The aim of this study was to examine Iranian adults aged 50 and above to determine the association between the prevalence of regional osteoporosis and their dietary intake of phosphorus, magnesium, potassium, and zinc. We conducted a cross-sectional analysis of 1353 participants (406 with osteoporosis, 947 healthy) from the Iranian Multicenter Osteoporosis Study (IMOS-2021). A validated 168-item food frequency questionnaire was utilized to evaluate dietary intake. The lumbar spine, whole hip, and femoral neck were assessed for bone mineral density (BMD) with dual-energy x-ray absorptiometry. Multivariable logistic regression models were used to estimate odds ratios (ORs) for osteoporosis, adjusting for potential confounders. Participants with osteoporosis were significantly older (63.76 vs. 59.61 years, P < 0.001), more likely to be women (67.2
Osteoporosis and osteopenia, characterized by reduced bone mineral density (BMD), increase fracture risk, particularly in older adults. Early detection is critical for preventing fractures and preserving quality of life. Variability in radiographic interpretation highlights the need for automated diagnostic approaches. This study evaluates whether deep learning (DL) analysis of lumbar radiographs can serve as an alternative to dual-energy X-ray absorptiometry (DEXA) for detecting osteopenia and osteoporosis. In this retrospective study, 1039 patients (aged 20–95 years, mean 64.99 ± 11.61) who underwent both DEXA and lumbar spine radiography within three months were included. BMD was classified using T-scores for adults over 50, including postmenopausal women and men, and Z-scores for younger participants. Lateral lumbar radiographs (L1–L4) were categorized as normal, osteopenic, or osteoporotic according to DEXA results. Five pretrained transfer learning models (DenseNet-169, EfficientNet-B7, Inception-ResNetV2, ResNet-152V2, Xception) were used for feature extraction, with hyperparameters optimized using the Grey Wolf Optimization (GWO) algorithm. Models were evaluated for both multiclass and binary classification tasks. In multiclass classification, DenseNet169 achieved the highest test AUC of 0.81. In binary classification, Xception (AUC: 0.90) was most effective in distinguishing normal from osteopenia, while InceptionResNetV2 (accuracy: 90.08
Tristetraprolin (TTP) is an RNA-binding protein essential for controlling cytokine production, and its deficiency leads to profound skeletal deterioration. Although TTP deficiency is associated with systemic inflammation and microbial dysbiosis, the contribution of the gut microbiota to bone pathology remains poorly defined. We investigated whether the microbiome causally modulates osteoimmune mechanisms and bone microarchitecture in TTP-deficient mice. To isolate the effects of the microbiome, we utilized specific pathogen-free (SPF) and germ-free (GF) co-housing mouse models. Microbial transfer bidirectionally regulated systemic inflammation and the expansion of monocytic myeloid-derived suppressor cells (M-MDSCs), a population with potent osteoclastogenic capacity. Importantly, microbiota transfer was sufficient to induce osteoclast activation and a selective deterioration of trabecular bone microarchitecture in otherwise healthy mice, without affecting overall bone mass. Crucially, the transmission of these osteoimmune and skeletal phenotypes was microbiota-dependent; while a baseline genetic bone deficit persisted in GF TTP-deficient mice, the co-housing-induced M-MDSC expansion and trabecular bone alterations were not observed under GF conditions. Our findings identify a microbiota-dependent osteoimmune axis that amplifies inflammatory bone loss in TTP deficiency. This work establishes the gut microbiome as a mechanistic modifier of bone quality in genetically driven inflammatory disease and highlights microbial targeting as a potential therapeutic strategy for inflammatory bone loss.
X-linked hypophosphatemic rickets (XLH) is a rare disease and its natural history affects the quality of life of patients, as it leads to bone deformities and architectural and qualitative changes in the bone. Sixteen XLH patients were selected from referral hospitals in Rio de Janeiro (12 women and four men) and compared to 16 healthy age- and sex-matched control individuals. All XLH were receiving calcitriol and oral phosphate supplements. Bone assessment was performed by high-resolution peripheral quantitative computed tomography (HR-pQCT) and dual-energy X-ray absorptiometry (DXA). XLH patients showed higher lumbar spine BMD Z-score, but lower 33
In cortical bone histology, the ratio of Haversian canal and secondary osteon areas reflects bone resorption and formation during metabolic events executed by Basic Multicellular Units (BMUs). Area data can be pooled where they are collected independently, and the ratio calculated from the mean of each measure. They can also be paired, where they are measured from the same secondary osteon at once and the mean of individual ratios is calculated. We evaluate the impact of pooling and pairing on the resulting ratio values and their interpretation of bone remodelling. Using both approaches, we calculated the area ratio of 551 Haversian canals and secondary osteons from measurements of existing midshaft femur histology slides. The sample represents n = 38 young and middle-aged females of different social backgrounds from a historical osteological collection. Univariate and bivariate statistics were used to compare and evaluate paired and pooled values and their differences. The pooled method usually returned a lower canal-to-osteon value than paired data across the whole sample, ages, and social groups. These methods differed in the ratios they produced, independently of the number of measurements per sample. The pooling technique indicated the presence of thicker lamellar bone within secondary osteons, suggesting greater quantities of bone formed during BMU activity, than the paired technique results, which suggested less bone formed per BMU. While pooling offers efficiency in data collection and analysis, we show that paired data yield more biologically precise and analytically flexible results at an individual BMU level.
To compare 24-month persistence and compliance of denosumab with alendronate in postmenopausal women with osteoporosis across 5 Asia–Pacific territories. This prospective cohort study included women aged ≥ 50 years from Australia, Taiwan, South Korea, Hong Kong, and Singapore. Participants received either a bi-annual denosumab injection or weekly oral alendronate as osteoporosis treatment, based on physician judgment. Multivariable logistic regression assessed whether therapy (denosumab or alendronate) was significantly associated with treatment persistence and compliance over 24 months of follow-up. The models were adjusted for age, fracture history, baseline bone mineral density (BMD), prior osteoporosis therapy, and prior oral glucocorticoid treatment. Adjusted odds ratios (aORs) and 95
Eldecalcitol is an active vitamin D3 derivative approved for the treatment of osteoporosis in Japan and postmenopausal osteoporosis in China. However, the impact of concomitant calcium supplementation on its safety profile is unclear. This was a prospective, observational, non-interventional post-marketing drug intensive monitoring study in Chinese postmenopausal women with osteoporosis (NCT05433207). Data were collected using an electronic case report form at baseline, before initial eldecalcitol dosing, and during routine clinical visits over a 1-year follow-up period. One thousand patients were enrolled from 29 Chinese clinical sites; 958 received eldecalcitol (853 without/105 with calcium supplementation). The mean age (standard deviation [SD]) of patients was 65.6 (9.0) years and mean (SD) time since osteoporosis diagnosis was 2.7 (3.8) years. Adverse drug reactions (ADRs) affected 39.2
This review examines the role of marrow adipose tissue fatty acid composition in skeletal homeostasis, focusing on osteoporosis. To avoid conceptual confusion, we define evidence tiers: human studies assessing endogenous marrow lipid profiles; mechanistic studies applying exogenous fatty acids in vitro and in vivo; indirect MRI-based surrogates of marrow fat quantity; and direct ex vivo measurements of fatty acid composition via GC-MS, LC-MS, and lipidomics. We also clarify the distinction between marrow fat quantity and fatty acid quality. Human data reveal disease-, age-, and site-related alterations in marrow lipid saturation and unsaturation; however, findings vary by skeletal site, marrow compartment, fracture status, analytical platform, and study population. Experimental evidence demonstrates that saturated fatty acids (e.g., palmitic acid) induce lipotoxicity and osteoblast dysfunction, whereas unsaturated fatty acids (e.g., oleic acid and n-3 polyunsaturated fatty acids) exert protective effects via modulation of mesenchymal stem cell differentiation, osteoclastogenesis, ferroptosis, autophagy, and mitochondrial metabolism. Collectively, current evidence supports an association between marrow fatty acid biology and osteoporotic bone loss. Causal, diagnostic, and therapeutic implications remain preliminary. This review's main contribution is a fatty-acid-centered framework that integrates evidence tiers, molecular categories, and skeletal-site heterogeneity, guiding future research.
Normocalcemic primary hyperparathyroidism (NPHPT) is thought to be an early form of hypercalcemic primary hyperparathyroidism (PHPT). However, some studies have shown that the adverse effects on bone and kidney health are similar in both conditions. This is a nationwide, multicentre, retrospective study. Data from centres, including 404 patients with NPHPT and 723 patients with mild PHPT from different regions of Turkey, were included in this study. All laboratory parameters, dual-energy X-ray absorptiometry, and renal ultrasounds were performed locally at each centre. The prevalence of adverse bone and kidney outcomes and metabolic and cardiovascular comorbidities were the main outcome measures. Patients with NPHPT had lower calcium and PTH levels. Skeletal outcomes revealed 29
Osteoporosis is a major public health concern, particularly in the aging population, where fragility fractures significantly impact quality of life and mortality. Despite the importance of early detection, screening rates for osteoporosis in Japan remain low. The Osteoporosis Self-Assessment Tool for Asians (OSTA) and Fracture Risk Assessment Tool (FRAX) are noninvasive screening tools. This study aimed to develop an efficient method for screening osteopenia using these tools. We analyzed data from 1060 Japanese women aged 40–74 years from the Research on Osteoarthritis/Osteoporosis Against Disability (ROAD) study. The OSTA and FRAX scores, as well as individual FRAX risk factors, were assessed for their ability to detect osteopenia. As FRAX score calculations are not publicly available, we evaluated the discriminative ability of the seven risk factors individually. Prior fragility fractures were deemed the most critical, and all 64 possible combinations of the remaining six risk factors were analyzed. OSTA had the highest discriminative ability (AUC = 0.81), followed by FRAX-Hip (AUC = 0.79) and FRAX-Major (AUC = 0.77). The sensitivity and specificity of OSTA ≤ –1 were 83.7
Proximal femoral fractures are highly prevalent in Japan, with over 200,000 cases annually and a rising trend. Fracture liaison service (FLS) interventions improve osteoporosis treatment initiation and reduce refracture rates. The content of FLS interventions varies by institution, and the effectiveness of our intervention remains unclear. The aim of this study was to evaluate the effectiveness of our FLS intervention in preventing fragility fractures within 1 year after proximal femoral fracture surgery. A retrospective case–control study was performed on patients aged ≥ 50 undergoing surgery for proximal femoral fracture between February 2021 and January 2024. Patients were divided into non-FLS (pre-August 2022) and FLS groups. Data including demographics, comorbidities, fracture type, medication initiation, and refracture occurrence within 1 year were extracted. Statistical analyses involved Mann–Whitney U, χ2 tests, and Cox proportional hazards modeling. Among 521 eligible patients, osteoporosis medication initiation within 3 months improved from 14
Introduction Medication-related osteonecrosis of the jaw (MRONJ) is a serious complication of antiresorptive therapy. Although surgical intervention is increasingly recommended, the optimal extent of mandibular resection-particularly indications for marginal versus segmental mandibulectomy-remains controversial. Conventional staging systems may not capture qualitative CT patterns that could be associated with surgical outcomes. Materials and methods This retrospective observational study included 76 patients with mandibular MRONJ who underwent surgical treatment between January 2018 and March 2024. Preoperative computed tomography (CT) images were evaluated for osteolysis, periosteal reaction, and osteosclerosis, and lesions were classified into three imaging-based types (A-C). Treatment outcomes and prognostic factors were analyzed separately for marginal and segmental mandibulectomy. Results Marginal mandibulectomy was performed in 46 patients and segmental mandibulectomy in 30 patients. Healing was achieved in 43.5% after marginal mandibulectomy and in 80.0% after segmental mandibulectomy. In the marginal mandibulectomy group, higher imaging-based MRONJ types (Types B and C), denosumab use, malignancy, and absence of sequestrum separation were associated with lower healing rates. In contrast, in the segmental mandibulectomy group, younger age and periosteal reaction were associated with improved healing. Conclusions This study suggests that radiological patterns of mandibular MRONJ are associated with surgical outcomes and may complement conventional staging. Although segmental mandibulectomy showed numerically higher healing, interpretation is limited by confounding by indication. CT-based imaging assessment may help anticipate the risk of delayed or incomplete healing after limited resection and support individualized selection of surgical extent. Future prospective studies incorporating standardized imaging evaluation and radiologic-pathologic correlation are warranted.
