Fragility Fractures: Risk Factors and Management in the Elderly

MiRNA-mRNA network in osteoporotic fractures proposes the functional mechanism of hsa-miR-32-3p/TNFSF11 axis

BACKGROUND AND AIMS

This study aimed to construct a miRNA-mRNA network in OF and explored the effect of the hsa-miR-32-3p/TNFSF11 axis on osteoclast function.

METHODS

GSE70318 and GSE74209 datasets were used to filter the differentially expressed miRNAs in OF. Then, the targets of these miRNAs intersected with the disease genes of OF. The target genes were annotated using GO terms and KEGG pathway enrichment analysis. The network for miRNA-gene-top 30 GO terms/top 20 pathways was drawn. Sankey diagrams were drawn for Parathyroid hormone synthesis, secretion, and action pathway (hsa04928) and ossification (GO:0001503) related to osteoporotic fracture. The hsa-miR-32-3p/TNFSF11 axis was selected for expression and functional verification.

RESULTS

A total of 21 differentially expressed miRNAs in OF were obtained by analyzing GSE70318 and GSE74209 datasets. A total of 36 genes were related to OF among the miRNA-targets. The genes were enriched in GO terms and KEGG pathways related to OF. Parathyroid hormone synthesis, secretion, and action pathway (hsa04928) and ossification proposed that the hsa-miR-32-3p/TNFSF11 axis may be involved in OF. The expression level of hsa-miR-32-3p was decreased in patients with low bone mineral density (BMD) and fracture, while the expression level of TNFSF11 mRNA was increased. Hsa-miR-32-3p complementarily bound with TNFSF11. Hsa-miR-32-3p inhibited osteoclast activation, while TNFSF11 promoted osteoclast activation.

CONCLUSIONS

The miRNA-mRNA network in OF proposed the TNFSF11 as a downstream target of hsa-miR-32-3p. The hsa-miR-32-3p/TNFSF11 axis was involved in the regulation of osteoclast activity.

CLINICAL TRIAL NUMBER

Not applicable.

USP2-induced upregulation of LEF1 through deubiquitination relieves osteoporosis development by promoting the osteogenic differentiation of bone marrow mesenchymal stem cells

BACKGROUND

Bone marrow mesenchymal stem cells (BMSCs) exhibit therapeutic potential for osteoporosis through their differentiation into osteoblasts. Here, we investigated the role and mechanism of lymphoid enhancer-binding factor 1 (LEF1) in regulating osteogenic differentiation of human BMSCs (hBMSCs).

METHODS

hBMSCs were exposed to the specific medium to induce their osteogenic differentiation. The ovariectomy (OVX)-induced osteoporotic mouse model was constructed. LEF1 and USP2 mRNA expression was analyzed by quantitative PCR, and protein levels were detected by immunohistochemistry and immunoblotting. Cell proliferation was assessed by CCK-8 assay. Alkaline phosphatase (ALP) expression and activity assay and Alizarin Red staining were used to evaluate osteogenic differentiation. LEF1 protein stability analysis and co-immunoprecipitation (Co-IP) assay were performed to test the USP2/LEF1 interaction.

RESULTS

During hBMSC osteogenic differentiation, LEF1 and USP2 levels were increased in hBMSCs. Inhibiting LEF1 or USP2 diminished the proliferation and osteogenic differentiation of hBMSCs in vitro. Mechanistically, USP2 stabilized LEF1 protein by mediating LEF1 deubiquitination. Increased expression of LEF1 reversed USP2 knockdown-imposed suppression on proliferation and osteogenic differentiation of hBMSCs. Moreover, increased USP2 expression reduced bone loss and enhanced osteogenic differentiation in OVX mice. Additionally, LEF1 and USP2 were downregulated in the bone marrow of patients with osteoporosis.

CONCLUSION

Our findings provide the first demonstration of the USP2/LEF1 cascade that enhances the osteogenic differentiation of hBMSCs, broadening the field for the development of BMSCs as effective agents in osteoporosis therapy.

Linc00963 up-regulation alleviates postmenopausal osteoporosis through suppression of miR-506-3p

BACKGROUND

This study aimed to investigate the regulatory effect of linc00963 on postmenopausal osteoporosis and the potential molecular mechanisms.

METHODS

Taking MC3T3-E1 cells as the study object, a cell cycle assay was used to evaluate the effect of linc00963 on cell proliferation. mRNA levels of Runx2, OCN, collagenia-1, OPG, RANKL and RANK were detected. Dual luciferase reporter assay verified the targeting relationship between linc00963 and miR-506-3p. A postmenopausal osteoporosis rat model was established after ovariectomy in 32 Sprague-Dawley rats. The rats were divided into sham group, OVX group, linc00963 overexpression group, and blank plasmid group. The bone mineral density (BMD) of the rat femur was measured by X-ray bone densitometer. Serum linc00963 expression in rat was detected by RT-qPCR. The protein expression of ALP, and BGP in the serum of rats was detected by ELISA.

RESULTS

Cell studies have shown that linc00963 alleviates postmenopausal osteoporosis by down-regulating the expression of miR-506-3p. Animal studies showed that compared with the sham group, the serum linc00963 level, BMD, serum Ca, P, LEP, SOD, and OPG levels in the OVX group were significantly decreased, while the levels of body weight, ALP, BGP, IL-6, IL-13, RANKL, and RANK were significantly increased. Compared with the OVX group, the use of linc00963 overexpression plasmid can significantly improve the above indexes and play a corresponding therapeutic effect on menopausal osteoporosis rats.

CONCLUSION

Linc00963 is involved in the pathogenesis of postmenopausal osteoporosis by up-regulating miR-506-3p and activating the OPG/RANKL/RANK pathway. Linc00963 is expected to be a potential therapeutic target for postmenopausal osteoporosis.

Osteonecrosis of the femoral head in post-COVID-19 patients: a retrospective comparative study

BACKGROUND

The COVID-19 pandemic has claimed many lives and continues to impact individuals through post-COVID-19 conditions. Osteonecrosis of the femoral head (ONFH) is increasingly recognized as a major post-COVID-19 complication, yet most studies are limited to case reports and small series. This study aimed to evaluate COVID-19-related factors potentially contributing to ONFH development in post-COVID-19 patients.

METHODS

A retrospective analysis was conducted on 84 patients with ONFH and a confirmed history of COVID-19. Baseline characteristics were collected, and patients were categorized into the following groups for comparative analysis: (1) vaccinated vs. unvaccinated, (2) unilateral vs. bilateral ONFH, (3) dexamethasone (DEX) and methylprednisolone (MPS) vs. DEX therapy, and (4) Association Research Circulation Osseus (ARCO) stage 2 vs. stage 3. Group differences and associations were analyzed.

RESULTS

The DEX and MPS-treated group had a greater extent of COVID-19 lung involvement compared to the DEX-treated group (59.2% vs. 36.3%, p = 0.002), as well as longer hospital stays in both general ward (14.2 days vs. 10.6 days, p = 0.018) and ICU (5.4 days vs. 3 days, p = 0.017). The DEX and MPS-treated group also had a longer duration of steroid therapy (19.3 days vs. 12.3 days, p < 0.001) and received higher DEX-equivalent cumulative steroid doses (380 mg vs. 125 mg, p < 0.001). Notably, ONFH symptoms developed earlier in the DEX and MPS-treated group compared to the DEX-treated group (7.5 months vs. 12 months, p = 0.004). Multivariable logistic regression analysis identified cumulative steroid dose as the sole predictor of ONFH severity (OR: 1.015, 95% CI: 1.001-1.028, p = 0.032), with ARCO stage 3 patients receiving higher cumulative steroid doses than stage 2 patients (240 mg vs. 126 mg, p = 0.018).

CONCLUSIONS

Our study demonstrated that cumulative steroid dose is the primary determinant of ONFH severity in post-COVID-19 patients. Additionally, combined use of corticosteroids may accelerate the onset of ONFH, highlighting the need for cautious steroid management in COVID-19 patients.

The effect of applying anti-osteoporosis drugs on the rehabilitation of patients with rotator cuff tears after arthroscopic rotator cuff repair: a meta-analysis

BACKGROUND

This comprehensive meta-analysis aimed to elucidate the effects of anti-osteoporosis (OP) drugs in patients who experienced rotator cuff tears and underwent arthroscopic repair.

METHODS

The PubMed, Embase, Web of Science, and Cochrane Central databases were searched to identify studies that examined the effects of anti-OP drugs among patients with rotator cuff tears who underwent arthroscopic rotator cuff repair. Specifically, studies that evaluated the retear rate and other subjective or objective outcomes were included in the analysis. The databases were searched from inception to January 13, 2025.

RESULTS

Ultimately, 5 articles were included in this meta-analysis. Compared with the control group, the anti-OP drug group had a lower retear rate, higher American Shoulder and Elbow Surgeon scores and a greater internal rotation angle. The Simple Shoulder Test, University of California, Los Angeles shoulder score, Constant Shoulder score, and forward flexion angle were not markedly different between the two groups.

CONCLUSION

Anti-OP drugs markedly promoted bone-to-tendon healing and improved quality of life among patients who underwent arthroscopic rotator cuff repair, especially with respect to activities that involve internal rotation of the shoulder.

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

Background

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

Methods

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

Results

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

Conclusion

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

Age-Related Cataract Extraction Is Associated With Decreased Falls, Fractures, and Intracranial Hemorrhages in Older Adults

BACKGROUND

Cataract extraction with intraocular lens insertion (CEIOL) is among the most frequently performed surgeries in the United States and is indicated for individuals with age-related cataracts causing visual impairment. The association between CEIOL and falls and hip fractures has been described, but there is a paucity of literature describing the association between CEIOL and various other common morbidity and mortality-increasing age-related traumatic injuries.

METHODS

This retrospective cohort study utilized TriNetX, a health database, to access de-identified electronic medical records. Cohorts of patients aged 60 years and older were identified using diagnostic and procedural codes. Cohort 1 was defined as patients with age-related cataracts who underwent CEIOL within 10 years of documented diagnosis of cataracts. Cohort 2 was defined as patients with age-related cataracts who did not undergo CEIOL within 10 years of documented diagnosis of cataracts. Propensity score matching for demographics and other relevant comorbidities was completed. Chi-square analysis was performed, and data were reported as odds ratios with 95% confidence intervals. Outcomes analyzed included proximal humerus fracture, distal radius fracture, hip fracture, ankle fracture, fall, subdural hemorrhage, and epidural hemorrhage.

RESULTS

Patients who underwent CEIOL demonstrated significantly lower odds of falls (p < 0.0001), proximal humerus fracture (p = 0.016), distal radius fracture (p = 0.0004), hip fracture (p < 0.0001), ankle fracture (p = 0.0002), subdural hemorrhage (p < 0.0001), and epidural hemorrhage (p = 0.006) as compared to patients with a documented diagnosis of age-related cataract without CEIOL.

CONCLUSIONS

CEIOL was significantly associated with decreased falls and reductions in major fall-related injuries among patients with age-related cataracts. These findings strongly support improved screening protocols to detect vision loss secondary to age-related cataracts, as this may decrease the incidence of common major fall-related injuries among patients with age-related cataracts.

Calycosin alleviates ovariectomy-induced osteoporosis by promoting BMSCs autophagy via the PI3K/Akt/mTOR pathway

Calycosin, the main extract from the traditional Chinese medicine (TCM) Astragalus membranaceus, has demonstrated anti-osteoporotic properties in ovariectomized (OVX) mice. However, the specific pathways through which it prevents osteoporosis remain unexplored. This study aimed to investigate the pathways by which calycosin promotes autophagy in bone marrow mesenchymal stem cells (BMSCs) and alleviates ovariectomy-induced osteoporosis. Mice were divided into three groups: sham, OVX, and OVX + calycosin. Following a 12-week intervention period, assessments included analysis of bone microstructure, serum concentrations of LC3II and ALP, and evaluation of Trap expression in femoral tissue. Immunohistochemical staining was used to assess the expression levels of PI3K, Runx2, and Beclin-1 in bone tissue. Additionally, levels of Runx2, ALP, p-PI3K, PI3K, mTOR, p-mTOR, Beclin-1, and ULK1 were analyzed. Osteogenic differentiation of BMSCs was evaluated using ALP and Alizarin red staining. OVX significantly impaired BMSCs osteogenic differentiation, resulting in bone loss. In contrast, calycosin increased bone mass, promoted osteogenesis, and reduced cancellous bone loss. Parameters, such as BMD, BV/TV, Tb.N, and Tb.Th, were significantly higher in the OVX + calycosin group compared to the OVX group. Additionally, Tb.Sp was notably reduced in the OVX + calycosin group. Calycosin also upregulated levels of Runx2, ALP, p-PI3K, p-mTOR, ULK1, and Beclin-1. In cellular studies, calycosin promoted BMSCs osteogenesis under OVX conditions; however, this effect was inhibited by LY294002. Calycosin effectively combats bone loss and improves bone structure. Its mechanism likely involves the promotion of autophagy in osteoblasts, thereby stimulating BMSC osteogenic differentiation. This effect may be mediated through the PI3K/Akt/mTOR pathway. These findings suggest that calycosin has the potential to serve as an alternative therapy for treating osteoporosis.

The efficacy of exercise prescription in patients with osteoporotic fractures: a systematic review and meta-analysis

BACKGROUND

Patients with osteoporotic fractures will further lose bone mineral density and the incidence of refractures will be greatly increased, which is one of the leading causes of death and disability in the elderly. Exercise prescription is effective in enhancing bone strength in patients with osteoporosis, but its effects on patients with osteoporotic fractures have not been systematically reviewed. The purpose of this study is to retrospectively analyze the effect of exercise prescription on bone mineral density in patients with osteoporotic fractures, so as to provide a basis for clinicians to provide postoperative guidance for fracture patients.

METHOD

We searched online databases for published studies on exercise prescription for people with osteoporotic fractures up to September 2024. We included 11 randomized controlled trials that reported the effect of exercise prescription on bone mineral density in people with osteoporotic fractures, and four of these studies reported the effect of exercise prescription on the incidence of refracture in people with osteoporotic fractures. We analysed changes in bone mineral density and incidence of refractures using a fixed-effect model, and meta-regression analyses were performed for subgroups.

RESULTS

Of the 701 articles reviewed, we included 11 randomized controlled trials in the meta-analysis. A total of 1101 samples were pooled, including 357 males and 744 females. This study found that exercise prescription was effective in increasing bone mineral density in patients with osteoporotic fractures (MD: 0.07; 95%CI: 0.06 to 0.09), reducing the incidence of refracture by about 3.67 times (OR: 3.67; 95%CI: 1.74 to 7.72). Both whole-body exercise (MD: 0.09; 95% CI: 0.06 to 0.11) and local exercise of the affected limb (MD: 0.06; 95%CI: 0.04 to 0.09) can effectively improve the patient's bone mineral density, and more than 1 year of exercise may be better (MD: 0.10; 95%CI: 0.07 to 0.14).

CONCLUSION

Reasonable exercise prescription can effectively improve bone mineral density and reduce the incidence of refracture in patients with osteoporotic fractures.

Correlation analysis of lumbar disc degeneration characteristics and bone mineral density in patients with osteoporosis based on the Roussouly classification

Background

Lumbar disc degeneration (LDD), endplate damage, and osteoporosis (OP) are closely linked; however, research on the influence of sagittal alignment on bone mineral density (BMD) and LDD is limited. This study aimed to explore the relationship between BMD, degenerative changes in intervertebral discs (IVDs), and endplate damage in patients with OP based on the Roussouly classification.

Methods

This retrospective study included 150 patients with and 150 without OP. Dual-energy X-ray absorptiometry (DXA) measured L1-4 vertebral BMD. Magnetic resonance imaging (MRI) assessed Pfirrmann grading (as a marker for disc dehydration status) and grading of endplate damage in the L1-S1 segments. The vertebral osteophyte score was evaluated. IVD degeneration and endplate damage were compared between groups and correlated with BMD. Patients were divided into four subgroups according to the Roussouly classification (based on different sagittal morphologies of spinopelvic anatomy) for further analysis.

Results

The Pfirrmann scores and endplate damage scores of the OP group at L1/2-L5/S1 were significantly higher than those of the control group (P<0.001). A negative correlation was observed between BMD and both Pfirrmann scores and endplate damage scores in the OP group (P<0.05). In the control group, no significant differences were observed in BMD and lumbar IVD parameters at L1/2-L5/S1 among the four patient subtypes. In the OP group, type II patients had the lowest BMD. Type I and II patients exhibited significantly greater disc dehydration and greater endplate damage sat L1/2-L5/S1 than type III and IV patients (P<0.05), with type II experiencing severe degeneration. Similarly, at the L4/5 and L5/S1 segments, type I and II patients demonstrated significantly greater disc dehydration and endplate damage compared to the type IV patients. Furthermore, type II patients showed more pronounced disc dehydration and endplate damage than type III patients. The correlation between BMD and IVD parameters was stronger in type I and II patients than in type III (P<0.05), with type II showing the strongest correlation. No significant correlation was found in type IV patients.

Conclusions

Patients with OP exhibited higher degrees of lumbar disc dehydration and endplate damage than the control group. A negative correlation was observed between BMD and the extent of lumbar disc dehydration, as well as endplate damage. Type II patients exhibited the lowest BMD. Types I and II displayed significantly greater LDD and endplate damage than types III and IV, with type II experiencing more severe degeneration than type I.

Osteoporotic Fragility Fracture Is Associated With an Increased Rate of New Mental Disorder Diagnosis

INTRODUCTION

Fragility fractures can be substantially life-altering with notable effects on patient well-being and mental health. The purpose of this study was to evaluate the risk of developing a new mental disorder diagnosis within 2 years following osteoporotic fragility fracture.

METHODS

A retrospective cohort study was conducted using a large national insurance claims database. Patients with proximal humerus, wrist, pelvis, hip, and spine fractures were matched in a 1:4 ratio with nonfracture control patients. Rates of mental disorders after primary fragility fractures were compared using multivariable logistic regression. Mental disorders evaluated included alcohol use disorder, generalized anxiety disorder, bipolar disorder, major depressive disorder, drug use disorder, panic disorder, posttraumatic stress disorder, and suicide attempt.

RESULTS

Elderly patients who sustained fragility fractures had a statistically significant increased risk of being diagnosed with many of the queried mental disorders within 2 years following fracture compared with control patients with no fracture. Comparing each individual fragility fracture demonstrated that hip fractures had the greatest risk of developing any of the queried mental disorders (OR:1.88, CI: 1.74-2.03).

CONCLUSION

There is an increased risk of being diagnosed with a new mental disorder following fragility fracture in patients older than 65 years. Mental health screening and potential psychiatric evaluation should be considered for patients following fragility fracture.

STUDY DESIGN

Original Research (Level III).

Efficacy of acupuncture for primary osteoporosis: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Primary osteoporosis (POP) is a common metabolic bone disorder that has a devastating effect on their quality of life in patients. Acupuncture, a traditional Chinese therapy, has been used to treat osteoporosis for over 2000 years. This study aimed to determine the efficacy of acupuncture in treating POP compared to conventional medicine or placebo.

METHODS

We searched for potentially relevant studies in PubMed, Web of Science, Embase, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, China Biology Medicine disc, Wanfang database and ClinicalTrials.gov up to December 20, 2024. Randomized controlled trials investigating treatment of POP for which acupuncture was administered as a stand-alone treatment or combined with conventional medicine compared to conventional medicine or placebo, were included. The outcomes included bone mineral density (BMD), visual analogue scale (VAS) scores, clinical effectiveness rate, estradiol (E2), Oswestry Disability Index (ODI), and levels of serum alkaline phosphatase (ALP). Data were synthesized using a random-effects meta-analysis model, and the observed heterogeneity was investigated using subgroup analyses. Study quality was appraised using the Cochrane RoB 2 tools, and the quality of the aggregated evidence was evaluated using the GRADE guidelines. Publication bias was assessed by funnel plots and validated by Egger's test.

RESULTS

Forty eligible articles with 2654 participants were identified. Compared to the control group, acupuncture effectively increased the BMD (MD 0.04 [0.03-0.06], P < 0.001, I2 = 92%), clinical efficacy (RR 1.24 [1.14-1.34], P < 0.001, I2 = 81%), and levels of E2 (SMD 0.30 [0.09-0.52], P = 0.006, I2 = 0%), and reduced the VAS scores (SMD - 1.79 [- 2.29 to - 1.29], P < 0.001, I2 = 95%). Data on ODI and ALP were insufficient for meta-analysis.

CONCLUSION

The current evidence suggests that the efficacy of acupuncture in improving the symptoms of POP are encouraging for its use in clinical practice as a physical intervention for patients with POP. However, since the included patients were all from China, there was a risk of sample bias, high-quality multicenter studies in different countries or regions should be conducted in the future.

Ferrostatin-1 inhibits osteoclast differentiation and prevents osteoporosis by suppressing lipid peroxidation

BACKGROUND

Osteoporosis (OP) is a systemic disease characterized by low bone mass. New progress has been made in the study of OP, such as lipid peroxidation. However, the role of lipid peroxides in osteoclast differentiation is still unclear.

METHODS

Bone marrow macrophages (BMMs) were extracted from C57BL/6J mice and induced to differentiate into osteoclasts, which were observed via TRAP staining, Phalloidin staining and bone pit assays. Related substances of lipid peroxidation were detected during osteoclastogenesis. The levels of osteoclastogenesis and lipid peroxides were measured by qRT-PCR, Western Blot and immunofluorescence. Activation of the p38/JNK/MAPK pathway was detected by Western Blot. The capacity for osteogenesis and angiogenesis of cells after treatment with supernatant of BMMs was evaluated. Furthermore, Ferrostatin-1 (Fer-1), from which femur and serum samples were comprehensively evaluated, was used in OVX mice.

RESULTS

During osteoclastogenesis, the levels of ROS, MDA, ACSL4 and LPCAT3 increased with increasing duration of RANKL stimulation, while there were no significant changes in the levels of GSH or GPX4. Fer-1 inhibited osteoclast differentiation and decreased the level of lipid peroxides. In addition, Fer-1 inhibited osteoclast-related markers by inhibiting the p38/JNK/MAPK pathway. Furthermore, the supernatant of BMMs after Fer-1 treatment promoted osteogenesis and angiogenesis. Finally, Fer-1 successfully alleviated OP in OVX mice by reducing the level of lipid peroxidation in vivo.

CONCLUSION

Fer-1 suppresses osteoclast differentiation by reducing lipid peroxidation levels regulated by ACSL4, which is mediated through the p38/JNK/MAPK signaling pathway. Additionally, Fer-1 enhances the coupling between osteogenesis and angiogenesis and has an anti-OP effect in vivo.

miR-208a-3p discriminates osteoporosis, predicts fracture, and regulates osteoclast activation through targeting STC1

BACKGROUND

Osteoporosis (OP) frequently occurs in post-menopausal women, increasing the risk of fracture. Early screening OP could improve the prevention of fractures.This study focused on the significance of miR-208a-3p in diagnosing OP and development regulation, aiming to explore a novel biomarker and therapeutic target for OP.

METHODS

The study enrolled a total of 154 post-menopausal women and grouping was performed based on the incidence of OP and fracture. The significance of miR-208a-3p was evaluated from the perspectives of menopausal correlation, OP diagnosis, and fracture prediction. In mechanism, the regulatory effect and mechanism of miR-208a-3p on osteoclast activation was investigated.

RESULTS

miR-208a-3p was menopause-related showing a negative correlation with E2 and positive correlations with FSH and LH. Significant upregulation of miR-208a-3p was observed in post-menopausal women with OP and showed significant diagnostic potential. Increasing miR-208a-3p was positively correlated with bone metabolism markers and negatively correlated with BMD of post-menopausal women with OP. Moreover, miR-208a-3p was also identified as a risk factor for fracture. STC1 was identified as a direct target of miR-208a-3p and was negatively regulated by miR-208a-3p. Silencing miR-208a-3p significantly alleviated macrophage inflammation and osteoblast activation, which was reversed by the knockdown of STC1.

CONCLUSION

Serum miR-208a-3p served as a diagnostic biomarker for OP and a risk factor for fracture in post-menopausal women. miR-208a-3p regulated macrophage inflammation and further mediated osteoclast activation via targeting STC1.

NEDD4 family E3 ligases in osteoporosis: mechanisms and emerging potential therapeutic targets

Osteoporosis is a systemic skeletal disorder characterized by reduced bone density and an increased risk of fractures, particularly prevalent in the aging population. Osteoporotic complications, including vertebral compression fractures, hip fractures, and distal forearm fractures, affect over 8.9 million individuals globally, placing a significant economic strain on healthcare systems. Recent advances have expanded our understanding of the mechanisms underlying osteoporosis, particularly the intricate regulatory networks involved in bone metabolism. A central player in these processes is ubiquitin-mediated proteasomal degradation, a crucial post-translational modification system that involves ubiquitin, the ubiquitin-activating enzyme (E1), ubiquitin-conjugating enzyme (E2), ubiquitin ligase (E3), deubiquitinating enzymes, and the proteasome. Among the various E3 ligases, the NEDD4 family has emerged as a key regulator of both bone development and osteoporotic pathology. This review delineates the role of NEDD4 family in osteoporosis and identifies potential drug targets within these pathways, offering insights into novel therapeutic approaches for osteoporosis through targeted intervention.

Circular RNAs in the management of human osteoporosis

BACKGROUND

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

SOURCES OF DATA

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

AREAS OF AGREEMENT

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

AREAS OF CONTROVERSY

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

GROWING POINTS

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

DATA AVAILABILITY

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

The antiosteoporotic effect of oxymatrine compared to testosterone in orchiectomized rats

BACKGROUND

Castration of adult male rats led to the development of osteoporosis. Oxidative stress and inflammatory factors have been identified as potential causative factors. Notably, oxymatrine (OMT) possesses potent anti-inflammatory and antioxidant activities. This study aims to elucidate the antiosteoporotic effects of OMT compared to testosterone in an orchiectomized (ORX) rat model of osteoporosis.

METHODS

A total of 60 Wistar male rats were divided into the following groups: control (CTRL), surgery + no orchiectomy (SHAM), ORX, ORX + testosterone, and ORX + OMT. Urinary deoxypyridinoline (DPD), calcium (Ca), and phosphorus (P), as well as serum testosterone, parathormone (PTH), alkaline phosphatase (ALP), osteocalcin, N-telopeptide of type I collagen (NTX I), tartrate resistance acid phosphatase (TRAP), and total Ca and P levels were evaluated. Bone was assessed for malondialdehyde (MDA), reduced glutathione (GSH), interleukin 6 (IL-6), Kelch-like ECH-associated protein 1 (Keap1), nuclear factor erythroid 2-related factor 2 (Nrf2), heme oxygenase 1 (HO-1) expression, and receptor activator of nuclear factor κB ligand/ osteoprotegerin (RANKL/OPG) ratio. Bone dual-energy X-ray absorptiometry (DEXA) scan and histological and immunohistochemical studies were performed.

RESULTS

Testosterone or OMT treatment ameliorated the reduced bone mineral density (BMD) and bone mineral content (BMC) in the DEXA scan and the changes in PTH and Ca levels. Compared to the ORX group, bone formation, and turnover markers were also significantly reversed in the treatment groups. Treatment with testosterone or OMT significantly reduced bone MDA, IL-6, Keap1, RANKL, and RANKL/OPG ratio, and significantly elevated bone GSH, Nrf2, and HO-1. Moreover, testosterone or OMT treatment has restored cortical bone thickness and osteocyte number and reduced bone levels of TNF-α in ORX rats. Consequently, treatment with either testosterone or OMT exhibited nearly equal therapeutic efficacy; however, neither of them could normalize the measured parameters.

CONCLUSION

OMT treatment showed equal efficacy compared to testosterone in ameliorating osteoporosis in ORX rats, possibly by improving some inflammatory and oxidative stress parameters.

YBX1 alleviates ferroptosis in osteoporosis via the ATF4/FSP1 axis in an m5C manner

BACKGROUND

Interactions between RNA-binding proteins and RNA regulate RNA transcription during osteoporosis. Ferroptosis, a programmed cell death caused by iron metabolism, plays a vital role in osteoporosis. However, the mechanisms by which RNA-binding proteins are involved in ferroptosis during osteoporosis remain unclear.

METHODS

We established an in vitro model of osteoporosis induced by D-galactose (D-gal) in MC3T3-E1 cells. Ferroptosis suppressor protein 1 (FSP1), activating transcription factor 4 (ATF4), and Y-box binding protein 1 (YBX1) knockdown MC3T3-E1 cells were generated, and their effects on ferroptosis were verified by measuring lipid reactive oxygen species levels and cellular Fe2+. Chromatin immunoprecipitation and luciferase assays were performed to confirm the binding of ATF4 to the FSP1 promoter. RNA pulldown and RNA immunoprecipitation experiments were used to determine the binding between YBX1 and ATF4 mRNA and to test the effect of YBX1 on ATF4 mRNA stability in a 5-methylcytosine (m5C)-dependent manner.

RESULTS

FSP1 or YBX1 knockdown led to a D-gal-induced increase in lipid reactive oxygen species levels and cellular Fe2+ in MC3T3-E1 cells, which was alleviated by ATF4 overexpression. ATF4 inhibits ferroptosis by binding to the FSP1 promoter. In addition, YBX1 increased ATF4 mRNA stability through m5C RNA modification and inhibited ferroptosis in MC3T3-E1 cells via the ATF4/FSP1 axis.

CONCLUSION

Our results showed that YBX1 could alleviate ferroptosis via the ATF4/FSP1 axis in an m5C-dependent manner in D-gal-induced osteoblasts, suggesting that YBX1 may be a new target for osteoporosis treatment.

Soft tissue flap reconstruction in infected or exposed total knee arthroplasty: A systematic review and network meta-analysis

BACKGROUND

Total knee arthroplasty (TKA) infection or exposure associated with soft tissue deficiency represents a challenging scenario for the reconstructive surgeon. The aim of the study is to determine the most successful reconstructive option for infected or exposed TKA comparing local muscle flaps (LMF), local fasciocutaneous flaps (LFF), and free muscle flaps (FMF).

METHODS

A systematic review and single-arm network meta-analysis (PRISMA) was conducted to compare outcomes of complicated TKA requiring soft tissue coverage with either LMF, LFF and FMF. The protocol was registered on PROSPERO (CRD42023388731). PubMed, Embase, Web of Science and Cochrane Library were queried. MINORS criteria were employed for bias assessment. Outcomes included infection recurrence, TKA failure, above-knee amputation, and arthrodesis.

RESULTS

A total of 30 studies and 555 flaps were included. Pooled prevalence was 0.18 (95% CI: 0.11-0.26) for infection recurrence, 0.18 (95% CI: 0.11-0.28) for arthroplasty failure, 0.10 (95% CI: 0.08-0.13) for above-knee amputation and 0.10 (95% CI: 0.08-0.13) for arthrodesis. Local fasciocutaneous flaps demonstrated the lowest risk of infection recurrence (LFF = 0.04 ± 0.037, LMF = 0.27 ± 0.043, FMF = 0.26 ± 0.092), arthroplasty failure (LFF = 0.11 ± 0.068, LMF = 0.28 ± 0.045, FMF = 0.22 ± 0.094) and knee arthrodesis (LFF = 0.03 ± 0.027, LMF = 0.14 ± 0.03, FMF = 0.08 ± 0.06) after flap coverage of infected TKA. Free muscle flaps were associated with the lowest risk of above knee amputation (FMF = 0.08 ± 0.07, LFF = 0.10 ± 0.07, LMF = 0.11 ± 0.03). The mean MINORS score was 11.1 (95% CI: 11-12) with major weakness being the lack of prospective enrollment of the patients.

CONCLUSION

Based on the available literature, when appropriate, LFF appear to be the best reconstructive choice for soft tissue reconstruction in complicated TKA.

The effect of surgical management in mitigating fragility fracture risk among individuals with primary hyperparathyroidism

BACKGROUND

Primary hyperparathyroidism predominately affects women who are postmenopausal and causes complications, including fragility fractures. Its treatment is parathyroidectomy, which is associated with low complication and >95% cure rates. Considering fractures are associated with premature death, we aimed to determine whether the surgical management of individuals with biochemical diagnosis of primary hyperparathyroidism was associated with a reduction in fracture risk.

METHODS

In this population-based cohort study, we used administrative health databases to identify adults ≥18 year old who were biochemically diagnosed with primary hyperparathyroidism between 2007 and 2016 in Ontario. Patients were included if their calcium was ≥2.6 mmol/L (≥10.42 mg/dL) with a concurrent parathyroid hormone of ≥2.2 pmol/L (≥20.75 pg/mL). We followed patients and compared the incidence of fractures between those with and without parathyroidectomy. To control for potential confounding, we used inverse probability of treatment weighting to estimate the average treatment effect in the treated. Fine-Gray competing risk regression models were used to determine the association between surgery and time to fracture.

RESULTS

In a cohort of 28,059 with a biochemical diagnosis of primary hyperparathyroidism, the mean age (standard deviation) was 65 years (14.2 years), and 75% (n = 21,139) were female. Only 12.6% (n = 3,523) underwent parathyroidectomy. Weighted fracture cumulative incidence at 12 years postdiagnosis was 10.17% (n = 182) in surgical patients and 14.04% (n = 2,004) in nonsurgical patients. Parathyroidectomy prevented 1 fracture for every 26 surgeries performed (weighted risk difference, 3.87%, 95% confidence interval, 0.96%-6.62%) and reduced the hazard of fracture by 22% (weighted hazard ratio, 0.78; 95% confidence interval, 0.64-0.95).

CONCLUSION

In a large, publicly funded health system, parathyroidectomy significantly reduced the short- and long-term risk of fragility fractures in patients with primary hyperparathyroidism.

Association between polymorphisms of glucagon-like peptide-1 receptor gene and susceptibility to osteoporosis in Chinese postmenopausal women

BACKGROUND

The influence of the glucagon-like peptide-1 receptor (GLP-1R) on bone metabolism is well-established. However, it has been observed that single nucleotide polymorphisms (SNPs) in the GLP-1R gene can partially affect its function. Therefore, this study aims to investigate the association between SNPs in the GLP-1R gene and postmenopausal osteoporosis (PMOP) within the Chinese Han population.

METHODS

This study employed a cross-sectional case-control design, recruiting a total of 152 participants, including 76 patients with osteoporosis (OP) (case group) and 76 healthy individuals (control group). Seven tag SNPs of GLP-1R were selected from the National Center of Biotechnology Information and Genome Variation Server. The association between GLP-1R polymorphisms and PMOP risk was assessed using different genetic models and haplotypes, while also exploring SNP-SNP and SNP-environment interactions.

RESULTS

Our results showed that minor alleles A at rs3765468, A at rs3765467 and G at rs4714210 showed significant associations with an increased risk of OP. Individuals with rs3765468 AG-AA genotype and rs3765467 AG-AA genotype exhibited a significantly higher risk of PMOP. Moreover, haplotype analysis revealed a significant association of the GACACA haplotype on PMOP risk (P = 0.033). Additionally, a multiplicative interaction was observed between rs3765468 and rs3765467 that was associated with an increased risk of PMOP (Pinteraction = 0.012).

CONCLUSIONS

Specific SNPs in the GLP-1R gene were linked to an increased risk of PMOP. This study improves our understanding of the genetic basis of PMOP in this population and suggests that genetic screening can identify individuals at risk for developing PMOP, enabling early prevention.

Similarities in distribution pattern between acute multiple osteoporotic vertebral compression fractures and vertebral fractures cascades

BACKGROUD

Osteoporotic vertebral compression fractures (OVCF) cascades (OVCFcs) repeatedly cause vertebral compression to involve multiple vertebra. This study aimed to introduce an accelerated form of OVCFcs: acute multiple OVCF (amOVCF).

METHODS

OVCF patients with multiple vertebral augmentations in a spine center between June 2016 and October 2020 were retrospectively studied. Demographics, spine trauma, anatomical distribution, and distribution pattern of OVCF in OVCFcs and amOVCF were summarized and compared.

RESULTS

429 patients with multiple vertebral augmentations in 1164 vertebra were included. There were 210 OVCFcs accumulating 622 OVCF and 219 amOVCF simultaneously involving 542 vertebra. The OVCFcs progressed at 0.48 fractures and 0.56 vertebra per year. Both OVCFcs and amOVCF demonstrated asymmetrical bimodal distribution in spine and most frequently involved L1. The incidence of adjacent OVCF was 40.14% in amOVCF with 2 OVCF and 84.72% in amOVCF with ≥ 3 OVCF, and the distribution pattern of OVCF was not significantly different between amOVCF and OVCFcs. The female/male ratio was 5.56 in OVCFcs and not different from that of 4.34 in amOVCF. The age of females (73.41 ± 8.08 and 76.29 ± 8.25 years old) but not males (77.20 ± 10.13 and 79.75 ± 10.21 years old) was significantly increased from initial to last OVCF in OVCFcs. amOVCF had similar age (72.26 ± 10.09 years old) as OVCFcs at initial OVCF (73.99 ± 8.51 years old) and were significantly younger than OVCFcs at last OVCF (76.82 ± 8.64 years old). 54.29% in OVCFcs and 48.4% in amOVCF reported no evident trauma, and the ratio of apparent spine trauma was higher in amOVCF (43.38%) than in OVCFcs (28.54%).

CONCLUSIONS

amOVCF are accelerated form of OVCFcs showing similar anatomical distribution and distribution pattern of OVCF in spine. Both amOVCF and OVCFcs cause multiple fragility fractures without significant spine trauma.

Asperuloside alleviates osteoporosis by promoting autophagy and regulating Nrf2 activation

BACKGROUND

Osteoporosis is a metabolic bone disease that has a common occurrence in postmenopausal women. Asperuloside (ASP) has been reported to exert anti-inflammatory and anti-oxidative effects in numerous diseases, such as rheumatoid arthritis and acute lung injury. However, whether ASP plays a role in osteoporosis has not been addressed.

METHODS

In vivo, ovariectomy (OVX) was used to induce mouse osteoporosis. Then, the mice were treated with 20 and 40 mg/kg ASP. In vitro, MC3T3-E1 cells were treated with 0, 1, 10, 20, 40 and 80 µM ASP. We chose 20 and 40 µM for further experiments due to no significant effects on cell viability.

RESULTS

The data indicated that ASP reduced osteoporosis in OVX mice and promoted osteogenic differentiation and mineralization in MC3T3-E1 cells. In addition, we explored that ASP protected against osteoporosis via inducing autophagy and activating Nrf2.

CONCLUSION

ASP alleviates OVX-induced osteoporosis by promoting autophagy and regulating Nrf2 activation.

A Retrospective Audit of Osteoporosis Management Following Fragility Fractures in a Hospital Setting

Background Fragility fractures, often caused by osteoporosis, are a major public health concern among the growing population of the United Kingdom (UK). In addition to being a major source of illness and mortality, the rising incidence of osteoporosis places a heavy strain on healthcare systems if it is not adequately managed. In order to lower the risk of additional fractures, current guidelines place a strong emphasis on the timely evaluation and treatment of fragility fractures. Methods This retrospective audit was carried out in Warrington Hospital, UK, to examine the management of fragility fractures in patients aged 65 years and above across two cycles (January to March 2022 and April to May 2023, respectively). All data was obtained from electronic medical records, and management was assessed, including treatment with bisphosphonates, vitamin D, dual-energy X-ray absorptiometry (DEXA) scans and further referrals for metabolic bone clinics. Results The first cycle included 144 inpatients and showed significant under-utilization with only 16% receiving bisphosphonates treatment (23 inpatient prescriptions), low referrals for DEXA scan and metabolic bone clinics. Assessment and supplementation of vitamin D was also suboptimal. The second cycle of the audit reviewed 165 patients and showed minor improvement in bisphosphonates prescription, although post-discharge rates were low with around 80% of patients (104 of 131, as 34 patients were prescribed while inpatient) not receiving medications. The DEXA scans and metabolic bone clinic referrals also remained inadequate in the second cycle. Conclusions This audit highlighted the significant gap in the management of fragility fractures and persistent deficiencies in spite of robust guidelines and interventions set by various bodies. The implementation of treatment guidelines for osteoporotic patients at hospital level can help in timely initiation of antiresorptive therapy, DEXA scans and utilisation of metabolic bone clinics to optimise outcomes and reduce the burden on healthcare systems. There is a need for further research and education to improve this adherence to set guidelines and improve outcomes.

Orthoplastics Management of Open Lower Limb Fractures at a Major Trauma Centre: Audit of Adherence to BOAST4 Guidelines

Introduction

The British Orthopaedic Association Standards for Trauma and Orthopaedics (BOAST) guide the optimal management of open lower limb fractures. Adherence of the newly established Orthoplastic service at the Major Trauma Centre covering the Southeast of England was audited in relation to these standards.

Materials and methods

Audit standards were produced. Data were collected using hospital records and the Trauma Audit and Research Network database. All open lower limb fractures managed between August 2020-August 2022 were included. Data collected included patient and injury demographics, and information related to initial and definitive management.

Results

Overall, 133 patients were identified, 70 men and 63 women, with an average age of 58 years. Women had a higher average age (69 years) and ASA grade (71% ASA 3 or higher). Low-energy injuries occurred in 69% of women compared to 78% of high-energy injuries in men (p<0.001). Among them, 108 (81%) were debrided within 24 h. The average time to first debridement was 18.78 h, and 95 (75%) were definitively closed within 72 h, 76 with primary closure, 7 with split-thickness skin graft, 7 with local flap and 36 with free flap. Overall, the post-operative infection rate was 13% with 94% of these fractures definitively closed within 72 h.

Conclusion

Most open lower limb fractures occurred in older women with higher ASA grade, from low-energy mechanisms. Most injuries were definitively managed as per the BOAST guidelines, but further efforts are required to improve the adherence to initial debridement targets, including training, appropriate resource allocation and implementation of procedures and proformas to guide injury management and improve documentation.

Vertebroplasty for painful osteoporotic vertebral compression fractures: a protocol for a single-center doubled-blind randomized sham-controlled clinical trial. VOPE2

BACKGROUND

One in three women and one in five men over the age of 50 will experience an osteoporotic fracture. Vertebral fractures can be very painful, affect patients' daily function, and in severe cases require hospitalization. Traditionally, fracture pain is treated conservatively with analgesics, and bracing. Vertebral augmentation, also known as vertebroplasty, has been used during the last three decades as a minimally invasive treatment option for vertebral compression fractures, but the evidence base for its efficacy is weak. We describe a double-blind randomized sham-controlled clinical trial to assess the impact of vertebroplasty on self-reported clinical outcomes in patients with painful osteoporotic vertebral compression fractures and vertebral oedema.

METHODS

Two hundred and forty patients with painful osteoporotic vertebral fractures and MRI verified oedema will be randomized in a prospective, double-blind, single-center, clinical trial to either vertebroplasty or a sham procedure, with the possibility of crossover 12 weeks after randomization and operation. The primary outcome will be difference in self-reported pain 12 weeks after treatment between the vertebroplasty and sham group. Secondary outcomes will be patient-reported disability, health-related quality of life, societal costs of treatment and complications. Analysis will be based on intention-to-treat. Repeated measures ANCOVA with baseline ODI, Numerical Pain Rating Scale, EQ-5D-5 L, and number of levels involved as co-variates will be performed.

DISCUSSION

With an aging population, the prevalence of osteoporosis and related complications such as vertebral compression fractures is expected to increase. Therefore, there is a growing need for evidence-based fracture treatments. This study fills a gap in the evidence base for treatment of painful osteoporotic vertebral fractures and will likely influence future treatment guidelines.

TRIAL REGISTRATION

The study has been evaluated and approved by the Regional Committees on Health Research for Southern Denmark October 9 2023 (Projekt-ID S-20230058) and the Danish Data Protection Agency 23/40,938. The protocol has been registered at ClinicalTrials.gov with trial registration number NCT06141187 November 21, 2023.

Developing predictive models for residual back pain after percutaneous vertebral augmentation treatment for osteoporotic thoracolumbar compression fractures based on machine learning technique

BACKGROUND

Machine learning (ML) has been widely applied to predict the outcomes of numerous diseases. The current study aimed to develop a prognostic prediction model using machine learning algorithms and identify risk factors associated with residual back pain in patients with osteoporotic vertebrae compression fracture (OVCF) following percutaneous vertebroplasty (PVP).

METHODS

A total of 863 OVCF patients who underwent PVP surgery were enrolled and analyzed. One month following surgery, a Visual Analog Scale (VAS) score of ≥ 4 was deemed to signify residual low back pain following the operation and patients were grouped into a residual pain group and pain-free group. The optimal feature set for both machine learning and statistical models was adjusted based on a 2000-resample bootstrap-based internal validation via an exhaustive search. The area under the curve (AUC), classification accuracy, sensitivity, and specificity of each model were then calculated to evaluate the predictive performance of each model.

RESULTS

In our current study, two main findings were observed: (1) Compared with statistical models, ML models exhibited superior predictive performance, with SVM demonstrating the highest prediction accuracy; (2) several variables were identified as the most predictive factors by both the machine learning and statistical models, including bone cement volume, number of fractured vertebrae, facet joint violation, paraspinal muscle degeneration, and intravertebral vacuum cleft.

CONCLUSION

Overall, the study demonstrated that machine learning classifiers such as SVM can effectively predict residual back pain for patients with OVCF following PVP while identifying associated predictors in a multivariate manner.

Simple clinical predictors for making directive decisions in osteoporosis screening for women: a cross-sectional study

BACKGROUND

Osteoporosis screening strategies vary according to a country's policies. Simple and highly accurate diagnostic predictors should be developed and utilized. This cross-sectional study aimed to determine the diagnostic performances of weight, body mass index (BMI), and age for osteoporosis. Moreover, this study proposes and validates new cutoff values for these indicators.

METHODS

Women aged 50 years or older who underwent Dual-energy x-ray absorptiometry (DXA) and did not receive any treatment for osteoporosis were enrolled. Age, weight, and BMI were used to analyze the diagnostic models. New cutoff values were proposed using the maximum Youden index value.

RESULTS

A total of 1598 women were classified into normal bone mineral density, osteopenia, and osteoporosis groups. The mean age, weight, and BMI were 73.2 years, 53.6 kg, and 23.2 kg/m2, respectively, in the osteoporosis group, which significantly differed from those of the other groups. The new cutoff values for diagnosing osteoporosis at any site were 57.4 kg for weight, 23.8 kg/m2 for BMI, and 72 years for age. The area under the receiver operating characteristic curve (AUC) for weight < 57.4 kg, BMI < 23.8 kg/m2, and age ≥ 72 years cutoff values were 0.664, 0.633, and 0.558, respectively. The weight cutoff value yielded a significantly higher AUC than the BMI and age cutoff values (P = 0.002 and P < 0.001, respectively).

CONCLUSIONS

This study proposes new cutoff values for simple clinical predictors to facilitate directive decision-making in osteoporosis screening in women. Weight, which are easily obtained in clinical practice, are the most effective predictors of osteoporosis screening.

Combining OSTA and BMR to predict osteoporosis in Chinese population

INTRODUCTION

Osteoporosis is a debilitating bone disease that significantly contributes to disability and a loss of autonomy among older adults. This study aimed to characterize osteoporosis and explore the feasibility of combining OSTA and BMR for osteoporosis prediction.

METHODS

A cross-sectional study involving 1435 participants (1300 women and 135 men) was conducted. Spearman's correlation, simple linear regression analyses, and multiple linear regression models were utilized to investigate the association between OSTA, BMR, and bone mineral density (BMD). Furthermore, the efficacy of integrating OSTA with BMR for osteoporosis screening and prediction was assessed through receiver operating characteristic (ROC) curves.

RESULTS

In the total population, the sensitivity of combination variable W was 58.63%, and the specificity was 70.90%. When OSTA and BMR were employed separately to diagnose osteoporosis, the sensitivity was 47.70% and 55.34%, respectively, while the specificity was 63.80% and 69.80%, respectively.

CONCLUSIONS

The combined utilization of OSTA and BMR formula represents an effective screening method for osteoporosis.

Validity and reliability of the osteoporotic fracture treatment score (OF score) and outcomes across various treatments in osteoporosis vertebral compression fracture patients

BACKGROUND

Osteoporotic vertebral compression fractures (OVF) are prevalent and substantially impact healthcare systems and patients' quality of life. The osteoporotic fracture treatment score (OF score), developed by the German Society of Orthopedics and Trauma (DGOU), guides surgical decisions, but its reliability and validity are underexplored. This study assessed the OF score's inter- and intraobserver reliability, validated its treatment recommendations, and investigated intermediate outcomes of different DGOU-recommended surgical strategies for OVF.

METHODS

A retrospective cohort study was conducted. Inter- and intraobserver reliability of the OF score and its subcomponents were analyzed using clinical and radiographic data. Validity was assessed by comparing the OF score's recommended treatments with actual treatments received. Outcomes at the final follow-up were back pain visual analog scale, Oswestry Disability Index, EQ-VAS, EQ-5D-5 L, adjacent fracture incidence, local kyphotic angle, and reoperation rates. Patients with at least 1-year follow-up were included.

RESULTS

A total of 157 patients (84.7% female; mean age 74.2 ± 10.5 years) were evaluated. The most frequent osteoporotic fracture (OF) types were OF4 (49.0%) and OF3 (40.8%). The OF score demonstrated good interobserver reliability (ICC = 0.77, 95% CI: 0.65-0.86) and intraobserver reliability (ICC = 0.83, 95% CI: 0.72-0.90). Kappa values for subcomponents ranged from 0.57 to 0.89. Excluding patients with indeterminate recommendations (OF score = 6), 82.9% received treatments concordant with OF score recommendations. Receiver operating characteristic curve analysis showed an area under the curve of 0.77 (95% CI: 0.67-0.86); an OF score cutoff > 6.5 predicted actual treatment with 87.9% sensitivity and 61.0% specificity. All surgical treatments showed comparable improvements in clinical outcomes. However, patients treated with stand-alone cement augmentation (CA) had less local kyphotic angle correction (P = 0.004) and greater postoperative kyphotic progression (P < 0.001) than those undergoing short-segment (SS-PI) or long-segment instrumentation (LS-PI). No significant differences in adjacent fractures or complications were observed.

CONCLUSIONS

The OF score is a reliable and valid system with good discriminative ability for surgical decision-making in OVF patients. CA, SS-PI, and LS-PI are viable options with comparable functional outcomes. However, in OF3 or OF4 fractures, caution is advised due to lesser kyphosis correction and greater kyphotic progression with CA compared to SS-PI or LS-PI, as recommended by the DGOU.

Reference intervals of adjacent disc height in fresh osteoporotic vertebral compression fractures and the association with postoperative adjacent segment complications: a quantitative study in Chinese postmenopausal women

BACKGROUND

Preoperative adjacent disc height (DH) was found as an independent risk factor for adjacent segment degeneration (ASD) after percutaneous kyphoplasty (PKP), indicating the preoperative status of the adjacent intervertebral discs may be closely related to adjacent segment complications. To establish the reference intervals (RIs) for adjacent DH of fresh osteoporotic vertebral compression fracture (OVCF) in Chinese postmenopausal women, and investigate the association with adjacent segment complications after PKP.

METHODS

Consecutive inpatients diagnosed with fresh OVCF between November 2015 and August 2023 were reviewed. The enrolled patients were divided into subgroups based on injured vertebral level; then, the cranial and caudal DH were measured. The characteristics of DH among subgroups were identified, and specific RIs were established using the indirect Hoffmann method. The associations between DH and adjacent segment complications were assessed using multivariate analysis.

RESULTS

The DH of the cranial disc was significantly lower than the corresponding caudal disc in all vertebral levels, which showed an increasing trend from T11 to L4. The RIs of DH were as follows: T11 (cranial), 2.14-5.14 mm; T11 (caudal), 2.64-5.89 mm; T12 (cranial), 2.69-5.77 mm; T12 (caudal), 3.18-6.57 mm; L1 (cranial), 3.05-6.59 mm; L1 (caudal), 3.40-8.29 mm; L2 (cranial), 3.68-8.36 mm; L2 (caudal), 4.57-9.78 mm; L3 (cranial), 4.53-8.92 mm; L3 (caudal), 5.26-10.07 mm; L4 (cranial), 4.70-11.42 mm; and L4 (caudal), 5.52-12.12 mm. Increased risks of adjacent segment complications after PKP were observed in patients with decreased adjacent DH.

CONCLUSION

The estimated vertebral level and disc level-specific RIs for adjacent DH of fresh OVCF were established in the Chinese postmenopausal women population. A decrease in adjacent DH posed high risks of adjacent segment complications after PKP for treating OVCF.

Suboptimal osteoporosis care in hospitalized patients: a retrospective analysis of vertebral compression fractures detected on computed tomography

Vertebral compression fractures (VCFs) are the most common osteoporotic fractures. Only 1/3 of patients with VCFs are clinically diagnosed. In our institution, the Fracture Liaison Service (FLS) was launched in 2017 to improve osteoporosis management for hospitalized patients. (1) To assess osteoporosis awareness among medical providers for emergency department (ED)/hospitalized patients aged 50 or greater; (2) To estimate the rate of FLS consults or referrals to primary care providers (FLS/PCP) by primary teams. A centralized radiology system was used to examine all thoracic and lumbar computed tomography (CT) scans conducted between June 1, 2017 and June 1, 2022. 449 studies were identified with the radiologic impression "compression fracture". 182 studies were excluded after manual chart review. 267 hospitalizations/ED visits with lumbar and/or thoracic spine CT scans were included. Referrals to FLS (26) or PCP (27) were made in 53 cases (~ 20% of the total). In the ED subgroup (131 hospitalizations), only 17 patients had FLS/PCP referrals. The "compression fracture" was mentioned in 227 (85%) discharge notes (any part), while "osteoporosis" was mentioned in only 74 (28%) hospitalizations. A statistically significant difference was found between the two groups when "osteoporosis" was mentioned in the "assessment and plan" section (p = 0.02). Our data show that the overall osteoporosis care for affected patients is suboptimal. Medical providers often overlook the presence of osteoporosis, leading to a lack of consultation with the FLS of referral to PCPs for further evaluation and treatment.

Role of mir-32-3p in the diagnosis and risk assessment of osteoporotic fractures

BACKGROUND

Osteoporotic fractures (OPF) are fractures that occur with low-energy injuries or during daily activities, representing a serious consequence of osteoporosis (OP). With the worsening of population aging, the number of OPF patients continues to expand, causing a significant burden on families and society. Consequently, it is significant to diagnose and analyze OPF at the molecular level.

OBJECTIVE

The aim of this research was to explore the diagnostic value of miR-32-3p in OPF patients and to exploit new biomarkers for clinical applications.

METHODS

The miR-32-3p expression level of patients was detected by RT-qPCR. Diagnostic accuracy of miR-32-3p analyzed adopting ROC curve. Additionally, the risk factors correlation with the occurrence of OPF were assessed by logistic analysis. The effect of miR-32-3p on BMSCs was verified by in vitro transfection experiments.

RESULTS

miR-32-3p expression was lower in OPF patients than in OP patients. ROC curve implied that miR-32-3p exhibits commendable sensitivity (88.9%) and specificity (75.6%) to differentiate between OP and OPF patients (AUC = 0.905, P < 0.001). Furthermore, miR-32-3p was correlated with the development of OPF and was a risk factor for OPF (P < 0.001). Functional assays revealed that transfection with miR-32-3p mimic could promote proliferation and inhibit apoptosis, whereas transfection with miR-32-3p inhibitor had the opposite effect.

CONCLUSION

miR-32-3p demonstrates significant diagnostic potential for OPF patients. It is likely that miR-32-3p probably is a new diagnosis biomarker for OPF, offering promising therapeutic avenues through targeted interventions.

Advancements in the Management of Fragility Fractures in Orthopaedic Patients

Osteoporosis is a major risk factor for fragility fractures. The British Orthopaedics Association Standards for Trauma and Orthopaedics (BOAST) and Getting it Right First Time (GIRFT) guidelines on fragility fracture management highlight the need to initiate prompt, coordinated multidisciplinary care with a focus on early mobilisation to improve patient outcomes. Medical management of fragility fractures focuses on the prevention of progressive frailty. Advancements in medical therapy include romosozumab, recommended by the National Institute for Health and Care Excellence guidance in patients with imminent fracture risk, which improves overall bone mineral density. Regional nerve blocks are an increasingly common form of perioperative anaesthesia with fewer side effects than opioids and rates of postoperative delirium. Surgical management of osteoporotic fractures poses unique challenges, such as complex fracture patterns and increased risk of implant failure. The surgical approach to fragility fractures has undergone major advancements over the past 20 years, with developments such as polyaxial locking and far cortical locking systems that achieve secondary bone healing, as well as cement augmented screw fixation to provide stable fixation in osteoporotic bone. The development of minimally invasive surgical approaches has led to improved periosteal blood flow around a fracture site, as well as reduced operating time, hospital stay, and time to pain-free weight-bearing. In the future, we are likely to see a focus on minimally invasive surgical techniques for vertebral and pelvic fragility fractures to improve patients' mobility and independence before discharge, subsequently improving quality of life and preventing progressive frailty.

Oral dehydroepiandrosterone supplementation enhances osteoporotic fracture healing in the OVX rats

Osteoporosis easily causes delayed fracture union, even non-union. It has been demonstrated that dehydroepiandrosterone (DHEA) supplementation can increase estrogen levels and improve bone mineral density (BMD) in the elderly, while the role of DHEA on fracture healing remains unknown. This study aimed to elucidate the impact of DHEA supplementation on osteoporotic fracture healing. Seventy-two female Sprague-Dawley rats were used. Forty-eight rats received ovariectomy (OVX), and the remaining rats received a sham OVX operation (sham group). A right transverse femoral osteotomy was performed in all rats at 12 weeks post-OVX. OVX rats were randomly allocated into 2 groups (n = 24 in each group): (i) ovariectomized rats (control group) and (ii) ovariectomized rats treated with DHEA (DHEA group, 5 mg/kg/day). The DHEA supplementation was initiated on the first day post-fracture for 3, 6, and 12 weeks. Fracture healing was evaluated by radiography, histology, biomechanical analysis, and dual-energy X-ray absorptiometry (DEXA). Serum biomarkers were analyzed using enzyme-linked immunosorbent assay (ELISA). At 3 and 6 weeks, radiographs revealed reduced calluses formation and lower radiographic scores in the control group than in other groups. The sham and DHEA groups showed higher BMD and bone mineral content (BMC) at the fracture site than the control group after fracture. Histological analysis revealed the fracture callus was remodeled better in the sham and DHEA groups than in the control group. At the early phase of healing, DHEA supplementation increased osteoblast number, callus area, and cartilage area than the control group. An increased bone area was observed in the DHEA group than in the control group at the late phase of healing. Additionally, improved biomechanical characteristics were observed in both the sham and DHEA groups than those in the control group post-fracture. ELISA showed higher levels of insulin-like growth factor-1 (IGF-1) and 17β-estradiol (E2) in the DHEA group than in the control group post-fracture. Furthermore, the DHEA group exhibited significantly elevated alkaline phosphatase (ALP) and osteocalcin (OC) levels compared to the control group at 6 and 12 weeks. The DHEA group and the control group did not exhibit a notable difference in TRAP-5b levels. The present study demonstrated that the DHEA treatment has a favorable impact on osteoporotic fracture healing by enhancing callus formation, consolidation, and strength in the OVX rats.

The association of weight-adjusted waist index with the risk of osteoporosis in patients with type 2 diabetes: a cross-sectional study

BACKGROUND

The relationship between obesity and type 2 diabetes with bone health has always been a topic of debate. The weight-adjusted waist index has become a commonly used indicator for assessing central obesity, fat, and muscle mass. However, currently there is no research reporting the association between weight-adjusted waist index and risk of osteoporosis in populations of type 2 diabetes. Therefore, this study aims to provide new information on the association between weight-adjusted waist index and risk of osteoporosis in type 2 diabetes.

METHODS

This cross-sectional study involved 963 patients with type 2 diabetes who were admitted to the Department of Endocrinology of Cangzhou Central Hospital. Multivariate logistic regression models were used to assess the association between weight-adjusted waist index and osteoporosis. The potential nonlinear association was evaluated. The effects of interaction between subgroups were assessed using the likelihood ratio test.

RESULTS

Weight-adjusted waist index was positively associated with the risk of osteoporosis, regardless of traditional confounding factors. For each 1 unit increased in weight-adjusted waist index, the risk of osteoporosis increased by 67%. Furthermore, there was a nonlinear relationship between weight-adjusted waist index and osteoporosis. The subgroup analysis did not reveal any significant interactions.

CONCLUSIONS

Our study indicated a positive association between weight-adjusted waist index and the risk of osteoporosis in adult Chinese type 2 diabetes patients, and this relationship was nonlinear.

MiR-331-3p facilitates osteoporosis and may promote osteoporotic fractures by modulating NRP2 expression

BACKGROUND

Osteoporosis (OP) is a high-incidence bone disease that is prone to osteoporotic fractures (OF), so it has attracted widespread attention.

AIM

This study investigated the specific expression and role of miR-331 in patients with OP and OF. The findings have profound implications for the clinical prevention and treatment of these conditions.

METHODS

The study included 60 OP patients, 46 OF patients, and 40 healthy controls. The expression level of miR-331-3p was detected using RT-qPCR. BMP2 was used to stimulate differentiation in MC3T3-E1 cells. After induction, the expression activity of osteogenic differentiation-related gene markers was detected using RT-qPCR. The target gene analysis was conducted using a luciferase reporter assay.

RESULTS

The levels of miR-331-3p were significantly elevated, while NRP2 levels were significantly reduced in OF patients. Post-surgery, miR-331-3p levels decreased over time. MiR-331-3p was found to negatively regulate the luciferase activity of NPR2 in MC3T3-E1 cells. Furthermore, overexpression of miR-331-3p inhibited cell proliferation and decreased the levels of osteoblast differentiation markers.

CONCLUSION

The up-regulation of miR-331-3p can promote OP and might also encourage the occurrence of OF by regulating NRP2. However, this needs further verification.

Health-economic evaluation of orthogeriatric co-management for patients with pelvic or vertebral fragility fractures

BACKGROUND

Orthogeriatric co-management (OGCM) addresses the special needs of geriatric fracture patients. Most of the research on OGCM focused on hip fractures while results concerning other severe fractures are rare. We conducted a health-economic evaluation of OGCM for pelvic and vertebral fractures.

METHODS

In this retrospective cohort study, we used German health and long-term care insurance claims data and included cases of geriatric patients aged 80 years or older treated in an OGCM (OGCM group) or a non-OGCM hospital (non-OGCM group) due to pelvic or vertebral fractures in 2014-2018. We analyzed life years gained, fracture-free life years gained, healthcare costs, and cost-effectiveness within 1 year. We applied entropy balancing, weighted gamma and two-part models. We calculated incremental cost-effectiveness ratios and cost-effectiveness acceptability curves.

RESULTS

We included 21,036 cases with pelvic (71.2% in the OGCM, 28.8% in the non-OGCM group) and 33,827 with vertebral fractures (72.8% OGCM, 27.2% non-OGCM group). 4.5-5.9% of the pelvic and 31.8-33.8% of the vertebral fracture cases were treated surgically. Total healthcare costs were significantly higher after treatment in OGCM compared to non-OGCM hospitals for both fracture cohorts. For both fracture cohorts, a 95% probability of cost-effectiveness was not exceeded for a willingness-to-pay of up to €150,000 per life year or €150,000 per fracture-free life year gained.

CONCLUSION

We did not obtain distinct benefits of treatment in an OGCM hospital. Assigning cases to OGCM or non-OGCM group on hospital level might have underestimated the effect of OGCM as not all patients in the OGCM group have received OGCM.

The association of combined vitamin C and D deficiency with bone mineral density and vertebral fracture

PURPOSE

Both vitamin C and D deficiencies are extremely common in clinical practice, especially in elderly population. Unfortunately, the role of vitamin C deficiency in osteoporosis related consequences is often neglected. The aim of the present study is to analyse if combined vitamin C and D deficiency would have an association with bone mineral density (BMD) and osteoporotic vertebral fracture (OVF).

METHODS

Ninety-nine post-menopausal female patients admitted in the department of spine surgery of third affiliated hospital of Sun Yat-sen University were enrolled in the study. The participants were divided into four groups; vitamin D deficiency alone (comparator group), vitamin C deficiency alone and combined vitamin C and D deficiency as experimental group. The levels of vitamin C, vitamin D, calcium, phosphorous, BMD and condition of OVF were analysed.

RESULTS

There were statistically significant differences between the groups in terms of vitamin C and D levels. In terms of lumbar BMD, significant differences were observed between vitamin D deficiency alone and combined vitamin C and D deficiency. Only the combined vitamin C and D deficiency had a significant negative association with lumbar BMD and T-score. Similarly, combined vitamin C and D deficiency had a significant positive association with lumbar osteoporosis. None of the groups had any significant association with OVF. Combined vitamin C and D deficiency was found to be significantly associated with lower lumbar BMD and osteoporosis.

CONCLUSION

Combined vitamin C and D deficiency results in lower bone mineral density and higher risk of osteoporosis. We believe that existence of deficiencies of both vitamins could have a synergistic effect. Therefore, we recommend that vitamin C and D should be routinely measured in clinical practice.

Associations of dietary inflammatory index scores and serum inflammatory factors with the risk of osteoporosis: a cross-sectional study from Xinjiang, China

BACKGROUND

Previous studies have shown that the inflammatory potential of the diet is associated with a variety of chronic noncommunicable diseases characterized by a chronic low-grade inflammatory response. However, the relationships between dietary inflammatory potential and organismal inflammatory status and osteoporosis have been less studied. This study aimed to investigate the relationships among inflammatory diet, inflammatory state and osteoporosis in the Xinjiang multiethnic population.

METHODS

The participants consisted of 4452 adults aged 35 to 74 years from Xinjiang, China. The dietary inflammatory index (DII) was calculated using dietary data collected with a semiquantitative food frequency questionnaire, and information about osteoporosis was derived from quantitative ultrasound measurements. The relationships of the DII score and inflammatory factors with the risk of osteoporosis were analysed using multivariate logistic regression, and the nonlinear associations between DII and osteoporosis were further analysed using restricted cubic splines.

RESULTS

The results showed that proinflammatory diets were associated with a greater risk of osteoporosis (T3 vs. T1: OR = 1.87; 95% CI = 1.44, 2.45) and that there was no nonlinear relationship between the DII and the risk of osteoporosis. Increased concentrations of the inflammatory factors IL-6, IL-10, IL-12p70, IL-17, and IL-23 were associated with a greater risk of osteoporosis.

CONCLUSIONS

The risk of osteoporosis can be reduced by increasing the consumption of an appropriate anti-inflammatory diet.

Health-economic evaluation of orthogeriatric co-management for patients with forearm or humerus fractures: an analysis of insurance claims data from Germany

Orthogeriatric co-management (OGCM) describes a collaboration of orthopedic surgeons and geriatricians for the treatment of fragility fractures in geriatric patients. While its cost-effectiveness for hip fractures has been widely investigated, research focusing on fractures of the upper extremities is lacking. Thus, we conducted a health economic evaluation of treatment in OGCM hospitals for forearm and humerus fractures.In a retrospective cohort study with nationwide health insurance claims data, we selected the first inpatient stay due to a forearm or humerus fracture in 2014-2018 either treated in hospitals that were able to offer OGCM (OGCM group) or not (non-OGCM group) and applied a 1-year follow-up. We included 31,557 cases with forearm (63.1% OGCM group) and 39,093 cases with humerus fractures (63.9% OGCM group) and balanced relevant covariates using entropy balancing. We investigated costs in different health sectors, length of stay, and cost-effectiveness regarding total cost per life year or fracture-free life year gained.In both fracture cohorts, initial hospital stay, inpatient stay, and total costs were higher in OGCM than in non-OGCM hospitals. For neither cohort nor effectiveness outcome, the probability that treatment in OGCM hospitals was cost-effective exceeded 95% for a willingness-to-pay of up to €150,000.We did not find distinct benefits of treatment in OGCM hospitals. Assigning cases to study groups on hospital-level and using life years and fracture-free life years, which might not adequately reflect the manifold ways these fractures affect the patients' health, as effectiveness outcomes, might have underestimated the effectiveness of treatment in OGCM hospitals.

Effectiveness of desertliving cistanche in managing hyperlipidemic osteoporosis in ovariectomized rats through the PI3K/AKT signaling pathway

BACKGROUND

To aim of this study is to assess the mechanism through which Desertliving Cistanche modulates the PI3K/AKT signaling pathway in the treatment of hyperlipidemic osteoporosis in ovariectomized rats.

METHODS

We randomly assigned specific-pathogen-free (SPF) rats into five groups (n = 10 per group). The normal control group received a standard diet, while the model group, atorvastatin group, diethylstilbestrol group, and treatment group were fed a high-fat diet. Four weeks later, bilateral ovariectomies were conducted, followed by drug interventions. After six weeks of treatment, relevant indicators were compared and analyzed.

RESULTS

Compared to the normal control group, rats in the model group exhibited blurred trabecular morphology, disorganized osteocytes, significantly elevated levels of bone-specific alkaline phosphatase (BALP), bone Gla-protein (BGP), total cholesterol (TC), tumor necrosis factor-α (TNF-α), and receptor activator of NF-κB ligand (RANKL). Also, the model group revealed significantly reduced levels of ultimate load, fracture load, estradiol (E2), bone mineral density (BMD), osteoprotegerin (OPG), and phosphoinositide 3-kinase (PI3K) and protein kinase B (Akt) in femoral tissue. The atorvastatin group presented with higher TC and TNF-α levels compared to the normal control group. Conversely, the treatment group demonstrated enhanced trabecular morphology, denser structure, smaller bone marrow cavities, and reduced BALP, BGP, TC, TNF-α, and RANKL levels. Furthermore, the treatment group exhibited higher levels of E2, BMD, OPG, and PI3K and Akt in bone tissue compared to the model group. The treatment group also had lower TC and TNF-α levels than the atorvastatin group. Biomechanical analysis indicated that after administration of Desertliving Cistanche, the treatment group had reduced body mass, increased ultimate and fracture load of the femur, denser bone structure, smaller bone marrow cavities, and altered periosteal arrangement compared to the model group.

CONCLUSION

Our study revealed that Desertliving Cistanche demonstrated significant efficacy in preventing and treating postmenopausal hyperlipidemic osteoporosis in rats.

Prevalence of osteoporosis and associated factors among people aged 50 years and older in the Madhesh province of Nepal: a community-based cross-sectional study

BACKGROUND

The high prevalence of osteoporosis has increased the economic burden on the health system globally. The burden of osteoporosis and its associated factors have not been adequately assessed in community settings in the Nepalese context thus far. Therefore, this study aimed to assess the prevalence of osteoporosis and its associated factors, lifestyle behaviors, and dietary calcium intake.

METHODS

A community-based cross-sectional study was conducted among 395 people aged 50 years and older in the Madhesh Province of Nepal between July 2022 and August 2023. The Osteoporosis Self-assessment Tools for Asians (OSTA) index was used to measure osteoporosis. A structured questionnaire was used to collect sociodemographic information, anthropometric data, lifestyle behavior, daily dietary calcium intake, and frequency of calcium-rich food consumption. A food frequency questionnaire and 24-hour recall methods were used to assess dietary intake. The chi-square test, binary logistic regression and Mann‒Whitney U test were applied to measure the association between predictors and the outcome of interest.

RESULTS

The prevalence of no risk, moderate risk and high risk of osteoporosis were 38.7%, 39%, and 22.3% respectively. The risk of osteoporosis was higher in females (aOR = 5.18, CI: 2.10-12.75, p < 0.001) and increased risk with advancing age (aOR = 32.49, CI: 14.02-75.28, p < 0.001). Similarly, underweight was associated with increased odds of having osteoporosis (aOR = 13.42, CI = 4.58-39.30, p < 0.001). The incidence of osteoporosis was strongly associated with daily calcium intake of 225 mg (100, 386).

CONCLUSION

This study revealed a high prevalence of osteoporosis among people aged 50 years and older due to the combined effect of being underweight and having inadequate calcium intake. Nutritional counselling services encourage people to consume sufficient calcium-rich food and adopt an appropriate lifestyle behaviours to maintain healthy body weight so that osteoporosis and osteoporotic fractures could be prevented. Further research can explore the impact of socioeconomic status and medical comorbidities on a large scale.

PMAIP1 regulates autophagy in osteoblasts via the AMPK/mTOR pathway in osteoporosis

Osteoporosis (OP) is a highly prevalent disorder characterized by low bone mass that severely reduces patient quality of life. Although numerous treatments for OP have been introduced in clinic, many have side effects and high costs. Therefore, there is still an unmet need for optimal solutions. Here, raw signal analysis was used to identify potential high-risk factors for OP, and the biological functions and possible mechanisms of action (MOAs) of these factors were explored via gene set enrichment analysis (GSEA). Subsequently, molecular biological experiments were performed to verify and analyze the discovered risk factors in vitro and in vivo. PMAIP1 was identified as a potential risk factor for OP and significantly suppressed autophagy in osteoblasts via the AMPK/mTOR pathway, thereby inhibiting the proliferation and differentiation of osteoblasts. Furthermore, we constructed an ovariectomy (OVX) model of OP in rats and simultaneously applied si-PMAIP1 for in vivo interference. si-PMAIP1 upregulated the expression of LC3B and p-AMPK and downregulated the expression of p-mTOR, and these effects were reversed by the autophagy inhibitor. Micro-CT revealed that, si-PMAIP1 significantly inhibited the development of osteoporosis in OVX model rats, and this therapeutic effect was attenuated by treatment with an autophagy inhibitor. This study explored the role and mechanism of PMAIP1 in OP and demonstrated that PMAIP1 may serve as a novel target for OP treatment.

Groin pain aggravated in short term contracted by COVID-19 in THA patients: a case-crossover study

BACKGROUND

The coronavirus disease 2019 (COVID-19) rapidly spreads worldwide and causes more suffering. The relation about the aggravation of inguinal pain and COVID-19 was unclear in patients with total hip arthroplasty (THA). This study aimed to evaluate the risk of groin pain aggravation in short-term THA patients after COVID-19.

METHODS

Between 2020 and 2022, 129 patients with THA who were affected COVID-19 were enrolled. A short-standardized questionnaire was administered during follow-up to inquire about the aggravation of groin ache before and after SARS-COV-2 affection. Furthermore, we evaluated the potential association between the presence of increased pain and various factors, including age, gender, body mass index, diagnosis, and length of hospital stay.

RESULTS

The case-crossover study revealed an increased risk of inguinal soreness aggravation when comparing 8 weeks after COVID-19 with 12 weeks before COVID-19 (Relative risk [RR], 9.5; 95% Confidence intervals [CI], 2.259-39.954). For COVID-19 positive patients, multivariate analysis showed length of stay was an independent factor significantly associated with increased risk of aggravation of groin pain (Odds ratio [OR], 1.26; 95%CI, 1.03-1.55, p = 0.027).

CONCLUSION

This study confirms the association between COVID-19 and the exacerbation of soreness in the groin region in THA patients and extended length of stay is a possible contributing factor. This study expands the current literature by investigating the risk of aggravation of inguinal pain in patients with THA after COVID-19, providing valuable insights into postoperative outcomes in this specific population. Trial registration This retrospective study was approved by the Institutional Review Board of Shanghai general hospital (No.2023-264).

Long non-coding RNA MIAT serves as a biomarker of fragility fracture and promotes fracture healing

BACKGROUND

Fragility fracture is common in the elderly. Osteoblast differentiation is essential for bone healing and regeneration. Expression pattern of long non-coding RNA MIAT during fracture healing was examined, and its role in osteoblast differentiation was investigated.

METHODS

90 women with simple osteoporosis and 90 women with fragility fractures were included. Another 90 age-matched women were set as the control group. mRNA levels were tested using RT-qPCR. Cell viability was detected via CCK-8, and osteoblastic biomarkers, including ALP, OCN, Collagen I, and RUNX2 were tested via ELISA. The downstream miRNAs and genes targeted by MIAT were predicted by bioinformatics analysis, whose functions and pathways were annotated via GO and KEGG analysis.

RESULTS

Serum MIAT was upregulated in osteoporosis women with high accuracy of diagnostic efficacy. Serum MIAT was even elevated in the fragility fracture group, but decreased in a time manner after operation. MIAT knockdown promoted osteogenic proliferation and differentiation of MC3T3-E1, but the influences were reversed by miR-181a-5p inhibitor. A total of 137 overlapping target genes of miR-181a-5p were predicted based on the miRDB, TargetScan and microT datasets, which were mainly enriched for terms related to signaling pathways regulating pluripotency of stem cells, cellular senescence, and osteoclast differentiation.

CONCLUSIONS

LncRNA MIAT serves as a promising biomarker for osteoporosis, and promotes osteogenic differentiation via targeting miR-181a-5p.

Vertebral HU value and the pectoral muscle index based on chest CT can be used to opportunistically screen for osteoporosis

BACKGROUND

Existing studies have shown that computed tomography (CT) attenuation and skeletal muscle tissue are strongly associated with osteoporosis; however, few studies have examined whether vertebral HU values and the pectoral muscle index (PMI) measured at the level of the 4th thoracic vertebra (T4) are strongly associated with bone mineral density (BMD). In this study, we demonstrate that vertebral HU values and the PMI based on chest CT can be used to opportunistically screen for osteoporosis and reduce fracture risk through prompt treatment.

METHODS

We retrospectively evaluated 1000 patients who underwent chest CT and DXA scans from August 2020-2022. The T4 HU value and PMI were obtained using manual chest CT measurements. The participants were classified into normal, osteopenia, and osteoporosis groups based on the results of dual-energy X-ray (DXA) absorptiometry. We compared the clinical baseline data, T4 HU value, and PMI between the three groups of patients and analyzed the correlation between the T4 HU value, PMI, and BMD to further evaluate the diagnostic efficacy of the T4 HU value and PMI for patients with low BMD and osteoporosis.

RESULTS

The study ultimately enrolled 469 participants. The T4 HU value and PMI had a high screening capacity for both low BMD and osteoporosis. The combined diagnostic model-incorporating sex, age, BMI, T4 HU value, and PMI-demonstrated the best diagnostic efficacy, with areas under the receiver operating characteristic curve (AUC) of 0.887 and 0.892 for identifying low BMD and osteoporosis, respectively.

CONCLUSIONS

The measurement of T4 HU value and PMI on chest CT can be used as an opportunistic screening tool for osteoporosis with excellent diagnostic efficacy. This approach allows the early prevention of osteoporotic fractures via the timely screening of individuals at high risk of osteoporosis without requiring additional radiation.

A Multifunctional Therapeutic Strategy Using P7C3 as A Countermeasure Against Bone Loss and Fragility in An Ovariectomized Rat Model of Postmenopausal Osteoporosis

By 2060, an estimated one in four Americans will be elderly. Consequently, the prevalence of osteoporosis and fragility fractures will also increase. Presently, no available intervention definitively prevents or manages osteoporosis. This study explores whether Pool 7 Compound 3 (P7C3) reduces progressive bone loss and fragility following the onset of ovariectomy (OVX)-induced osteoporosis. Results confirm OVX-induced weakened, osteoporotic bone together with a significant gain in adipogenic body weight. Treatment with P7C3 significantly reduced osteoclastic activity, bone marrow adiposity, whole-body weight gain, and preserved bone area, architecture, and mechanical strength. Analyses reveal significantly upregulated platelet derived growth factor-BB and leukemia inhibitory factor, with downregulation of interleukin-1 R6, and receptor activator of nuclear factor kappa-B (RANK). Together, proteomic data suggest the targeting of several key regulators of inflammation, bone, and adipose turnover, via transforming growth factor-beta/SMAD, and Wingless-related integration site/be-catenin signaling pathways. To the best of the knowledge, this is first evidence of an intervention that drives against bone loss via RANK. Metatranscriptomic analyses of the gut microbiota show P7C3 increased Porphyromonadaceae bacterium, Candidatus Melainabacteria, and Ruminococcaceae bacterium abundance, potentially contributing to the favorable inflammatory, and adipo-osteogenic metabolic regulation observed. The results reveal an undiscovered, and multifunctional therapeutic strategy to prevent the pathological progression of OVX-induced bone loss.

Effect of Lycium barbarum polysaccharide on osteoblast proliferation and differentiation in postmenopausal osteoporosis

OBJECTIVE

We aimed to investigate the effect of Lycium barbarum polysaccharide (LBP) on the proliferation and differentiation of osteoblasts in postmenopausal individuals with osteoporosis using in vitro cell experiments.

METHODS

We assessed the effect of long-term LBP consumption on the intestinal metabolites of individuals using a simulation of the human intestinal microbiota ecosystem. We also tested the capacity of LBP in proliferating MC3T3-E1 cells using the cell counting kit-8 (CCK-8) method and analyzed the effect of intestinal metabolites on the osteogenic differentiation of MC3T3-E1 cells by testing bone metabolism viability with relevant indicators.

RESULTS

The level of short-chain fatty acids (SCFAs) significantly increased (p < 0.05), and the concentrations of acetic acid, propionic acid, and butyric acid all showed an upward trend after the treatment using LBP. At appropriate concentrations, the fermentation supernatant can enhance osteoblast proliferation by significantly increasing the active expression of bone-alkaline phosphatase (B-ALP) and osteocalcin (OCN) in osteoblasts (p < 0.05).

CONCLUSION

By modulating the metabolites of intestinal microbiota, production of SCFAs, the prebiotic properties of LBP can enhance osteoblast differentiation through in vitro simulation experiment and cell-based assay.

Enhancing postmenopausal osteoporosis: a study of KLF2 transcription factor secretion and PI3K-Akt signaling pathway activation by PIK3CA in bone marrow mesenchymal stem cells

Introduction

Mesenchymal stem cells can develop into osteoblasts, making them a promising cell-based osteoporosis treatment. Despite their therapeutic potential, their molecular processes are little known. Bioinformatics and experimental analysis were used to determine the molecular processes of bone marrow mesenchymal stem cell (BMSC) therapy for postmenopausal osteoporosis (PMO).

Material and methods

We used weighted gene co-expression network analysis (WGCNA) to isolate core gene sets from two GEO microarray datasets (GSE7158 and GSE56815). GeneCards found PMO-related genes. GO, KEGG, Lasso regression, and ROC curve analysis refined our candidate genes. Using the GSE105145 dataset, we evaluated KLF2 expression in BMSCs and examined the link between KLF2 and PIK3CA using Pearson correlation analysis. We created a protein-protein interaction network of essential genes involved in osteoblast differentiation and validated the functional roles of KLF2 and PIK3CA in BMSC osteoblast differentiation in vitro.

Results

We created 6 co-expression modules from 10 419 differentially expressed genes (DEGs). PIK3CA, the key gene in the PI3K-Akt pathway, was among 197 PMO-associated DEGs. KLF2 also induced PIK3CA transcription in PMO. BMSCs also expressed elevated KLF2. BMSC osteoblast differentiation involved the PI3K-Akt pathway. In vitro, KLF2 increased PIK3CA transcription and activated the PI3K-Akt pathway to differentiate BMSCs into osteoblasts.

Conclusions

BMSCs release KLF2, which stimulates the PIK3CA-dependent PI3K-Akt pathway to treat PMO. Our findings illuminates the involvement of KLF2 and the PI3K-Akt pathway in BMSC osteoblast development, which may lead to better PMO treatments.