The Global Burden of Osteoporosis, Low Bone Mass, and Its Related Fracture in 204 Countries and Territories, 1990-2019

Urinary pentosidine as a potential biomarker of impaired bone health: a systematic review and meta-analysis

Background

Urinary pentosidine, an advanced glycation end product (AGE), has been proposed as a potential biomarker for impaired bone health, especially in older adults and those with diabetes. This study aimed to systematically review and meta-analyze the association of urinary pentosidine with bone mineral density (BMD) and fracture risk.

Methods

A comprehensive search of Embase, PubMed, Scopus, and Web of Science databases was conducted and records were gathered from 1960 to February 2024. Relevant papers were screened and data were extracted by two independent reviewers. Hedges' g standardized mean difference (SMD) and 95% confidence intervals (CI) were calculated to compare urinary pentosidine levels between patients with and without fractures.

Results

A total of 12 studies comprising 5,878 participants were included in the systematic review. The meta-analysis revealed that patients with fractures had significantly higher urinary pentosidine levels compared to those without fractures (SMD [95% CI] = 0.53 [0.39-0.68]; I² = 54%; P < 0.01). In patients with vertebral fractures, pentosidine levels were also elevated (SMD [95% CI] = 0.51 [0.32-0.70]; I² = 64%; P < 0.01). Additionally, some studies demonstrated that an increase in urinary pentosidine was significantly associated with fracture risk (aHR = 1.20 [95% CI = 1.07-1.33]; P = 0.001) and BMD reduction (β = -0.125 [95% CI = -0.248, -0.002]; P = 0.047). However, other studies showed inconsistent results, particularly regarding the association between pentosidine and BMD or fracture risk in non-diabetic populations (aRR [95%CI] = 1.08 [0.79-1.49]; P = 0.6). Diagnostic accuracy analyses revealed a sensitivity of 71.9% and specificity of 61.2% for urinary pentosidine in predicting vertebral fracture in patients with type 2 diabetes mellitus.

Conclusion

This systematic review and meta-analysis demonstrate that elevated urinary pentosidine levels are associated with an increased risk of fractures and, to a lesser extent, reduced bone mineral density. Its diagnostic accuracy improves when integrated with other clinical markers, such as BMD and bone turnover indices. However, due to the variability in results, further research is needed to standardize pentosidine's use as a reliable biomarker for impaired bone health in clinical practice.

Multiscale metal-based nanocomposites for bone and joint disease therapies

Bone and joint diseases are debilitating conditions that can result in significant functional impairment or even permanent disability. Multiscale metal-based nanocomposites, which integrate hierarchical structures ranging from the nanoscale to the macroscale, have emerged as a promising solution to this challenge. These materials combine the unique properties of metal-based nanoparticles (MNPs), such as enzyme-like activities, stimuli responsiveness, and photothermal conversion, with advanced manufacturing techniques, such as 3D printing and biohybrid systems. The integration of MNPs within polymer or ceramic matrices offers a degree of control over the mechanical strength, antimicrobial efficacy, and the manner of drug delivery, whilst concomitantly promoting the processes of osteogenesis and chondrogenesis. This review highlights breakthroughs in stimulus-responsive MNPs (e.g., photo-, magnetically-, or pH-activated systems) for on-demand therapy and their integration with biocomposite hybrids containing cells or extracellular vesicles to mimic the native tissue microenvironment. The applications of these composites are extensive, ranging from bone defects, infections, tumors, to degenerative joint diseases. The review emphasizes the enhanced load-bearing capacity, bioactivity, and tissue integration that can be achieved through hierarchical designs. Notwithstanding the potential of these applications, significant barriers to progress persist, including challenges related to long-term biocompatibility, regulatory hurdles, and scalable manufacturing. Finally, we propose future directions, including machine learning-guided design and patient-specific biomanufacturing to accelerate clinical translation. Multiscale metal-based nanocomposites, which bridge nanoscale innovations with macroscale functionality, are a revolutionary force in the field of biomedical engineering, providing personalized regenerative solutions for bone and joint diseases.

An update on the pharmacotherapy of osteoporosis

INTRODUCTION

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

AREAS COVERED

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

EXPERT OPINION

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

Sex-specific association between dietary carbohydrate intake and bone mineral density among American adolescents: National Health and Nutrition Examination Survey

BACKGROUND

The association between dietary carbohydrate intake and bone mineral density (BMD) remains controversial, and research on this topic among adolescents is lacking. This study aimed to examine the relationship between dietary carbohydrate intake and BMD in adolescents.

METHODS

This study examined data from adolescents (12-19 years) in the National Health and Nutrition Examination Survey (NHANES) (2005-2010). Dietary carbohydrate intake was assessed via two 24-hour recalls. BMD at the lumbar spine, total spine, total femur, and femoral neck was measured by dual-energy X-ray absorptiometry (DXA). A two-day dietary weighted multivariate regression analysis was employed to adjusted for covariates and assess the relationship between carbohydrate intake and BMD. The consistency of the associations and potential modifying factors were further evaluated through stratification and interaction analyses, both weighted by the two-day dietary data. Additionally, stratified curve fitting elucidated sex-specific differences in this relationship.

RESULTS

After excluding missing data, 2616 adolescents aged 12-19 years were included in the study. In the fully adjusted two-day dietary sample weighted analysis model, a positive association was observed between dietary carbohydrate intake and BMD among all participants. Dietary carbohydrate intake was positively associated with lumbar spine BMD (β = 1.31, 95 % CI = 0.38-2.23), total spine BMD (β = 1.31, 95 % CI = 0.39-2.24), and femoral neck BMD (β = 0.91, 95 % CI = 0.05-1.77) among all participants. Subgroup analyses revealed a significant sex interaction effect (P < 0.05). Subsequently, stratified curve fitting and sex-specific multivariate regression analyses were conducted. The results indicated a positive correlation between dietary carbohydrate intake and BMD in males, whereas no such correlation was observed in females. The multivariate analysis results further confirmed the sex-specific differences in the relationship between dietary carbohydrate intake and BMD, consistent with the initial findings.

CONCLUSION

Our study demonstrated that carbohydrate consumption significantly enhances BMD during adolescent bone growth. This effect is sex-specific.

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.

Mapping the role of macro and micronutrients in bone mineral density: a comprehensive Mendelian randomization study

BACKGROUND

Macro and micronutrients may play an important role in osteoporosis development; however, observational studies have yielded inconsistent results. Clarifying these associations is vital to the development of nutritional recommendations aimed at preventing osteoporosis.

METHODS

Utilizing the largest available genome-wide association study (GWAS) summary statistics to date, we performed a two-sample Mendelian randomization (MR) analysis to investigate the causal effects of energy-adjusted macronutrient intake (fat, protein, carbohydrate, and sugar) and circulating levels of 20 micronutrients (ten each for vitamins and minerals) on heel estimated bone mineral density (eBMD), a promising marker for osteoporosis risk and fracture susceptibility. Sensitivity, sex-specific, and one-sample MR analyses were applied to further validate and annotate the results.

RESULTS

Among all nutrients, four genetically predicted circulating levels of micronutrients were suggestively associated with eBMD (vitamin A: β IVW = - 0.054, PIVW = 3.70 × 10-2; vitamin B12: β IVW = - 0.020, PIVW = 3.71 × 10-6; vitamin E: β IVW = 0.277, PIVW = 3.22 × 10-2; selenium: β IVW = 0.023, PIVW = 5.37 × 10-3; all Pintercept > 0.05). All these results were also considered robust, as sensitivity analyses yielded directionally consistent results. However, only the causal effects of vitamin B12 and selenium on eBMD remained significant after Bonferroni correction and were not confounded by obesity, smoking status, or alcohol consumption. Sex-specific analysis revealed a male-specific causal association between vitamin E and eBMD ( β IVW = 0.275, PIVW = 9.81 × 10-14). Additionally, using individuallevel data from the UK Biobank cohort, one-sample MR analysis found no causal relationships between diet-derived nutrient intake and eBMD in the overall population, as well as in the females or the males.

CONCLUSIONS

Our findings suggest that appropriate levels of plasma vitamin B12 and adequate levels of serum selenium are crucial for delaying bone loss and promoting bone health, emphasizing the need for nutritional recommendations to maintain optimal levels of these nutrients to promote eBMD and prevent osteoporosis.

Accuracy of Phantomless Calibration of Routine Computed Tomography Scans for Opportunistic Osteoporosis Screening in the Spine Clinic

STUDY DESIGN

Diagnostic accuracy study.

OBJECTIVE

To establish a simple method of phantomless bone mineral density (BMD) measurement by using preoperative lumbar computed tomography (CT) scans, and compare the accuracy of reference tissue combinations to diagnose low BMD against uncalibrated Hounsfield units (HUs).

SUMMARY OF BACKGROUND DATA

HUs are used as a measure of BMD; however, associations between HU and T-scores vary widely. Quantitative CT (qCT) scans are more accurate, but they require density calibration with an object of known density (phantom), which limits feasibility. As an emerging technique, phantomless (internal) calibration of routine CT scans may provide a good opportunity for screening.

MATERIALS AND METHODS

Patients who were scheduled to undergo lumbar surgery, with a preoperative CT scan, and a dual-energy x-ray absorptiometry (DXA) scan within six months were included. Four tissues were selected for calibration: subcutaneous adipose (A), erector spinae (ES), psoas (P), and aortic blood (AB). The HUs of these tissues were used in linear regression against ground-truth values. Calibrations were performed by using two different internal tissues at a time to maintain simplicity and in-office applicability.Volumetric bone mineral densities (vBMD) derived from internally calibrated CT scans were analyzed for new threshold values for low bone density. Areas under the curve (AUC) were calculated with 95% CI.

RESULTS

Forty-five patients were included (M/F=10/35, mean age: 63.3). Calibrated vBMDs had stronger correlations with DXA T -scores when compared with HUs, with L2 exhibiting the highest coefficients. Calibration by using A and ES with the threshold of 162 mg/cm 3 had a sensitivity of 90% in detecting low BMD (AUC=0.671).

CONCLUSIONS

This novel method allows simple, in-office calibration of routine preoperative CT scans without the use of a phantom. Calibration using adipose and erector spinae with a threshold of 162 mg/cm 3 is proposed for low bone density screening with high sensitivity (90%).

LEVEL OF EVIDENCE

Level III.

Association between serum α-Klotho levels and mortality in US adults with osteoporosis

BACKGROUND

Klotho, a protein known for its significant involvement in the aging process and age-related diseases, has been demonstrated to be inextricably linked to osteoporosis. Nevertheless, the relationship between serum Klotho levels and mortality risk among individuals with osteoporosis has not been definitively established. Therefore, the purpose of the current research is to examine the potential relationship between serum Klotho levels and mortality risk in individuals aged 40 and above with osteoporosis.

METHODS

The current study included adults aged 40 years and older diagnosed with osteoporosis from the National Health and Nutrition Examination Survey. Osteoporosis diagnosis was based on a history of osteoporosis or bone mineral density. Moreover, Cox proportional hazards regression, Kaplan-Meier (KM) curves, and restricted cubic spline (RCS) curves were utilized to assess the relationship between Klotho levels and mortality risk. In addition, subgroup analysis was performed using stratification and interaction analysis for all covariates.

RESULTS

A total of 1004 participants (median age: 65 years) with a median follow-up of 9.33 years were included in the final analysis. This study found that serum Klotho levels established a U-shaped relationship with the risk of all-cause mortality in individuals with osteoporosis, with a nadir of Klotho levels was approximately 900 pg/mL, in which lower (< 850 pg/mL) or higher (> 950 pg/mL) Klotho levels were significantly associated with an increased risk of all-cause mortality. Moreover, the results of subgroup analysis indicated that the associations between Klotho levels and mortality risk were modified by several factors, especially a history of hypertension. Specifically, Klotho levels established an L-shaped relationship with the risk of all-cause mortality among participants with a history of hypertension, while a positive and linear relationship with the risk of all-cause mortality among those without a history of hypertension.

CONCLUSIONS

For individuals with osteoporosis, it is necessary to be alert to cases with high or low Klotho levels, which may potentially indicate an increased mortality risk.

ACT001 improves OVX-induced osteoporosis by suppressing the NF-κB/NLRP3 signaling pathway

Osteoporosis (OP) is a common systemic metabolic bone disease characterized by the decrease in bone mass and hyperactivity of osteoclasts. ACT001 is approved as an orphan drug by FDA and has shown multiple protective effects against tissue injury. However, its role in prevention of osteoclast differentiation and the underlying mechanisms have not been elucidated. Herein, we show that ACT001 inhibited RANKL-induced osteoclast differentiation and F-actin ring formation through suppressing the expression of Nfatc1, TRAP, Ctsk, Dc-stamp without obvious cytotoxicity in vitro. ACT001 restrained the phosphorylation of NF-κB and the activation of NLRP3 inflammasome, thereby decreased the expression of pyroptosis-related protein. (GSDMD, caspase-1, IL-1β, IL-18). Consistent with ACT001, the NLRP3 inflammasome inhibitor MCC950 treatment also suppressed the osteoclastogenesis through inhibiting the transcriptional activation of Nfatc1. Furthermore, ACT001 protected ovariectomy-induced bone loss in mice, reduced the number of osteoclasts, downregulated the expression of NLRP3 and IL-1β. These data indicate that ACT001 can reduce RANKL-induced osteoclast differentiation through suppressing the NF-κB/NLRP3 pathway, and attenuate the bone loss induced by estrogen-deficiency, suggesting its therapeutic potential for bone homeostasis maintenance and osteoporosis treatment.

Potential of Kefir-Derived Peptides, Probiotics, and Exopolysaccharides for Osteoporosis Management

PURPOSE OF REVIEW

Osteoporosis is a prevalent skeletal disorder in postmenopausal women and older adults. Kefir has gained attention for its potent antioxidative, anti-inflammatory, and immunomodulatory properties. This review consolidates findings on kefir-derived peptides' interventions in osteoporosis models and evaluates the therapeutic potential of kefir components in preventing osteoporosis, thereby enhancing its application in clinical nutrition strategies for osteoporosis management.

RECENT FINDINGS

Kefir-derived peptides exhibit osteoprotective potential in various animal models of osteoporosis, in which several antioxidative and ACE-inhibitory peptides have been shown to promote osteoblast differentiation and mineralization. In addition, emerging evidence supports the role of kefir-derived probiotics and exopolysaccharides (kefiran) in mitigating bone loss. Kefir holds significant promise in the management of osteoporosis due to its unique composition of bioactive components promoting bone health. While research is still in its early stages, evidence suggests kefir's potential as a natural approach to osteoporosis prevention and management.

Posttranslational Modification in Bone Homeostasis and Osteoporosis

Bone is responsible for providing mechanical protection, attachment sites for muscles, hematopoiesis micssroenvironment, and maintaining balance between calcium and phosphorate. As a highly active and dynamically regulated organ, the balance between formation and resorption of bone is crucial in bone development, damaged bone repair, and mineral homeostasis, while dysregulation in bone remodeling impairs bone structure and strength, leading to deficiency in bone function and skeletal disorder, such as osteoporosis. Osteoporosis refers to compromised bone mass and higher susceptibility of fracture, resulting from several risk factors deteriorating the balanced system between osteoblast-mediated bone formation and osteoclast-mediated bone resorption. This balanced system is strictly regulated by translational modification, such as phosphorylation, methylation, acetylation, ubiquitination, sumoylation, glycosylation, ADP-ribosylation, S-palmitoylation, citrullination, and so on. This review specifically describes the updating researches concerning bone formation and bone resorption mediated by posttranslational modification. We highlight dysregulated posttranslational modification in osteoblast and osteoclast differentiation. We also emphasize involvement of posttranslational modification in osteoporosis development, so as to elucidate the underlying molecular basis of osteoporosis. Then, we point out translational potential of PTMs as therapeutic targets. This review will deepen our understanding between posttranslational modification and osteoporosis, and identify novel targets for clinical treatment and identify future directions.

Global epidemiology of lower limb fractures: Trends, burden, and projections from the GBD 2021 study

BACKGROUND

Lower limb fractures are a significant global public health issue, imposing considerable social and economic burdens. Despite their prevalence, comprehensive analyses of the global epidemiology of lower limb fractures remain scarce. This study aims to address this gap.

METHODS

Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, we analyzed four types of lower limb fractures: fractures of foot bones excluding the ankle (FFB), hip fractures (FH), fractures of the patella, tibia or fibula, or ankle (FPTFA), and femur fractures excluding the femoral neck (FF), and conducted a detailed assessment of them.

RESULTS

FPTFA was the most burdensome fracture type, with Slovenia showing the highest age-standardized incidence rate (ASIR), and Saudi Arabia having the highest age-standardized prevalence rate (ASPR) and years lived with disability rate (ASYR). The burden of lower limb fractures increased with age, but FFB and FPTFA showed a "double peak" age distribution, with FFB most common in the 20-24 age group. Lower limb fractures were more prevalent in males among younger individuals and in females among older populations. From 1990 to 2021, the burden of lower limb fractures, excluding FH, decreased (EAPC <1), though the incidence of FF is projected to increase (EAPC = 0.14, 95 % CI 0.1-0.18) over the next decade.

CONCLUSION

Although the global burden of lower limb fractures, excluding FH, has decreased in recent years, vigilance is still needed. Given the projected rise in FF incidence over the next decade, preventive measures should be implemented early.

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.

Association between vertebral fractures and brain volume: insights from a community cohort study

Investigating vertebral fractures and brain structure, we found significant gray matter volume reductions in the right hippocampus, amygdala, and parahippocampal gyrus, especially in males. These findings emphasize the importance of integrating skeletal and neural health in osteoporosis management.

PURPOSE

Vertebral fractures (VF) due to osteoporosis impact morbidity and quality of life in the elderly. The relationship between VF and changes in brain structure remains underexplored. This study aimed to investigate the association between VF and gray matter volume (GMV) reductions in specific brain regions and to explore potential sex differences.

METHODS

Data from 1,751 participants (571 males, 1,180 females; mean age 64.9, range 18-97) in the fourth survey of the population-based Research on Osteoarthritis/Osteoporosis Against Disability study (2015-2016) were used. Participants were classified into those with and without VF (VF + and VF - groups) based on Genant's semiquantitative method, assessed by spine radiographs. Voxel-based morphometry was applied to MRI images to measure GMV, and a general linear model analysis was performed to compare GMV between groups, adjusting for age, sex, total brain volume, and Mini-Mental State Examination scores as covariates. Additionally, a two-way analysis of variance was conducted on the significant GMV cluster, with sex and VF presence as independent variables, to explore interaction effects.

RESULTS

The VF+ group consisted of 113 participants, while the VF- group included 1,638 participants. The analysis identified a significant cluster with reduced GMV in the VF + group compared to the VF - group. This cluster included the right hippocampus, right amygdala, and right parahippocampal gyrus. Further analysis revealed that males in the VF + group exhibited more pronounced GMV reductions in the significant cluster compared to females.

CONCLUSION

These findings suggest that VF is associated with significant reductions in brain regions critical for memory, emotional processing, and visuospatial memory, with more severe effects observed in males.

Global burden of injury due to low bone mineral density in adults aged 55 years and older, 1990 to 2021: A population-based study

OBJECTIVES

This study aimed to assess the global burden of injuries due to low bone mineral density (BMD) among adults aged 55 and above from 1990 to 2021, focusing on mortality and disability-adjusted life years (DALYs) and analyzing trends across sexes, age groups, and sociodemographic index (SDI) regions.

METHODS

Data from the Global Burden of Disease Study 2021, covering 204 countries and territories, were analyzed. Joinpoint regression quantified temporal changes in mortality and DALYs, calculating average annual percentage change (AAPC). Age-period-cohort modeling elucidated demographic influences, and decomposition analysis identified key contributors to mortality changes.

RESULTS

Globally, in 2021, the crude DALY rate for injuries due to low BMD was 900.32 (95 % UI: 742.64 to 1081.51) per 100,000, and the crude mortality rate was 27.04 (95 % UI: 22.49 to 30.75) per 100,000. The age-standardized mortality rate for injuries due to low BMD showed no significant change from 1990 to 2021 (AAPC 0.26 %, P = 0.071), but there was a significant increase in countries with a high SDI (AAPC 0.51 %, P = 0.001). The burden of disease in persons aged 80 years and older remained substantial, with a slight increase. Decomposition analysis identified population growth as the main driver of increasing mortality and DALYs.

CONCLUSION

Despite the reductions in DALY rates, the mortality has remained stable worldwide; however, has risen significantly in high SDI countries. The substantial and slightly increasing burden of disease in people aged 80 years and older underscores the need for targeted strategies for the prevention and management of low BMD to mitigate the future global impact of these injuries.

Exploring the relationship between serum 25-hydroxyvitamin D levels and intestinal fungal communities and their metabolites in postmenopausal Chinese women

BACKGROUND

Research gaps persist in understanding the interactions between serum 25 (OH)D levels, intestinal fungi, and their metabolites in postmenopausal women.

METHODS

This study, approved by the Ethics Committee of Zhongshan Hospital, Xiamen University, recruited postmenopausal women from Xiamen. Clinical assessments included Body Mass Index (BMI) calculations and blood tests for various bone-related markers using Roche's electrochemiluminescence system. Bone density was measured via dual-energy X-ray absorptiometry. Fecal DNA was extracted for Internal Transcribed Spacer (ITS) sequencing with a two-stage PCR process and analyzed using high-throughput Illumina sequencing. Metabolites were extracted from fecal samples and analyzed by ultra-high-performance liquid chromatography combined with mass spectrometry. Statistical analyses and data visualization were performed using R, focusing on fungal community structure and correlations with metabolites.

RESULTS

The study analyzed 81 postmenopausal women, categorized into vitamin D deficient (VDD), insufficient (VDI), and sufficient (VDS) groups based on serum 25 (OH)D levels. Other health markers, including age and BMI, were consistent across groups. Notably, Linear discriminant analysis identified distinct fungal communities across VDD, VDI, and VDS groups. In the VDD group, notable fungi included Hanseniaspora occidentalis and Pichia. The VDI group showed enrichment of Candida, while the VDS group had higher abundances Such as Phanerochaete, and Nectriaceae. Alpha diversity metrics, such as the Chao1 index, differed significantly among the groups (p < 0.05). Correlation analysis (Spearman) revealed that fungi like Trichosporon and Penicillium positively associated with 25 (OH)D3, whereas fungi such as Cystofilobasidium were negatively correlated with bone mineral density (BMD). Metabolites like Glutaric acid positively correlated with 25 (OH)D3, while L-Citrulline and Deoxycholic acid were negatively correlated. Additionally, Argininosuccinic acid correlated positively with BMD, whereas Acamprosate and p-Hydroxyphenylacetic acid were negatively associated.

CONCLUSION

In postmenopausal women, fungal community composition varies significantly with vitamin D status, potentially correlating with serum 25 (OH)D levels and BMD, indicating that specific fungal species may be relevant for therapeutic strategies with osteoporosis and offering insights into the broader bone health effects of vitamin D.

Osteoporosis risk and its association with all-cause and cause-specific mortality among the elderly: a 16-year nationwide cohort study

BACKGROUND

Aged osteoporosis poses a significant threat to the well-being and longevity of older individuals, yet evidence regarding the relationship between osteoporosis risk and mortality among the elderly population in Asia remains unknown.

AIMS

Our study aimed to investigate associations between osteoporosis risk and all-cause mortality, as well as cause-specific mortality, among the Chinese elderly population.

METHODS

Pooled data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) conducted between 2002 and 2018 were utilized to analyze the associations between osteoporosis risk and all-cause, heart disease, cardiovascular disease (CVD), respiratory disease, and cancer mortality. Cox proportional hazards models were employed for this analysis. Osteoporosis risk was assessed using the Osteoporosis Self-Assessment Tool for Asians (OSTA). Restricted cubic spline (RCS) functions were applied to explore the nonlinear relationship between OSTA and mortality. The robustness of the Cox models was evaluated through internal verification, subgroup analyses, and sensitivity analyses.

RESULTS

A total of 12,711 elderly individuals aged ≥ 65 years were included for analysis at baseline. During a 16-year follow-up, 7,963 individuals in the cohort were identified as deceased. Compared to those with low osteoporosis risk, elderly individuals with high osteoporosis risk demonstrated a significantly elevated risk of all-cause, heart disease, CVD, respiratory disease and cancer mortality. The relationship between OSTA level and all-cause and cause-specific mortality exhibited a significant L-shaped pattern.

CONCLUSIONS

The risk of osteoporosis is independently associated with the prediction of mortality. The OSTA may serve as a suitable predictor for mortality related to osteoporosis among the Asian population.

Global knowledge mapping of receptor activator of nuclear factor kappa-B ligand in osteoporotic fractures: a bibliometric analysis (2001-2024)

Background

Receptor activator of nuclear factor kappa-B ligand (RANKL) plays a critical role in bone metabolism and the pathogenesis of osteoporotic fractures. This study aims to conduct a bibliometric analysis of global research pertaining to RANKL and osteoporotic fractures to identify key trends, influential studies, and collaborative networks.

Methods

A literature search was conducted to identify articles found in the Web of Science Core Collection database regarding RANKL and osteoporotic fractures from 2001 to 2024. A bibliometric analysis was performed using VOSviewer, CiteSpace, and R 4.3.3 for the publication volume, country and institution contributions, journal impact, author influence, and research hotspots.

Results

A total of 214 articles were analyzed. Publication rates have steadily increased, with a peak of 21 papers in 2020. The U.S., China, and South Korea were the top contributing countries, and leading institutions included Harvard University and Dankook University. The Journal of Bone and Mineral Research, Osteoporosis International, and Bone were the journals of highest impact. At the level of authors, Heiss-Christian published the highest number and Christiansen-Claus had the strongest citation impact (1,368 citations). Research evolved from basic biological mechanisms (2001-2010) through clinical applications (2011-2017) to recent renewed interest in fundamental RANKL biology (2018-2024). Key research hotspots included postmenopausal osteoporosis, bone mineral density, and osteoclast differentiation, with emerging focus on RANKL's role beyond skeletal metabolism.

Conclusion

This bibliometric analysis provides a comprehensive overview of RANKL research in osteoporotic fractures, highlighting key priorities for future investigation. Future studies should prioritize understanding RANKL's broader physiological roles, developing better predictive markers, and optimizing personalized treatment strategies.

Exploring the classification and treatment of osteoporosis from the perspectives of natural medicines, molecular targets, and symptom clusters

Osteoporosis (OP) is a metabolic bone disease characterized by reduced bone density and fragility, impairing quality of life. Traditional treatments often overlook symptoms like back and joint pain, increasing burden. This study aims to map relationships between natural medicines, targets, and symptom clusters, demonstrating their effectiveness in personalized OP treatment to enhance clinical strategies and self-assessment. We used compounds and targets, applying Summary data-based Mendelian Randomisation (SMR) analysis for biological process and molecular function enrichment. Additionally, we employed Phenome-Wide Association Studies (PheWAS) to select two natural drugs-Rhizoma Drynariae (RD) and Lycii Fructus (LF)-for case analysis. The study found that RD primarily improves symptoms such as indigestion, constipation, fatigue, polyuria, and depression, while LF significantly ameliorates symptoms related to the nervous and muscular systems, such as hoarseness, dizziness, vertigo, and fever symptoms. This analysis successfully differentiated two groups of symptoms and precisely constructed a logical chain among "natural Medicines-molecular tArGets-Illness-symptom Clusters" (MAGIC chain) achieving a refined classification of OP. The results of this study support the effectiveness of implementing personalized medical strategies in the treatment of OP, providing a scientific basis for the clinical application of natural medicines and patient self-management.

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.

Association between dietary protein intake and bone mineral density in adolescents: a cross-sectional study

Elevated daily protein consumption was significantly correlated with enhanced bone mineral density (BMD) across multiple skeletal sites in adolescents, as observed in the National Health and Nutrition Examination Survey. These results highlight the pivotal role of dietary protein in fostering bone health in the youth.

BACKGROUND

The relationship between dietary protein intake and bone mineral density (BMD) remains inconclusive, particularly among adolescents. This study aimed to investigate the association between dietary protein intake and BMD in adolescents.

METHODS

This cross-sectional study utilized data from 12-19-year-old participants in the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2010. Average daily protein intake was calculated from two consecutive 24-h dietary recalls. Dual-energy X-ray absorptiometry (DXA) was used to evaluate the BMD of the total femur, femoral neck, total spine, and lumbar spine. Multivariate linear regression was used to evaluate the association between dietary protein intake and BMD, adjusted for dietary protein intake per 10 g/day and multiple covariates. Stratified analysis, interaction analysis, and sensitivity analysis were performed to assess the consistency of this relationship and identify potential modifiers.

RESULTS

After excluding missing data, the analysis included 2,640 adolescents. In the fully adjusted model, dietary protein intake showed a significant positive association with both total femur BMD (per 10 g/d: β = 5.25, 95% Cl = 1.69 ~ 8.82) and femoral neck BMD(per 10 g/d: β = 5.23, 95% Cl = 1.56 ~ 8.89). This positive association between dietary protein intake and BMD persisted in sensitivity analyses after multiple interpolation with all covariates missing. Subgroup analyses found no interaction between subgroups, or interaction results showed no clinical significance.

CONCLUSION

This study suggests that higher dietary protein intake is associated with increased BMD in US adolescents, highlighting the potential role of protein in adolescent bone health.

Plasma levels of amino acids and osteoporosis: a cross-sectional study

The role of amino acids (AAs) with bone health is still controversial. We examined the association between AAs and osteoporosis in a cross-sectional study of 135 participants aged 45 years or older from the Second Hospital of Jilin University. Plasma AAs were measured with targeted quantitative methodology. We measured bone mineral density (BMD) with dual energy x-ray absorptiometry, and osteoporosis was defined as a T-score ≤ -2.5. We estimated odds ratios (OR) and corresponding 95% confidence intervals (CIs) for the associations between AAs (per 1 standard deviation increase) with osteoporosis. Approximately 18.5% of participants (n = 25) had osteoporosis. Total (adjusted β = 0.052; P = 0.002) and non-essential AA (adjusted β = 0.064; P = 0.002) levels were associated with femoral neck BMD T-scores. Greater levels of total (adjusted OR: 0.734; 95% CI: 0.655-0.821), essential (adjusted OR: 0.763; 95% CI: 0.623-0.934) and non-essential AAs (adjusted OR: 0.721; 95% CI: 0.629-0.826) were associated with lower odds of osteoporosis. Higher tryptophan (adjusted OR: 0.498; 95% CI: 0.281-0.882), cysteine (adjusted OR: 0.561; 95% CI: 0.321-0.983), glycine (adjusted OR: 0.513; 95% CI: 0.285-0.922), and ornithine levels (adjusted OR: 0.581; 95% CI: 0.345-0.978) were associated with reduced osteoporosis risk. Higher AA levels were associated with higher femoral neck BMD, and lower odds of osteoporosis.

Fabrication of 3D Biofunctional Magnetic Scaffolds by Combining Fused Deposition Modelling and Inkjet Printing of Superparamagnetic Iron Oxide Nanoparticles

BACKGROUND

Recently, magnetic composite biomaterials have raised attention in bone tissue engineering as the application of dynamic magnetic fields proved to modulate the proliferation and differentiation of several cell types.

METHODS

This study presents a novel method to fabricate biofunctional magnetic scaffolds by the deposition of superparamagnetic iron oxide nanoparticles (SPIONs) through thermal Drop-On-Demand inkjet printing on three-dimensional (3D) printed scaffolds. Firstly, 3D scaffolds based on thermoplastic polymeric composed by poly-L-lactic acid/poly-caprolactone/poly(3-hydroxybutyrate-co-3-hydroxyvalerate) were fabricated by Fused Deposition Modelling. Then, in a second step, SPIONs were incorporated onto the surface of the scaffolds by inkjet printing following a designed 2D pattern.

RESULTS

A complete characterization of the resulting magnetic scaffolds was carried out attending to the surface SPIONs deposits, demonstrating the accuracy and versatility of the production technique, as well as the stability under physiological conditions and the magnetic properties. Biological evaluation with human bone marrow mesenchymal stems cells demonstrated biocompatibility of the scaffolds and increased osteogenic capability under the application of a magnetic field, due to the activation of mechanotransduction processes.

CONCLUSION

These results show that the developed 3D magnetic biofunctional scaffolds can be a very promising tool for advanced and personalised bone regeneration treatments.

Association of triglyceride-glucose index with bone mineral density and fracture: a systematic review

BACKGROUND AND AIM

Studies have found inconsistent results regarding triglyceride-glucose (TyG) index and bone health. This systematic review aims to synthesize the existing evidence on the association between the (TyG) index, bone mineral density (BMD), and bone fractures.

METHOD

A comprehensive search of PubMed, Scopus, Web of Science, and Embase databases was performed for studies published up to December 26, 2024. Inclusion criteria encompassed human studies examining the TyG index in relation to BMD or fractures. The risk of bias was assessed using the Newcastle-Ottawa Scale (NOS). Data synthesis included both qualitative and descriptive statistical analyses.

RESULTS

From 201 studies identified, 12 met the inclusion criteria comprising 817,242 participants. Most studies reported a significant association between TyG index and bone fractures. The studies reported inconsistent findings regarding the association between the TyG index and BMD. While some studies found no correlation between the TyG index and BMD in individuals aged ≥ 50 years, studies on the general population aged ≥ 18 years demonstrated a significant correlation between the TyG index and BMD. Variations in the age of study populations, the presence of diabetes, BMI, and adjustment factors likely contributed to these discrepancies. Further research is needed to clarify the role of the TyG index in bone health and its potential utility as a surrogate marker.

CONCLUSION

The TyG index is associated with bone fractures and can serve as a surrogate marker for osteoporosis in the general populations rather than exclusively for the elderly.

Intersectoral Collaboration Between Traditional Bonesetters and Formal Healthcare: A Systematic Review on Past Initiatives and Stakeholder Perspectives

BACKGROUND

Bone fractures in low- and middle-income countries are commonly managed by traditional bonesetters (TBSs). Past studies emphasize the potential for improved fracture care through intersectoral cooperation. This review gauged support among stakeholders for intersectoral collaboration and the results of previous initiatives.

METHODS

Five medical databases were reviewed. Studies focusing on stakeholder perspectives and articles detailing collaborative initiatives were included. Data extraction and synthesis were carried out using the Cochrane Consumers and Communication Review Group's template. Additionally, all studies underwent quality assessment.

RESULTS

Of the 3821 identified articles, 16 were included after full-text screening. Twelve articles presented stakeholder perspectives, whereas four discussed collaborative initiatives. The overall article quality was low: articles on stakeholder perspectives scored on average 1.42 out of 4 points, whereas articles on collaborative initiatives scored a mean 1.25 points. In total, 62% of stakeholders (75% of TBSs, 92% of hospital staff, and 52% of patients) expressed support for intersectoral collaboration. The ratio between stakeholders expressing support versus those opposing was 4.4:1. No articles presented data on governmental perspectives. The most mentioned collaborative forms were TBS training (24% of stakeholders) and an integrative model (16% of stakeholders). Interventional studies all consisted of TBS training, reporting improved clinical outcomes and increased practice integration.

CONCLUSION

Despite the limited and low-quality evidence on collaboration initiatives and perspectives, most stakeholders seem supportive of intersectoral collaboration, with training and integration being commonly suggested. Future research efforts exploring the feasibility of embedding TBSs into current primary care systems should ensure the involvement of local and national government.

Combining systemic and local osteoporosis treatments: A longitudinal in vivo microCT study in ovariectomized rats

INTRODUCTION

Managing osteoporotic patients at immediate fracture risk is challenging, in part due to the slow and localized effects of anti-osteoporotic drugs. Combining systemic anti-osteoporotic therapies with local bone augmentation techniques offers a promising strategy, but little is known about potential interactions. We hypothesized that integrating systemic treatments with local bone-strengthening biomaterials would have an additive effect on bone density and structure. This study investigated interactions and synergies between systemic therapies and injectable biomaterials, HA2 and HA2-ZOL, designed for local bone strengthening. HA2-ZOL incorporates Zoledronate, a bisphosphonate, to enhance anti-resorptive effects. These materials were tested in an in vivo rat model of osteoporosis using microCT and histology.

METHODS

Thirty-six ovariectomized Wistar rats were treated systemically with vehicle (VEH), alendronate (ALN), or parathyroid hormone (PTH). One week later, their tibiae were randomly assigned to local treatment groups: HA2, HA2-ZOL, or NaCl control. Bilateral injections targeted metaphyseal trabecular bone, with microCT scans tracking changes over 8 weeks. Regions of interest (ROIs) were identified and analyzed for bone volume fraction (BV/TV), tissue mineral density (TMD), and trabecular morphology. Histological analyses were performed at week 8 to assess bone structure and mineral inclusions.

RESULTS

VEH animals with NaCl injections experienced marked bone loss, partially mitigated by ALN and PTH. HA2 injections increased BV/TV by factors of 2.5 to 3.4 across treatments compared to baseline, with effects confined to the injected material. HA2-ZOL amplified this response, with BV/TV increases up to 4.8-fold, particularly in VEH and PTH animals. The effects peaked at 2-4 weeks post-injection, followed by remodeling and restoration. Both local treatments increased trabecular thickness, with HA2-ZOL showing slower post-peak resorption.

DISCUSSION

HA2 injections significantly densified bone, independent of systemic therapy. Zoledronate in HA2-ZOL enhanced bone formation and delayed resorption in control and PTH animals, but offered no additional benefit when combined with systemic bisphosphonate. These findings support the hypothesis of an additive effect, suggesting that injectable hydrogels with localized drug delivery can complement systemic therapies by rapidly increasing local bone density, thereby potentially preventing fractures in high-risk osteoporotic patients.

Fractured FRAX: Nurses' role in reckoning with racism in international osteoporosis fracture risk calculations

AIM

This paper will examine racism's role in calculating fracture risk via the use of race- and ethnicity-based calculations and offer guidance for nurses to mitigate the risk of further exacerbating race-based inequities in fracture care.

BACKGROUND

Using race adjustments in fracture risk calculation, such as in the FRAX, reflects the history of systemic racism in nursing and medicine, particularly in screening for and treating osteoporosis. Osteoporosis-related fractures, which result in increased costs, disability, and death, are a public health problem.

SOURCES OF EVIDENCE

The critique examines genetic and sociohistorical evidence to illuminate the fallacy that race has biological underpinnings and outline the implications of using race in fracture risk assessment.

DISCUSSION

Race-based risk calculation, including assessing fracture risk, is one of the mechanisms by which the medical and healthcare sectors perpetuate systemic racism.

IMPLICATIONS FOR NURSING PRACTICE AND POLICY

Nurses are called to action to address the contributing role of race-based algorithms, such as the FRAX, to unequal treatment. Nurses should advocate for the removal of race in these clinical decision-making tools and case studies. Additionally, nurses should advocate for their replacement with better tools that do not use race but rather measures of structural racism to calculate risk. Policy guidance should be issued so that race, a sociohistorical tool of categorization to preserve power structures, should no longer be used as an approximation of other more relevant and precise risk factors for fractures or other diseases.

CONCLUSION

Nurses are critical in cultivating and implementing antiracist approaches to remediate health inequities in screening and treatment of osteoporosis and other preventable diseases.

Racial diversities in lifespan bone mass: findings from the China BCL Study and US NHANES

BACKGROUND

Bone mass at different life stages is instrumental for developing effective, long-term osteoporosis prevention strategies.

AIM

We aimed to investigate the developmental patterns of bone mass across the entire lifespan among the Chinese population and to compare these patterns with those of different racial groups, including Whites, Blacks and Mexicans in the US population.

DESIGN

A population-based study.

METHODS

Our study analyzed data from the China Body Composition Life-course (2013-2023) Study and the United States National Health and Nutrition Examination Survey (2005-2018). We measured bone mineral content (BMC) and density (BMD) using dual-energy X-ray absorptiometry at various anatomical sites, including the whole-body (WB), lumbar spine, total hip and femoral neck.

RESULTS

In the Chinese population, WB BMC and BMD increased rapidly during childhood and adolescence, with males and females achieving approximately 90.6% and 95.7% of their respective peak bone mass. Peak bone mass for WB, total hip and femoral neck BMC/BMD occurred generally between the ages of 21 and 30, whereas the lumbar spine BMD peak occurred approximately a decade later. After reaching the peak, a gradual bone loss was observed from ages 30 to 40, with an acceleration post age 40, especially in females. Comparative analyses indicated that Chinese individuals exhibited the lowest bone mass levels and accrual rates over their lifespan, followed successively by Whites, Mexicans and Blacks.

CONCLUSION

By exploring bone mass changes and racial disparities among the Chinese and US populations, this study emphasizes the need for establishing sex- and ethnic-specific public health strategies to prioritize bone health throughout the entire life course.

Fixation Failure in Osteoporotic Bone: A Review of Complications and Outcomes

Background

Osteoporotic bone poses significant challenges for fixation of fractures due to its compromised bone quality. This issue impacts patient outcomes and, necessitate proper understanding of the biomechanical limitations and the adequacy of current fixation devices.

Objective

This article aims to address the gaps in literature by examining both the biomechanical and biological factors that contribute to fixation failure in osteoporotic bone, and by analyzing the limitations of current management strategies, with the aim of identifying effective interventions for this vulnerable patient group.

What is Already Known

Literature acknowledges that osteoporotic bones have reduced bone density and compromised structural integrity, making fixation devices less effective. Fixation failure frequently occurs in these patients due to diminished bone strength and insufficient fixation support, which collectively hinder optimal stabilization and healing.

Gap in Literature

Despite recognition of the high failure rates associated with osteoporotic bone fixation, there is limited literature detailing a comprehensive approach that integrates biomechanical, biological, and technological advancements to improve fixation outcomes. This article reviews current diagnostic techniques and explores potential innovations in materials and regenerative strategies aimed at enhancing fixation success. Which also guide us about need for future research to focus on developing and validating multifaceted approaches that combine advanced fixation materials and bone regeneration technologies to mitigate failure risks and improve patient outcomes.

Conclusion

With increasing life expectancy, the incidence of osteoporosis and hence osteoporotic fractures steadily increasing there are multiple fractures which are responsible for this, however as orthopedic surgeon we are required to deal with these fractures in increasing numbers so we need to develop a comprehensive approach to prevention of these fractures' adequate treatment and also the prevention of refractures which are far too common.

Association of long-term exposure to ambient air pollution with osteoporosis among cancer survivors: Results from the Korea National Health and Nutrition Examination Survey

INTRODUCTION

Recent studies suggest that ambient air pollution may contribute to osteoporosis; however, research focusing on populations with greater susceptibility is lacking. This study seeks to explore the association between air pollution and osteoporosis focusing on cancer survivors.

MATERIALS AND METHODS

We analyzed data from 8977 individuals (2245 cancer survivors, 6732 cancer-free population) obtained from the Korea National Health and Nutrition Examination Survey (KNHANES) during 2007-2009 and 2015-2021. Air pollution exposures to PM10, PM2.5, SO₂, NO₂, and CO were estimated using air quality models and satellite data. Moving average concentrations over 1-3 years prior to the survey were calculated. Logistic regression models adjusting for demographic and lifestyle factors were used to assess the association between air pollution and osteoporosis status. Analyses were stratified by cancer survivorship status and sex.

RESULTS

Among cancer survivors, particularly female cancer survivors, higher long-term exposure to air pollutants was associated with greater odds of osteoporosis. Cancer survivors exposed to higher PM10 over 1-, 2-, and 3-year periods had greater odds of osteoporosis (all p < 0.05). In female cancer survivors, 1-year exposure to PM2.5 was associated with 25 % higher odds of osteoporosis (OR = 1.25, 95 % CI = 1.02-1.54), and NO₂ exposure showed a similar association (OR = 1.42; 95 % CI = 1.06-1.90). These associations were not observed in the individuals without cancer history.

CONCLUSION

The association between air pollution and osteoporosis was observed in cancer survivors, especially among female cancer survivors. Our findings emphasize the need for targeted interventions for at-risk populations such as cancer survivors.

Targeting p38 MAPK: A potential bridge between ER stress and age-related bone loss

The endoplasmic reticulum (ER) is crucial in the development of numerous age-related bone disorders. Notably, ER stress can precipitate bone loss by orchestrating inflammatory responses, apoptosis, and autophagy through the activation of the p38 MAPK pathway. Age-related bone loss diseases pose a significant burden on society and healthcare as the global population ages. This review provides a comprehensive analysis of recent research advancements, delving into the critical role of ER stress-activated p38 MAPK in inflammation, apoptosis, and autophagy, as well as its impact on bone formation and bone resorption. This review elucidates the molecular mechanisms underlying the involvement of ER stress-activated p38 MAPK in osteoporosis, rheumatoid arthritis, periodontitis, and osteoarthritis and discusses the therapeutic potential of targeting p38 MAPK. Furthermore, this review provides a scientific foundation for new therapeutic strategies by highlighting prospective research directions.

Novel Combination of Traditional Ayurvedic Herb Piper longum L. and Modern Stem Cell Therapy for the Reversal of Glucocorticoid-Induced Osteoporosis

Glucocorticoids induced osteoporosis (GIOP) is a global concern without effective therapies. The present study investigated the potential of the umbilical cord-derived mesenchymal stem cells (UCMSCs) and traditional medicine Piper longum L. in the reversal of GIOP. Twelve-week-old female Swiss Albino mice were subjected to the dexamethasone treatment for 4 weeks to induce GIOP. Further, the mice were randomized into four different groups for treatment, viz., phosphate buffered saline (PBS), UCMSCs, P. longum L. aqueous extract through feed, and a combination of UCMSCs and P. longum L. extract. Post therapy, GIOP mice regained the weight and hair loss in the UCMSCs and P. longum L. extract group. ALP activity and mRNA expression of RunX2, ALP, and OPN were significantly increased. Micro-CT analysis revealed remarkable improvement in key parameters such as bone volume, bone surface density, tissue surface, trabecular thickness, and number. Our results unequivocally demonstrate that a combination of the UCMSCs and P. longum L. is highly effective in the reversal of GIOP as compared to P. longum L. or UCMSCs alone. The therapeutic effect can be attributed to the osteogenic and paracrine potential of UCMSCs and the anti-inflammatory effect of P. longum L.

Evolving strategies for osteoporosis management in postmenopausal women: From tradition to innovation

Osteoporosis is a chronic condition primarily affecting postmenopausal women, significantly impacting their well-being and quality of life. Traditional treatment approaches include medications, vitamins, and exercise, but there is a growing interest in alternative therapies that enhance bone health. This review was conducted by searching multiple databases, including PubMed, Medline, and Google Scholar, for studies related to osteoporosis treatment. Articles focusing on both traditional therapies such as bisphosphonates, calcium, and vitamin D supplementation, and newer advancements like vibration therapy and bone-building devices such as Osteoboost were included. Traditional treatments, such as vitamin supplementation, exercise, and bisphosphonates, remain foundational in osteoporosis management, helping to maintain bone density and reduce fracture risks. Recent developments, including vibration therapy and Osteoboost, show promising results in bone regeneration without the use of medication. While traditional therapies continue to play an essential role, advancements like vibration therapy present novel alternatives for managing osteoporosis. Further research is necessary to optimize these approaches, ensuring they maximize benefits while minimizing risks, ultimately improving patient outcomes and quality of life.

Derivation of hiPSC line (ICADRB2i007-A-3) from an individual with osteoporosis linked to ADRB2: c.46G > A

Osteoporosis is a complex multifactorial bone disease with a strong genetic component. Among the various genes implicated in the progression of osteoporosis, those encoding G-protein-coupled receptors (GPCRs) play a crucial role in its pathogenesis. This superfamily of membrane receptors regulates myriad of cellular events including physiological and pathological processes in bone tissue. Beta-2-adrenergic receptor (a member of the GPCR superfamily) mediates cues from sympathetic nervous system to the bone tissue being expressed on both types of bone cells osteoblasts and osteoclasts. While the impact of this receptor typically investigated using animal models, the human gene ADRB2 coding beta-2-adrenergic receptor harbors numerous non-synonymous single-nucleotide polymorphisms (SNPs) that alter the activity of the receptor. One of the most prevalent SNP is c.46G > A; however, its impact on bone homeostasis has only been explored in epidemiological studies with results showing considerable variability. In this study, we generated for the first time induced pluripotent stem cells (iPSCs) line from the patient with osteoporosis carrying c.46G > A in ADRB2. This new cell line exhibits hallmarks of pluripotency, normal karyotype, and ability to differentiate into three-germ layers. Furthermore, we conducted a comparative analysis of ADRB2 expression between newly obtained iPSCs and those derived from healthy donors. This comparison extended to mesenchymal stem cells (iMSCs) derived from these iPSC lines, assessing both basal and osteogenic conditions at the mRNA and protein levels. Our findings revealed that iMSCs from an osteoporotic patient with the c.46G > A in ADRB2 exhibited decreased ADRB2 expression, which correlated with a diminished potential for osteogenic differentiation. Newly obtained iPSCs line represents a promising cell source for in vitro osteoporosis model and offers the possibility to study in-depth the specific impact of c.46G > A in ADRB2 on osteoporosis pathogenesis.

Fabrication and in vitro cytocompatibility evaluation of porous bone scaffold based on cuttlefish bone-derived nano-carbonated hydroxyapatite reinforced with polyethylene oxide/chitosan fibrous structure

A novel porous bone scaffold based on nano-carbonated hydroxyapatite reinforced with fibrous-like structured polyethylene oxide/chitosan network (nCHA/PEO/CS) was introduced and fabricated via freeze-drying. Prior to this, the nCHA was synthesized through a hydrothermal reaction based on cuttlefish bone (CFB, Sepia officinalis). The raw cuttlefish bone (raw-CFB) was first decomposed to obtain cuttlefish bone-derived calcium oxide (CaO-CFB) by calcination at 1000 °C, which was used for synthesizing nCHA. The chemical composition analysis showed that the nCHA formed AB-type CHA with a high carbonate content of 7.38 wt%, which is in the range of carbonate content in native bone (2-9 wt%). The Ca/P molar ratio of nCHA was 1.712, very close to the Ca/P of biological apatite of 1.71. Morphological analysis revealed that nCHA consists of nanosized particles, potentially offering a large surface area to volume to promote ion exchange and cell interaction. The excellent physicochemical and morphological properties of nCHA proposed suitability as a bone scaffold precursor combined with PEO and CS. The nCHA/PEO/CS scaffolds were freeze-dried with varying PEO/CS concentrations. Physicochemical analysis indicated that increasing the PEO/CS concentration decreased the crystallinity of the scaffold, causing it to be lower than the nCHA crystallinity, which may be beneficial for cell growth. Morphological analysis revealed that the scaffold structure comprised nCHA cross-linked within a fibrous-like structured PEO/CS network, which appropriately mimics the fibrous structure of extracellular matrix (ECM) in natural bone. However, the nCHA/PEO/CS-11 scaffold formed more appropriate pores with suitable porosity for cell development, blood vessel formation, and nutrient perfusion. The nCHA/PEO/CS-11 scaffold also demonstrated sufficient compressive strength and good swelling behavior, which may favor bone regeneration. The nCHA/PEO/CS-11 scaffold demonstrated high cytocompatibility and facilitated the adherence of MC3T3E1 cells on the scaffold surface. The nCHA/PEO/CS-11 scaffold also promoted cell osteogenic differentiation. Owing to its desirable and suitable characteristics, the nCHA/PEO/CS-11 scaffold is promising in bone tissue engineering.

Twenty-Year Trends in Osteoporosis Treatment and Post-Fracture Care in South Korea: A Nationwide Study

BACKGROUND

Osteoporosis is a significant public health issue in aging populations. Despite advances in pharmacotherapy, underdiagnosis and undertreatment remain prevalent even in patients with recent fractures. This study examined 20-year trends (2002- 2022) in anti-osteoporotic medication (AOM) usage in South Korea.

METHODS

Data from the Korean National Health Information Database were retrospectively analyzed. The study included individuals aged ≥50 years and analyzed prescription trends, medication adherence, measured by the medication possession ratio (MPR), and treatment initiation rates post-fracture. The AOMs examined included bisphosphonates, selective estrogen receptor modulators, denosumab (DMAB), teriparatide (TPTD), and romosozumab (ROMO).

RESULTS

Over two decades, AOM use has shifted significantly from oral to injectable formulations, with injectables surpassing oral medications in 2020; from 397,440 prescriptions in 2016 to 1,162,779 in 2022. Prescriptions for DMAB surged following its approval as a first-line therapy in 2019, increasing 2.65 times from 217,606 in 2019 to 575,595 in 2022. The MPR improved from 35.4% in 2003 to 73.2% in 2021, with females demonstrating higher adherence than males. Post-fracture treatment rates increased from 31.1% in 2006 to 39.9% in 2021 but remained below 50%. Vertebral fractures had the highest treatment initiation rates, while anabolic agents, such as TPTD and ROMO were underprescribed despite their efficacy.

CONCLUSIONS

This 20-year analysis highlights significant progress in osteoporosis management in South Korea, including a shift towards injectable therapies and improved adherence. However, the persistent undertreatment of high-risk patients underscores the requirement for enhanced access to anabolic agents, clinician education, and policy reforms to optimize post-fracture care.

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

Background

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

Methods

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

Results

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

Conclusion

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

Controlled delivery of mesenchymal stem cells via biodegradable scaffolds for fracture healing

Biodegradable controlled delivery systems for mesenchymal stem cells (MSCs) have emerged as novel advancements in the field of regenerative medicine, particularly for accelerating bone fracture healing. This detailed study emphasizes the importance of quick and adequate fracture treatment and the limitations of existing methods. New approaches employing biodegradable scaffolds can be placed within a fracture to serve as a mechanical support and allow controlled release of in situ MSCs and bioactive agents. They are made up of polymers and composites which degrade over time, aiding in natural tissue regrowth. The fabrication methods, including 3D printing, electrospinning, and solvent casting, with particulate leaching that enable precise control over scaffold architecture and properties, are discussed. Progress in controlled drug delivery systems including encapsulation techniques and release kinetics is described, highlighting the potential of such strategies to maintain therapeutic benefits over a prolonged time as well as improving outcomes for fracture repair. MSCs play a role in bone regeneration through differentiation using biodegradable scaffolds, paracrine effects, and regulation of inflammation focusing on fracture healing. Current trends and future directions in scaffold technology and MSC delivery, including smart scaffolds with growth factor incorporation and innovative delivery approaches for fracture healing are also discussed.

Early-life malnutrition exposure associated with higher osteoporosis risk in adulthood: a large-scale cross-sectional study

INTRODUCTION

Evidence on the association between early-life malnutrition exposure at different developmental stages and the subsequent risk of osteoporosis and fractures in adulthood remains sparse and equivocal. This study sought to elucidate the relationship between malnutrition exposure in early-life and the occurrence of osteoporosis and fractures later in life.

METHODS

This research is a cross-sectional analysis carried out within the framework of the China Community-based Cohort of Osteoporosis (CCCO), an ongoing community-based cohort study. Participants were stratified by birthdate into several categories: nonexposed, fetal, early childhood, mid-childhood, late childhood, and adolescence exposure groups. The nonexposure and adolescence exposure groups were consolidated into an 'age-matched group' to provide a robust comparative framework for analyzing the probability of developing osteoporosis (defined as a T-score ≤-2.5 in bone mineral density) and the frequency of self-reported fracture. Multiple logistic regression models were utilized to investigate the association between early-life malnutrition exposure and the risks of osteoporosis and fracture. Additionally, our findings were validated in the China Northwest Cohort (CNC).

RESULTS

A total of 12 789 participants were included into the final analysis. After adjusting for various covariates, individuals exposed to malnutrition during their fetal and childhood stages (early, middle, and late) increased the likelihood of developing osteoporosis in adulthood, compared to their age-matched counterparts. In these four groups, the ORs (95% CI) for osteoporosis risk were 1.223 (1.035 to 1.445), 1.208 (1.052 to 1.386), 1.249 (1.097 to 1.421), and 1.101 (1.001 to 1.210), respectively (all P -values <0.05). Specifically, the late childhood exposure group showed a heightened risk of fracture, with an OR (95% CI) of 1.155 (1.033-1.291) and a P -value of 0.01127. Stratified analyses further found a significant correlation between early-life exposure to malnutrition and an elevated risk of osteoporosis in participants with lower educational attainment, overweight, or obese participants. Additionally, corroborating evidence from the CNC confirmed the influence of malnutrition exposure on osteoporosis risk.

CONCLUSIONS

Early-life exposure to malnutrition had a detrimental impact on bone health. Individuals who had experienced malnutrition during fetal and childhood stages (early, middle, and late) exhibited a high susceptibility to osteoporosis in adulthood, compared to age-matched cohorts. This susceptibility was particularly pronounced in women, and individuals who were overweight or obese, or had lower levels of education.

Polydatin accelerates osteoporotic bone repair by inducing the osteogenesis-angiogenesis coupling of bone marrow mesenchymal stem cells via the PI3K/AKT/GSK-3β/β-catenin pathway

BACKGROUND

Polydatin (POL), a natural stilbenoid, has multiple pharmacological activities. However, its effect on osteoporotic bone defects has not yet been examined. This study was designed to explore the unknown role of POL on osteoporotic bone repair.

METHODS

The effect of POL on osteogenesis and angiogenesis were investigated firstly. Then a series of angiogenesis-related assays were carried out to explore the relationship between osteogenesis and angiogenesis of POL, and the underlying mechanism was further explored. Whereafter, ovariectomy-induced osteoporosis rats with bone defect were treated with POL or placebo, the imageological and histological examinations were conducted to assess the effect of POL on osteoporotic bone repair.

RESULTS

The moderate concentrations (1 μM and 10 μM) of POL enhanced the osteogenesis of bone marrow mesenchymal stem cells (BMSCs) and elevated the expression of angiogenic-specific markers. Further research found that POL-induced human umbilical vein endothelial cells migration and tube formation through the osteogenesis-angiogenesis coupling of BMSCs, and the POL-induced osteogenesis-angiogenesis coupling was reversed after co-cultured with LY294002. Mechanistically, this was conducted via activating PI3K/AKT/GSK-3β/β-catenin pathway. After that, using the osteoporotic bone defect rat model, the authors, observed that POL facilitated osteoporotic bone repair through enhancing osteogenesis and CD31 hi EMCN hi type H-positive vessels formation via the PI3K/AKT/GSK-3β/β-catenin pathway.

CONCLUSION

The data above indicated that POL could accelerate osteoporotic bone repair by inducing the osteogenesis-angiogenesis coupling of BMSCs via the PI3K/AKT/GSK-3β/β-catenin pathway, which provided new insight and strategy for osteoporotic bone repair.

Gene expression and hormonal signaling in osteoporosis: from molecular mechanisms to clinical breakthroughs

Osteoporosis is well noted to be a universal ailment that realization impaired bone mass and micro architectural deterioration thus enhancing the probability of fracture. Despite its high incidence, its management remains highly demanding because of the multifactorial pathophysiology of the disease. This review highlights recent findings in the management of osteoporosis particularly, gene expression and hormonal control. Some of the newest approaches regarding the subject are described, including single-cell RNA sequencing and long non-coding RNAs. Also, the review reflects new findings on hormonal signaling and estrogen and parathyroid hormone; patient-specific approaches due to genetic and hormonal variation. Potential new biomarkers and AI comprised as factors for improving the ability to anticipate and manage fractures. These hold great potential of new drugs, combination therapies and gene based therapies for osteoporosis in the future. Further studies and cooperation of scientists and clinicians will help to apply such novelties into practical uses in the sphere of medicine in order to enhance the treatment of patients with osteoporosis.

Gender-Specific effects of L-arginine supplementation on bone mineral density and trabecular bone volume in Sprague-Dawley rats; stereological study

BACKGROUND

L-arginine (Arg) is a semi-essential amino acid that can be used as a key mediator for the release of growth hormone (GH), insulin-like growth factor-1(IGF-1), and other growth factors. In this study, we comprehensively evaluated the effect of Arg intake on bone growth and associated markers.

METHODS

The study involved 24 Sprague-Dawley rats (12 males, 12 females) divided into two groups (Age = 24 days). One group received a standard diet, while the other was injected with 10 mg/kg of Arg daily for 90 days. Serum bone markers like calcium (Ca), phosphorous(P), and alkaline phosphatase (ALP) were analyzed via colorimetric assays. stereological study and bone mineral density (BMD) were conducted via dissector method and Hologic Dual-energy x-ray absorptiometry (DXA) system; respectively.

RESULTS

Biochemical assays showed no significant differences in Ca, P, and ALP levels between groups. Male rats in the case group exhibited lower testosterone levels (p.value = 0.009). Stereological and bone mineral density (BMD) analyses revealed contrasting gender-specific outcomes. Female rats in the case group had higher BMD (p.value = 0.001), while males had lower BMD compared to controls (p.value = 0.018). Arg consumption affects trabecula volume values differently in females compared to males (p.value = 0.022). Furthermore, the study observed decreased osteocytes and osteoblasts in male case rats. The gender-based differences in BMD were attributed to Arg's paradoxical impact on testosterone levels in males.

CONCLUSION

Overall, Arg supplementation was found to influence BMD and trabecular bone volume, with outcomes varying depending on gender. The study highlights the intricate interplay between Arg, sex hormones, and bone health, offering insights into these complex relationships.

Application of extracellular vesicles in diabetic osteoporosis

As the population ages, the occurrence of osteoporosis is becoming more common. Diabetes mellitus is one of the factors in the development of osteoporosis. Compared with the general population, the incidence of osteoporosis is significantly higher in diabetic patients. Diabetic osteoporosis (DOP) is a metabolic bone disease characterized by abnormal bone tissue structure due to hyperglycemia and insulin resistance, reduced bone strength and increased risk of fractures. This is a complex mechanism that occurs at the cellular level due to factors such as blood vessels, inflammation, and hyperglycemia and insulin resistance. Although the application of some drugs in clinical practice can reduce the occurrence of DOP, the incidence of fractures caused by DOP is still very high. Extracellular vesicles (EVs) are a new communication mode between cells, which can transfer miRNAs and proteins from mother cells to target cells through membrane fusion, thereby regulating the function of target cells. In recent years, the role of EVs in the pathogenesis of DOP has been widely demonstrated. In this article, we first describe the changes in the bone microenvironment of osteoporosis. Second, we describe the pathogenesis of DOP. Finally, we summarize the research progress and challenges of EVs in DOP.

Effectiveness of Bisphosphonates in Young Adults with Fragility Fractures: Representative Population-Based Cohort Study

CONTEXT

Fragility fractures in young adults present significant clinical challenges due to the limited evidence on the effectiveness of bisphosphonates in preventing subsequent fractures.

OBJECTIVE

To evaluate the effectiveness of bisphosphonate therapy in reducing the fracture risk among premenopausal women with a history of osteoporotic fractures.

DESIGN

A population-based retrospective cohort study was conducted using data from the National Health Insurance Service-National Sample Cohort (NHIS-NSC) in South Korea, covering the years 2003 to 2014.

SETTING

A nationwide healthcare setting utilizing a representative cohort database.

PARTICIPANTS

Among 2,087 premenopausal women with osteoporotic fractures, participants were propensity score-matched based on age and body mass index at a 1:3 ratio, resulting in 132 bisphosphonate users and 396 non-users.

INTERVENTION

Bisphosphonate treatment.

MAIN OUTCOME MEASURES

The incidence of osteoporotic fractures.

RESULTS

Bisphosphonate users had a significantly lower risk of major osteoporotic fractures (HR 0.618, 95% CI 0.396 - 0.963) compared to non-users. Ibandronate users showed significant reductions in both major osteoporotic (HR 0.376, 95% CI 0.164 - 0.861) and nonvertebral fractures (HR 0.214, 95% CI 0.052 - 0.877). Also, longer duration of bisphosphonate use (≥180 days) was associated with a significantly lower risk of major osteoporotic and nonvertebral fractures (HR 0.528, 95% CI 0.300 - 0.929; HR 0.409, 95% CI 0.187 - 0.895, respectively).

CONCLUSIONS

Bisphosphonate therapy significantly reduces fracture risk in premenopausal women with previous osteoporotic fractures, especially at higher cumulative doses. These findings support considering bisphosphonates as a treatment option in premenopausal women at high risk of fractures.

The Association Between Antipsychotics and Bone Fragility: An Updated Comprehensive Review

BACKGROUND

Antipsychotic drugs appear to be related to reduced bone mineral density (BMD). We conducted a narrative review to collect the available literature investigating the relationship between antipsychotic use and bone fragility.

METHODS

A review of the published literature was conducted and reported through PubMed/Scopus/Cochrane libraries. We included studies using any antipsychotic treatment where the bone metabolism, osteoporosis, and/or risk of fractures has been assessed.

RESULTS

After screening 1707 items, we finally included 15 papers. A total of 3245 initial patients were identified, of whom 1357 patients with a mean age of 43.8 years underwent antipsychotic treatment and were analyzed. The mean antipsychotic treatment duration of the treated group was 15.8 ± 13.9 years. Among the included studies, two reported a statistically significant difference in lumbar BMD reduction between the antipsychotic exposed group and the control group. Femoral neck BMD levels had been reported in four of the case-control studies; two reported a statistically significant difference in femoral neck BMD reduction between the antipsychotic exposed group and the control group.

CONCLUSIONS

Prolonged use of antipsychotic treatment seems to be associated with an increased risk of reduced BMD, and, consequentially, with an augmented risk of bone fragility and fractures. This effect is not limited to vulnerable groups, such as those with significant medical comorbidities, the elderly, and postmenopausal women, but may also apply to anyone using antipsychotics in the long-term. Clinicians' awareness of antipsychotic prescriptions should optimize their potential while reducing this risk.

Osteoporosis Management for Shoulder Surgeons

PURPOSE OF REVIEW

The aim of this review is to aggregate currently available literature as it pertains to treating surgical shoulder pathology in patients with osteoporosis.

RECENT FINDINGS

Emerging data surrounding perioperative use of anti-osteoporosis medications for patients undergoing shoulder surgery have not shown definitively favorable or unfavorable outcomes. Similar evaluations in animal studies have shown promising results as a biologic augment to tendon and bone healing, especially with newer, anabolic agents. The mainstay of bone health management remains pre-operative evaluation, using opportunistic radiographic and CT based validated measurements, along with optimization of risk factors. Surgical techniques continue to incorporate implants that perform well in osteopenic bone. Promising pre-clinical studies have identified anabolic anti-osteoporosis medications as viable biologic augments to shoulder surgery, which has not been borne out in any clinical studies at this time.

Denosumab-associated symptomatic hypophosphatemia in normal kidney function: two case reports

We report two cases of symptomatic severe hypophosphatemia requiring hospitalization and intravenous phosphate supplementation following denosumab therapy for osteoporosis. The two patients had normal kidney function and no previously reported risk factors for hypophosphatemia, both presented neurological symptoms and severe fatigue. After hospital admission, they were treated with intravenous phosphate: serum phosphate improved to normal levels and the patients were discharged with oral phosphate supplements and-in one patient-with oral calcitriol therapy. As prescription rates of denosumab therapy increase, attention should be paid to the risk of developing hypophosphatemia: the risk of such complication may be lower by early and regular monitoring of Ca, Pi, and PTH, as well as early supplementation of phosphate and/or vitamin D as needed. Whenever a patient receiving denosumab therapy complains otherwise unexplained fatigue, exercise intolerance, muscle pain, cramping, and paresthesias, we suggest hypophosphatemia as a potential complication to be ruled out.

Low-molecular-weight estrogenic phytoprotein suppresses osteoporosis development through positive modulation of skeletal estrogen receptors

Age-related osteoporosis is a metabolic skeletal disorder caused by estrogen deficiency in postmenopausal women. Prolonged use of anti-osteoporotic drugs such as bisphosphonates and FDA-approved anti-resorptive selective estrogen receptor modulators (SERMs) has been associated with various clinical drawbacks. We recently discovered a low-molecular-weight biocompatible and osteoanabolic phytoprotein, called HKUOT-S2 protein (32 kDa), from Dioscorea opposita Thunb that can accelerate bone defect healing. Here, we demonstrated that the HKUOT-S2 protein treatment can enhance osteoblasts-induced ossification and suppress osteoporosis development by upregulating skeletal estrogen receptors (ERs) ERα, ERβ, and GPR30 expressions in vivo. Also, HKUOT-S2 protein estrogenic activities promoted hMSCs-osteoblasts differentiation and functions by increasing osteogenic markers, ALP, and RUNX2 expressions, ALP activity, and osteoblast biomineralization in vitro. Fulvestrant treatment impaired the HKUOT-S2 protein-induced ERs expressions, osteoblasts differentiation, and functions. Finally, we demonstrated that the HKUOT-S2 protein could bind to ERs to exert osteogenic and osteoanabolic properties. Our results showed that the biocompatible HKUOT-S2 protein can exert estrogenic and osteoanabolic properties by positively modulating skeletal estrogen receptor signaling to promote ossification and suppress osteoporosis. Currently, there is no or limited data if any, on osteoanabolic SERMs. The HKUOT-S2 protein can be applied as a new osteoanabolic SERM for osteoporosis treatment.

Global, regional and national trends in the burden of low bone mineral density from 1990 to 2030: A Bayesian age-period-cohort modeling study

Low bone mineral density (LBMD) remains a global public health concern. To provide deeper insights, we retrieved and calibrated LBMD death and Disability-Adjusted Life Years (DALYs) data from the Global Burden of Disease 2021 (GBD 2021) database. We calculated the age-standardized rate (ASR) and estimated annual percentage change (EAPC) to delineate LBMD trends across sexes, age groups, Sociodemographic Index (SDI) regions, and countries. Spearman rank order correlation analysis was used to explore the relationship between SDI and ASR. Additionally, we constructed Bayesian age-period-cohort (BAPC) models to predict future trends in LBMD up to 2030, with the mean absolute percentage error (MAPE) used to evaluate prediction accuracy. Our analyses revealed that global deaths related to LBMD nearly doubled, from 250,930 in 1990 to 463,010 in 2021, and are projected to rise to 473,690 by 2030. However, the ASR exhibited an opposite trend, decreasing from 17.91 per 100,000 in 1990 to 15.77 per 100,000 in 2021, and is expected to further decline to 13.64 per 100,000 by 2030. The EAPC indicated descending trends in 1990-2021 and 2022-2030. Trends in LBMD varied across different subgroups by sex, age, and location. Males are projected to continue experiencing higher death numbers than females, though the gap is narrowing. The 90 to 94 age group consistently had the highest ASR from 1990 to 2030. Lower SDI remains a critical factor contributing to the higher burden of LBMD. Spearman rank order correlation analysis showed a negative correlation between SDI and ASR. We categorized 6 distinct trends in ASR across different countries, with most expected to experience a decline by 2030. The MAPE value (0.038 < 0.1) indicated that the BAPC model produced reliable predictions even under the COVID-19 pandemic.

Comparison of whole body bone mineral density measurements between dual energy X-ray absorptiometry and novel bioelectrical impedance analysis

Bone mineral density (BMD) is a crucial indicator of osteoporosis. Bioelectrical impedance analysis (BIA) introduces a new method for assessing body composition, specifically BMD measurement. Compared with existing ultrasound and dual-energy X-ray absorptiometry for BMD screening and diagnosis, BIA has the advantages of safety, convenience and speed. However, the accuracy of BIA for BMD measurement needs to be explored. This study aimed to evaluate the accuracy of the novel BIA technique in conducting whole-body BMD assessments in the general population of Taiwan. Overall, 318 healthy adults in Taiwan (37.67 ± 19.44 years of age; 145 male and 173 female patients) were included. Whole-body BMD was measured via foot-to-foot BIA-StarBIA-201 (StarBIA Meditek Co. LTD, Taichung, Taiwan) and the dual-energy X-ray absorptiometry (DXA) Lunar Prodigy technology (GE Medical Systems, Madison, WI, USA). Linear regression analysis, Pearson's correlation coefficient, the Bland-Altman plot, and paired t tests were used. The whole-body BMDs measured by BIA and DXA were 1.139 ± 0.124 g/cm2 and 1.202 ± 0.168 g/cm2, respectively. The regression equation was y = 1.057x + 0.063. The Pearson correlation coefficient, mean difference, and limits of agreement were r = 0.737, - 0.053 g/cm2, and - 0.290-0.165 g/cm2, respectively. The regression equation was y = 1.057x + 0.063. The Pearson correlation coefficient, mean difference, and limits of agreement were r = 0.737 (p < 0.001), - 0.053 g/cm2, and - 0.290-0.165 g/cm2, respectively. Standing BIA was correlated with the DXA gold standard for estimating whole-body BMD in adults; however, its interchangeability remains limited. The potential bias in the measurement results of this study represents a current challenge with BIA compared with that of DXA, and there is still room for improvement. The convenient BIA method for measuring whole-body BMD may be useful in the application of primary screening and future development of BMD assessment methods. BIA is widely used to measure body composition, but its application to the measurement of BMD represents a novel technological breakthrough.