Incidence and economic burden of osteoporosis-related fractures in the United States, 2005-2025

Impact of biodegradation on the mechanical and fatigue properties of 3D-printed PLA bone scaffolds

A proper degradation rate of bone scaffolds ensures optimal mechanical support and effective tissue regeneration. The present study examines the degradation effects of simulated body fluids (SBF) on the compressive and fatigue strength of 3D-printed PLA bone scaffolds. Scaffolds with varying surface-to-volume (S/V) ratios and identical porosity (60 %) were immersed in Hanks' solution for a maximum period of 30 days. Static and dynamic compression tests were performed at different immersion times to assess how S/V ratio influences the degradation process. CT images showed that scaffold pore structure remained interconnected after biodegradation, with no significant change in strut thickness or dry weight. Results also indicated that while the compressive strength and modulus of scaffolds remained largely unchanged during biodegradation, their fatigue resistance reduced significantly. This reduction in fatigue resistance was attributed to the embrittlement of PLA material caused by crystalline phase changes during degradation. Microscopic images and X-ray analysis revealed the brittle fracture of scaffolds at the diagonal shear plane and the presence of SBF's salts within the scaffold material. Scaffolds with higher S/V ratios exhibited a greater decrease in fatigue resistance. The failure cycle of scaffolds with S/V ratios of 3.4, 2.4, and 1.9 mm-1 decreased by 77 %, 76 %, and 60 %, respectively after 30 days of biodegradation. Higher S/V ratios increased the surface exposure to the corrosive media. This resulted in higher water absorption, which subsequently intensified the embrittlement of the scaffolds.

Life-threatening vascular injury in an elderly patient with isolated pubic ramus fracture: A case report

BACKGROUND

Pubic ramus fractures are generally considered fragility fractures in the elderly population, commonly deriving from a low-impact fall. Treatment is ordinarily conservative and hemodynamic complications are exceedingly infrequent. Notwithstanding, patients with copious comorbidities should be carefully monitored for potential vascular injury.

CASE SUMMARY

This case report presents the management of a 75-year-old male patient with a history of diabetes mellitus and arterial hypertension who was admitted to the emergency room with a superior pubic ramus fracture. The patient experienced a significant drop in hematocrit and hemoglobin levels post-admission, necessitating urgent intervention. A computed tomography angiography revealed active bleeding, leading to the embolization of the medial femoral branch. The patient was stabilized hemodynamically and was discharged after 15 days, with recommendations for home-based follow-up care.

CONCLUSION

This report denotes the various challenges and strategies in managing simple fractures that are treated conservatively, but need prompt monitoring for occult vascular injuries that can be fatal.

Characterization of strains induced by in vivo locomotion and axial tibiotarsal loading in a chukar partridge model

Rodent models have offered valuable insights into the mechanobiological mechanisms that regulate bone adaptation responses to dynamic mechanical stimuli. However, using avian models may provide new insights into the mechanisms of bone adaptation to dynamic loads, as bird bones have distinct features that differ from mammalian bones. This paper illuminates these aspects by evaluating the mechanical environment in a novel avian, chukar partridge tibiotarsus (TBT), during fast locomotion and in cortical and cancellous tissue under in vivo dynamic compressive loading within the TBT. We measured in vivo mechanical strains at the TBT midshaft on the anterior, medial, and posterior surfaces during locomotion at various treadmill speeds. The mean in vivo strains measured on the anterior, medial, and posterior surfaces of the TBT midshaft were 154 με, -397 με, and -438 με, respectively, at a treadmill speed of 2 m/s. The mean experimentally measured strains on the anterior, medial, and posterior surfaces of the TBT were 114.7 με, -952.6 με, and -593.7 με under an in vivo dynamic compressive load of 130 N. The study, which employs a micro-computed tomography (microCT) based finite element model in combination with diaphyseal strain gauge measures, found that cancellous strains were greater than those in the midshaft cortical bone. Sensitivity analyses revealed that the material property of cortical bone was the most significant model parameter. In the midshaft cortical volume of interest (VOI), daily dynamic loading increased the maximum moment of inertia and reduced the bone area in the loaded limb compared to the contralateral control limb after three weeks of loading. Despite the strong correlations between the computationally modeled strains and experimentally measured strains at the medial and posterior gauge sites, no correlations existed between the computationally modeled strains and strain gradients, and histologically measured bone formation thickness at the mid-diaphyseal cross-section of the TBT.

Age-dependent changes in CT vertebral attenuation values in opportunistic screening for osteoporosis: a nationwide multi-center study

OBJECTIVES

To examine how vertebral attenuation changes with aging, and to establish age-adjusted CT attenuation value cutoffs for diagnosing osteoporosis.

MATERIALS AND METHODS

This multi-center retrospective study included 11,246 patients (mean age ± standard deviation, 50 ± 13 years; 7139 men) who underwent CT and dual-energy X-ray absorptiometry (DXA) in six health-screening centers between 2022 and 2023. Using deep-learning-based software, attenuation values of L1 vertebral bodies were measured. Segmented linear regression in women and simple linear regression in men were used to assess how attenuation values change with aging. A multivariable linear regression analysis was performed to determine whether age is associated with CT attenuation values independently of the DXA T-score. Age-adjusted cutoffs targeting either 90% sensitivity or 90% specificity were derived using quantile regression. Performance of both age-adjusted and age-unadjusted cutoffs was measured, where the target sensitivity or specificity was considered achieved if a 95% confidence interval encompassed 90%.

RESULTS

While attenuation values declined consistently with age in men, they declined abruptly in women aged > 42 years. Such decline occurred independently of the DXA T-score (p < 0.001). Age adjustment seemed critical for age ≥ 65 years, where the age-adjusted cutoffs achieved the target (sensitivity of 91.5% (86.3-95.2%) when targeting 90% sensitivity and specificity of 90.0% (88.3-91.6%) when targeting 90% specificity), but age-unadjusted cutoffs did not (95.5% (91.2-98.0%) and 73.8% (71.4-76.1%), respectively).

CONCLUSION

Age-adjusted cutoffs provided a more reliable diagnosis of osteoporosis than age-unadjusted cutoffs since vertebral attenuation values decrease with age, regardless of DXA T-scores.

KEY POINTS

Question How does vertebral CT attenuation change with age? Findings Independent of dual-energy X-ray absorptiometry T-score, vertebral attenuation values on CT declined at a constant rate in men and abruptly in women over 42 years of age. Clinical relevance Age adjustments are needed in opportunistic osteoporosis screening, especially among the elderly.

Regions of interest in opportunistic computed tomography-based screening for osteoporosis: impact on short-term in vivo precision

OBJECTIVE

To determine an optimal region of interest (ROI) for opportunistic screening of osteoporosis in terms of short-term in vivo diagnostic precision.

MATERIALS AND METHODS

We included patients who underwent two CT scans and one dual-energy X-ray absorptiometry scan within a month in 2022. Deep-learning software automatically measured the attenuation in L1 using 54 ROIs (three slice thicknesses × six shapes × three intravertebral levels). To identify factors associated with a lower attenuation difference between the two CT scans, mixed-effect model analysis was performed with ROI-level (slice thickness, shape, intravertebral levels) and patient-level (age, sex, patient diameter, change in CT machine) factors. The root-mean-square standard deviation (RMSSD) and area under the receiver-operating-characteristic curve (AUROC) were calculated.

RESULTS

In total, 73 consecutive patients (mean age ± standard deviation, 69 ± 9 years, 38 women) were included. A lower attenuation difference was observed in ROIs in images with slice thicknesses of 1 and 3 mm than that in images with a slice thickness of 5 mm (p < .001), in large elliptical ROIs (p = .007 or < .001, respectively), and in mid- or cranial-level ROIs than that in caudal-level ROIs (p < .001). No patient-level factors were significantly associated with the attenuation difference. Large, elliptical ROIs placed at the mid-level of L1 on images with 1- or 3-mm slice thicknesses yielded RMSSDs of 12.4-12.5 HU and AUROCs of 0.90.

CONCLUSION

The largest possible regions of interest drawn in the mid-level trabecular portion of the L1 vertebra on thin-slice images may yield improvements in the precision of opportunistic screening for osteoporosis via CT.

Predictors of Fracture in Middle-Aged and Older Adults With Type 2 Diabetes and Overweight or Obesity

CONTEXT

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Crosstalk between kidney and bones: New perspective for modulating osteoporosis

Growing evidence indicates an interesting interplay between kidney and bone. The pathophysiological condition of the skeletal system is intricately associated with the normal functioning of the kidneys. This relationship is modulated by various factors, including calcium and phosphate, 1-α-hydroxylase, erythropoietin (EPO), klotho, fibroblast growth factor 23 (FGF23), bone morphogenetic protein-7 (BMP-7), and extracellular vesicles (EVs). These interactions are notably evident in conditions such as chronic kidney disease with bone mineral density (CKD-BMD), renal osteodystrophy (ROD), and osteoporosis (OP). Furthermore, innovative methodologies such as cell co-culture, organ-on-a-chip, single-cell sequencing, and spatial transcriptomics are highlighted as instrumental in advancing the study of inter-organ interactions. This review, grounded in the pathogenesis, diagnostic and therapeutic modalities, and pharmacological treatments of OP, synthesizes evidence from molecular biology to clinical perspectives. It aims to establish a foundation for the development of more complex and physiologically relevant in vitro models and to propose potential therapeutic strategies.

CXCR4 is a response gene for parathyroid hormone which affects osteoblast and osteoclast function in vitro

Aims

To investigate the role of CXCR4 in response to teriparatide (TPTD) treatment in osteoblasts and osteoclasts.

Methods

Primary murine and human osteoblasts and osteoclasts, MC3T3 cell lines, and hMSC-TERT4 cell lines were treated with TPTD and/or AMD3100, a pharmacological inhibitor of CXCR4. Changes in gene expression, osteoblast viability, mobility, mineralization capacity, and alkaline phosphatase activity were investigated. Osteoclastogenesis and cell fusion were also assessed in response to both treatments.

Results

TPTD increased messenger RNA levels of CXCR4 in all stages of both murine and human osteoblast differentiation. Mineralization analysis showed that CXCR4 was involved in bone matrix formation in response to TPTD. Alkaline phosphatase activity was also impaired by CXCR4 inhibition at early stages of osteoblast differentiation, while it was promoted at late stages, suggesting that CXCR4 could produce a delay in osteoblast maturation. Moreover, we also found a direct activation of osteoclastogenesis after TPTD treatment in murine and human osteoclasts. This process seems to involve CXCR4 activity, since AMD3100-induced CXCR4 inhibition led to a reduction in both murine and human osteoclastogenesis. This process, however, could not be prevented by TPTD treatment.

Conclusion

Our results suggest that CXCR4 is a responsive gene to TPTD treatment, involved in the regulation of osteoblast and osteoclast generation and function. Further in vivo studies are required to confirm this role, and to determine whether pharmacological strategies targeting CXCR4 could potentially improve the treatment outcome for osteoporotic patients.

The association between relative fat mass (RFM) and lumbar bone density in US adults: Insight from 2011-2018 NHANES

BACKGROUND

The relationship between obesity and osteoporosis has been widely studied. Studies have shown that relative fat mass (RFM) can be used to predict obesity. However, its relationship with bone mineral density (BMD) is unclear. The aim of this study was to investigate the relationship between RFM and lumbar BMD.

METHODS

We used data from the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2018. Multiple linear regression models were applied to examine the relationship between RFM and lumbar BMD. We used smoothed curve fitting and threshold effect analysis to check for non-linear trends. Subgroup analyses were performed to explore differences in various populations. The Receiver operating characteristic (ROC) curve was used to evaluate the diagnostic potential of body mass index (BMI), weight-adjusted waist circumference index (WWI), waist circumference (WC), and RFM for OP.

RESULTS

A total of 10636 participants were included. Multiple linear regression showed a significant negative link between RFM and lumbar BMD. In subgroup studies and smoothed curve fitting, RFM was consistently associated with lower BMD across subgroups. ROC curve indicate that RFM is more sensitive than BMI, WWI and WC in diagnosing OP capacity.

CONCLUSION

RFM is negatively associated with lumbar BMD in US adults. This suggests that RFM contributes to the study of low BMD.

Accelerated ultrashort echo time quantitative magnetization transfer (UTE-qMT) imaging of macromolecular fraction (MMF) in cortical bone based on a self-attention convolutional neural network

PURPOSE

To combine ultrashort echo time quantitative magnetization transfer (UTE-qMT) imaging with a self-attention convolutional neural network (SAT-Net) for accelerated mapping of macromolecular fraction (MMF) in cortical bone.

MATERIALS AND METHODS

This institutional review board-approved study involved 31 young female subjects (young control, <45 years) and 50 postmenopausal subjects (6 normal (old control), 14 with osteopenia (osteopenia group), and 30 with osteoporosis (OP group)). After written informed consent was obtained from each subject, 15 UTE-qMT images of the tibial midshaft were acquired with three saturation powers (500°, 1000°, and 1500°) and five frequency offsets (2, 5, 10, 20, and 50 kHz) for each power to estimate the baseline MMF using a two-pool model. The densely connected SAT-Net model was used to predict bone MMF maps based on seven evenly distributed UTE-qMT images, which were well separated in terms of MT powers and frequency offsets (namely 5 and 20 kHz for 500° and 1500°, and 2, 10, 50 kHz for 1000°). Errors relative to the baseline MMF were calculated. Linear regression was used to assess the performance of the SAT-Net model. The mean MMF values for different groups were calculated.

RESULTS

Conventional two-pool modeling of seven evenly distributed UTE-qMT input images shows a significant relative error of ∼34 %. In comparison, the SAT-Net model accurately predicted MMF values for the tibial midshafts of 81 human subjects with a high correlation (R2 = 0.97, P < 0.0001) between the baseline and predicted values. The SAT-Net model accelerated UTE-qMT data acquisition by 2.1-fold, with relative errors in MMF mapping less than 2.4 %. The average MMF values were 46.10 ± 13.25 % for the young control group, 40.03 ± 2.56 % for the old control group, 31.22 ± 13.18 % for the osteopenia group, and 22.53 ± 8.12 % for the OP group.

CONCLUSION

While it is difficult to accelerate MMF mapping in bone using conventional two-pool modeling, the SAT-Net model allows accurate MMF mapping with a substantial reduction in the number of UTE-qMT input images. UTE-qMT with SAT-Net makes clinical evaluation of bone matrix possible.

Managing delayed union of fragility fractures of the pelvis successfully using romosozumab: A case report

Fragility fractures of the pelvis (FFPs) are typically caused by minor trauma or without any trauma in older individuals with osteoporosis. In recent years, FFP incidence has increased considerably owing to the increasing number of individuals in the aging population as well as impaired daily life. Surgeries are the main treatment options for some types of FFPs; however, the potential of the use of romosozumab, an FDA-approved humanized monoclonal antibody that can bind and inhibit sclerostin, is yet to be evaluated. Romosozumab substantially increases bone mineral density (BMD) in the spine and the hip, improves bone strength, and prevents the occurrence of new fractures. Previous studies have demonstrated the efficacy of romosozumab in promoting fracture healing, including the healing of nonunion in some fractures. Herein, we present a case of a 61-year-old woman who had FFP delayed union, after falling 4 months before visiting our hospital. She presented with bilateral buttock and leg pain. Baseline BMD measured using dual-energy X-ray absorptiometry revealed a T-score of -3.8 and -3.2 for the lumbar spine and total hip, respectively. As the patient's BMD indicated a high risk of fractures, romosozumab was administered. Her pain improved 3 months after the medication. Computed tomography taken after 3 months revealed that the fracture had healed, suggesting that romosozumab is an effective medication for treating FFP delayed union and nonunion.

To Study the Functional Outcome of Vertebroplasty versus Conservative Management in Osteoporotic Fractures

Introduction

Osteoporotic vertebral compression fractures (VCFs) significantly affect morbidity and quality of life. While conservative management (analgesics, bracing, and physiotherapy) is standard, vertebroplasty offers a minimally invasive alternative. This study compared the functional outcomes of vertebroplasty and conservative management in patients with osteoporotic fractures.

Materials and Methods

A prospective study of patients (≥60 years) with acute/subacute VCFs assessed pain (visual analog scale) and function (Oswestry disability index) at baseline, 3, 6, and 12 months. Patients underwent either vertebroplasty or conservative management. Statistical analysis included Chi-square and Mann-Whitney U-tests.

Results

Among 162 patients (81 per group), vertebroplasty led to significantly greater pain relief and functional improvement at all follow-ups (P < 0.0001). However, new fractures were more frequent in the vertebroplasty group (9.68% vs. 3.23%).

Conclusion

Vertebroplasty provides faster pain relief and better functional recovery but carries a higher risk of new fractures, requiring careful patient selection.

How neighborhood socioeconomic status, green space, and walkability are associated with risk for fracture among postmenopausal women

Although most fractures, and about half of hip fractures, occur outdoors among older women, limited research has uncovered neighborhood predictors for fractures among older women. This study assessed the independent associations of neighborhood socioeconomic status (SES), walkability, and green space with incident any and hip fracture among postmenopausal women. The Women's Health Initiative recruited a national sample of postmenopausal women (50-79 yr) across 40 U.S. clinical centers and conducted yearly assessments from 1993 to 2012 (n = 161 808). Women reporting a history of hip fracture or walking limitations were excluded from the analytic sample, yielding a final sample of 157 583 participants. Fracture events were self-reported and adjudicated annually. Walkability was calculated annually using measures of population density, land use mix, and presence/quantity of nearby high-traffic roadways. Neighborhood green space was calculated annually using measures of exposure to trees/vegetation. Neighborhood SES, walkability, and green space were categorized into tertiles: high, intermediate, and low. The time-varying relationship between neighborhood environmental factors and age at first fracture (any; hip) was examined using extended Cox proportional hazards modeling with adjustment. Neighborhood SES (intermediate vs low: hazard ratio = 1.03, 95% CI, 1.01-1.05; high vs low, hazard ratio = 1.01, 95% CI, 0.99-1.03) and green space (intermediate vs low, hazard ratio = 1.15, 95% CI, 1.12-1.18; high vs low hazard ratio = 1.18, 95% CI, 1.15-1.21) were associated with increased any incident fractures, while walkability had a mixed association (intermediate vs low hazard ratio = 1.06, 95% CI, 1.04-1.07; high vs low, hazard ratio = 0.97, 95% CI, 0.95-0.98). Neighborhood SES, walkability, and green space did not have a relationship with hip fracture after adjustment for important covariates. Results indicate that macroscale neighborhood features did not protect against fractures. Additional research is needed to investigate more granual neighborhood features that might influence injury risk and support physical activity among postmenopausal women.

Molecular mechanisms and treatment strategies for estrogen deficiency-related and glucocorticoid-induced osteoporosis: a comprehensive review

Osteoporosis, a debilitating condition characterized by reduced bone mass and increased fracture risk, is notably influenced by estrogen deficiency and glucocorticoid treatment. This comprehensive review elucidates the molecular mechanisms underpinning estrogen deficiency-related osteoporosis (EDOP) and glucocorticoid-induced osteoporosis (GIOP). The role of estrogen in bone metabolism is critically examined, highlighting its regulatory effects on bone turnover and formation through various signaling pathways. Conversely, this review explores how glucocorticoids disrupt bone homeostasis, focusing on their impact on osteoclast and osteoblast function and the subsequent alteration of bone remodeling processes. The pathogenesis of both conditions is intertwined, with estrogen receptor signaling pathways and the role of inflammatory cytokines being pivotal in driving bone loss. A detailed analysis of pathogenetic and risk factors associated with EDOP and GIOP is presented, including lifestyle and genetic factors contributing to disease progression. Modern therapeutic approaches emphasize pharmacologic, non-pharmacologic, and herbal treatments for managing EDOP and GIOP. In summary, current therapeutic strategies highlight the efficacy and the safety of various interventions. This review concludes with future directions for research, suggesting a need for novel treatment modalities and a deeper understanding of the underlying mechanisms of osteoporosis. By addressing the multifaceted nature of EDOP and GIOP, this work aims to provide insights into developing targeted therapeutic strategies and improving patient outcomes in osteoporosis management.

Ergothioneine alleviates osteoporosis via the ROS-MAPK signaling Axis

The accumulation of reactive oxygen species (ROS) within cells regulates the formation and function of osteoclasts, which is crucial therapeutic target for the treatment of osteoporosis. Ergothioneine (EGT) is a rare amino acid with strong antioxidant and anti-inflammatory properties. However, its application on osteoporosis has not been reported. In this study, we investigated the effects of EGT on osteoclastogenesis in vitro and in ovariectomized (OVX) mice. The results revealed that EGT could suppress RANKL-induced podosome belt formation and osteoclast development in vitro, while reducing intracellular ROS levels by upregulating key antioxidant enzymes, including HO-1 and Catalase. EGT was also found to downregulate the expression of critical osteoclast-specific proteins such as Trap, c-Fos, and Ctsk through attenuation of MAPK signaling. The potential of EGT to protect against trabecular bone loss in OVX mice was further demonstrated by micro-CT imaging, possibly by reducing osteoclast numbers shown by histological outcomes. These findings together highlighted the potential value of EGT as a novel tool for treating osteoporosis through its ability to suppress osteoclastogenesis and mitigate the accumulation of intracellular ROS.

Biases in the performance of FRAX without BMD in predicting fracture risk in a multiethnic population with diabetes: the Diabetes and Aging Study

Fracture risk calculators, such as the Fracture Risk Assessment Tool (FRAX), calculate the risk of major osteoporotic fracture (MOF) and hip fracture but do not account for the excess risk of fracture in people with diabetes. We examined the predictive performance of FRAX without BMD in ethnically diverse, older patients with diabetes. Patients included were between ages 65 and 89 from the Kaiser Permanente Northern California Diabetes Registry and not already taking osteoporosis medications. Race and ethnicity were self-identified. We calculated FRAX without BMD based on baseline characteristics and assessed how well FRAX predicted MOF and hip fracture over follow-up. Predictive performance was based on measures of discrimination (area under the receiver operator curve, AUC) and calibration (observed-to-predicted ratio, O/P). We identified 96 914 patients (47.0% female), of whom 5383 (5.6%) and 1767 (1.8%) had MOF and hip fracture, respectively, over a mean follow-up of 4.3 yr. The AUC for MOF and hip fracture were 0.72 and 0.77, respectively. FRAX mildly underestimated MOF and hip fracture rates (O/P 1.2 for both) overall. Discrimination was similar by race and ethnicity and diabetes duration but was worse in those over age 75 (AUC < 0.7). In some groups, there were substantial calibration errors, such as Hispanic women (O/P: 1.8 and 1.5), Black men (O/P: 1.5 and 1.8), those with duration of diabetes ≥20 yr (O/P: 1.6 and 1.5), and those over the age of 80 (O/P: 1.4 and 1.2) for MOF and hip fracture, respectively. While the discriminatory performance of FRAX without BMD was good overall in patients with diabetes, it underestimated risk in Hispanic women, Black men, those with long duration of diabetes, and in the oldest patients with diabetes. These algorithmic biases suggest that diabetes-specific tools may be needed to stratify fracture risk in patients with diabetes.

Association between urinary catecholamines and glucocorticoids and bone mineral density and osteoporosis in Puerto Rican adults

Chronic stress leads to elevated stress hormones, which may be linked to bone breakdown. Puerto Rican adults living on the US mainland have higher prevalence of stress than the general population, and higher and/or similar prevalence of osteoporosis compared with non-Hispanic Whites. The role of stress on bone remains unclear and may be modified by diet. A Dietary Approaches to Stop Hypertension (DASH) pattern, as a measure of dietary quality, was most protective for bone outcomes among Puerto Ricans. In this cross-sectional study, 958 Boston Puerto Rican Health Study participants were included (aged: 59.9 ± 7.6 yr). Stress markers (epinephrine, norepinephrine, cortisol) were collected via 12-h urine samples and elevated concentrations were categorized using sex-specific cutoffs. BMD was assessed via DXA. Analysis of covariance models with least squares means were used to test differences in mean BMD between participants with elevated and non-elevated stress markers. Multivariable logistic regression examined associations between stress markers and osteoporosis in postmenopausal females and males. Models were adjusted for age, height, smoking, alcohol use, education, glucocorticoid use, and diabetes. Higher urinary epinephrine was associated with lower BMD at the LS (p = .012), FN (p = .005), trochanter (p < .001), and TH (p < .001) in Puerto Rican adults, and with higher odds of osteoporosis among males (odds ratio = 4.01 [95%CI: 1.11, 14.5], p = .03). An interaction between DASH and norepinephrine was noted for postmenopausal females at the LS. No associations were noted for norepinephrine or cortisol (p > .11), although higher urinary norepinephrine was associated with lower LS BMD in postmenopausal females not taking estrogen, with lower adherence to DASH (p = .03). Higher urinary epinephrine and norepinephrine were associated with poorer bone outcomes in Puerto Rican adults, in a sex-specific manner, warranting future longitudinal studies to clarify associations. Dietary quality may moderate these associations.

Surgery within Two Days of Admission Reduces Complications and Mortality of Patients with Trochanteric Femur Fractures: A Japanese DPC Study

An early surgery for older adult patients with hip fractures is recommended to avoid perioperative complications in existing clinical guidelines. Few studies have analyzed only transtrochanteric fractures. The purpose of this study was to assess whether surgery within two days of admission reduces the incidence of pneumonia, deep vein thrombosis, pulmonary embolism, pressure ulcers, and mortality during hospitalization in patients with older adult transtrochanteric femur fractures. In this retrospective study, we used the Japanese National Administrative DPC (Diagnosis Procedure Combination) database that covers April 2016 to March 2022. Transtrochanteric femur fracture was included in patients aged 65 years or older who underwent surgery. The perioperative complications with pneumonia, deep vein thrombosis, pulmonary embolism, pressure ulcers, and mortality during hospitalization were assessed after propensity score matching, focusing on surgeries conducted within two days of admission. After one-to-one propensity score matching for age, sex, and comorbidity, we identified 79,649 pairs of patients who underwent surgery either within two days or after the third day of admission. Surgery delayed beyond two days was independently associated with increased pneumonia, pulmonary embolism, pressure ulcers, and mortality during hospitalization with risk ratios of 1.335 (95% CI: 1.256-1.418, p < 0.0001), 1.287 (95% CI: 1.225-1.351, p < 0.0001), 1.229 (95% CI: 1.094-1.380, p < 0.0001), and 1.063 (95% CI: 0.978-1.155, p = 0.0035), respectively. Surgery within two days of admission for transtrochanteric femur fracture effectively prevents perioperative complications and reduces mortality during hospitalization.

Proximal Hip Fracture: Does Canal Width Matter?

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

Targeted Dual Microdroplets for Modulating Osteoclast Differentiation and Function: A Novel Therapeutic Approach to Combat Osteoporosis

Osteoporosis, a condition marked by reduced bone mass and structural deterioration, continues to be a major public health concern, especially as global populations age. Excessive osteoclast formation is a hallmark of osteoporosis. The transcription factor nuclear factor of activated T-cells cytoplasmic 1 (NFATc1) is indispensable for the early differentiation of osteoclasts, orchestrating the expression of essential genes, while at the later stages, cathepsin K (CTSK) is essential for bone resorption activities of mature osteoclasts. Here, we fabricated ultrasound-responsive microdroplets (MDs) by modulating both the early stages of osteoclast differentiation and the functions of mature osteoclasts via targeting the NFATc1 and CTSK. The internalization of these dual MDs was evaluated in human bone marrow-derived mesenchymal stromal cells (hBMSCs) and murine RAW 264.7 macrophages, alongside the biocompatibility assay. Their effects on osteogenesis and osteoclastogenesis were further investigated in vitro, followed by in vivo analysis in osteoporotic rat models. The dual MDs exhibited a well-defined core-shell structure and demonstrated efficient cellular uptake with minimal cytotoxicity. Furthermore, dual MDs showed a minimal effect on the osteogenic differentiation of the hBMSCs. In in vitro osteoclastogenesis assays, dual MDs effectively suppressed both osteoclast differentiation and formation through a synergistic inhibitory effect. In vivo studies demonstrated that osteoporotic rats receiving dual MDs showed significant protection against bone loss induced by ovariectomy. These results highlight the potential of dual MDs as a sophisticated, targeted therapeutic approach to osteoporosis treatment.

Efficacy and safety of abaloparatide, denosumab, teriparatide, oral bisphosphonates, and intravenous bisphosphonates in the treatment of male osteoporosis: a systematic review and Bayesian network meta-analysis

Study Design

A Systematic Review and Bayesian Network Meta-Analysis.

Objective

To compare the efficacy and safety of abaloparatide (ABA), denosumab (DEN), teriparatide (TER), oral bisphosphonates (OBP), and intravenous bisphosphonates (IBP) in the treatment of male osteoporosis through a network meta-analysis.

Summary of Background Data

Currently, a variety of medications are available for the treatment of male osteoporosis, including abaloparatide, denosumab, teriparatide, and bisphosphonates. These medications are widely applied in male osteoporosis, and existing randomized controlled trials (RCTs) provide strong evidence of their efficacy. However, there is a lack of sufficient systematic comparative studies to guide the choice between these treatments, particularly for specific male osteoporosis populations.

Methods

This systematic review and network meta-analysis (NMA) were conducted strictly in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and the relevant standards recommended by the Cochrane Collaboration. We performed pairwise meta-analysis using Stata 18.0 software to assess the magnitude of effect sizes and the consistency of findings across studies. For network meta-analysis (NMA), we used R version 4.3.1 along with the gemtc and BUGSnet packages to handle complex multi-treatment comparisons. Using these methods, we were able to comprehensively assess the relative efficacy and safety of different treatment options. All statistical analyses were conducted using Review Manager software (version 5.4), a widely used tool in medical research for meta-analysis, forest plot generation, and bias risk assessment.

Results

Overall, clinical decisions should carefully balance drug efficacy and safety. Although TER performs best in reducing the occurrence of all adverse events, its efficacy in some BMD targets (such as total hip BMD) is relatively lower. In comparison, while OBP has a clear advantage in reducing severe adverse events, its efficacy in some BMD improvements (such as femoral neck BMD) is slightly less. Therefore, clinicians should consider the specific needs of the patient, the treatment goals, and the safety profile of the drug when selecting a medication, particularly for long-term use.

Conclusion

The results indicate that abaloparatide and teriparatide are significantly superior to other drugs in improving lumbar spine and femoral neck BMD, while oral bisphosphonates is the most effective in improving total hip BMD. In terms of safety, teriparatide demonstrates the best performance in all adverse events, and oral bisphosphonates shows a clear advantage in reducing severe adverse events. Future treatment decisions should balance efficacy and safety, with clinical treatment tailored to the individual needs of the patient, including the site of bone loss and sensitivity to adverse events. Future research should explore combination therapies or multi-target strategies to optimize both efficacy and safety.

Intra-Individual Differences of the Femoral Cortical Thickness Index in Elderly Patients with a Proximal Femoral Fracture

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

National Surgical Trends in Distal Radius Fixation in Medicare Beneficiaries: Increased Utilization by Plastic Surgeons and Hand Surgeons

INTRODUCTION

Several randomized controlled trials have been published concerning the treatment of distal radius fracture interventions (DRFIs) in elderly patients. This study aims to investigate the surgical trends in the management of DRFs within the Medicare population.

METHODS

In this retrospective study, we collected data from the Centers for Medicare and Medicaid Services between 2013 and 2022 for claims for DRFIs identified using Current Procedural Terminology codes 25606, 25607, 25608, and 25609. Results were categorized by primary operator type (general orthopaedic surgeon, general plastics, general surgeon, subspecialty hand surgeon) and place of service (inpatient, outpatient, other).

RESULTS

A total of 101,857 DRFIs were identified. The overall rate of DRFIs declined by 12% (29.5 to 26.1 per 100,000 individuals). The utilization of closed reduction percutaneous pinning experienced a 63% decrease (4.8 to 1.8 per 100,000). Conversely, open treatment for distal radial intra-articular fractures saw an 11% increase in utilization (10.0 to 11.1 per 100,000). Orthopaedic surgeons and general surgeons experienced a notable decrease in utilization of DRFIs of 22% and 6%, respectively, whereas plastic surgeons and hand surgeons saw an increase in utilization of 74% and 13%, respectively, over the same 10-year period. Outpatient DRFIs increased by 11%, whereas inpatient and other decreased by 17% and 36%, respectively.

CONCLUSION

There has been a notable decline in DRFIs within the Medicare population. We observed a diminishing procedure share among general orthopaedic surgeons and general surgeons, accompanied by a rising utilization of plastic surgeons and hand surgeons in addressing DRFIs.

LEVEL OF EVIDENCE

NA, Database Review.

Plates made from magnesium alloy with a long period stacking ordered structure promote bone formation in a rabbit fracture model

Operative treatment is an option for fractures when the fracture is unstable or the patient wishes to return early to daily life or social activities. Metal plates such as titanium and stainless steel are often used in fracture surgery, but the metal plate lacks bone-healing activity and is not bioabsorbable, requiring a second surgery to remove it after bone union. Here we show that a magnesium (Mg) plate made from an alloy of yttrium, zinc, and aluminum with magnesium as the main component in a long-period stacking ordered structure promotes bone formation in a rabbit tibia fracture model and is also bioabsorbable. We show that the Mg plate significantly promoted bone and callus formation compared to a titanium plate in the rabbit tibia fracture model. Moreover, the Mg plate was mostly bioabsorbed once bone union was achieved, but rabbits showed no evidence of biotoxic effects, such as weight loss or increased blood magnesium levels. We also demonstrate that treatment with exogenous magnesium significantly enhanced calcium deposition in an in vitro osteoblast culture system. Magnesium is an essential element, and its radiolucency facilitates observation of the fracture site during Mg plate fixation, while its lack of magnetic properties allows its use in patients who require MRI scans. Accordingly, we propose that a use of a Mg plate could be beneficial in treating bone fracture.

Risk factors for non-vertebral fractures in community-dwelling elderly: a 10-year follow-up study in New Zealand

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

TRIAL REGISTRATION

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

Enabling adenosine signaling to promote aged fracture healing

Bone fractures and related complications are a significant concern for older adults, particularly with the growing aging population. Therapeutic interventions that promote bone tissue regeneration are attractive for geriatric fracture repair. Extracellular adenosine plays a key role in bone homeostasis and regeneration. Herein, we examined the changes in extracellular adenosine with aging and the potential of local delivery of adenosine to promote fracture healing using aged mice. Extracellular adenosine level was found to be significantly lower in aged bone tissue compared to young mice. Concomitantly, the ecto-5'-nucleotidase CD73 expression was also lower in aged bone. Local delivery of adenosine using injectable, in situ curing microgel delivery units yielded a pro-regenerative environment and promoted fracture healing in aged mice. This study offers new insights into age-related physiological changes in adenosine levels and demonstrates the therapeutic potential of adenosine supplementation to circumvent the compromised healing of geriatric fractures.

Anatomical structure of the medullary cavity of proximal femur with three-dimensional computed tomography

BACKGROUND

The lateral femoral wall is an important anatomical parameter of the proximal femur, but intramedullary nail fixation for intertrochanteric fractures may cause iatrogenic lateral wall fractures due to population-based design differences. This study aims to measure the anatomical parameters of the proximal femoral medullary cavity and provide data to help design intramedullary nails tailored to the Chinese population to reduce the risk of complications such as lateral wall fractures.

METHODS

Consecutive patients undergoing full-length or upper half CT scans of the femur were included from January 2010 to December 2021. The anatomical parameters of medullary cavity were defined and measured, including prominence length, canal-shaft angle and proximal minimum diameter. Intraclass Correlation Coefficient (ICC) was used to estimate the inter- and intra-observer agreements.

RESULTS

A total of 168 patients, comprising 78 men and 90 women, were included. The mean prominence length was 67.4 ± 4.9 mm (males: 70.8 ± 3.6 mm, females: 64.4 ± 3.9 mm). The mean canal-shaft angle was 5.5° ± 0.7° (males: 5.6 ± 0.8°, females: 5.5 ± 0.7°). The mean proximal minimum diameter was 22.7 ± 1.8 mm (males: 24.0 ± 1.5 mm, females: 21.6 ± 1.4 mm) at the level of 1/3 prominence length from bottom to top. Gender differences were observed in these parameters (p < 0.001) except for the canal-shaft angle (p = 0.45). The mean proximal minimum diameter was significantly larger in the group aged 50 years and older (23.1 ± 1.7 mm) compared to the group younger than 50 years (22.4 ± 1.9 mm) (p = 0.02). Inter- and intra-observer agreement was almost perfect for all the parameters (all ICC values > 0.8).

CONCLUSIONS

Males have a longer prominence length and larger proximal minimum diameter than females. The proximal minimum diameter is larger in the older population than in the younger population. The measurement results help support the design of intramedullary nails tailored to the Chinese population.

CLINICAL TRIAL NUMBER

Not applicable.

Rate of Osteoporosis Evaluation and Treatment Following Kyphoplasty in Patients With Vertebral Compression Fractures: A Retrospective Study and Review of the Literature

Background

Lifetime risk of an osteoporotic fracture is 50% for women and 20% for men. Of these fractures, vertebral compression fractures (VCF) are the most common. While surgery plays a crucial role in managing these fractures, preventative measures are also critical when addressing the risk of osteoporotic VCFs. Although many recent guidelines recommend osteoporosis evaluation and treatment for patients with VCFs, the true proportion of patients who undergo an osteoporosis workup following their kyphoplasty procedure is unknown. The aim of this study is to assess the frequency of osteoporosis screening and treatment in patients who undergo a kyphoplasty procedure to correct a vertebral fragility fracture.

Methods

This study utilized the TriNetX Research Network, a database containing de-identified patient information. Using this database, we identified patients from 89 institutions with non-traumatic VCFs and VCFs that resulted from low-energy trauma who subsequently underwent a kyphoplasty procedure. We then analyzed any follow-up osteoporosis treatment or screening they received.

Results

A total of 3371 patients were identified to have undergone kyphoplasty to treat a VCF for the first time. To our knowledge, this is the largest study of its kind to date. Among these patients, 71.3% never had a DEXA scan or prior medical treatment for osteoporosis within 2 years before their kyphoplasty procedure. Additionally, 56.1% of all patients with VCFs treated with kyphoplasty for the first time were never screened or treated for osteoporosis in the two years preceding and 1 year following the procedure.

Conclusion

Our results suggest that only 15.2% of patients with a vertebral fragility fracture secondary to decreased bone density are screened and treated for osteoporosis. Despite existing guidelines recommending osteoporosis evaluation and treatment for patients with VCFs, our findings highlight missed opportunities for intervention. Improving the implementation of existing screening protocols and increasing awareness among healthcare providers could reduce VCF-associated morbidity and mortality.

Automatic segmentation of cortical bone microstructure: Application and analysis of three proximal femur sites

Osteoporosis is the most common bone metabolic unbalance, leading to fragility fractures, which are known to be associated with structural changes in the bone. Cortical bone accounts for 80 % of the skeleton mass and undergoes remodeling throughout life, leading to changes in its thickness and microstructure. Although many studies quantified the different cortical bone structures using CT techniques (3D), they are often realised on a small number of samples. Therefore, the work presented here proposes a method to quantify cortical bone microstructure using 2D histology, shows its application on a set of 94 samples and compares to 3D methods. Fresh frozen human femur pairs from 47 donors aged between 57 and 96 years were obtained from the Medical University of Vienna. Bone samples were cut from 3 sites: proximal part of the diaphysis, inferior and superior segments of the neck. The samples were stained with toluidine blue and imaged under light microscopy. After manual segmentation of a few regions of interest by multiple operators, a convolutional neural network was trained in combination with a random forest for automatic segmentation. The segmentation analysis compares morphology and structure distribution of Haversian canals, osteocyte lacunae, and cement lines with literature, between anatomical sites, sex, left and right sides, and relation to ageing. Morphological analysis of the segmentation gives results similar to the literature. Comparison between male and female donors shows no significant differences. There is no significant difference between left and right femur on paired samples but significant differences are observed between anatomical locations. The structures' relative amounts do not present significant changes with age but only weak tendencies. Nevertheless, a strong correlation was observed between osteocyte lacunae density and bone areal fraction. This study presents a full process to stain and automatically segment digital cortical bone images. Its application to a large sample set of proximal femora provides strong statistics on the cortical bone structures morphology and distribution. Similarities observed between sides and sexes together with differences observed between sites could indicate that mechanical loading might be a main driver for bone microstructure. Additionally, the relationship between osteocyte lacunae density and bone areal fraction could suggest that bone porosity is regulated by osteocyte survival.

How Would You Manage This Patient With Decreased Bone Density? Grand Rounds Discussion From Beth Israel Deaconess Medical Center

Osteoporosis is a skeletal condition characterized by low bone mass and fragility resulting in an increased risk for fracture. It affects all bones, but fractures most often occur in the hip and spine. Osteoporosis is common in postmenopausal women, with estrogen deficiency thought to be a major contributing factor. Screening for osteoporosis with bone densitometry is recommended in all women 65 years of age or older and in postmenopausal women younger than 65 who are at increased risk. In 2023, the American College of Physicians published updated guidance on the pharmacologic treatment of osteoporosis. Among the recommendations was for clinicians to take an individualized approach regarding whether to start treatment with a bisphosphonate in women older than 65 years with osteopenia (a lesser degree of bone loss) to reduce the risk for fractures. Here, 2 bone endocrinologists debate how to manage a patient with both osteopenia and osteoporosis on bone densitometry. They discuss how to interpret and address these findings.

Atypical Femur Fractures-An Analysis of 69 Patients from 15 Years

Background/Objectives: Bisphosphonates are effective in preventing osteoporotic fractures. However, the risk of atypical femur fractures (AFFs) increases with long-term bisphosphonate use. There are few existing publications on the analysis of clinical outcomes of atypical femur fracture cases in Chinese patients. Our objective was to review the clinical outcomes of AFF cases managed in a tertiary center in Hong Kong, China. Methods: Cases of AFF managed in the Prince of Wales Hospital from 2010 to 2024 were included. Data on demographics, type and duration of bisphosphonate use prior to AFF, fixation method, and mobility 1 year post-operation were retrospectively retrieved. One-way ANOVA was used to compare the duration of use prior to the development of AFF between different types of bisphosphonates. Results: Sixty-nine cases of AFF were included, with a mean age of 73.8 ± 9.7 years. A total of 95.6% of patients had a history of bisphosphonate use, with a mean duration of usage of 6.8 ± 5.6 years prior to the occurrence of AFF. The duration of bisphosphonate use prior to the development of AFF was comparable between alendronate, ibandronate, and a history of using more than one type of anti-resorptive agent. A non-union rate of 5.8% was observed in the current cohort, with 48.2% returning to pre-morbid mobility 1 year post-operation. Conclusions: AFF is more commonly seen in female patients with a history of bisphosphonate use. Considering the high success rate demonstrated in the current cohort, treating AFF with closed reduction followed by fixation with a long cephalomedullary device in dynamic locking together with immediate full-weight-bearing rehabilitation post-operation may be effective.

Shoulder Arthroplasty Patients Are Underscreened for Osteoporosis

INTRODUCTION

Osteoporosis screening and subsequent treatment has been shown to be efficacious in decreasing the rates of fragility fractures and periprosthetic fractures (PPF). However, current screening and treatment rates are low. This study aims to determine (1) the prevalence of total shoulder arthroplasty (TSA) patients who meet criteria for osteoporosis screening, (2) the prevalence of those screened, and (3) the 5-year cumulative incidence of fragility fracture (FF) and periprosthetic fractures (PPF).

METHODS

The PearlDiver database was used to identify all patients older than 50 years who underwent TSA. Guidelines from the American Association of Clinical Endocrinologists were used to stratify patients into "high risk" and "low risk" of osteoporosis cohorts using International Classification of Disease codes for various risk factors. The prevalence of osteoporosis screening using dual-energy x-ray absorptiometry (DXA) scan was analyzed, and the 5-year cumulative incidence of FF and PPF was calculated between the "low-risk" and "high-risk" groups using Kaplan-Meier analysis.

RESULTS

In total, 66,140 (65.5%) who underwent TSA were considered "high risk" for osteoporosis. Of the "high-risk" patients, 11.7% patients received routine osteoporosis screening preoperatively. Within 5 years, "high-risk" TSA patients had markedly higher cumulative incidence for PPF (HR: 1.4; 95% CI: 1.0-1.9; P = 0.037) and FF (HR: 2.42; 95% CI: 2.1-2.8; P < 0.001) when compared with those at "low risk".

DISCUSSION

There is a high prevalence of osteoporosis among patients undergoing TSA but a low rate of routine osteoporosis screening in this cohort. Patients with osteoporosis who are categorized as "high risk" have an increased rate of fragility fractures and PPF. Therefore, there is an opportunity to increase appropriate osteoporosis screening and management in this cohort, which may affect future risk of FF and periprosthetic fracture.

LEVEL OF EVIDENCE

III.

The causal relationship of inflammation-related factors with osteoporosis: A Mendelian Randomization Analysis

BACKGROUND

We used Mendelian randomization (MR) approach to examine whether genetically determined inflammation-related risk factors play a role in the onset of osteoporosis (OP) in the European population.

METHODS

Genome-wide association studies (GWASs) summary statistics of estimated bone mineral density (eBMD) obtained from the public database GEnetic Factors for OSteoporosis Consortium (GEFOS) including 142,487 European people. For exposures, we utilized GWAS data of 9 risk factors including diseases chronic kidney disease (CKD) (41,395 cases and 439,303 controls), type 2 diabetes (T2D) (88,427 cases and 566,778 controls), Alzheimer's disease (AD) (71,880 cases, 383,378 controls) and major depression disorder (MDD) (9240 cases and 9519 controls) and lifestyle behaviors are from different consortiums. Inverse variance weighted (IVW) analysis was principal method in this study and random effect model was applied; MR-Egger method and weighted median method were also performed for reliable results. Cochran's Q test and MR-Egger regression were used to detect heterogeneity and pleiotropy and leave-one-out analysis was performed to find out whether there are influential SNPs.

RESULTS

We found that T2D (IVW: β = 0.05, P = 0.0014), FI (IVW: β = -0.22, P < 0.001), CKD (IVW: β = 0.02, P = 0.009), ALZ (IVW: β = 0.06, P = 0.005), Coffee consumption (IVW: β = 0.11, P = 0.003) were causally associated with OP (P<0.006after Bonferroni correction).

CONCLUSIONS

Our study revealed that T2D, FI, CKD, ALZ and coffee consumption are causally associated with OP. Future interventions targeting factors above could provide new clinical strategies for the personalized prevention and treatment of osteoporosis.

Are balance and lower extremity muscle strength correlated with fracture risk independent of bone mineral density in postmenopausal women?: A cross-sectional study

BACKGROUND

Postmenopausal women are at increased risk of fractures due to reduced bone mineral density (BMD) and impaired physical function. While fracture risk assessment tools like FRAX include clinical factors and BMD, they exclude functional measures such as balance and muscle strength, which are critical for fall prevention. This study aimed to evaluate the correlation between two functional tests- the 30-Second Sit to Stand Test (30STS) and the One Leg Stance Test (OLST)- and fracture risk, independent of BMD in postmenopausal women aged 50-70.

METHODS

This cross-sectional study included 156 postmenopausal women aged 50-70. Fracture risk was assessed using FRAX. Postural balance was evaluated using the OLST, while lower extremity muscle strength was measured with the 30STS. Both tests were analyzed for correlations with 10-year risks of major osteoporotic fractures (MOF), hip fractures, femoral neck BMD, and T-score at the lumbar spine and femoral neck. Participants were grouped based on OLST (<10 s) and 30STS (<15 repetitions) cut-offs, and fracture risks were compared.

RESULTS

OLST and 30STS scores were significantly negatively correlated with 10-year hip fracture risk (r = -0.347, p < 0.001 and r = -0.197, p = 0.014, respectively). A significant negative correlation was also observed between OLST scores and 10-year MOF risk (r = -0.245, p = 0.002). Participants with OLST <10 s had significantly higher 10-year hip and MOF risks, while those with 30STS <15 had significantly higher 10-year hip fracture risk only. No correlation was found with femoral neck BMD.

CONCLUSION

LST and 30STS are associated with fracture risk independent of BMD in postmenopausal women aged 50-70. These practical tests may help identify individuals at higher fracture risk and support early interventions.

Acute pain trajectories in elderly patients with fragility hip fractures

BACKGROUND

Pain management for hospitalized elderly patients with fragility hip fractures (FHF) remains challenging. This study aims to distinguish acute pain trajectories in FHF patients that can inform personalized analgesia management.

METHODS

We conducted a prospective observational study of patients aged 65 and older with FHF at a Level I trauma center. The primary outcome was daily average pain assessed for five days post-injury using the Brief Pain Inventory (BPI). We used group-based trajectory modeling (GBTM) to distinguish acute pain trajectories. Then, factors and secondary outcomes (opioid use and hospital length of stay [LOS]) associated with more severe pain trajectories were identified.

RESULTS

We enrolled 100 consecutive patients with FHF between June 2022 and June 2023. We identified three distinct acute pain trajectories: minimal pain, subsiding pain, and persistent pain. Factors associated with more severe pain trajectories included higher initial pain on admission (OR 1.17, 95 % CI 1.02-1.36, P = 0.047), higher BMI (OR 1.15, 95 % CI 1.02-1.29, P = 0.021), and intertrochanteric fracture type (OR = 6.46, 95 % CI 1.49-27.98, P = 0.013). The persistent pain trajectory was significantly associated with 40 % more opioid use (P = 0.01) and a longer LOS (LOS ratio = 1.45, 95 % CI 1.21-1.74, P < 0.001).

CONCLUSION

Acute pain in FHF patients can be classified into distinct trajectories, providing a basis for personalized pain management. More severe pain trajectories are associated with higher opioid use and longer length of hospital stay.

Association between osteoporosis under treatment and all-cause and specific-cause mortalities: a nationwide retrospective cohort study in South Korea

BACKGROUND

Despite the association between osteoporosis treatment and reduced mortality, evidence on specific-cause mortality is lacking. Therefore, this study explored the association between osteoporosis under treatment and all-cause and specific-cause mortalities using nationwide retrospective cohort data from South Korea.

METHODS

This study utilized data from the National Health Insurance Service screening cohort of South Korea from 2002 to 2019. Participants with osteoporosis who had undergone treatment at least twice and were diagnosed based on bone densitometry were included. Control groups were matched 1:1 based on age, sex, income, and region. Propensity score overlap weighting was applied to balance covariates. Cox proportional hazards models and Fine-Gray sub-distribution hazard models were used to assess all-cause and specific-cause mortalities across 14 disease categories based on the Korean standard classification of diseases.

RESULTS

Finally, 34,181 participants were included in both osteoporosis and control groups. The largest age group was 55-59 years, with a majority of female participants (81.60%). Osteoporosis under treatment was significantly associated with reduced all-cause mortality with consistent results across various demographic and clinical subgroups. Specific-cause mortality analysis revealed lower mortality due to neoplasms and metabolic diseases and higher mortality from respiratory and muscular diseases. However, increased risks of respiratory and muscular disease-related mortality were observed.

CONCLUSIONS

Osteoporosis treatment was associated with reduced all-cause and specific-cause mortalities, particularly from neoplasms and metabolic diseases. Further studies, particularly randomized controlled trials, are required to confirm these results, establish causality, and explore the medication-specific effects on mortality.

Does Orthopaedic Subspecialty Training Affect Treatment Decision-Making and Outcomes for Displaced Femoral Neck Fractures?

BACKGROUND

Approximately 1.3 to 2.2 million femoral neck fractures occur annually globally, with up to 80% being displaced, requiring hemiarthroplasty or total hip arthroplasty (THA). As the population ages, femoral neck fractures may surpass six million by 2050. Optimal treatment for displaced femoral neck fractures is debated with literature supporting both hemiarthroplasty and THA. Our objective was to determine if subspecialty training plays a role in the decision-making and outcomes of displaced femoral neck fractures.

METHODS

A retrospective analysis was performed for 386 patients who underwent hemiarthroplasty or THA for displaced femoral neck fracture at an academic health system from 2017 to 2023. To assess subspecialty training impact, patients were stratified based on training: adult reconstruction (AR) fellowship or other orthopaedic training (non-AR). Procedure duration, 90-day postoperative complications, length of stay, and discharge disposition were compared between cohorts. A subanalysis was performed to compare the procedures.

RESULTS

The AR surgeons performed THA 31.8% for femoral neck fractures compared to 10.5% for non-AR-trained surgeons (P < 0.001). Patients treated by AR-trained surgeons were on average younger (79 versus 82 years; P = 0.01). Procedure duration was shorter for hemiarthroplasty (80.4 versus 90.1 minutes; P = 0.01) and THA (94.9 versus 132.6 minutes; P = 0.01) when performed by AR surgeons (overall P = 0.01). The THA patients were more likely discharged home when treated by AR surgeons (55.3 versus 28%; P = 0.03). The AR-trained surgeons used cemented prostheses less compared to non-AR surgeons (16.9 versus 33.2%; P < 0.001).

CONCLUSIONS

Subspecialty training plays a role in decision-making, procedure duration, and discharge disposition for femoral neck fractures. The AR-trained surgeons more often perform THA for femoral neck fractures compared to non-AR-trained surgeons. The AR-trained surgeons completed hemiarthroplasty and THA in significantly shorter time compared with non-AR-trained surgeons and more frequently discharged patients home.

Association between plain water intake and the risk of osteoporosis among middle-aged and elderly people in the United States: a cross-sectional study

Background

The connection between plain water intake (PWI) and osteoporosis risk is still unclear. The investigation aimed to identify the relationship between PWI and osteoporosis risk in middle-aged and elderly individuals in the United States (US).

Methods

This cross-sectional study was conducted among participants aged 50 years and older in the following waves of the National Health and Nutrition Examination Survey (NHANES): 2007-2008, 2009-2010, 2013-2014, and 2017-2018. The relationship between PWI and osteoporosis risk was examined by multivariable logistic regression models, accompanied by subgroup analyses and interaction tests. Smooth curve fitting and threshold effect analysis were utilized.

Results

The present investigation included 6,686 participants. In accordance with the fully adjusted model, individuals in the highest PWI tertile had a significantly reduced risk of osteoporosis in contrast to those in the lowest tertile [odds ratio (OR) = 0.62; 95% confidence interval (CI): 0.49-0.77; P for trend<0.001]. After adjusting for all covariates, a higher PWI was linked to a decreased risk of osteoporosis (OR = 0.92; 95% CI: 0.86-0.98; p = 0.008). No significant interactions were detected in the subgroup analyses for age, gender, race, body mass index, diabetic history, hypertension status, smoking history, consumption of prednisone or cortisone, or moderate or strenuous activity (all P for interaction>0.05). Smooth curve fitting and threshold effect analysis revealed that when PWI was less than 1,220 mL/day, there was a significant negative connection between PWI and osteoporosis risk (OR = 0.79; 95% CI: 0.70-0.89; p < 0.001); nevertheless that association was not significant when PWI was greater than 1,220 mL/day (OR = 1.06; 95% CI: 0.95-1.17; p = 0.288).

Conclusion

The outcomes of our investigation indicated that among middle-aged and older US adults, a higher PWI was connected with a moderately reduced osteoporosis risk. Managing PWI might reduce the osteoporosis risk.

Association between dietary acid load and risk of osteoporotic fractures in adults: a systematic review and meta-analysis of observational studies

AIM

We aimed to systematically review and conduct a meta-analysis of the available evidence about the association between dietary acid load (DAL) and fractures in adults.

METHOD

Relevant studies were searched through Web of Science, Scopus, PubMed, and Google Scholar until October 2024. The random-effect model was used to calculate the pooled Odd ratios (OR) and 95% confidence intervals (CIs). Publication bias was evaluated by statistical test of Egger. Subgroup analyses were conducted by study confounders. Moreover, the quality of studies was asessed using the Newcastle Ottawa Scale which is designed for observational studies.

RESULTS

Six studies were included in this review. According to the methodological heterogeneity between studies and their different charactristics, we performed the analysis based on random-effect model that indicated a marginally significant association between DAL and risk of fracture (N event = 5275, Pooled OR: 1.10; 95% CI: 0.99-1.21, P = 0.073) (I2 = 12.9%; P = 0.321). According to subgroup analysis, there was no significant association between DAL and risk of fracture in the cross-sectional effect sizes (N event = 337, OR:0.69; 95%CI:0.47-1.00). There was a significant association between DAL and a greater risk of fracture in cohort studies (N event = 4938, OR:1.12; 95%CI:1.03-1.22, P = 0.006). Also, high-quality studies (OR:1.12; 95%CI:1.03-1.22; P = 0.006) showed a significant association between DAL and fracture risk.

CONCLUSION

DAL was marginally related to a higher risk of fracture. This finding is a trigger for bone health management with a healthy balanced dietary intake.

Predictive modelling of knee osteoporosis

OBJECTIVE

The objective of this research was to develop a machine learning-based predictive model for osteoporosis screening using demographic and clinical data, including T-scores derived from calcaneus Quantitative Ultrasound (QUS). The study aimed to offer a cost-effective and accessible alternative to Dual-Energy X-ray Absorptiometry (DXA) scans, especially in resource-constrained settings.

RESULTS

The model achieved a classification accuracy of 88%, outperforming traditional decision trees by 10%. This improvement in accuracy demonstrates the potential of the random forest algorithm in identifying patients at risk of osteoporosis. Misclassification rates were minimal, with most errors occurring in distinguishing osteopenia from normal cases. The findings indicate that machine learning models trained on QUS data can aid in early identification of osteoporosis, reducing reliance on costly DXA scans.

Efficient evaluation of osteotoxicity and mechanisms of endocrine disrupting chemicals using network toxicology and molecular docking approaches: triclosan as a model compound

This study aimed to demonstrate the utility of a network toxicology strategy in elucidating osteotoxicity and the molecular mechanisms of endocrine-disrupting chemicals (EDCs) using triclosan exposure in postmenopausal osteoporosis (PMOP) as a case study. The potential targets of triclosan were identified using the Comparative Toxicogenomics Database, SwissTargetPrediction, and TargetNet. PMOP-related targets were obtained from GeneCards, DisGeNET, and DrugBank. A total of 478 overlapping genes between disease targets and triclosan effectors were identified. Subsequent analysis using STRING and Cytoscape, applying the Matthews correlation coefficient algorithm, identified five core genes: STAT3, TP53, EGFR, MYC, and JUN. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analyses performed using R revealed that triclosan-induced PMOP is primarily associated with disrupted endocrine signaling and activation of the Phosphoinositide 3-kinase (PI3K)-Protein kinase B (Akt) signaling pathway. Molecular docking using CB-Dock2 confirmed strong binding affinities between triclosan and the core targets. Collectively, these results indicate that triclosan adversely affects bone health by disrupting endocrine regulation and energy metabolism through the PI3K-Akt pathway. This study establishes a theoretical framework for understanding how long-term triclosan exposure induces or exacerbates PMOP by investigating the underlying molecular mechanisms. These findings present a novel paradigm for evaluating the health risks posed by environmental pollutants.

Public Insurance and Language Preferences Are Associated With a Longer Time to Surgery for Distal Radius Fractures

INTRODUCTION

Insurance type can result in disparities in access to specialist orthopaedic care. Here, we sought to quantify how insurance type affects time to surgery in patients with a distal radius fracture that needs surgical treatment.

METHODS

A retrospective cohort study of patients ≥18 years with surgically managed, closed distal radius fractures was conducted. We measured the time from injury to surgery, the time from injury to clinic visit, and the time from clinic visit to surgery. Data were analyzed using linear regression models.

RESULTS

We included 131 patients (69.0%) with private insurance and 56 patients (29.5%) with public insurance. The mean time from injury to surgery for the entire cohort was 12.4 ± 0.6 days. Private insurance patients had an average time from injury to surgery of 11.0 ± 0.5 days; public insurance patients had an average of 16.2 ± 1.3 days (P < 0.001). The increased time from injury to surgery for publicly insured patients was due to a 4.3-day longer (P < 0.001) time from injury to clinic visit; the time from clinic visit to surgery was similar (0.9 days, P = 0.216). In a stratified analysis, age was an effect modifier of the relationship between insurance type and time to surgery, with greater delays for younger patients. Preferred language other than English was associated with a 5.4 day longer time to surgery (P = 0.022) in a multivariate model.

DISCUSSION

In patients with surgically treated distal radius fractures, public insurance was associated with a longer time to surgery, with such effect more pronounced for younger patients. Patients who spoke a language other than English also experienced greater delays. These findings warrant system-level efforts to address inequitable delays in care.

Osteoporosis in Men: an Overlooked Patient Population

PURPOSE OF REVIEW

The purpose of this review is to describe the approach to osteoporosis management in men in the setting of limited evidence.

RECENT FINDINGS

Although men have less fractures than women, men have greater mortality after fractures as well as increased complications, including infection and major cardiovascular events. Unfortunately, men are not routinely screened for osteoporosis, partially due to limited insurance coverage in the United States. Due to screening barriers and lack of robust evidence of fracture reduction with therapeutic agents in men, treatment rates have also been low. A 2022 network meta-analysis of osteoporosis treatment in men found that with all the randomized controlled trials performed in men, there was only sufficient power to show vertebral fracture reduction. A large case-control observational study from 2024 did find that osteoporosis treatment reduced odds of hip fracture similarly in men and women. Men have fractures, with greater morbidity and mortality than women. Although osteoporosis research is lacking in men, providers should assess fracture risk in men and allow them the opportunity to reduce their fracture risk.

Comparative Analysis of Romosozumab Versus Vertebroplasty With Denosumab: Efficacy, Safety, and Secondary Bone Mineral Density Outcomes

OBJECTIVE

This study aimed to compare the efficacy and safety of romosozumab, a bone anabolic agent, versus vertebroplasty, a conventional surgical intervention, in treating osteoporotic vertebral compression fractures (OVCFs).

METHODS

A retrospective analysis included 86 thoracic/lumbar compression fracture patients from 2014 to 2022 at a medical center. Forty-two patients received romosozumab (monthly injections for 1 year) followed by 1 year of denosumab, while 44 underwent vertebroplasty followed by denosumab injections biannually for 2 years. Outcomes were assessed using the Numerical Rating Scale (NRS) for pain, bone mineral density (BMD), vertebral compression ratio, and Cobb angle over 12 months.

RESULTS

At 12 months, the romosozumab group showed a greater reduction in NRS scores (4.90 ± 1.01 vs. 4.27 ± 1.34, p = 0.015) and a higher increase in lumbar BMD (0.8 ± 0.5 vs. 0.5 ± 0.3, p = 0.000) compared to the vertebroplasty group. There were no significant differences in changes in hip total BMD and femur neck BMD (p = 0.190, p = 0.167, respectively). Radiographic assessments showed no significant differences in vertebral compression ratio (14.7% vs. 14.8%; p = 0.960) or Cobb angle (4.2° vs. 4.9°; p = 0.302). The incidence of major osteoporotic fractures was lower in the romosozumab group (7.1% vs. 25.0%, p = 0.051), with similar rates of cardiovascular events in both groups (4.8% vs. 9.1%, p = 0.716).

CONCLUSION

Romosozumab has demonstrated superior pain reduction and lumbar BMD improvement compared to vertebroplasty at 12 months, with no significant differences in radiographic outcomes or adverse events, suggesting it as an alternative to vertebroplasty for OVCF.

LncRNA H19 promotes osteoclast differentiation by sponging miR-29c-3p to increase expression of cathepsin K

BACKGROUND

Osteoporosis is a prevalent metabolic bone disease. Osteoporotic fractures can lead to severe functional impairment and increased mortality. Long noncoding RNA H19 has emerged as a pivotal player in bone remodeling, serving both as a biomarker and a regulator. While previous research has elucidated H19's role in promoting osteogenic differentiation through diverse mechanisms, its involvement in osteoclast differentiation remains largely unknown.

METHODS

In this study, we used lentiviral vectors to stably overexpress or knockdown H19 in RAW264.7 cell lines. Quantitative reverse polymerase chain reaction, Western blot, tartrate resistant acid phosphatase staining and bone resorption assay were performed to assess the level of osteoclast differentiation and bone resorption capacity. And fluorescence in situ hybridization, dual-luciferase reporter and RNA immunoprecipitation were used to explore the specific mechanism of H19 regulating osteoclast differentiation in vitro. Then, ovariectomized osteoporosis models in wild type mice and H19 knockout mice were conducted. And micro-CT analysis, HE staining, and immunohistochemistry were performed to verify the mechanism of H19 regulating osteoclast differentiation in vivo. Bone marrow derived monocytes and bone mesenchymal stem cells were extracted from mice and assayed for osteoclastic and osteogenic-related assays, respectively.

RESULTS

In vitro, H19 promoted osteoclast differentiation and bone resorption of RAW264.7 cells, while miR-29c-3p inhibited them. Both H19 and cathepsin K were the target genes of miR-29c-3p. In vivo, H19 knockout mice have increased femur bone mineral density, decreased osteoclast formation, and reduced cathepsin K expression. MiR-29c-3p agomir could increase bone mineral density in osteoporotic mice on the premise of H19 knockout.

CONCLUSIONS

H19 upregulates cathepsin K expression through sponging miR-29c-3p, which promoting osteoclast differentiation and enhancing bone resorption. This underscores the potential of H19 and miR-29c-3p as promising biomarkers for osteoporosis.

Increased Risk of 10-Year Revision Following Total Hip Arthroplasty for Femoral Neck Fracture

BACKGROUND

As the incidence of femoral neck fractures (FNFs) increases with the aging population, understanding its impact on surgical outcomes is important to improving implant survival and patient satisfaction. Despite increasing use of total hip arthroplasty (THA) as management for FNF, few studies have examined long-term implant survivability. Thus, this study sought to determine the 10-years cumulative incidence of revision and indications for revision in patients undergoing THA for FNF in comparison to osteoarthritis.

METHODS

Patients who underwent primary THA for FNF or osteoarthritis were identified using a national administrative claims database and propensity-score matched in a 1:2 ratio based on age, gender, the Charlson Comorbidity Index (CCI), smoking, obesity, and diabetes mellitus. Kaplan-Meier and Cox proportional hazards analyses were used to observe the cumulative incidence and risk of all-cause revision, periprosthetic joint infection (PJI), dislocation, mechanical loosening, and periprosthetic fracture (PPF) within 10 years of primary THA. In total, 19,735 patients who underwent THA for FNF and 39,383 patients who underwent THA for osteoarthritis were included.

RESULTS

The 10-years cumulative incidences of all-cause revision (7.1 versus 4.9%), PJI (5.0 versus 3.3%), dislocation (6.8 versus 3.8%), mechanical loosening (3.1 versus 1.9%), and PPF (7.8 versus 4.0%) were significantly higher for those who underwent THA for FNF versus osteoarthritis. Femoral neck fractures were associated with higher risks of revision (hazard ratio [HR]: 1.6), PJI (HR: 1.7), dislocation (HR: 2.0), mechanical loosening (HR: 1.6), and PPF (HR: 2.2) (P < 0.001 for all).

CONCLUSIONS

Despite the advantages of THA, femoral neck fractures remain a major risk factor for long-term complications. Tailored preoperative planning, surgical techniques, and postoperative bone health optimization in these patients may help minimize poor outcomes.

Mining and analysis of adverse event signals for alendronate based on the real-world data of FDA adverse event reporting system database

OBJECTIVE

Our study aims to assess alendronate-related adverse events (AEs) from the US FDA adverse event reporting system database.

METHODS

The AE data associated with alendronate between the first quarter of 2004 and the first quarter of 2024 were selected. Various signal quantification methods, including the ROR, PRR, BCPNN, and EBGM, were applied for analysis.

RESULTS

In 34,943 reports where alendronate was the primary suspected drug for the AE, 24 affected system organ classes and 1046 significant preferred terms were identified in this study. Several significant AEs beyond drug instructions with strong signals were determined, including low turnover osteopathy, fracture delayed union, fracture nonunion, loss of anatomical alignment after fracture reduction, fracture malunion, periprosthetic fracture, carotid bruit, oral fibroma, traumatic occlusion, and phlebolith. The median time to onset of alendronate-related AEs was 306 days (interquartile range [IQR] 12-1,461 days), and the majority of cases occurred 2 years later (18.80%) and within 30 days (14.49%).

CONCLUSIONS

The current study detected multiple potential new AE signals for alendronate, and more clinical research is required to further validate our results and clarify their associations.

Generating Virtual Bone Scans for the Purpose of Investigating the Effects of Cortical Microstructure

Evaluating the contribution of microstructure to overall bone strength is tricky since it is difficult to control changes to pore structure in human or animal samples. We developed an open-source program that can generate three-dimensional (3D) models of micron-scale cortical bone. These models can be highly customized with a wide array of variable input parameters to allow for generation of samples similar to micro-computed topography scans of cortical bone or with specific geometric features. The program can generate samples with specific desired porosities and minor deviations in pore diameter from human samples: 1.67% (±4.90) using literature values, and 1.36% (±2.39) with optimized values. When coupled with finite element analysis, this open-source program could be a useful tool for evaluating stress distributions caused by microstructural changes.

Association between the Sp1-binding-site polymorphism in the collagen type I alpha 1 (COLIA1) gene and bone phenotypes: the Dubbo Osteoporosis Epidemiology Study

INTRODUCTION

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSIONS

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

Ultra-processed food intake and prevalence of osteoporosis in US adults aged 50 years and older: a cross-sectional analysis

Dietary quality may be a factor in the progression of non-communicable, chronic diseases. This analysis of NHANES data demonstrates association between consumption of UPF and prevalence of osteoporosis and osteopenia in adults 50 years and older. UPF intake is an important consideration when recommending dietary patterns for optimum bone health PURPOSE: Declining bone mineral density in older adults can result in osteoporosis, leading to decreased physical function, quality of life, and increased risk of mortality. Poor dietary quality may contribute to the progression of this disease. This study explores the association between the consumption of ultra-processed foods (UPF) and the prevalence of osteoporosis and osteopenia in adults aged 50 years and older.

METHOD

Using regression analysis and adjusting for covariates, 24-h recall data from adults 50 years and over in four cycles of NHANES were examined for associations between prevalence of osteoporosis and intakes of UPF as a proportion of daily energy intake.

RESULTS

Mean (SE) intake of UPF as a proportion of total daily energy ranged from 29.5% (0.3) in the lowest quintile to 76.3% (0.3) in the highest. 50.5% of women and 28.0% of men had osteopenia, 8.2% and 1.8%, respectively, had osteoporosis. Increased risk of osteopenia or osteoporosis was observed in the highest quintile of UPF intake compared to that of the lowest: OR 1.52 (95% CI 1.28, 1.79). The odds of self-reported prior fractures at hip, wrist, or spine in women increased by 1.9% for every percentage increase in proportion of UPF intake (95% CI 1.003, 1.035). Increased risk of fracture was not observed among men.

CONCLUSIONS

These findings indicate an association between osteoporosis and osteopenia and the intake of UPF as a proportion of total daily energy. Further investigation into the impact of dietary quality on osteoporosis and fracture risk is warranted, particularly in post-menopausal women.