The clinician's guide to prevention and treatment of osteoporosis

Osteoporosis management in patients presenting to the emergency department with fragility fractures: A retrospective observational study

Objectives

This study aimed to determine the rate of anti-osteoporotic treatment (AOT) within one year in patients presenting to the emergency department with fragility fractures and to investigate the effects of physiatrist visit, secondary cause of osteoporosis, and previous fracture history on the rate of AOT.

Methods

This study included patients aged 50 years and older who presented to the emergency department between January 1, 2019, and June 1, 2023, with fragility fractures. Demographic characteristics of the patients, a history of fragility fractures, causes of secondary osteoporosis, and clinical features of AOT within one year were recorded using the hospital information system. The effects of physiatrist visit, secondary cause of osteoporosis and previous fracture history on the rate of AOT were examined by chi-square analysis.

Results

The study included a total of 357 patients, with a mean age of 73.5 + 10.1 (range: 51-100) years. The rate of patients receiving AOT was 8.4%. It was observed that 63.3% of the patients receiving AOT had a physiatrist visit, and 70% had secondary osteoporosis. Physiatrist visit and the presence of secondary osteoporosis cause affected the AOT rate statistically significantly (p = .000, p = .003, respectively), while the previous fracture history did not affect the treatment rate (p = .147).

Conclusions

Patients presenting to the emergency department with fragility fractures had a low rate of receiving AOT within one year. Physiatrist visits and finding a secondary cause of osteoporosis increase the detection rate of fragility fractures.

3D-printed gallium-infused scaffolds for osteolysis intervention and bone regeneration

Exacerbation of osteolysis in osteoporotic bone defects presents a significant challenge for implant-based treatments. This underscores the urgent need to develop implants that actively mitigate osteolysis while simultaneously promoting bone regeneration. In this study, the osteogenic potential of mesoporous bioactive glass (MBG) and β-tricalcium phosphate (β-TCP) was combined with the anti-bone resorption property of Ga doping. Ga-MBG was synthesized using a self-transformation method and subsequently incorporated into β-TCP at concentrations of 5 wt%, 10 wt% and 15 wt%. Scaffolds were prepared using extrusion-based 3D printing. The cytocompatibility of the composite scaffolds and their regulatory effects on the differentiation of osteoblasts and osteoclasts were systematically examined. In addition, the molecular mechanisms underlying bone regeneration and osteolysis regulation in osteoblasts were explored. Subsequently, cranial defects were repaired in a rat model of osteoporosis to assess the therapeutic efficacy and biological safety of the optimal concentration of the Ga-MBG/TCP composite scaffold. These findings indicated that the 10 wt% Ga-MBG/TCP composite scaffold exhibited excellent biocompatibility, enhanced new bone formation, and effectively mitigated osteolysis. These results provide a foundation for further investigation into the optimal concentration of Ga-MBG implants and highlight their potential application in future therapies for osteoporotic bone defects.

Chemerin mediates exercise-induced improvements of bone microstructure and bone mass in diabetes or high fat diet mice

To clarify the roles and mechanisms of adipokine chemerin in exercise-induced bone improvements in type 2 diabetes mellitus (DM) mice and mice fed on high fat diet (HFD). DM mice were established by HFD + streptozotocin injection, exogenous chemerin was supplemented prior to running, and found that exogenous chemerin reversed 6-week exercise-induced improvements in cancellous bone parameters in DM mice. While adipose-specific chemerin knockout improved microstructure and mass of cancellous bone in HFD mice and further increased exercise-induced bone improvements, accompanied with promoted osteogenesis and inhibited osteoclasis represented as the changes of RANKL, M-CSF, Runx2, Osterix, OPG, ALP and CTSK. These results indicated that reduced chemerin contributed to exercise-induced enhancements in the microstructure and mass of cancellous bone in DM and HFD mice in association with osteogenesis promotion and osteoclasis inhibition, which is beneficial to clarify chemerin's impact on bone remodeling in metabolic diseases at sedentary and exercise states.

The Association of Preoperative Bone Mineral Density and Outcomes After Anterior Cervical Discectomy and Fusion: A Systematic Review

STUDY DESIGN

This is a systematic review.

OBJECTIVE

To evaluate anterior cervical discectomy and fusion (ACDF) outcomes and complications as a function of preoperative bone mineral density (BMD).

SUMMARY OF BACKGROUND DATA

Preoperative BMD optimization is commonly initiated before lumbar spinal fusion, but the effects of BMD on ACDF are less known. Consequently, it remains unclear whether preoperative BMD optimization is recommended before ACDF.

METHODS

This systematic review included relevant clinical articles using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched PubMed, Web of Science, SCOPUS, and MEDLINE from database inception until October 1, 2023. Eligible studies included those evaluating low BMD and outcomes after ACDF. All articles were graded using the Methodological Index for Non-Randomized Studies (MINORS) scale and Critical Appraisal Skills Programme (CASP) assessment tools.

RESULTS

The initial retrieval yielded 4271 articles for which 4 articles with 671 patients were included in the final analysis. The mean patient age was 56.4 ± 3.9 years, and 331 patients (49.3%) were female. A total of 265 (39.5%) patients had low BMD (T score<-1.0) before ACDF. Preoperative low BMD was associated with cage subsidence in single-level ACDF (odds ratio (OR) 2.57; P =0.063; 95% Confidence Interval (CI): 0.95-6.95), but this result did not reach statistical significance. Osteoporosis (T score<-2.5) was associated with the development of adjacent segment disease following ACDF (OR 4.41; P <0.01; 95% CI: 1.98-9.83). Low pre-operative BMD was associated with reoperation within 2 years ( P <.05) and strongly associated with pseudarthrosis (OR: 11.01; P =0.002; 95% CI 2.4-49.9).

CONCLUSIONS

Patients with low BMD who undergo ACDF have higher rates of subsidence, adjacent segment disease, and pseudarthrosis than those with normal BMD. Given the individual and system-wide burdens associated with these complications, some patients may benefit from preoperative BMD screening and optimization before undergoing ACDF.

Characteristics of patients with very high fracture risk in a community-dwelling geriatric cohort

OBJECTIVE

Bone anabolic treatment has been shown to be superior to oral bisphosphonates, especially in osteoporosis patients with a very high fracture-risk. The current German osteoporosis guideline classifies the very high 3-year fracture-risk based upon a novel fracture-risk model. As age is a severe risk-factor, we examined the distribution and associations to geriatric assessment parameters of the very high-risk group in a well-characterized cohort of community-dwelling geriatric patients.

METHODS

Analyses were based on 166 patients (mean age 82 ± 6 years) taken from MUSAR (MUnich SArcopenia Registry). Fracture-risk was calculated as described in the current German guideline. Thereupon, patients were allocated to the low-/moderate (<5 %), high- (5-10 %) or very high-risk group (>10 %). Associations of geriatric assessment parameters with the group allocation to the fracture-risk group were evaluated by covariate-adjusted linear regression analysis.

RESULTS

>80 % of the study population were at an increased fracture-risk. Besides, >50 % were allocated to the very high-risk group. Patients in the very high-risk group showed limitations in all physical performance tests (short physical performance battery (SPPB), gaitspeed, handgrip strength and chair rise test). Also, polypharmacy and a risk for malnutrition (from mini nutritional assessment short form (MNA-SF)), were present. All parameters showed significant associations with group allocation to very high-risk group.

CONCLUSION

Most of the geriatric patients are at a very high-risk for osteoporotic fractures. Also, this group presented several limitations in the comprehensive geriatric assessment highlighting the vulnerability of this group. Clinicians need to reinforce fracture-risk assessment and familiarize with treatment options.

Molecular Mechanism of Ginsenoside Rg3 Alleviation in Osteoporosis via Modulation of KPNA2 and the NF-κB Signalling Pathway

Osteoporosis is mainly caused by an imbalance in osteoclast and osteoblast regulation, resulting in an imbalance in bone homeostasis. Ginsenoside Rg3 (Rg3) has been reported to have a therapeutic effect on alleviating osteoporosis. Nonetheless, the underlying mechanisms have not been completely elucidated. Herein, the molecular mechanism of Rg3 alleviation in osteoporosis was further explored. An in vitro model was established utilising the receptor activator of nuclear factor-kappaB ligand (RANKL) to induce osteoclast differentiation of RAW264.7 cells. RNA-sequencing results showed that karyopherin subunit alpha 2 (KPNA2) is one of the significantly differentially expressed genes regulated by Rg3 in RANKL-induced RAW264.7 cells. Basic experiments further suggested that KPNA2 is up-regulated in a time-dependent manner in the RANKL-induced RAW264.7 cells, while Rg3 treatment reduced its expression in a dose- and time-dependent manner. Knockdown of KPNA2 inhibited osteoclast formation and the expression of related molecules, including those in the nuclear factor kappa-B (NF-κB) pathway. The NF-κB inhibitor, JSH-23, partially abolished the impact of KPNA2 overexpression on osteoclast formation, indicating KPNA2 activates NF-κB. Furthermore, KPNA2 overexpression partially abolished the inhibitory impact of Rg3 on osteoclast formation, indicating that KPNA2 is a target of Rg3. These results suggest that KPNA2 plays a role in how Rg3 influences on osteoclast differentiation and osteoporosis through the NF-κB pathway.

Transcription factor SMAD5 upregulates ALG5 to alleviate osteoporosis development by inducing osteogenic differentiation

Background

Impaired osteogenic differentiation ability of mesenchymal stem cells (MSCs) plays a pathogenic role in osteoporosis (OP). ALG5, a key glucosyltransferase, participates in the synthesis of the glucose-residue donor. However, little is known about the role of ALG5 in OP pathogenesis and osteogenic differentiation.

Methods

The GSE35956 dataset was used to observe OP-associated factors. ALG5 and SMAD5 mRNA analysis was performed by quantitative PCR. Induction of osteoblastic differentiation of human MSCs (hMSCs) was done using specific media for 14 days. The ovariectomy (OVX)-induced osteoporotic mouse model was established. Calcium deposition was detected by alkaline phosphatase (ALP) activity assay and Alizarin Red staining. Protein expression was evaluated by immunoblot analysis. The relationship of SMAD5 with the ALG5 promoter was predicted by the online tool JASPAR and validated by luciferase assay.

Results

In bone marrow of OP, ALG5 and SMAD5 levels were decreased. Overexpression of ALG5 acted for in vitro enhancement of osteogenic differentiation and autophagy of hMSCs. Mechanistically, SMAD5 enhanced ALG5 transcription to increase ALG5 expression. Moreover, increased SMAD5 expression promoted in vitro osteogenic differentiation of hMSCs through ALG5. ALG5 and SMAD5 were also underexpressed in bone samples of OVX-osteoporotic mice. Furthermore, increased SMAD5 expression alleviated OP development of OVX mice by inducing osteogenic differentiation by upregulating ALG5.

Conclusion

Our findings demonstrate that increased SMAD5 expression upregulates ALG5 to enhance osteogenic differentiation of hMSCs and thus alleviates OP development, providing novel potential approaches to combat OP.

Vitamin D Supplementation May Prevent or Treat Deficiency After Total Knee Arthroplasty: A Retrospective Cohort Analysis

BACKGROUND

Vitamin D deficiency is associated with poorer functional outcomes and increased complication rates after total knee arthroplasty (TKA). Yet, there is no longer term study evaluating vitamin D levels and supplementation after TKA. Our study aimed to compare quantitative vitamin D levels and supplementation regimens after TKA stratified by patient sex and race.

METHODS

A retrospective cohort study of primary TKA patients at a single hospital from 2015 to 2022 was conducted. We analyzed vitamin D preoperatively and postoperatively up to 2 years. Vitamin D deficiency was defined as <30 ng/mL. A subgroup analysis was conducted in patients with vitamin D <21 ng/mL. Supplementation categories included none, low (<1,001 IU), medium (1,001 to 5,000 IU), and high (>5,000 IU).

RESULTS

A total of 400 (66.0% female) patients who underwent 430 primary TKA procedures were included, and 65.3% received supplementation. Patients who were vitamin D sufficient preoperatively demonstrated higher vitamin D levels and ability to maintain sufficiency postoperatively using low-dose supplementation compared with no supplementation ( P = 0.004). Those who were vitamin D deficient preoperatively demonstrated higher vitamin D levels postoperatively using medium to high doses ( P = 0.02). For patients who became deficient postoperatively, supplementation was associated with achieving repletion at an average of 10.2 months ( P < 0.001). Black patients demonstrated 2.8 times higher odds of having a vitamin D level less than 30 ng/mL ( P = 0.03).

CONCLUSION

Our study demonstrated that low-dose vitamin D supplementation (<1,001 IU) was beneficial for vitamin D-sufficient TKA patients to achieve higher levels and maintain vitamin D sufficiency. Vitamin D-deficient TKA patients benefitted from medium-to-high dose supplementation (1,001 to 5,000+), but only 33.7% achieved vitamin D repletion. This work highlights the need to continue vitamin D surveillance postoperatively and the need to continue vitamin D repletion.

[Influencing fracture healing by specific osteoporosis medications]

BACKGROUND

Osteoporosis is a widespread disease defined by a reduction in bone mass and structure, thereby increasing the risk of fragility fractures. Treatment typically involves specific medications, which either inhibit bone resorption (antiresorptive) or stimulate bone formation (anabolic) and may potentially influence the healing of osteoporotic fractures. On the other hand, metabolic disorders, immune system dysfunctions or circulatory problems can impair fracture healing. Therefore, the targeted use of osteoporosis medications could be a strategy to promote the healing of impaired fractures.

OBJECTIVE

The aim of this study is to provide a current overview of the effects of osteoporosis medications approved in Germany on fracture healing. The focus is on the potential influence of these medications in the context of osteoporosis treatment. Additionally, the current state of research is examined to explore to what extent the targeted use of these medications could improve fracture healing.

MATERIAL AND METHODS

A literature search was conducted in the PubMed database using topic-specific keywords. Preclinical studies, clinical trials, review articles and meta-analyses were considered to present the current scientific knowledge with clinical relevance.

RESULTS

Preclinical and clinical studies suggest that specific osteoporosis medications do not have a clinically relevant negative impact on the healing of fragility fractures. Osteoanabolic substances even tend to have a positive effect on fracture healing in both normal and impaired healing processes; however, the available studies are limited and none of the medications have been approved for this specific use.

DISCUSSION

Osteoporosis medications with antiresorptive or osteoanabolic effects are primarily used to treat osteoporosis, especially after fragility fractures, to reduce the risk of further fractures. There is no clinically relevant impairment of fracture healing due to these medications. Further studies would be required to obtain approval for these medications specifically to improve fracture healing.

Glycyrol alleviates osteoporosis through dual modulation on osteoclastogenesis and osteogenesis by targeting Syk signaling pathway

BACKGROUND

Osteoporosis, characterized by an imbalance between osteoclast-mediated bone resorption and osteoblast-mediated bone formation, has become a serious public health challenge worldwide. Glycyrol (GC) is a representative natural coumestan isolated from licorice that shows multiple pharmacological activities, but its anti-osteoporotic effect and underlying mechanisms remain unclear.

RESULTS

GC significantly suppressed lipopolysaccharide-induced mouse bone loss and dexamethasone-induced zebrafish bone formation deficiency. Meanwhile, GC exhibited dual effects of inhibiting osteoclast formation and bone resorption, and stimulating osteoblast differentiation and mineralization. By combining kinomic screening assay, bioinformatics analysis and cellular target engagement validation, spleen tyrosine kinase (Syk) was identified as a key kinase target of GC. Subsequently, Syk was determined to play important roles in promoting osteoclast formation and impeding osteoblast differentiation. Interestingly, GC directly bound to the active cavity of Syk through hydrogen bonds and significantly inhibited its activity. Moreover, GC remarkably inhibited RANKL-induced activation of Syk/PLCγ2/Ca2+/NFATc1 and MAPK pathways in macrophages undergoing differentiation into osteoclasts.

CONCLUSION

These results demonstrated that GC exerted a dual regulation on osteoclastogenesis and osteogenesis and consequently alleviated osteoporosis through targeting Syk and its downstream signaling pathways. In addition, the current study emphasizes the key roles of Syk in bone resorption and formation, suggesting the application potential of Syk inhibitors for the management of bone diseases. Meanwhile, this study provides evidence supporting the development of GC or its derivatives as effective anti-resorptive and bone anabolic agents for the prevention or treatment of osteoporosis and other bone diseases.

Advances in research of metabolic bone disease secondary to chronic pancreatitis

Chronic pancreatitis (CP) is a progressive chronic inflammatory disease that can cause irreversible damage to pancreatic tissue, ultimately leading to pancreatic endocrine and exocrine insufficiency. Metabolic bone disease (MBD) is one of the systemic complications of CP, which includes osteopenia and osteoporosis, characterized by degradation of bone microstructure and an increased risk of fragility fracture. Nearly half of the patients with CP suffer from MBD, which is affected by a number of factors. Pancreatic exocrine insufficiency and pancreatic diabetes mellitus, which are also systemic complications of CP, can affect bone mineral density by lowering serum calcium, and increased levels of inflammatory factors in chronic inflammatory states, as well as the use of opioids to alleviate the pain of CP, can disrupt the balance between bone formation and resorption and promote the development of MBD. In addition, known risk factors for osteoporosis, such as smoking, alcohol abuse, aging, and low body mass index, account for a higher proportion of CP cases than in the general population and contribute to the high prevalence of MBD in CP patients. Foreign guidelines recommend that CP patients be regularly screened for fat-soluble vitamin deficiency, tested for bone mineral density, and evaluated for fracture risk, and encourage all CP patients to actively take preventive measures. In this article, we present a review on the research progress of CP-related metabolic bone disease, discussing the prevalence, related risk factors, and prevention and management of MBD, which will provide a reference for clinical workers.

Bifidobacterium longum increases serum vitamin D metabolite levels and modulates intestinal flora to alleviate osteoporosis in mice

The elderly population is prone to osteoporosis, owing to the deterioration of the skin, liver, and kidney functions. Vitamin D (VD) supplementation has a limited effect, and VD deficiency is mostly treated with medication. Several studies have shown that the gut microbiota alters intestinal VD metabolism and that probiotic supplements can influence circulating VD levels. Therefore, in the present study, we screened a strain of Bifidobacterium longum FSHHK13M1 that can increase the level of VD metabolites in the fermented supernatant species in vitro by modeling fecal bacterial fermentation. The results showed that FSHHK13M1 intervention significantly increased the serum levels of 1,25-dihydroxy VD and osteocalcin. It activated the expression of the VDR, OPG, Wnt10b/β-catenin, and Runx2/Osterix pathways and inhibited the expression of RANKL/RANK pathway. Furthermore, there was an enhancement in the quantity of bone trabeculae and the proportion of bone volume. Concurrently, the gut microbiota in mice with osteoporosis exhibited signs of imbalance. FSHHK13M1 intervention increased the relative abundance of specific bacteria, such as Faecalibaculum rodentium, Limosilactobacillus fermentum, Bifidobacterium pseudolongum, and Akkermansia muciniphila. These results suggest that B. longum FSHHK13M1 alleviates retinoic acid-induced osteoporosis symptoms by modulating related genes, regulating the intestinal flora and increasing the level of active VD.IMPORTANCEOsteoporosis is a systemic metabolic disease in which the patient's bone mass decreases for a variety of reasons, and the microstructure of the bone tissue is altered, leading to an increase in bone brittleness and susceptibility to fracture. Osteoporosis is almost always present in the elderly population, and fractures from falls are an important predisposing factor for mortality risk in the elderly population. Supplementation is quite limited for them as they are not able to utilize vitamin D well due to declining liver, kidney, and skin functions. In the present study, a strain of Bifidobacterium longum probiotic was found to increase the levels of the active form of vitamin D and ameliorate osteoporosis. This may play an important role in preventing osteoporosis and reducing fracture risk in the elderly.

Temporal trends in the burden of vertebral fractures caused by falls in China and globally from 1990 to 2021: a systematic analysis of the Global Burden of Disease Study 2021

BACKGROUND

This study aimed to estimate temporal trends in the burden of vertebral fractures (VFs) caused by falls by gender and age in China and globally from 1990 to 2021.

METHODS

Data concerning the characteristics of VFs caused by falls in China and worldwide, with a focus on metrics in incidence, prevalence and years lived with disability (YLDs) and their age-standardised rates, were sourced from the Global Burden of Disease (GBD) Study 2021. Joinpoint regression analysis was used to identify periods with significant changes. The average annual percentage change (AAPC) was calculated to reflect the temporal trends from 1990 to 2021. We utilised the age-period-cohort (APC) model to assess the effects of age, period, and cohort on the burden of VFs in China.

RESULTS

From 1990 to 2021, the age-standardised incidence rate (ASIR), age-standardised prevalence rate (ASPR) and age-standardised YLD rate (ASYR) of VFs caused by falls exhibited an overall increase in China, whereas a general decline was observed globally. Furthermore, the ASIR, ASPR and ASYR were higher for males than females in China and worldwide. In 2021, across all age groups, the disease burden of VFs was primarily observed among the elderly population, particularly in the older female population, both in China and globally. The impact of age, period, and cohort on the incidence, prevalence, and YLDs exhibited variations in China.

CONCLUSION

The burden of VFs in China remains significant, particularly among older females. Given the considerable size of the elderly population and the ageing of the Chinese population, VFs remain critical public issues. Therefore, continued efforts must be made to address the health consequences of VFs caused by falls.

Is there a disparity in osteoporosis referral and treatment among people with affective disorders? A ten-year data linkage study

AIMS

People with affective disorders (AD) are at increased risk of osteoporosis and fractures. Osteoporosis treatment/referral is thus essential in this population. However, it is unclear whether osteoporosis treatment/referral differs between those with and without AD. This retrospective cohort study compared osteoporosis treatment/referral in people with and without AD across linked primary and mental health care data.

METHODS

People with AD (ICD-10 codes F3*) between 1.5.2009-30.11.2019, aged 18+ at first diagnosis, from Lambeth, South London were randomly matched 1:4 to healthy controls based on age band and gender. Outcomes including treatments (prescription of calcium, calcium with vitamin D) and referral (referrals for osteoporosis screening and/or prevention) were analysed using conditional and multivariable logistic regression analyses.

RESULTS

People with AD (n = 23,932) were more likely than controls (n = 76,593) to have a recorded prescription of calcium (odds ratio [OR] = 1.64, 95 % confidence interval [CI] 1.40-1.92) and calcium with vitamin D (OR = 2.25, 95 % CI 2.10-2.41), and be referred for osteoporosis screening (OR = 1.87, 95 % CI 1.76-1.99) within 2 years after the date of the first AD diagnosis in adjusted analyses. Older age, female sex, having an ethnic minority background, Class A analgesics use were significant predictors for all osteoporosis management pathways within AD patients.

CONCLUSION

Findings from the present study suggest that compared to the general population, people with AD are more likely to receive osteoporosis screening/treatments. Whether this increased screening/treatment is sufficient to reduce the burden of osteoporosis and fractures in this population is unclear and warrants further consideration.

The association between sex hormones and bone mineral density in US females

Osteoporosis and osteoporosis-related fractures exhibits a higher prevalence among females, particularly those aged 50 and above, implying a potential association between sex hormones and bone mineral density (BMD). However, the precise role of sex hormones in BMD remains elusive. Meanwhile, estradiol-to-testosterone ratio (E2/T ratio) or testosterone-to-estradiol ratio (T/E2 ratio) is a new biomarker of sex hormone milieu. We investigated whether sex hormones, E2/T ratio and T/E2 ratio were associated with BMD or fractures risk in US females. This study is a cross-sectional study, and the data sourced from the National Health and Nutrition Examination Survey (NHANES) 2013-2014 cycle. This study primarily focuses on females aged 50 and above, employing weighted multivariate linear regression, restricted cubic spline (RCS) model to examine the association between sex hormones and BMD or FRAX scores. We included 1,012 females. Testosterone was not associated with BMD or fracture risk. Increasing estradiol and E2/T ratio were positively correlated with BMD and negatively correlated with osteoporosis-related fractures risk, while increasing T/E2 ratio was negatively correlated with BMD and increased risk of osteoporosis-related fractures. The T/E2 ratio showed better specificity for predicting low BMD compared to estradiol alone. These findings suggest that hormonal ratios can serve as predictive biomarkers for osteoporosis and fractures. This study highlights the potential of E2/T and T/E2 ratios as biomarkers for assessing osteoporosis risk in postmenopausal women. Incorporating these ratios into clinical practice could improve early diagnosis and risk stratification for osteoporosis-related fractures. Future longitudinal studies are needed to confirm these findings and further explore the causal relationships between sex hormones and bone health.

Identification of endoplasmic reticulum stress and mitochondrial dysfunction related biomarkers in osteoporosis

BACKGROUND

Endoplasmic reticulum stress (ERS) and mitochondrial dysfunction (MD) involved in bone metabolism disorders. However, the particular mechanisms of ERS and MD related genes (ERS&MDRGs) in osteoporosis (OP) have not been elucidated. In present study, biomarkers related to ERS and MD in OP were identified.

METHODS

Differentially expressed genes (DEGs) were obtained based on GEO dataset. ERS&MDRGs were derived from Genecard database. Initially, ERS&MD related DEGs (ERS&MDRDEGs) were obtained by overlapping DEGs and ERS&MDRGs. The key module was screened by WGCNA. The intersection of ERS&MDRDEGs and key module was screened by machine learning to obtain key genes. Then, receiver operating characteristic curve (ROC) was drawn to calculated diagnostic accuracy of key genes. The ssGSEA and Cibersort algorithms were performed to analyze immune cell infiltration. The miRNA-mRNA-TF network were draw by cytoscape software. Moleculaer docking and DGIdb database were employed for screening potential drugs. Finally, the expression of key genes was verified by qRT-PCR.

RESULTS

The 122 ERS&MDRDEGs were obtained by preliminary screening. ERS&MDRDEGs were mainly enriched in lipid metabolism, calcium ion transport, and ossification. The 5 key genes were identified, including AAAS, ESR1, SLC12A2, TAF15, and VAMP2. Immune infiltration analysis showed monocyte and macrophage were different between OP and control groups. The miRNA-mRNA-TF regulatory network indicated has-miR-625-5p, has-miR-296-3p, CTCT and EP300 as potential regulatory targets. The 2 potential small molecule drugs, namely bumetanide and elacestrant were screened. The expression of AAAS, ESR1, VAMP2 were higher, and SLC12A2 and TAF15 were lower in OP than control group.

CONCLUSION

This research identified 5 key genes AAAS, ESR1, SLC12A2, TAF15 and VAMP2. Bumetanide and elacestrant were potential drugs. These findings provided valuable insights into the pathophysiology of OP and the development of new therapeutic strategies.

Opportunistic screening for osteoporosis: validation study for L1 bone density measurements using contrast-enhanced chest and abdominal CTs

OBJECTIVE

To retrospectively validate the diagnostic power of attenuation values on chest and abdomen/pelvis CECTs, together and separately, compared with dual-energy X-ray absorptiometry (DEXA)-determined osteoporosis diagnoses, and to determine thresholds for accurate osteoporosis diagnosis.

MATERIALS AND METHODS

Subjects were identified using the electronic health record. Included patients received DEXA and CECT scans within 60 days of each other. Patients were excluded if taking osteoporosis medication, undergoing dialysis, receiving hormone or cancer therapy, had a history of cancer, osseous metastases, fractures, or compressions. Minimum, mean, and maximum CECT attenuation values of L1 trabecular bone axial cross-sections were measured by a non-physician in Hounsfield units (HUs) using an elliptical region of interest (ROI) tool. DEXA diagnoses were dichotomized as positive (osteoporosis) or negative (osteopenia/normal). The area under the receiver-operator characteristic curves (AUCs) were compared to identify ideal CECT attenuation thresholds.

RESULTS

Two hundred nineteen subjects (mean age 66 ± 0.6 [range 35-92]; 196 (89%) females and 23 (11%) males) were included for analysis. Thirty-one (14%) subjects were positive and 188 (86%) were negative for osteoporosis. Minimum, mean, and maximum combined chest and abdomen/pelvis attenuation values demonstrated AUCs of 0.75 (95% CI 0.67-0.84), 0.931 (95% CI 0.88-0.99), and 0.82 (95% CI 0.73-0.90). The optimal mean attenuation threshold for osteoporosis diagnosis was 120 HU (84% sensitive, 90% specific). There was no statistical difference in diagnostic power between mean attenuation values of chest and abdomen/pelvis CECTs.

CONCLUSION

CECT mean attenuation values of either chest or abdomen/pelvis CECTs could be used as appropriate thresholds in screening for osteoporosis.

Evidence-based joint statement position of perioperative bone optimization in the arthroplasty candidate, from FEMECOT, AMMOM, ACOMM, SCCOT, SECOT, SEFRAOS, SEIOMM

BACKGROUND

The prevalence of patients living with joint replacements is increasing. Nearly two-thirds of patients undergoing elective arthroplasty procedures have low bone mineral density (LBMD), defined as osteopenia in 38.5% and osteoporosis in 24.8%; among those with osteoporosis, only 32.8% received treatment at the time of surgery.

MATERIALS AND METHODS

A group of 7 national societies (FEMECOT, AMMOM, ACOMM, SCCOT, SECOT, SEFRAOS, SEIOMM) developed a joint statement position on the diagnosis of osteoporosis and perioperative bone optimization in candidates for arthroplasty "Arthroplasty Bone Optimization." We performed a scoping review of the available literature, followed by a systematic review and meta-analysis. Subsequently, a Delphi-modified method was used to gather the different positions.

RESULTS

After analyzing the literature, we came up with five recommendations: (1) Patients scheduled for elective arthroplasty should undergo a bone health assessment (BHA). (2) If poor bone quality is observed during surgery and a bone health assessment has not been conducted promptly, a complete BHA, including a DXA scan, is imperative. (3) In the arthroplasty candidate, if LBMD or osteoporosis are noticed, bone loss-related factors should be corrected, and appropriate treatment for osteoporosis should be started before or right after arthroplasty. The use of anti-resorptive and bone anabolic agents has been shown to reduce periprosthetic bone loss, complications, and non-septic revision rates after joint arthroplasty. (4) In arthroplasty candidates, the diagnosis of osteoporosis or low bone mineral density (LBMD) should not delay the surgery. (5) Monitoring central and periprosthetic bone mineral density through DXA protocols can help identify bone loss in central and periprosthetic areas in patients with risk factors or osteoporosis.

CONCLUSIONS

Perioperative bone optimization should be considered in all patients who are candidates for arthroplasty. The orthopedic surgeon and multidisciplinary team should be encouraged to diagnose and treat the arthroplasty candidates' bone by screening for bone loss-related factors and diagnosing osteoporosis and starting treatment according to the current international guidelines. Following these recommendations could reduce periprosthetic bone loss, complications, and aseptic revision rates following arthroplasty surgery. More research is needed to understand the implications of osteoporosis and its treatment for joint replacement outcomes and long-term survival.

The association between different insulin resistance indexes and bone health in the elderly

The triglyceride-glucose (TyG) index and its related indexes (TyG-BMI, TyG-WC, TyG-WHtR) are effective markers for screening metabolic diseases like insulin resistance (IR). However, few studies have explored the relationship between the TyG and its related indexes with bone density (BMD), osteopenia, and osteoporosis. This is a cross-sectional study that involved 1,303 adults aged 50 years and above from the National Health and Nutrition Examination Survey 2007-2010, and 2013-2014. In the multivariable-adjusted model, linear regression analysis and logistic regression analysis demonstrated that TyG and its related indexes have a significant positive correlation with BMD and a negative correlation with osteopenia/osteoporosis in the femoral neck, lumbar spine, and total hip region. Trend analysis further confirms these associations (p < 0.05). Restricted cubic spline analysis showed a nonlinear relationship between these indexes with BMD and osteopenia/osteoporosis. Sensitivity analyses further confirmed the robustness of these associations. This study reveals the significant and complex correlation between the TyG and its related indexes with BMD and osteoporosis, indicating the potential link between IR and bone health. The TyG and related indexes offer a new perspective for the diagnosis, prevention, and treatment of osteoporosis.

Screening for Osteoporosis to Prevent Fractures: US Preventive Services Task Force Recommendation Statement

Importance

Osteoporotic fractures are associated with psychological distress, subsequent fractures, loss of independence, reduced ability to perform activities of daily living, and death.

Objective

The US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate the evidence on the benefits and harms of screening for osteoporosis to prevent fractures in adults 40 years or older with no known diagnosis of osteoporosis or history of fragility fracture.

Population

Adults 40 years or older without known osteoporosis or history of fragility fractures.

Evidence Assessment

The USPSTF concludes with moderate certainty that screening for osteoporosis to prevent osteoporotic fractures in women 65 years or older has moderate net benefit. The USPSTF concludes with moderate certainty that screening for osteoporosis to prevent osteoporotic fractures in postmenopausal women younger than 65 years at increased risk has moderate net benefit. The USPSTF concludes that the evidence is insufficient and the balance of benefits and harms for screening for osteoporosis to prevent osteoporotic fractures in men cannot be determined.

Recommendation

The USPSTF recommends screening for osteoporosis to prevent osteoporotic fractures in women 65 years or older. (B recommendation) The USPSTF recommends screening for osteoporosis to prevent osteoporotic fractures in postmenopausal women younger than 65 years who are at increased risk for an osteoporotic fracture as estimated by clinical risk assessment. (B recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for osteoporosis to prevent osteoporotic fractures in men. (I statement).

Association Between Calcium Level, Bone Mineral Density, and Hip Fracture: Analysis Based on NHANES Data

Introduction: The relationships between calcium, bone mineral density, and hip fracture have been studied for a long time, but there are still different opinions on the matter. The aim of this study was to decipher the relationship between these factors from National Health and Nutrition Examination Survey (NHANES) data. Methods: After we performed data cleaning for the obtained NHANES data, we used multiple imputation to obtain the complete data and conducted an analysis for different variables. First, by using multivariate linear regression models, we confirmed the association between calcium and bone mineral density, and then we confirmed the association between bone mineral density and hip fracture by using multivariate logistic regression models. A mediation analysis of these variables was performed. Results: The analysis in this study included data on 18,003 participants from the NHANES, and we were able to find a strong association between calcium and bone mineral density (p < 0.001). The association between bone mineral density and hip fracture was also significant (p < 0.001). One augmented gram of daily calcium intake was associated with a 0.04 unit increase in BMD level, and a one unit increase in BMD level could downgrade the occurrence of hip fracture for 5.4 times. The mediation analysis showed that the femur BMD level and total BMD level have a mediating relationship with hip fracture, and no clear relationship among calcium, BMD, and hip fracture could be established. Conclusions: Although it is difficult to draw strict conclusions from the mediation analysis in this study, we can observe a clear association between calcium and BMD as well as an association between BMD and hip fracture.

UTE MRI technical developments and applications in osteoporosis: a review

Osteoporosis (OP) is a metabolic bone disease that affects more than 10 million people in the USA and leads to over two million fractures every year. The disease results in serious long-term disability and death in a large number of patients. Bone mineral density (BMD) measurement is the current standard in assessing fracture risk; however, the majority of fractures cannot be explained by BMD alone. Bone is a composite material of mineral, organic matrix, and water. While bone mineral provides stiffness and strength, collagen provides ductility and the ability to absorb energy before fracturing, and water provides viscoelasticity and poroelasticity. These bone components are arranged in a complex hierarchical structure. Both material composition and physical structure contribute to the unique strength of bone. The contribution of mineral to bone's mechanical properties has dominated scientific thinking for decades, partly because collagen and water are inaccessible using X-ray based techniques. Accurate evaluation of bone requires information about its components (mineral, collagen, water) and structure (cortical porosity, trabecular microstructure), which are all important in maintaining the mechanical integrity of bone. Magnetic resonance imaging (MRI) is routinely used to diagnose soft tissue diseases, but bone is "invisible" with clinical MRI due to its short transverse relaxation time. This review article discusses using ultrashort echo time (UTE) sequences to evaluate bone composition and structure. Both morphological and quantitative UTE MRI techniques are introduced. Their applications in osteoporosis are also briefly discussed. These UTE-MRI advancements hold great potential for improving the diagnosis and management of osteoporosis and other metabolic bone diseases by providing a more comprehensive assessment of bone quantity and quality.

Assessment of trabecular bone Hounsfield units in the lumbar spine for osteoporosis evaluation in individuals aged 65 and above: a review

Osteoporosis is a prevalent condition that significantly increases fracture risk, particularly in the elderly population. Despite its widespread occurrence, osteoporosis is often underdiagnosed and inadequately managed. Traditional diagnostic methods, such as dual-energy X-ray absorptiometry (DXA), have limitations in terms of accessibility and accuracy, necessitating exploration of alternative diagnostic approaches.This review aims to evaluate the diagnostic potential of Hounsfield Unit (HU) values derived from abdominal computed tomography (CT) scans, specifically focusing on the trabecular bone of the lumbar spine, for osteoporosis assessment in individuals aged 65 and older. The review seeks to assess the sensitivity, specificity, and overall diagnostic performance of HU values in distinguishing between normal bone density, osteopenia, and osteoporosis, and to identify areas for further investigation to establish standardized diagnostic criteria.This review compiles existing studies on the use of HU values from abdominal CT scans for osteoporosis diagnosis. It examines the relationship between HU values and DXA T-scores, analyzes optimal HU thresholds for classifying bone density categories, and explores the potential of CT scans as a viable alternative to DXA.The findings indicate that HU values from abdominal CT scans show strong correlations with DXA T-scores, suggesting a promising diagnostic tool for assessing bone density and quality. HU values have demonstrated the ability to differentiate between osteopenia, osteoporosis, and normal bone density, with varying sensitivity and specificity depending on the established HU threshold. CT scans are identified as a scalable, cost-effective alternative to DXA, with the added benefit of utilizing routine abdominal CT scans, which are often conducted for other clinical reasons, thereby reducing additional costs and radiation exposure.HU values derived from abdominal CT scans represent a promising approach for osteoporosis screening, offering a potential solution for routine, cost-effective, and accurate diagnosis, especially in older adults. However, there is a need for standardized HU thresholds and further research to refine diagnostic criteria and enhance the accuracy of osteoporosis detection. Establishing standardized guidelines would improve diagnostic consistency and facilitate early intervention, potentially improving patient outcomes and reducing healthcare burdens.

Use of SMART objectives in an interprofessional training event: screening for fall and osteoporosis risk

INTRODUCTION

SMART objectives are a major component of health coaching and lifestyle medicine, however, there are limited studies describing their use in current health care curriculums. This study incorporated SMART objectives within an Interprofessional Education (IPE) event offered to students who were screening community-dwelling adults within their community for falls and osteoporosis risk. The purpose was to evaluate if students could confidently develop a SMART objective with their client that was relevant to the screening results.

METHODS

Student participants were recruited from pharmacy, nursing, and physical therapy programs at Rutgers University. The IPE event consisted of an educational pre-session assignment, 2-h virtual training session, student-led home screening with a self-selected community volunteer, and a 2-h virtual educational and debriefing session. Students taught peers through interprofessional education on their respective discipline's screening assessment tools during each session. Based on the screening results, students collaborated with their clients to develop a SMART objective aimed at addressing an identified problem.

RESULTS

Post 3 yearly programs, 520 pharmacy, nursing, and DPT students completed the SMART objective, and 518 SMART objectives were analyzed. Analysis indicated all students were about 90 % confident in developing SMART objectives and 92 % confident in communicating with clients. Most students, regardless of discipline, felt comfortable developing a SMART objective and communicating with clients.

CONCLUSION

A significant number of people screened were found to have risk factors for falls or osteoporosis. Regardless of discipline, students worked with their client to develop appropriate SMART objectives. SMART objectives can enhance IPE programs, curriculums that include client counseling regarding lifestyle changes, and client engagement.

The effects of pre-operative anti-osteoporotic use on total joint arthroplasty complications: A national database study

Background

The current study aims to analyze the effect of pre-operative non-bisphosphonate anti-osteoporotic drugs on complication and revision rates following total joint arthroplasty (TJA).

Methods

A retrospective cohort analysis of the PearlDiver (PearlDiver Technologies, Colorado Springs, CO) database was performed. The database was queried to identify all patients who underwent total hip arthroplasty (THA) or total knee arthroplasty (TKA) with history of hip or knee osteoarthritis and either osteopenia or osteoporosis. The treatment groups consisted of patients prescribed non-bisphosphonate and bisphosphonate osteomodulatory agents for 1 year prior to and following surgery. The treatment groups were matched to control cohorts by age, gender, and comorbidities. Chi-square analyses were used to compare outcomes between paired cohorts.

Results

There were no statistically significant differences (p ≤ 0.05) in risk of aseptic loosening, broken prosthesis, dislocation of prosthetic joint, periprosthetic fracture, periprosthetic osteolysis, postoperative infection, full or partial revision, or stress fracture between both the non-bisphosphonate and bisphosphonate groups following THA or TKA. Comparisons between both groups and control cohort also yielded no significant differences.

Conclusion

The current study detected no significant differences in early post-operative complications following TJA between patients treated with different classes of anti-osteoporotic medications versus untreated osteopenic/osteoporotic patients. Further research is required to fully understand the impact of osteomodulatory medications on TJA outcomes. Analysis should continue to ensure a high-quality standard of care and aim to better understand outcomes for such patients requiring TJA.

Sentinel fracture: the necessity of improved post-fracture care

Fragility fractures caused by osteoporosis, the most common metabolic bone disease, place a significant burden on affected individuals and impose substantial economic costs. A fragility fracture implies an imminent elevated risk for subsequent fractures, particularly in the short term. Therefore, osteoporosis must be addressed in the event of a sentinel fracture, if not already previously treated. Regardless of whether the fracture is treated conservatively or surgically, post-fracture care is particularly important. Early mobilization followed by fall risk assessment and the initiation of adequate bone-specific medication are essential milestones in preventing subsequent fractures. Monitoring patients increases adherence to bone-specific medication and fall prevention strategies. Comprehensive post-fracture care is important and should be performed by a multidisciplinary team. Coordinated care models, such as the fracture liaison service (FLS), have shown enhancements in the initiation of and adherence to secondary prevention of fragility fractures. Despite recommendations by several guidelines including that published by the Austrian Society for Bone and Mineral Research, only one fracture liaison service has been implemented in Austria.

Osteoporosis testing and treatment remain low in both Traditional Medicare and Medicare Advantage

Little is known regarding osteoporosis management between Traditional Medicare (TM) and Medicare Advantage (MA). MA beneficiaries had higher rates of osteoporosis testing and higher rates of osteoporosis drug treatment initiation rates. Following an osteoporotic fragility fracture, MA beneficiaries were more likely to be prescribed osteoporosis treatment. While osteoporosis testing and treatment initiation rates are low in both TM and MA, rates tended to be higher in MA.

PURPOSE

Osteoporosis represents a substantial clinical challenge in the United States, particularly for older women, and requires effective care coordination. Medicare Advantage (MA) plans have financial incentives in the form of star ratings to improve osteoporosis testing and treatment. The objective of this study was to compare osteoporosis management practices between Traditional Medicare (TM) beneficiaries and MA female enrollees.

METHODS

We conducted a cross-sectional study using a nationally representative 20% sample of 2017-2019 TM claims and MA encounter records. We identified 2,994,203 female TM beneficiaries and 1,924,132 MA enrollees. The exposure was enrollment in MA. The primary outcomes were the rates of guideline-recommended bone mineral density (BMD) testing and osteoporosis drug initiation following a new osteoporosis diagnosis and after a new osteoporotic fragility fracture.

RESULTS

MA beneficiaries had higher unadjusted (22.0% vs. 19.8% in TM; P < 0.001) and adjusted rates (0.8 percentage points [p.p.] higher; P < 0.001) of BMD testing. Osteoporosis drug treatment initiation rates were higher in the MA cohort, both unadjusted (24.9% vs. 20.3% in TM; P < 0.001) and adjusted (4.0 p.p. higher; P < 0.001). Following an osteoporotic fragility fracture, MA beneficiaries were more likely to be prescribed pharmacologic treatment (28.7% vs. 21.1% in TM; P < 0.001), with an adjusted increase of 5.9 p.p (P < 0.001).

CONCLUSION

Overall osteoporosis testing and treatment initiation rates in both TM and MA enrollees were low, with improved rates in MA compared to TM.

Association of standardized serum 25-hydroxyvitamin D with falls in post-menopausal women

Vitamin D status has long been related to falls risk. In this planned secondary analysis of a vitamin supplementation trial in postmenopausal women, standardized 25-hydroxyvitamin D concentration up to 60 ng/mL was not associated with increased falls. Women with 25(OH)D ≥ 60 ng/mL had higher odds of ≥ 2 falls.

PURPOSE

Falls are common and cause fractures. High circulating 25(OH)D may increase falls risk; thus, recent guidance recommends 25(OH)D not exceed 50 ng/mL. Prior falls studies have not reported standardized 25(OH)D (s25D) data. The purpose of this planned secondary analysis of a 4-year calcium/vitamin D supplementation trial was to evaluate the association of s25D with falls.

METHODS

This study recruited 2,303 postmenopausal women. The analytic dataset consisted of pooled concatenated data from years 2-4 (NTotal = 5,732). Serum 25(OH)D was measured annually and subsequently retrospectively standardized using Vitamin D Standardization Program methods. Falls were recorded by diary. Incidence for ≥ 1 fall and ≥ 2 falls was assessed by s25D group (≤ 20, 20- < 30, 30- < 40, 40- < 50, 50- < 60 and ≥ 60 ng/mL) using multivariable logistic regression.

RESULTS

Mean (SD) baseline s25D was 32.6 ng/mL (8.3) with no difference between supplement and placebo groups. s25D increased to 41.3 ng/mL at year 2 in the supplement group then remained stable. By s25D group, incidence for ≥ 1 fall varied from 22-32% (p = 0.19). For ≥ 2 falls incidence varied (p = 0.03) from 6% (< 20 ng/mL) to 17% (≥ 60 ng/mL.) There was no significant association between s25D and ≥ 1 fall. Those with s25D ≥ 60 ng/mL had a higher adjusted odds of ≥ 2 falls (OR = 1.99 ± 1.2-3.3) compared to women with s25D of 30- < 40 ng/mL.

CONCLUSION

s25D up to 60 ng/mL was not associated with greater risk for ≥ 1 or ≥ 2 falls. Women with a s25D ≥ 60 ng/mL were at higher odds for ≥ 2 falls, however this group included only ~ 2% of study observations; therefore, confirmation in other cohorts is necessary.

Comparative Effectiveness of Abaloparatide and Teriparatide in Women 50 Years of Age and Older: Update of a Real-World Retrospective Analysis

BACKGROUND

Abaloparatide and teriparatide are osteoanabolic treatments indicated for postmenopausal women and men with osteoporosis at high risk of fracture. In the Abaloparatide Comparator Trial In Vertebral Endpoints study, bone mineral density improvements were significantly greater with abaloparatide compared to teriparatide at the total hip and femoral neck. We conducted a retrospective claims study to examine the incidences of hip and nonvertebral fractures and cardiovascular events in women aged ≥50 years initiating abaloparatide or teriparatide therapy, expanding on a previous retrospective claims study.

METHODS

This retrospective observational study used anonymized claims data from ICON's Symphony Health, PatientSource for women aged ≥ 50 years with ≥ 1 prescription fill for abaloparatide or teriparatide. The index date was the date of the initial prescription dispensed. Times to first hip fracture, nonvertebral fracture, and serious cardiovascular event were compared between logistic regression-based propensity score-matched cohorts and in predefined subgroups by age, prior antiresorptive use, and prior fracture using Cox proportional hazards models.

RESULTS

Patients (21 676 per cohort) were well matched on 73 baseline parameters. Forty-five percent of patients in the abaloparatide arm and 47% in the teriparatide arm were exposed to treatment for longer than 12 months. Over 18 months (+ 30 days follow-up), 245 (1.1%) and 296 (1.4%) women in the abaloparatide and teriparatide cohorts, respectively, had a hip fracture (HR [95% CI] 0.83 [0.70, 0.98]; P = .027); 947 (4.4%) and 1078 (5.0%) had a nonvertebral fracture (0.88 [0.80, 0.96]; P = .003). There were no significant treatment-subgroup interactions (P ≥ .2). Cardiovascular events were similar between groups.

CONCLUSIONS

There were significantly lower rates of hip and nonvertebral fractures with abaloparatide compared to teriparatide, which were consistent across subgroups. No differences in cardiovascular safety were noted between cohorts.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSION

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

'Bone Health-Across a Woman's Lifespan'

Despite a high burden of osteoporosis and minimal trauma fractures worldwide, there is still a treatment gap in timely diagnosis and optimal treatment. There is also a lack of international consensus and guidelines on the management of bone fragility in premenopausal women. This review article provides an overview of the current understanding of factors impacting women's bone health across the adult lifespan, as well as dilemmas in the diagnosis, assessment and management of osteoporosis in premenopausal and postmenopausal women, premature ovarian insufficiency and bone health following breast cancer.

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.

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

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

Associations of the serum 25-hydroxyvitamin D with mortality among patients in osteopenia or osteoporosis

PURPOSE

The correlation between serum vitamin D and mortality in patients with osteopenia or osteoporosis remains unclear. Therefore, this study examined the relationship between serum 25-hydroxy vitamin D [(25(OH)D] and mortality in patients with osteopenia or osteoporosis.

METHODS AND RESULT

This prospective cohort study included patients with osteopenia or osteoporosis from the National Health and Nutrition Examination Survey from 2001 to 2018. Multivariate Cox regression models examined the correlation between serum 25(OH) D and all-cause mortality, cardiovascular mortality (CVD), and cancer mortality. The cohort included 9282 adult participants with a median follow-up period of 97.01 months, including 1394 all-cause deaths, 413 CVD-related deaths, and 322 cancer deaths. In fully adjusted models, higher serum 25(OH) D levels (≥75.0 nmol/L) were associated with a lower risk of all-cause mortality (hazard ratio 0.54, 95 % confidence interval 0.41 to 0.73) and cardiovascular death (0.47, 0.29 to 0.76), using participants with low 25(OH) D levels (<25 nmol/L) as the reference. In addition, we found an L-shaped non-linear dose-response relationship between serum 25(OH) D and all-cause and cardiovascular mortality, with inflection points of 38.8 nmol/L and 53.6 nmol/L, respectively.

CONCLUSION

Higher serum 25(OH) D concentrations are strongly associated with a diminished risk of all-cause and CVD mortality in patients with osteopenia or osteoporosis, this association has a threshold effect. More in-depth intervention studies are needed to clarify underlying mechanisms.

Parathyroid hormone levels following denosumab vs. zoledronic acid therapy for osteoporosis

The objective of this retrospective, database study was to characterize the rate, magnitude and timeline of increases in parathyroid hormone (PTH) levels post-denosumab (DMAb) vs. zoledronic acid (ZA) injection in patients with osteoporosis and near normal baseline PTH. Included were osteoporotic females, ≥50 years, initiating treatment with 60 mg DMAb or 5 mg ZA. PTH levels within 6-months post-DMAb or 12-months post-ZA injection were extracted from the electronic database of a 4.5 million-member health maintenance organization. The indication for PTH measurements was unknown. Exclusion criteria were creatinine >2 mg/dL, vitamin D < 50 nmol/L or parathyroid hormone level > 1.5 × upper limit of normal (ULN). Among 3317 women, 1992 received DMAb and 1325 ZA. The DMAb group was older (73.3 ± 8.5 vs. 69.8 ± 8.6 years, p < 0.001) and more patients treated with DMAb compared with patients treated with ZA had prior non-vertebral fractures (7.7 % vs. 5.2 %, p < 0.01) and had previously been treated with osteoporosis medication (56.3 % vs. 50.3 %, p < 0.001). Among the patients, 14.9 % had at least one post-treatment PTH > 1.5 ULN. Of 7273 post-treatment PTH tests, 62.6 % were within normal limits, while 24.8 % were mildly elevated at 1.01-1.5 ULN. Two-months after both treatments, >1.5 ULN PTH levels peaked at ∼20 %. Elevated PTH was associated with eGFR < 60 mL/min/1.73 m2 and comorbidities. In conclusion, most PTH levels post-DMAb or ZA in osteoporotic patients with baseline PTH < 1.5 ULN, were within normal range. PTH increased to >1.5 ULN in 14.9 % of patients; peaking in the first 2-months post-treatment and declining thereafter. Elevated PTH may be related to anti-resorptive effects and is not medication specific. PTH measurements in the first few months post-DMAb and ZA therapy should be limited.

The L-shaped association between body roundness index and all-cause mortality in osteoporotic patients: a cohort study based on NHANES data

Purpose

This study aims to investigate the relationship between the body roundness index (BRI) and overall mortality rates in individuals with osteoporosis (OP), utilizing information sourced from the NHANES database, in order to assess BRI's capability as an indicator for predicting mortality risk.

Methods

Data from NHANES (2005 to 2010, 2013-2014, and 2017-2018) were analyzed, including 1,596 osteoporotic individuals aged 50 and above. BRI was calculated based on waist circumference (WC) and height, categorizing participants into high (>4.07) and low (≤4.07) BRI groups. To analyze the relationship between BRI and mortality while accounting for important covariates, we employed weighted Cox proportional hazards models, conducted Kaplan-Meier survival analyses, and utilized restricted cubic splines (RCS).

Results

Higher BRI was significantly associated with better long-term survival, showing an "L"-shaped nonlinear inverse relationship with mortality, with a threshold at BRI = 5. In subgroup analyses, this association remained relatively stable.

Conclusion

The "L"-shaped association between BRI and mortality indicates that BRI may serve as a useful indicator for evaluating mortality risk in patients with OP, thereby informing clinical interventions and public health approaches.

Radiomorphometric indices for measuring mandibular bone quality in oncologic patients

OBJECTIVE

This retrospective study compared the thickness and degree of resorption of the mandibular cortex in patients with head and neck cancer (AG), patients with cancer at sites other than the head and neck (BG), and patients with no cancer (CG) to describe and compare the changes in the mandible after antineoplastic therapy and their possible clinical implications.

MATERIALS AND METHODS

A total of 287 panoramic radiographs were examined. The following radiomorphometric indices were analyzed: mental index (MI), panoramic mandibular index (PMI), and mandibular cortical index (MCI). Analysis of variance (ANOVA) and the Kruskal‒Wallis test, with p < 0.05 considered significant, were performed.

RESULTS

Males predominated in the AG (83%), while females predominated in the BG and CG (78.6 and 62%, respectively). In the AG, tongue carcinoma (22.1%) was prevalent, while in the BG, breast carcinoma was predominant (53.8%). All parameters measured in the AG and BG patients were significantly lower than those in the CG patients: MI (p < 0.001), right PMIc/a (p < 0.001), left PMIc/a (p < 0.001), right PMIc/b (p = 0.004), left PMIc/b (p < 0.001), and MCI (p < 0.001).

CONCLUSIONS

Radiomorphometric indices MI, PMI, and MCI were significantly lower in panoramic radiographs of patients with head and neck cancer and patients with cancer in other regions of the body than in those of nononcological patients.

Clinical Relevancies of Sarcopenic Obesity in Patients with Metabolic Dysfunction-Associated Fatty Liver Disease (MASLD)

AIM

Sarcopenic obesity (SO) is associated with adverse outcomes in diseased patients. This study aimed to examine the prevalence and risks associated with SO, with a focus on the impact of SO on cardiovascular risk in patients with MASLD.

MATERIALS AND METHODS

In this cross-sectional study, patients with MASLD were prospectively enrolled. Through dual-energy X-ray absorptiometry (DXA) scans, their body compositions were analyzed to identify who had SO and osteopenia/osteoporosis. The primary aim is to investigate risks associated with SO, followed by analyzing the association between SO and cardiovascular disease (CVD).

RESULTS

Two hundred and twenty-three patients with MASLD were enrolled. The prevalence of SO was 47.1%, respectively. Patients coexisted with MASLD and SO had increased visceral adipose tissue (VAT), higher fatty liver index (FLI) and fibrosis 4 (FIB-4) score. Regression analysis revealed higher FLI and FIB-4 score, as well as history of hypertension, were risks associated with SO. The 10-year atherosclerotic cardiovascular disease (ASCVD) risk score was higher in patients coexisted with MASLD and SO compared to those without (10.1% vs. 7.3%, p = 0.006). Regression analysis showed that increased VAT and FIB-4 score were associated with raised risk of ASCVD.

CONCLUSION

Prevalence of SO in MASLD patients is considerable. The presence of SO also linked to higher risk of ASCVD. Therefore, the recognition of SO in patients with MASLD is important in clinical care.

Opportunistic screening for metabolic bone disease in high energy fracture patients

OBJECTIVE

Metabolic bone disease (MBD, referring to osteopenia and osteoporosis) and its sequelae are associated with substantial morbidity, mortality, and healthcare costs. MBD screening and bone densitometry referral are underutilized in the general population despite published screening guidelines. Prior studies have correlated vertebral body Hounsfield unit (HU) measurements with MBD. The purpose of this study is to use this method to identify the prevalence of undiagnosed MBD in patients presenting to the hospital after high energy trauma, and to determine whether opportunistic MBD screening using this method would be valuable in this cohort.

DESIGN

Retrospective review.

SETTING

Level 1 trauma center and safety net hospital.

PATIENTS

307 patients with a high energy femur fracture who underwent abdomen/pelvis computed tomography (CT) were identified from a trauma database.

INTERVENTION

L1 vertebral body radio density (in Hounsfield units, HU) was measured from trauma CT scans. Risk factors for MBD were identified from the medical record.

MAIN OUTCOME MEASUREMENTS

Prevalence of MBD and proportion of patients with MBD risk factors meriting further work-up.

RESULTS

The prevalence of MBD among high energy trauma patients was similar to the age-matched general population. Over half (50.5 %) of all patients had at least one risk factor for MBD. Among patients 50 to 64 years of age with any given MBD risk factor, over a third of individuals had MBD. In this population, the prevalence of MBD was highest (40.0 %) among those who used tobacco products and had a concurrent alcohol use disorder.

CONCLUSION

Opportunistic screening for MBD using a CT measurement technique can facilitate earlier diagnosis and treatment for affected individuals presenting after high energy trauma. Opportunistic screening may be particularly impactful in pre-menopausal women and in men, who frequently have MBD risk factors but who have a low referral rate for bone density testing and treatment.

LEVEL OF EVIDENCE

Diagnostic level III.

Rheumatoid arthritis and the risk of fracture: A Mendelian randomization study

Observational epidemiological studies indicate a higher fracture incidence in rheumatoid arthritis (RA) patients compared to the general population. However, the causal relationship between RA and fracture risk, particularly traumatic and osteoporotic fractures, is not well established. We performed Mendelian randomization (MR) analysis to evaluate the causal relationship between RA and fracture risk. We performed a MR analysis using summary statistics from genome-wide association studies to investigate the causal association between RA and the risk of traumatic fractures at 9 sites and 3 types of osteoporotic fractures. The primary analysis used inverse-variance weighting, supplemented by MR-Egger regression and other methods to assess causal relationships and sensitivity analyses, including heterogeneity and pleiotropy assessments, using R software with appropriate packages. The inverse-variance weighting results demonstrated a causal relationship between genetically predicted RA and an elevated risk of fractures, particularly traumatic fractures of the long bones and osteoporotic fractures, including fractures of shoulder and upper arm (odds ratio [OR] = 1.041, 95% confidence interval [CI]: 1.020-1.062, P = 9.06e-05), fractures of forearm (OR = 1.026, 95% CI: 1.007-1.044, P = .006), fracture of femur (OR = 1.036, 95% CI: 1.009-1.064, P = .009), fractures of lower leg, including joint (OR = 1.031, 95% CI: 1.016-1.047, P = 6.38e-05), fractures of rib(s), sternum, and thoracic vertebrae (OR = 1.041, 95% CI: 1.018-1.064, P = 4.08e-04), osteoporotic with pathological features (OR = 1.128, 95% CI: 1.071-1.188, P = 5.54e-06), postmenopausal osteoporotic with pathological features (OR = 1.060, 95% CI: 1.002-1.123, P = .044), and drug-induced osteoporotic with pathological features (OR = 1.255, 95% CI: 1.124-1.400, P = 5.02e-05). This study highlights the genetic causal link between RA and an increased risk of traumatic and osteoporotic fractures, presenting a new direction for future exploration of the mechanisms underlying RA-related fractures.

Trends in Osteoporosis Drug Therapy Receipt Among Commercial and Medicare Advantage Enrollees in the United States, 2011-2022

CONTEXT

A national assessment of osteoporosis drug therapy (ODT) use can inform the extent of underdiagnosis and undertreatment of osteoporosis.

OBJECTIVE

The aim was to describe trends in ODT use by age, sex, fragility fracture, and documented osteoporosis.

METHODS

This was a retrospective analysis of patient-quarter observations for adults aged ≥50 years with commercial or Medicare Advantage health insurance in the OptumLabs Data Warehouse between 2011 and 2022. The primary outcome was the proportion of patient-quarter observations with ODT use stratified by age, sex, fragility fracture, and documented osteoporosis. Cuzick tests were performed to assess trends ODT use.

RESULTS

Analysis of 166 673 420 patient-quarter observations revealed that over 70% of patients with fragility fractures did not have documented osteoporosis. Among women aged ≥65 years with documented osteoporosis, ODT fill rates increased between 2011 and 2022 from 36.3% to 50.1% for women without fragility fractures (P < .001) and from 30.8% to 43.7% for women with fragility fractures (P < .001). However, ODT fill rates declined (9.2% to 7.4% between 2011 and 2022) for women with fragility fractures and no documented osteoporosis (P = .015). Similar trends were observed among women aged 50-64 years and men.

CONCLUSION

ODT use for patients with documented osteoporosis has increased but remains low. Low rates of ODT use for patients with fragility fractures in the absence of documented osteoporosis suggests that underdiagnosis of osteoporosis contributes to underuse of ODTs.

Hierarchical Porous Microspheres-Assisted Serum Metabolic Profile for the Early Diagnosis and Surveillance of Postmenopausal Osteoporosis

With the aging global population, the incidence of osteoporosis (OP) is increasing, putting more individuals at risk. Since postmenopausal osteoporosis (PMOP) often remains asymptomatic until a fracture occurs, making the early clinical diagnosis of PMOP particularly challenging. In this work, the AuNPs-anchored hierarchical porous ZrO2 microspheres (Au/HPZOMs) is designed to assist laser desorption/ionization mass spectrometry (LDI-MS) for the requirement of serum metabolic fingerprints of PMOP, postmenopausal osteopenia (PMON), and healthy controls (HC) and realize the early diagnosis and surveillance of PMOP. With its large surface area, suitable surface roughness, and enhanced UV absorbance, the LDI efficiency of Au/HPZOMs is significantly enhanced. Combining machine learning, PMOP and non-PMOP (HC and PMON) are clearly distinguished with the area under the receiver operating characteristic curves reaching up to 1.000. Furthermore, seven key m/z features are identified, facilitating the specific detection of PMON and two stages of PMOP. The precision of distinguishing PMON and PMOP at different stages based on these features exceeds 86.5% in both the training and validation sets, aiding in the early diagnosis and monitoring of PMOP. This work sheds light on the metabolic profile for large-scale screening, early detection, and monitoring of PMOP, which will promote the application of fluid metabolism-driven precision medicine into practical clinical use.

Romosozumab adverse event profile: a pharmacovigilance analysis based on the FDA Adverse Event Reporting System (FAERS) from 2019 to 2023

OBJECTIVE

This study aims to analyze adverse drug events (ADE) related to romosozumab from the second quarter of 2019 to the third quarter of 2023 from FAERS database.

METHODS

The ADE data related to romosozumab from 2019 Q2 to 2023 Q3 were collected. After data normalization, four signal strength quantification algorithms were used: ROR (Reporting Odds Ratios), PRR (Proportional Reporting Ratios), BCPNN (Bayesian Confidence Propagation Neural Network), and EBGM (Empirical Bayesian Geometric Mean).

RESULTS

Screening for romosozumab-related AEs (adverse events) included 23 system organ categories (SOCs). PT (preferred terms) levels were screened for adverse drug reaction (ADR) signals. A total of 7055 reports with romosozumab as the primary suspect (PS) and 14,041 PTs induced by romosozumab as PS were identified. Common significant signals of general disorders and administration site conditions, musculoskeletal and connective tissue disorders have emerged. Specifically, unexpected AEs such as gastrointestinal disorder, respiratory, thoracic and mediastinal disorders also occur. Notably, fracture (n = 503, ROR = 107.8, PRR = 103.83, IC = 6.6, EBGM = 97.02) and bone density abnormal (n = 429, ROR = 343.65, PRR = 332.77, IC = 8.08, EBGM = 271.34) exhibited relatively high occurrence rates and signal strengths.

CONCLUSION

Our study identifies potential new AE signals and provides broader data support for the safety of romosozumab. In clinical application, doctors are provided with a warning to closely monitor adverse reactions to support their rational use in diseases such as osteoporosis.

LINC01271 promotes fracture healing via regulating miR-19a-3p/PIK3CA axis

OBJECTIVE

Osteoporosis increases the risk of fragility fractures, impacting patients' lives. This study aimed to investigate whether LINC01271 was involved in the process of fragility fractures and healing, providing a new perspective for its diagnosis and treatment.

METHODS

This study included 94 healthy individuals, 82 patients with osteoporosis, and 85 patients with fragility fractures as subjects. RT-qPCR was used to measure the levels of LINC01271, miR-19a-3p, PIK3CA, and osteogenic differentiation markers in osteoblasts and subjects' serum. Luciferase reporter assays, RIP experiments, and RNA pull-down assays were utilized to verify the target relationships between LINC01271 and miR-19a-3p, as well as between miR-19a-3p and PIK3CA. Cell proliferation and apoptosis were assessed using CCK-8 assays and flow cytometry.

RESULTS

Compared to the healthy control group, the serum levels of LINC01271 were significantly reduced in patients with osteoporosis and fragility fractures. Furthermore, LINC01271 levels increased with time-dependent fracture healing. In vitro studies indicated that LINC01271 boosted osteoblast proliferation, inhibited apoptosis, and augmented osteogenic differences, whereas its inhibition reverses their effects. LINC01271 and PIK3CA were identified as targets of miR-19a-3p, and overexpression of miR-19a-3p could antagonize the effect of LINC01271 in promoting fracture healing.

CONCLUSION

The results indicated that LINC01271 may play a key role in osteoblast function and fracture healing through its interaction with miR-19a-3p and regulation of PIK3CA.

Application of deep learning model based on unenhanced chest CT for opportunistic screening of osteoporosis: a multicenter retrospective cohort study

INTRODUCTION

A large number of middle-aged and elderly patients have an insufficient understanding of osteoporosis and its harm. This study aimed to establish and validate a convolutional neural network (CNN) model based on unenhanced chest computed tomography (CT) images of the vertebral body and skeletal muscle for opportunistic screening in patients with osteoporosis.

MATERIALS AND METHODS

Our team retrospectively collected clinical information from participants who underwent unenhanced chest CT and dual-energy X-ray absorptiometry (DXA) examinations between January 1, 2022, and December 31, 2022, at four hospitals. These participants were divided into a training set (n = 581), an external test set 1 (n = 229), an external test set 2 (n = 198) and an external test set 3 (n = 118). Five CNN models were constructed based on chest CT images to screen patients with osteoporosis and compared with the SMI model to predict the performance of osteoporosis patients.

RESULTS

All CNN models have good performance in predicting osteoporosis patients. The average F1 score of Densenet121 in the three external test sets was 0.865. The area under the curve (AUC) of Desenet121 in external test set 1, external test set 2, and external test set 3 were 0.827, 0.859, and 0.865, respectively. Furthermore, the Densenet121 model demonstrated a notably superior performance compared to the SMI model in predicting osteoporosis patients.

CONCLUSIONS

The CNN model based on unenhanced chest CT vertebral and skeletal muscle images can opportunistically screen patients with osteoporosis. Clinicians can use the CNN model to intervene in patients with osteoporosis and promptly avoid fragility fractures.

CRITICAL RELEVANCE STATEMENT

The CNN model based on unenhanced chest CT vertebral and skeletal muscle images can opportunistically screen patients with osteoporosis. Clinicians can use the CNN model to intervene in patients with osteoporosis and promptly avoid fragility fractures.

KEY POINTS

The application of unenhanced chest CT is increasing. Most people do not consciously use DXA to screen themselves for osteoporosis. A deep learning model was constructed based on CT images from four institutions.

The association between dietary omega-3 intake and osteoporosis: a NHANES cross-sectional study

Background

Recent research suggests that omega-3 fatty acids may play a role in bone metabolism through their influence on bone mineral density (BMD) and the regulation of bone turnover markers. However, epidemiological evidence linking omega-3 intake to the risk of developing osteoporosis is still emerging and remains inconclusive. This study aims to clarify the role of dietary omega-3 fatty acids in the prevention of osteoporosis.

Methods

We analyzed data from 8,889 participants categorized into normal, osteopenia, and osteoporosis groups based on their BMD scores from the National Health and Nutrition Examination Survey (NHANES). We measured dietary omega-3 intake using two 24-h dietary recall interviews. Dietary omega-3 intake was quantified and divided into quartiles. Multivariate logistic regression and subgroup analysis were used to explore the correlation between dietary omega-3 intake and osteoporosis. The dose-response relationship between the two was analyzed with a restricted cubic spline (RCS).

Results

Higher dietary intake of omega-3 fatty acids was inversely associated with the risk of osteoporosis. Participants in the highest quartile of omega-3 intake had a significantly lower risk (OR = 0.71, 95% CI: 0.53-0.93) compared to those in the lowest quartile, with a consistent trend across all adjusted models (p for trend <0.05). Subgroup analyses indicated stronger associations in individuals under 60 years of age, female and non-smokers. In individuals aged under 60, higher omega-3 intake was associated with significantly reduced osteoporosis risk (OR = 0.51, 95%CI: 0.26-0.95), females showed a protective effect of high omega-3 intake against osteoporosis (OR = 0.65, 95% CI: 0.49-0.87). Among non-smokers, higher omega-3 intake was associated with a lower risk of osteoporosis (OR = 0.64, 95% CI: 0.45-0.90), whereas in smokers, the association was not evident (OR = 0.91, 95%CI: 0.55-1.52). No significant associations were found in older participants or smokers. Intake of omega-3 and osteoporosis were linearly related (p for nonlinear = 0.366).

Conclusion

This study demonstrates a significant inverse relationship between dietary omega-3 fatty acid intake and osteoporosis risk, suggesting omega-3 s play a crucial role in bone health. However, further longitudinal studies are needed to confirm these findings and refine dietary recommendations for osteoporosis prevention.

Denosumab and clinical outcomes among men with osteoporosis: a retrospective cohort study

Most subjects in osteoporosis clinical trials were women with postmenopausal osteoporosis and while bridging studies (BMD endpoint) provide an expectation that osteoporosis medications will reduce fracture risk in men. This real-world study shows direct evidence of fracture risk reduction among men with osteoporosis (36% of hip fracture reduction with denosumab).

PURPOSE

Direct evidence for fracture risk reduction of medications used among men with osteoporosis is very limited. This study aims to evaluate the real-world effectiveness of denosumab in reducing fracture risk.

METHODS

This study included 13,797 men aged ≥ 50 years with osteoporosis who had initiated denosumab in Taiwan. Taiwan's National Health Insurance Research Database includes all Taiwan residents' complete health claim data. We compared incidence rates of clinical fractures between patients on denosumab 60 mg subcutaneously every 6 months (on-treatment) and patients ending therapy after one administration (off-treatment). Propensity score (PS) analysis, adjusting for measured differences at baseline covariates, was used to estimate the adjusted hazard ratio using a Cox proportion hazards model.

RESULTS

During follow-up, 248 hip fracture events occurred. The crude incidence rates of hip fracture were 1.13 events and 1.73 events per 100 person-years in on-treatment and off-treatment cohorts, respectively. After PS inverse probability of treatment weighting, the cohorts achieved balance in all 59 covariates. The hip fracture event rate was lower in on-treatment cohort versus off-treatment cohort by 36% (hazard ratio, 0.64 [95% CI 0.50-0.83]). A similar magnitude of risk reduction was observed in clinical vertebral and nonvertebral fractures. A series of sensitivity analysis, including a validation analysis using a-million individual health records, demonstrated that unmeasured confounders were not suggested to impact study result interpretation.

CONCLUSION

In this large, real-world study evaluating denosumab treatment among men with osteoporosis, the observed fracture risk reductions were consistent with the available risk reductions demonstrated in clinical trials among women with postmenopausal osteoporosis.