The prevalence of osteoporotic fractures in the elderly in China: a systematic review and meta-analysis

Irisin mitigates osteoporotic-associated bone loss and gut dysbiosis in ovariectomized mice by modulating microbiota, metabolites, and intestinal barrier integrity

BACKGROUND

Osteoporotic bone defects significantly affect patient health and quality of life. The gut-bone axis plays a crucial role in osteoporosis, and disruptions in gut microbiota are linked to systemic inflammation and compromised bone metabolism. Irisin, a myokine, has shown potential in protecting against osteoporosis, but its mechanisms of action on the gut-bone axis remain unclear. This study aimed to investigate the role of irisin in mitigating osteoporotic bone defects by examining its effects on gut microbiota, related metabolites, and intestinal barrier integrity.

METHODS

An osteoporosis model was created using ovariectomized (OVX) mice. The mice were divided into Sham, OVX, and r-irisin groups. Mice in the r-irisin group received intraperitoneal injections of 100 μg/kg irisin twice weekly for five weeks. Bone parameters were analyzed by micro-CT and histological staining. Gut microbiota composition was examined via 16S rDNA sequencing. Intestinal cytokines and barrier proteins were measured using immunohistochemistry and ELISA. Fecal metabolomic profiling was conducted using liquid chromatography-tandem mass spectrometry (LC-MS/MS), and correlations between gut microbiota, metabolites, and bone metabolism markers were evaluated.

RESULTS

Irisin treatment improved bone mineral density (BMD), bone volume/tissue volume (BV/TV), trabecular bone thickness (Tb.Th), and trabecular number (Tb.N), and reduced trabecular separation (Tb.Sp) in OVX mice. It enhanced new bone formation and collagen deposition. Irisin restored intestinal barrier integrity by increasing tight junction protein expression and reducing inflammatory cytokines in intestinal tissues. It also modulated gut microbiota diversity, reducing Firmicutes and increasing Verrucomicrobiota abundance. Key fecal metabolites, including atractylon (r = - 0.60, P < 0.01) and enterodiol (r = + 0.83, P < 0.01), showed strong correlations with BMD.

CONCLUSION

Irisin mitigates osteoporotic bone defects by enhancing bone formation, restoring intestinal barrier integrity, modulating gut microbiota composition, and influencing fecal metabolites. These preclinical findings highlight irisin's potential to mitigate osteoporosis via the gut-bone axis.

Clinical outcomes and safety of combined calcitriol and bisphosphonates in treating postmenopausal osteoporosis: a retrospective cohort study

OBJECTIVE

Despite the well-known benefits of calcitriol and bisphosphonates in managing osteoporosis, limited research has explored the combined therapeutic effects of these agents on bone metabolism, immune function, and clinical outcomes in postmenopausal osteoporosis patients. This study aims to evaluate the clinical efficacy and safety of calcitriol combined with bisphosphonates in the treatment of postmenopausal osteoporosis through a retrospective cohort analysis.

METHODS

A total of 152 postmenopausal osteoporosis patients treated at our hospital from March 2019 to June 2021 were enrolled and divided into two groups based on the treatment received. The control group received calcitriol alone, while the study group received calcitriol combined with bisphosphonates. Treatment outcomes were assessed by comparing Visual Analogue Scale (VAS) scores for pain, Barthel Index for daily living ability, and Oswestry Disability Index (ODI) for dysfunction before and after treatment. Bone metabolism markers (BALP, BGP, PINP, TRACP), immune cytokines (IL-6, TGF-β1, TNF-α, IL-10), and bone mineral density (BMD) were measured. The incidence of adverse reactions was also recorded.

RESULTS

The total effective rate in the study group was 96.05%, significantly higher than 84.21% in the control group (P < 0.05). Post-treatment VAS and ODI scores decreased significantly in both groups, with greater improvement in the study group (P < 0.05). Barthel Index scores increased more in the study group (P < 0.05). Bone metabolism markers (BALP, BGP, PINP, TRACP) and inflammatory cytokines (IL-6, TGF-β1, TNF-α) decreased more significantly in the study group, while IL-10 levels and BMD increased more markedly (P < 0.05). The incidence of adverse reactions was lower in the study group (2.63%) than in the control group (5.26%), but the difference was not statistically significant (P > 0.05).

CONCLUSION

The combination of calcitriol and bisphosphonates demonstrates superior clinical efficacy and safety in treating postmenopausal osteoporosis, effectively reducing pain and disability, enhancing bone metabolism and immune function, and improving bone mineral density and daily living ability.

Can the geriatric nutritional risk index predict the risk of osteoporosis in the elderly? A systematic review and meta-analysis

Objective

The elderly are at a high risk of malnutrition as well as osteoporosis. In this review, we examined if the geriatric nutritional risk index (GNRI) can predict the risk of osteoporosis in the elderly.

Methods

In this PRISMA compliant systematic review we searched the electronic databases of PubMed, Embase, ScienceDirect, and Web of Science. The search included studies from inception of databases to December 29, 2023. All studies examining the association between GNRI and osteoporosis were included.

Results

Seven studies were selected. All studies were cross-sectional in design. Meta-analysis of all seven studies showed that low GNRI was significantly associated with the risk of osteoporosis in elderly patients (OR: 1.33 95% CI: 1.15, 1.53). The interstudy heterogeneity was high as the I2 value was 87%. Results did not change on sensitivity analysis. Subgroup analysis based on study location, presence of diabetes, sample size, GNRI cut-off, method to determine cut-off, and diagnostic criteria for osteoporosis showed mixed results.

Conclusion

Low GNRI can be a simple marker for predicting osteoporosis in the elderly. Current evidence is from a few studies with a high risk of bias.

Circular RNAs in the management of human osteoporosis

BACKGROUND

Osteoporosis (OP) is a metabolic bone disease producing reduction in bone mass with consequent bone fragility. Circular ribonucleic acid (CircRNA) is a form of RNA that forms a loop structure rather than a linear one. CircRNA can be used for therapeutic purposes, including molecular targets or to test new therapies.

SOURCES OF DATA

A systematic search of different databases to July 2024 was performed to define the role of circRNA in OP therapy. Seventeen suitable studies were identified.

AREAS OF AGREEMENT

CircRNAs may be useful in studying metabolic processes in OP and identify possible therapeutic targets and new drug therapies.

AREAS OF CONTROVERSY

The metabolic processes involved in OP are regulated by many genes and cytokines that can be targeted by CircRNAs. However, it is not easy to predict whether the in vitro responses of the studied CircRNAs and their interaction with drugs are also applicable in vivo.

GROWING POINTS

Metabolic processes can be affected by gene dysregulation of CircRNAs on various growth factors. Areas timely for developing research: Despite the predictability of CircRNA pharmacological response in vitro, such pharmacological response cannot be expected to be replicated in vivo.

DATA AVAILABILITY

The data that support the findings of this study are available from the corresponding author.

A real-world analysis of 1,823 hospitalized osteoporotic fractures in Northeast China

Context

There are limited real-world data evidence assessing the clinical characteristics of hospitalized osteoporotic fractures in China.

Objective

To investigate the clinical characteristics of hospitalized major osteoporotic fractures in Northeast China.

Methods

We identified hospitalized fracture patients aged 50 and over from the First Affiliated Hospital of Jinzhou Medical University between January 1, 2018, and December 31, 2022. Major osteoporotic fractures including hip, vertebral, forearm and wrist, and humerus were diagnosed based on x-ray reports extracted from the electronic medical records (EMR). The cause of fracture, comorbidities, surgical methods, and anti-osteoporotic medications (AM) use were extracted from EMR.

Results

The study population included 1823 fracture patients, 510 males and 1313 females. Over half of fracture patients were aged over 70 years. Hip fractures accounted for 68.4% of all fractures in males and 57.9% in females. For those with hip fractures, the most common sites were the femoral neck (62.9%) and intertrochanteric (35.3%). Most fractures were due to falls (81.0% in males and 80.2% in females). The two most common comorbidities for males and females were hyperlipemia (45.9% vs. 47.1%) and hypertension (38.2% vs. 41.6%). Only 4.7% males and 8.6% females were treated with AM.

Conclusions

Hip fractures, especially femoral neck fractures, accounted for the majority of osteoporotic fractures in a tertiary public hospital in Northeast China. Common comorbidities in these fracture patients were hyperlipemia and hypertension. There was a very low rate of AM use among these patients.

Systemic immune-inflammatory index predicts fragility fracture risk in postmenopausal anemic females with type 2 diabetes mellitus: evidence from a longitudinal cohort study

BACKGROUND

Chronic low-grade inflammation is related to bone metabolism in patients with type 2 diabetes mellitus (T2DM). However, credible data indicating the relationship between inflammation and fragility fracture risk in postmenopausal anemic females with T2DM are sparse. The current study sought to investigate the relationships between the systemic immune-inflammatory index (SII) and fragility fracture events, as well as the future 10-year fragility fracture probability evaluated using the fracture risk assessment tool (FRAX) in postmenopausal females with T2DM.

METHODS

According to the tertiles of SII, 423 postmenopausal females with T2DM were divided into three groups: low-level (≤ 381.32, n = 141), moderate-level (381.32-629.46, n = 141), and high-level (≥ 629.46, n = 141). All participants were followed up for 7 years with a median of 46.8 months (1651 person-years). The association between SII and fragility fracture risk was assessed.

RESULTS

Of 423 subjects, 75 experienced a fragility fracture event. Spearman partial correlation analysis revealed that SII was negatively related to bone mineral density (BMD) and was positively associated with the future 10-year probability of major osteoporotic fracture (MOF) and hip fracture (HF). Restricted cubic spline (RCS) analysis revealed a positive correlation between SII and fragility fracture risk in an approximately inverted J-shaped dose-response pattern (P for overall < 0.0001). Multivariate Cox regression analysis demonstrated that patients with a high SII presented a greater risk of fragility fractures (P = 0.011). Stratified analysis revealed that fragility fractures in the high-level SII were predominantly associated with anemia with an increase of 4.15 times (P = 0.01). Kaplan‒Meier analysis indicated a greater cumulative incidence of fragility fractures in patients with a high SII (log-rank, all P = 0.0012). Receiver operating characteristic (ROC) analysis indicated an optimal SII cut-off value of 537.34, with an area under the curve (AUC) of 0.646, a sensitivity of 60%, and a specificity of 64.1% (P < 0.001).

CONCLUSION

The SII revealed a significant positive association with a real-world fragility fracture event and a future 10-year fragility fracture probability in postmenopausal females with T2DM, particularly evident in individuals with anemia. Therefore, monitoring the SII and hemoglobin in postmenopausal older women with T2DM is helpful in routine clinical practice to identify individuals at high risk for fragility fractures and to promptly execute appropriate fracture intervention procedures.

Effects of total flavonoids of Rhizoma Drynariae on biochemical indicators of bone metabolism: a systematic review and meta-analysis

Background

Evidence shows that the total flavonoids of Rhizoma Drynariae (TFRD) can improve bone mineral density (BMD). However, there is no evidence to summarize the improvement of biochemical indicators of bone metabolism (BIBM).

Methods

The PubMed, Web of Science, Cochrane Library, Embase, Chinese National Knowledge Infrastructure (CNKI), Wanfang Database, Chongqing VIP Information Database (VIP) and SinoMed were searched from inception to 6 May 2024. The final included studies performed meta-analyses using RevMan 5.3.

Results

Nine randomized controlled trials (RCTs) were ultimately included. The TFRD group had higher bone gla protein (BGP) and type I procollagen-N-propeptide (PINP) compared to the Other therapies (WMD: 5.11; 95% CI: 3.37, 6.84; p < 0.00001; WMD: 13.89; 95% CI: 11.81, 15.97; p < 0.00001). The tartrate-resistant acid phosphatase (TRACP) decreased significantly (WMD: -1.34; 95% CI: -1.62, -1.06; p < 0.00001). The alkaline phosphatase (ALP) increased significantly (WMD: 7.47; 95% CI: 6.29, 8.66; p < 0.00001). There were no significant differences in serum calcium (SC) or serum phosphorus (SP) levels between the TFRD and control groups (WMD: 0.08; 95% CI: -0.04, 0.20; p = 0.17; WMD: 0.02; 95% CI: -0.02, 0.05; p = 0.36).

Conclusion

TFRD can stimulate bone formation and prevent bone resorption in osteoporosis (OP) patients, but it has no effect on SC and SP.

Systematic Review Registration

https://www.crd.york.ac.uk/PROSPERO/.

Causal link between docosahexaenoic acid and osteoporosis: A 2-sample Mendelian randomization study

To explore the causal relationship between docosahexaenoic acid and osteoporosis. Possible causal links were investigated using a 2-sample Mendelian randomization study. Its genetic correlation was estimated using chained disequilibrium regression. Sensitivity tests were also performed. There was a causal association between docosahexaenoic acid and osteoporosis, and docosahexaenoic acid was a risk factor for osteoporosis (P = .033, odds ratio [95% CI] = 1.099 [1.008-1.198]). For every 1 standard deviation increase in docosahexaenoic acid lev, the risk of developing osteoporosis increased by 9.900%. The genetic correlation between docosahexaenoic acid (h2_Z = 5.260, P = 1.430e-7), osteoporosis (h2_Z = 8.780, P = 1.160e-98), and genes was significant, but there was a weak genetic correlation between docosahexaenoic acid and osteoporosis (rg = -0.040, P = 1.630e-18). Blood levels of docosahexaenoic acid are causally linked to osteoporosis and are a risk factor for osteoporosis. However, this causal link is not brought about by genetic variation. The exact mechanism needs to be explored further.

Construction and verification of risk prediction model of osteoporotic fractures in patients with osteoporosis in China

Objective

To explore the influencing factors of osteoporotic fractures (OPF) in patients with osteoporosis, construct a prediction model, and verify the model internally and externally, so as to provide reference for early screening and intervention of OPF in patients with osteoporosis.

Methods

Osteoporosis patients in the First Affiliated Hospital of Soochow University were selected, and the medical records of patients were consulted through the Hospital Information System (HIS) and the data management platform of osteoporosis patients, so as to screen patients who met the criteria for admission and discharge and collect data. SPSS 26.0 software was used for single factor analysis to screen statistically significant variables (p < 0.05). The influencing factors of OPF were determined by multivariate analysis, and a binary Logistic regression model was established according to the results of multivariate analysis. Hosmer-Lemeshow (H-L) goodness of fit and receiver operating characteristic curve (ROC) were used to test the model's efficiency, and Stata 16.0 software was used to verify the Bootstrap model, draw the model calibration curve, clinical applicability curve and nomogram.

Results

In this study, the data of modeling set and verification set were 1,435 and 580, respectively. There were 493 (34.4%) cases with OPF and 942 (65.6%) cases without OPF in the modeling set. There were 204 (35.2%) cases with OPF and 376 (64.8%) cases without OPF. The variables with statistically significant differences in univariate analysis are Age, BMI, History of falls, Usage of glucocorticoid, ALP, Serum Calcium, BMD of lumbar, BMD of feminist neck, T value of feminist neck, BMD of total hip and T value of total hip. The area under ROC curve of the risk prediction model constructed this time is 0.817 [95%CI (0.794 ~ 0.839)], which shows that the model has a good discrimination in predicting the occurrence of OPF. The optimal threshold of the model is 0.373, the specificity is 0.741, the sensitivity is 0.746, and the AUC values of the modeling set and the verification set are 0.8165 and 0.8646, respectively. The results of Hosmer and Lemeshow test are modeling set: (χ2 = 6.551, p = 0.586); validation set: [(χ2 = 8.075, p = 0.426)]. The calibration curve of the model shows that the reference line of the fitted curve and the calibration curve is highly coincident, and the model has a good calibration degree for predicting the occurrence of fractures. The net benefit value of the risk model of osteoporosis patients complicated with OPF is high, which shows that the model is effective.

Conclusion

In this study, a OPF risk prediction model is established and its prediction efficiency is verified, which can help identify the high fracture risk subgroup of osteoporosis patients in order to choose stronger intervention measures and management.