart Conditions cluster and the Musculoskeletal and Psychiatric Conditions cluster. Additional spatial variation is revealed, some of which may be related to urban/rural populations. Our work constitutes a step in the process of characterizing multimorbidity populations, leading to increased comprehension of the nature of multimorbidity, and towards potential applications to individual-based care, prevention, the development of clinical guidelines, and population management.

Etidronate for the primary and secondary prevention of osteoporotic fractures in postmenopausal women

BACKGROUND

Osteoporosis is an abnormal reduction in bone mass and bone deterioration, leading to increased fracture risk. Etidronate belongs to the bisphosphonate class of drugs which act to inhibit bone resorption by interfering with the activity of osteoclasts - bone cells that break down bone tissue. This is an update of a Cochrane review first published in 2008. For clinical relevance, we investigated etidronate's effects on postmenopausal women stratified by fracture risk (low versus high).

OBJECTIVES

To assess the benefits and harms of intermittent/cyclic etidronate in the primary and secondary prevention of osteoporotic fractures in postmenopausal women at lower and higher risk of fracture, respectively.

SEARCH METHODS

We searched the Cochrane Central Register of Control Trials (CENTRAL), MEDLINE, Embase, two clinical trial registers, the websites of drug approval agencies, and the bibliographies of relevant systematic reviews. We identified eligible trials published between 1966 and February 2023.

SELECTION CRITERIA

We included randomized controlled trials that assessed the benefits and harms of etidronate in the prevention of fractures for postmenopausal women. Women in the experimental arms must have received at least one year of etidronate, with or without other anti-osteoporotic drugs and concurrent calcium/vitamin D. Eligible comparators were placebo (i.e. no treatment; or calcium, vitamin D, or both) or another anti-osteoporotic drug. Major outcomes were clinical vertebral, non-vertebral, hip, and wrist fractures, withdrawals due to adverse events, and serious adverse events. We classified a study as secondary prevention if its population fulfilled one or more of the following hierarchical criteria: a diagnosis of osteoporosis, a history of vertebral fractures, a low bone mineral density T-score (≤ -2.5), or aged 75 years or older. If none of these criteria were met, we considered the study to be primary prevention.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane. The review has three main comparisons: (1) etidronate 400 mg/day versus placebo; (2) etidronate 200 mg/day versus placebo; (3) etidronate at any dosage versus another anti-osteoporotic agent. We stratified the analyses for each comparison into primary and secondary prevention studies. For major outcomes in the placebo-controlled studies of etidronate 400 mg/day, we followed our original review by defining a greater than 15% relative change as clinically important. For all outcomes of interest, we extracted outcome measurements at the longest time point in the study.

MAIN RESULTS

Thirty studies met the review's eligibility criteria. Of these, 26 studies, with a total of 2770 women, reported data that we could extract and quantitatively synthesize. There were nine primary and 17 secondary prevention studies. We had concerns about at least one risk of bias domain in each study. None of the studies described appropriate methods for allocation concealment, although 27% described adequate methods of random sequence generation. We judged that only 8% of the studies avoided performance bias, and provided adequate descriptions of appropriate blinding methods. One-quarter of studies that reported efficacy outcomes were at high risk of attrition bias, whilst 23% of studies reporting safety outcomes were at high risk in this domain. The 30 included studies compared (1) etidronate 400 mg/day to placebo (13 studies: nine primary and four secondary prevention); (2) etidronate 200 mg/day to placebo (three studies, all secondary prevention); or (3) etidronate (both dosing regimens) to another anti-osteoporotic agent (14 studies: one primary and 13 secondary prevention). We discuss only the etidronate 400 mg/day versus placebo comparison here. For primary prevention, we collected moderate- to very low-certainty evidence from nine studies (one to four years in length) including 740 postmenopausal women at lower risk of fractures. Compared to placebo, etidronate 400 mg/day probably results in little to no difference in non-vertebral fractures (risk ratio (RR) 0.56, 95% confidence interval (CI) 0.20 to 1.61); absolute risk reduction (ARR) 4.8% fewer, 95% CI 8.9% fewer to 6.1% more) and serious adverse events (RR 0.90, 95% CI 0.52 to 1.54; ARR 1.1% fewer, 95% CI 4.9% fewer to 5.3% more), based on moderate-certainty evidence. Etidronate 400 mg/day may result in little to no difference in clinical vertebral fractures (RR 3.03, 95% CI 0.32 to 28.44; ARR 0.02% more, 95% CI 0% fewer to 0% more) and withdrawals due to adverse events (RR 1.41, 95% CI 0.81 to 2.47; ARR 2.3% more, 95% CI 1.1% fewer to 8.4% more), based on low-certainty evidence. We do not know the effect of etidronate on hip fractures because the evidence is very uncertain (RR not estimable based on very low-certainty evidence). Wrist fractures were not reported in the included studies. For secondary prevention, four studies (two to four years in length) including 667 postmenopausal women at higher risk of fractures provided the evidence. Compared to placebo, etidronate 400 mg/day may make little or no difference to non-vertebral fractures (RR 1.07, 95% CI 0.72 to 1.58; ARR 0.9% more, 95% CI 3.8% fewer to 8.1% more), based on low-certainty evidence. The evidence is very uncertain about etidronate's effects on hip fractures (RR 0.93, 95% CI 0.17 to 5.19; ARR 0.0% fewer, 95% CI 1.2% fewer to 6.3% more), wrist fractures (RR 0.90, 95% CI 0.13 to 6.04; ARR 0.0% fewer, 95% CI 2.5% fewer to 15.9% more), withdrawals due to adverse events (RR 1.09, 95% CI 0.54 to 2.18; ARR 0.4% more, 95% CI 1.9% fewer to 4.9% more), and serious adverse events (RR not estimable), compared to placebo. Clinical vertebral fractures were not reported in the included studies.

AUTHORS' CONCLUSIONS

This update echoes the key findings of our previous review that etidronate probably makes or may make little to no difference to vertebral and non-vertebral fractures for both primary and secondary prevention.

External validation of a deep learning model for predicting bone mineral density on chest radiographs

We developed a new model for predicting bone mineral density on chest radiographs and externally validated it using images captured at facilities other than the development environment. The model performed well and showed potential for clinical use.

PURPOSE

In this study, we performed external validation (EV) of a developed deep learning model for predicting bone mineral density (BMD) of femoral neck on chest radiographs to verify the usefulness of this model in clinical practice.

METHODS

This study included patients who visited any of the collaborating facilities from 2010 to 2020 and underwent chest radiography and dual-energy X-ray absorptiometry (DXA) at the femoral neck in the year before and after their visit. A total of 50,114 chest radiographs were obtained, and BMD was measured using DXA. We developed the model with 47,150 images from 17 facilities and performed EV with 2914 images from three other facilities (EV dataset). We trained the deep learning model via ensemble learning based on chest radiographs, age, and sex to predict BMD using regression. The outcomes were the correlation of the predicted BMD and measured BMD with diagnoses of osteoporosis and osteopenia using the T-score estimated from the predicted BMD.

RESULTS

The mean BMD was 0.64±0.14 g/cm2 in the EV dataset. The BMD predicted by the model averaged 0.61±0.08 g/cm2, with a correlation coefficient of 0.68 (p<0.01) when compared with the BMD measured using DXA. The accuracy, sensitivity, and specificity of the model were 79.0%, 96.6%, and 34.1% for T-score < -1 and 79.7%, 77.1%, and 80.4% for T-score ≤ -2.5, respectively.

CONCLUSION

Our model, which was externally validated using data obtained at facilities other than the development environment, predicted BMD of femoral neck on chest radiographs. The model performed well and showed potential for clinical use.

Association of Decreased Bone Density and Hyperlipidemia in a Taiwanese Older Adult Population

Objective

This study aimed to determine if a combination of 2 abnormal lipid profiles revealed a stronger association with low bone mass than a single blood lipid abnormality alone.

Methods

This study enrolled 1373 participants who had received a dual-energy x-ray absorptiometry scan from January 2016 to December 2016 in a medical center in southern Taiwan. Logistic regression was used to examine association between lipid profiles and osteopenia or osteoporosis after adjusting for covariates.

Results

Compared to people with total cholesterol (TC) < 200 mg/dL, those with TC ≥ 240 mg/dL tended to have osteopenia or osteoporosis (OR 2.61; 95% CI, 1.44-4.71). Compared to people with low-density lipoprotein cholesterol (LDL-C) < 130 mg/dL, those with LDL-C ≥ 160 mg/dL tended to develop osteopenia or osteoporosis (OR 2.13; 95% CI, 1.21-3.74). The association of increased triglyceride and decreased bone mass was similar, although not statistically significant. Those with the combination of TG ≥ 200 mg/dL and TC ≥ 240 mg/dL had a stronger tendency to have osteopenia or osteoporosis (OR 3.51; 95% CI, 1.11-11.13) than people with only one blood lipid abnormality. Similarly, people with TG ≥ 200 mg/dL and LDL-C ≥ 160 mg/dL had a stronger tendency to have osteopenia or osteoporosis (OR 9.31; 95% CI, 1.15-75.42) than people with only one blood lipid abnormality, after adjustment for the same covariates.

Conclusion

Blood levels of TC, LDL-C, and TG were associated with osteopenia or osteoporosis. Results indicate that individuals aged older than 50 years with abnormal lipid profiles should be urged to participate in a bone density survey to exclude osteopenia or osteoporosis.

Management of Osteoporosis, Fracture and Falls in People with Multiple Sclerosis: Systematic Review of Guidelines

People with multiple sclerosis (MS) have a higher prevalence of osteoporosis, falls and fractures. Guidelines for MS populations targeting the management of osteoporosis, fracture and falls risk may help reduce the burden of musculoskeletal disease in this population. We aimed to systematically review current guidelines regarding osteoporosis prevention, screening, diagnosis and management in people with MS. In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, a systematic review of scientific databases (MEDLINE, CINAHL, Embase and Scopus) was performed (n = 208). In addition, websites from MS organisations and societies were screened for clinical guidelines (n = 28). Following duplicate removal, screening and exclusions (n = 230), in total six guidelines were included in this review. Three of the identified guidelines were specific to managing osteoporosis in MS, while two linked vitamin D to bone health and one was focused on the effect of acute glucocorticoid use for MS exacerbations on bone health. All guidelines were found to contain inadequate recommendations for osteoporosis screening, management and treatment in people with MS given the evidence of higher prevalence of osteoporosis at an earlier age and compounding risk factors in this population. Early diagnosis and treatment of osteoporosis in people with MS is necessary as fractures lead to significant morbidity and mortality. Development of structured clinical guidelines directed at specific healthcare services will ensure screening, appropriate management, and care of bone health in people with MS.

Osteoporosis guidelines on TCM drug therapies: a systematic quality evaluation and content analysis

OBJECTIVE

The aims of this study were to evaluate the quality of osteoporosis guidelines on traditional Chinese medicine (TCM) drug therapies and to analyze the specific recommendations of these guidelines.

METHODS

We systematically collected guidelines, evaluated the quality of the guidelines using the Appraisal of Guidelines Research and Evaluation (AGREE) II tool, and summarized the recommendations of TCM drug therapies using the Patient-Intervention-Comparator-Outcome (PICO) model as the analysis framework.

RESULTS AND CONCLUSIONS

A total of 20 guidelines were included. Overall quality evaluation results revealed that four guidelines were at level A, four at level B, and 12 at level C, whose quality needed to be improved in the domains of "stakeholder involvement", "rigor of development", "applicability" and "editorial independence". Stratified analysis suggested that the post-2020 guidelines were significantly better than those published before 2020 in the domains of "scope and purpose", "stakeholder involvement" and "editorial independence". Guidelines with evidence systems were significantly better than those without evidence systems in terms of "stakeholder involvement", "rigor of development", "clarity of presentation" and "applicability". The guidelines recommended TCM drug therapies for patients with osteopenia, osteoporosis and osteoporotic fracture. Recommended TCM drugs were mainly Chinese patent medicine alone or combined with Western medicine, with the outcome mainly focused on improving bone mineral density (BMD).

Identification of the transcriptome signatures and immune-inflammatory responses in postmenopausal osteoporosis

Postmenopausal osteoporosis is the most common type of osteoporosis in women. To date, little is known about their transcriptome signatures, although biomarkers from peripheral blood mononuclear cells are attractive for postmenopausal osteoporosis diagnoses. Here, we performed bulk RNA sequencing of 206 samples (124 postmenopausal osteoporosis and 82 normal samples) and described the clinical phenotypic characteristics of postmenopausal women. We then highlighted the gene set enrichment analyses between the extreme T-score group and the heathy control group, revealing that some immune-inflammatory responses were enhanced in postmenopausal osteoporosis, with representative pathways including the mitogen-activated protein kinase (NES = 1.6, FDR <0.11) pathway and B_CELL_RECEPTOR (NES = 1.69, FDR <0.15) pathway. Finally, we developed a combined risk prediction model based on lasso-logistic regression to predict postmenopausal osteoporosis, which combined eleven genes (PTGS2, CXCL16, NECAP1, RPS23, SSR3, CD74, IL4R, BTBD2, PIGS, LILRA2, MAP3K11) and three pieces of clinical information (age, procollagen I N-terminal propeptide, β isomer of C-terminal telopeptide of type I) and provided the best prediction ability (AUC = 0.97). Taken together, this study filled a gap in the large-scale transcriptome signature profiles and revealed the close relationship between immune-inflammatory responses and postmenopausal osteoporosis, providing a unique perspective for understanding the occurrence and development of postmenopausal osteoporosis.

The estimated prevalence of osteoporosis in Bahrain: a multi-centered-based study

OBJECTIVES

the primary aim of this study was to examine the prevalence and risk factors of low bone mineral density in Bahrain.

METHODS

this was a retrospective study, which targeted a cohort of 4822 Bahraini subjects (mean age 59.36 years: 93% females). Demographic data and results of lumbar and femur DEXA scan for the targeted sample, over the period 2016-2018, were retrieved from four hospitals.

RESULTS

The prevalence of low BMD was 62.3% (46.4% had osteopenia and 15.9% had osteoporosis). The highest rate of osteopenia was detected at the age group younger than 44 years. However, with increasing age, the rate of osteopenia declined, whereas osteoporosis increased (P < 0.001). Females were found to be at higher risk of developing both osteopenia (45.8%) and osteoporosis (18.1%) compared to males (39% and 12.4%, respectively) (P < 0.001). Postmenopausal women exhibited higher rates of low BMD (42.4% osteopenia, 22.3% osteoporosis) compared to elderly men (30.9% osteopenia, 9% osteoporosis).

CONCLUSIONS

We reported high prevalence of osteopenia and osteoporosis in Bahrain. Low BMD was more common in females, especially in postmenopausal women. Highest prevalence of osteopenia happened at young age. Therefore, we advocate screening at younger age than previously recommended.

Potential alleviation of bone mineral density loss with Janus kinase inhibitors in rheumatoid arthritis

OBJECTIVE

Rheumatoid arthritis (RA) is characterized by localized bone loss, general osteoporosis and increased fracture risks. Tumour necrosis factor inhibitors (TNFi), non-tumour necrosis factor inhibitors (non-TNFi) biologic, Janus kinase inhibitors (JAKi) had shown the suppression effects to osteoclast activation and improvement of bone mineral density (BMD). Anti-cyclic citrullinated peptide antibody (ACPA) is associated with osteoclast activation and the resultant bone loss. However, few studies have compared BMD changes among patients with RA treated with targeted therapies that have different mechanisms of action.

METHODS

This retrospective study recruited patients with RA who had undergone BMD testing twice. Changes in the BMD were compared using the generalized estimating equation (GEE) in treatment groups that received conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs), TNFi, non-TNFi biologics, and JAKi.

RESULTS

In total, 362 patients with RA were enrolled (csDMARDs, n = 153, TNFi, n = 71, non-TNFi biologics, n = 108, JAKi, n = 30). We observed greater changes in femoral BMD (left, 0.06, 95% CI 0.01-0.12, p = 0.016; right, 0.09, 95% CI 0.04-0.15, p = 0.001 by GEE) following JAKi treatment as compared with other treatments. Compared to the ACPA-negative group, patients with ACPA positivity exhibited greater improvement in the femoral BMD (left, 0.09, 95% CI 0.02-0.15, p = 0.008; right, 0.11, 95% CI 0.05-0.18, p = 0.001).

CONCLUSION

Compared to other targeted therapies, JAKi might exert a more potent effect to prevent BMD loss, specifically in ACPA-positive patients with RA, and could be a potential therapeutic option to mitigate generalized bone loss. Key Points •JAKi therapy inhibits systemic bone loss in patients with RA. •ACPA-positive RA patients exhibited a greater BMD improvement than ACPA-negative RA patients. •JAKi might more potently prevent BMD decline than conventional synthetic or biological DMARDs.

Continuous positive airway pressure treatment improves bone mineral density in men affected by severe obstructive sleep apnea syndrome

STUDY OBJECTIVES

Obstructive sleep apnea (OSA) and low bone mineral density (BMD) are 2 prevalent conditions with a significant negative impact on patients' well-being and quality of life. Recent research has shown low BMD at different bone sites in male patients with OSA. Although the efficacy of continuous positive airway pressure (CPAP) treatment for OSA has been widely demonstrated, the evidence for understanding its impact on BMD and other bone-related outcomes is insufficient. The aim of this observational study was to investigate the effect of 12 months of CPAP treatment on lumbar and femur BMD and bone-related serum biomarkers in male patients with severe OSA.

METHODS

Sixty patients (mean age: 55.1 ± 9.9 years) were consecutively included and underwent BMD measurement with dual-energy x-ray absorptiometry at baseline and after 12 months of CPAP treatment. Vitamin D, parathyroid hormone, and calcium serum levels were examined at the same time points.

RESULTS

A significant increase in BMD in the L1 (P < .001, d = 0.27) and L2 (P < .001, d = 0.26) vertebrae was observed after CPAP treatment, along with an increase in vitamin D (P < .001, d = 0.71) and calcium (P < .001, d = 0.73) levels and a decrease in parathyroid hormone levels (P < .001, d = 0.60). The increase in BMD in L1 was significantly correlated with the decrease in parathyroid hormone serum levels (r = -.50, P < .001).

CONCLUSIONS

Overall, these findings showed that beneficial OSA treatment might restore bone health and support CPAP treatment as a feasible strategy to improve BMD in male patients with severe OSA. Accordingly, diagnosing and targeting OSA may be warranted in the treatment of male patients with undetermined osteopenia and osteoporosis.

CITATION

Carpi M, Cordella A, Placidi F, et al. Continuous positive airway pressure treatment improves bone mineral density in men affected by severe obstructive sleep apnea syndrome. J Clin Sleep Med. 2024;20(1):67-73.

Effectiveness of romosozumab in patients with osteoporosis at high fracture risk: a Japanese real-world study

INTRODUCTION

To describe the real-world use of romosozumab in Japan, we conducted a chart review of > 1000 Japanese patients with osteoporosis (OP) at high risk of fracture, across multiple medical institutions.

MATERIALS AND METHODS

Treatment-naïve and prior OP-treatment patients who received romosozumab for 12 months followed by ≥ 6 months of sequential OP treatment were included. The primary objective described the baseline demographics and clinical characteristics; secondary objectives evaluated changes in bone mineral density (BMD) and bone turnover markers in all patients and effectiveness of romosozumab in a sub-group of treatment-naïve patients using the fracture risk assessment tool (FRAX®).

RESULTS

Of the 1027 patients (92.4% female), 45.0% were treatment-naïve. The mean ± SD age of treatment-naïve versus prior OP-treatment patients was 76.8 ± 8.5 and 77.1 ± 8.5 years. The most frequent prior OP treatment was bisphosphonates (45.0%). Romosozumab treatment for 12 months increased BMD at the lumbar spine in all groups; the median percent change from baseline in lumbar spine BMD was higher in the treatment-naïve (13.4%) versus prior OP-treatment group (bisphosphonates [9.2%], teriparatide [11.3%], denosumab [DMAb, 4.5%]). DMAb, bisphosphonates, or teriparatide after romosozumab maintained the BMD gains at all skeletal sites at month 18 in treatment-naïve patients. Most treatment-naïve patients were at high risk of fracture, BMD increased consistently with romosozumab regardless of the baseline fracture risk assessed by FRAX.

CONCLUSION

This large-scale, multicenter chart review provides clinically relevant insights into the profiles of patients initiating romosozumab, effectiveness of real-world romosozumab use, and sequential therapy in Japanese patients at high risk of fracture.

Association of osteoporosis and high serum homocysteine levels with intraoperative periprosthetic fracture during total hip arthroplasty: a propensity-score matching analysis

INTRODUCTION

Intraoperative periprosthetic fracture, one of the most frequent complications of total hip arthroplasty, is a very important factor that affects rehabilitation, hospitalization time, and cost of treatment. Osteoporosis is common in total hip arthroplasty patients and likely contributes to the increasing incidence of periprosthetic fracture. Despite this awareness, preoperative and postoperative osteoporosis evaluations remain insufficient. The purpose of this study was to evaluate the relationships between the occurrence of intraoperative periprosthetic fractures and both bone mineral density (BMD) and osteoporosis-related biomarkers.

MATERIALS AND METHODS

This single-center retrospective study included a total of consecutive 487 hip joints of patients with a mean age of 65.5 ± 11.8 years who underwent total hip arthroplasty between July 2017 and December 2020. Patients with low BMD defined as T-score < -1.0 versus those with normal BMD were matched by a 1:1 propensity score to balance for patient baseline characteristics, and outcome was analyzed by a modified Poisson regression model. Our primary outcome was the incidence of intraoperative periprosthetic fracture during surgery. We also investigated the effect modification of osteoporosis-related biomarkers, including tartrate-resistant acid phosphatase 5b (TRACP-5b), total procollagen type 1 amino-terminal propeptide (total P1-NP), intact parathyroid hormone (intact PTH), and homocysteine, on osteoporosis and outcomes.

RESULTS

After matching, 250 patients were analyzed. The risk of fracture was significantly higher in patients with low BMD than in normal BMD patients (Incidence rate ratio 5.00 [95% CI 1.11-22.43], p = 0.036). We also observed significant effect of high serum homocysteine on the occurrence of intraoperative fractures (Incidence rate ratio 8.38 × 106 [95% C; 3.44 × 106-2.01 × 107], p < 0.01).

CONCLUSION

Preoperative osteoporosis and high serum homocysteine levels were risk factors for intraoperative periprosthetic fractures.

LEVEL OF EVIDENCE

III, A single-center retrospective study.

Medication and bone health in multiple sclerosis: A systematic review and meta-analysis

BACKGROUND

People with multiple sclerosis (MS) are often prescribed medications associated with adverse effects on bone health. However, it is unclear whether these medications incur decreases in areal bone mineral density (aBMD) and higher fracture risk in this population.

OBJECTIVE

To investigate the effects of commonly used medications on aBMD and fracture risk among people with MS.

METHODS

MEDLINE, Embase, Scopus, CINAHL, and Web of Science were searched from their inception until February 5, 2023. We included randomized controlled trials as well as cross-sectional, retrospective, and prospective studies investigating whether glucocorticoids, immunomodulators, antidepressants, anticonvulsants, anxiolytics, opioids, or antipsychotics influenced aBMD or fracture risk in people with MS. Data were pooled using random effects meta-analyses to determine hazard ratios (HRs) and 95% CIs.

RESULTS

We included 22 studies (n = 18,193). Six studies were included in the meta-analyses of glucocorticoid use and aBMD, whereas 2 studies were included in the medication use and fracture risk meta-analyses. No studies assessed the effect of antidepressants, anxiolytics, anticonvulsants, opioids, and antipsychotics on aBMD, and no studies assessed the effect of immunomodulators on fracture risk. Glucocorticoid use was significantly negatively associated with femoral neck aBMD (correlation = -0.21 [95% CI = -0.29 to -0.13]), but not with lumbar spine aBMD (correlation = -0.21 [95% CI = -0.50 to 0.12]). There were no differences in fracture risk between users of glucocorticoids (HR = 1.71 [95% CI = 0.04 to 76.47]), antidepressants (HR = 1.84 [95% CI = 0.09 to 38.49]), or anxiolytics (HR = 2.01 [95% CI = 0.06 to 64.22]), compared with nonusers.

CONCLUSIONS

The available evidence is insufficient to support a relationship between greater fracture risk for people with MS taking glucocorticoid, antidepressant, or anxiolytic medication, compared with nonusers, and it is unclear whether these medications are associated with bone loss in people with MS, beyond that in the general population. Additional high-quality studies with homogenous methodology exploring how medications influence aBMD and fracture risk in people with MS are required.

Racial and Ethnic Differences in Studies of the Gut Microbiome and Osteoporosis

PURPOSE OF REVIEW

The purpose of this review is to summarize the scientific evidence published in the past 5 years examining the epidemiology of bone health as it relates to the gut microbiome, across race and ethnicity groups.

RECENT FINDINGS

The link between the gut microbiome and bone health is well established and is supported by numerous biological mechanisms. However, human study research in this field is dominated by studies of older adults residing in Asian countries. A limited number of epidemiological and randomized controlled trials have been conducted with individuals in other countries; however, they are marked by their racial and ethnic homogeneity, use varied measures of the gut microbiome, and different interventions (where applicable), making comparisons across race and ethnic groups difficult. As the global prevalence of osteoporosis increases, the need for lifestyle interventions is critical. Existing data suggest that racial and ethnic differences in gut microbiome exist. Studies examining the relation between bone health and gut microbial structure and function across diverse racial and ethnic groups are needed to determine appropriate microbiome-based interventions.

Bisphosphonates for postmenopausal osteoporosis: a network meta‐analysis

This is a protocol for a Cochrane Review (intervention). The objectives are as follows:

The aim of this systematic review is to investigate the direct and indirect evidence regarding the benefits and harms of bisphosphonates in the primary and secondary prevention of osteoporotic fractures for postmenopausal women. We will perform a network meta‐analysis, which will estimate the relative effects and relative ranking of the competing interventions for the outcomes of interest.

Addressing Challenges of Opportunistic Computed Tomography Bone Mineral Density Analysis

Computed tomography (CT) offers advanced biomedical imaging of the body and is broadly utilized for clinical diagnosis. Traditionally, clinical CT scans have not been used for volumetric bone mineral density (vBMD) assessment; however, computational advances can now leverage clinically obtained CT data for the secondary analysis of bone, known as opportunistic CT analysis. Initial applications focused on using clinically acquired CT scans for secondary osteoporosis screening, but opportunistic CT analysis can also be applied to answer research questions related to vBMD changes in response to various disease states. There are several considerations for opportunistic CT analysis, including scan acquisition, contrast enhancement, the internal calibration technique, and bone segmentation, but there remains no consensus on applying these methods. These factors may influence vBMD measures and therefore the robustness of the opportunistic CT analysis. Further research and standardization efforts are needed to establish a consensus and optimize the application of opportunistic CT analysis for accurate and reliable assessment of vBMD in clinical and research settings. This review summarizes the current state of opportunistic CT analysis, highlighting its potential and addressing the associated challenges.

The development, incidence and treatment trends of trochanteric fractures in Germany: a cohort study

BACKGROUND

Hip fractures are a major public health problem worldwide and can lead to disability, increased mortality, and reduced quality of life. We aim to provide a nationwide epidemiological analysis of trochanteric and subtrochanteric fractures and their respective surgical treatments.

METHODS

Data were retrieved from the national database of the German Department of the Interior. ICD-10-GM and OPS data from the period of 2006 to 2020 were analysed and all patients with trochanteric and subtrochanteric fractures as their main diagnosis, who were treated in a German hospital, were included. Patients were grouped by age and gender and linear regression was performed where suitable to calculate statistically significant correlations between variables and incidences.

RESULTS

985,104 pertrochanteric fractures and 178,810 subtrochanteric fractures were reported during the analysed period. We calculated a mean incidence of 80.08 ± 6.34 for pertrochanteric and 14.53 ± 1.50 for subtrochanteric fractures per million inhabitants. In both fracture types, a distinct dependence of incidence on age can be determined. Incidence rates equally rise in both sexes through the age groups with an increase of about 288-fold from those under the age of 60 to those over the age of 90 in pertrochanteric fractures, and about 123-fold in subtrochanteric fractures. Intramedullary nailing was the most common kind of treatment for both fracture types with augmentative cerclages on the rise throughout the whole period. Plate and dynamic compression screws were decreasing in frequency over the analysed period in both fractures.

CONCLUSIONS

We provided incidence data on per- and subtrochanteric fractures and their treatment. We calculated an economic impact of approximately 1.563 billion € per year in Germany. With regards to recent literature on costs of treatment and our findings regarding the implementation and utilization of different treatment methods, we conclude that the reinforcement of nationwide prevention programs is a relevant step in lessening the economic burden. We welcome the increased utilisation of intramedullary nailing as many studies show beneficiary outcomes and cost effectiveness in most of the included fracture types.

Rib Fracture Management in Older Adults: A Scoping Review

Background

Unique challenges posed by caring for patients of geriatric age, require concurrent management of chronic comorbidities and strategies to avoid or minimize complications related to the injury and/or hospitalization. The presentation in this population of two or more rib fractures is associated higher morbidity and mortality compared to a younger age group. A lack of guidelines regarding the management of multiple rib fractures in the elderly for primary care providers in the community and the complexity of rib fracture management led to reviewing available evidence regarding various approaches to rib fracture management.

Methods

Online databases (PubMed and MEDLINE) were used to identify 57 publications between 2000 and 2022 regarding the management of multiple rib fractures.

Results

The majority of publications were retrospective studies and observational cohort studies (56%). 32% of studies were review articles, meta-analyses, and guidelines. Three articles (5.3%) were randomized control studies. Four articles (7%) cited statistics from a national resource.

Conclusions

The management of rib fractures is predominantly non-surgical, managed with pain control and respiratory rehabilitation. Triaging protocols, available to healthcare providers in outpatient clinics, urgent care centers, and emergency departments, to identify the most vulnerable patients with rib fractures in a timely fashion likely help expedite the level of care they need. A comprehensive treatment team includes not only the primary trauma team (consisting of emergency physicians/trauma surgeons, trauma nurses, and mid-level practitioners) but also incorporates a multidisciplinary team with the early involvement of a geriatrician, physical therapist, anesthesiologist, social worker, and respiratory therapist when required to improve ventilation, breathing and patient comfort.

Does Dietary Polyunsaturated Fatty Acid Intake Associate With Bone Mineral Density and Limb Structural Changes in Early Rheumatoid Arthritis?

Background

Rheumatoid arthritis (RA) is an inflammatory disease that can result in bone erosion, lean mass lowering, and increase of fat mass without changes in body weight. The dietary consumption of polyunsaturated fatty acids (PUFAs) has been assessed in many studies due to their potential anti-inflammatory effect.

Aim

The aim of this research was to identify if dietary intake of PUFAs associates with bone mineral density (BMD) and limb structural changes in early rheumatoid arthritis (ERA) compared to a population-based control group. The study was conducted because previous results have been insufficient.

Methods

The study group consisted of 83 ERA patients and 321 control subjects. A dual-energy X-Ray absorptiometry (DXA) machine was used to measure hip, lumbar spine, and radius BMD, as well as arm and leg fat, lean, and bone mass. Dietary habits and inflammatory markers were assessed to evaluate the effects to BMD and limb structural changes.

Results

In ERA subjects, higher dietary consumption of PUFAs was associated with a decrease in arm fat mass (b -28.17, P = .02) and possibly with higher lumbar BMD (b 0.008, P = .058). Limb bone and lean mass changes were not associated with dietary intake of PUFAs.

Conclusion

Balanced nutrition is essential. Consuming PUFAs could be beneficial in ERA preventing structural changes to hands, but additional research is needed.