High-impact exercise can strengthen bones, but clinical use is limited because mechanical loading is difficult to measure outside laboratories. We validated a wrist-worn accelerometer against force-plate ground reaction forces and found that wearable data reliably reflect impact loading. This approach may enable practical monitoring of bone-stimulating exercise in real-world settings. Mechanical loading must surpass a minimum intensity threshold to stimulate osteogenic adaptation, yet clinicians lack practical tools to quantify impact dose outside laboratory settings. Wearable accelerometers could enable safe, scalable monitoring of bone-strengthening exercise, but their validity for estimating osteogenic loading remains uncertain. This study examined whether wrist-worn accelerometry can support approximate estimation and coarse classification of platform-derived impact loading during maximal countermovement jumps in postmenopausal women. Thirty-eight women were enrolled; 37 contributed 125 valid CMJs with concurrent force-platform and wrist-accelerometer recordings. The primary model predicted peak platform-derived vertical acceleration from peak wrist vector-magnitude acceleration and body mass. Coefficient inference used linear regression with participant-clustered robust standard errors. Predictive performance and four-class osteogenic classification (< 2 g, 2– < 3 g, 3– < 3.9 g, ≥ 3.9 g) were evaluated using leave-one-subject-out cross-validation. Fuller anthropometric models and residual-based outlier filtering were examined as sensitivity analyses. In the primary reduced model, wrist vector magnitude and body mass were both independently associated with peak platform acceleration. In leave-one-subject-out validation, the model explained 44.3
Abdominal aortic calcification was associated with lower femoral neck BMD in unadjusted analyses, but its independent skeletal stratification value was limited in hospitalized patients with surgically treated fragility fractures. AAC was not independently associated with fracture severity or refracture risk in this cohort. Abdominal aortic calcification (AAC) has been linked to lower bone mineral density (BMD) and fracture risk in community-based populations, but its relevance for skeletal stratification after surgically treated fragility fracture is unclear. We examined associations between AAC burden and BMD, FRAX-estimated fracture probabilities, fracture severity, and refracture risk. We retrospectively studied 230 hospitalized adults with surgically treated fragility hip or vertebral fractures. AAC was quantified on lateral spine radiographs using the 24-point Kauppila score. Associations with BMD, FRAX probabilities, and fracture severity were assessed using correlation and multivariable regression. Refracture was analyzed using Kaplan–Meier and Cox models from a common baseline defined as the latest of the index operation, DXA, and AAC assessment dates. Higher AAC burden was associated with lower femoral neck BMD in unadjusted analyses (Spearman ρ = − 0.230, p < 0.001), but this association was attenuated after adjustment. AAC showed weak positive correlations with FRAX-estimated probabilities but was not independently associated with vertebral or hip fracture severity. In common-baseline refracture analysis, 24/224 patients had a first refracture. Refracture-free survival did not differ by AAC group (log-rank p = 0.982), and high AAC was not associated with refracture risk (HR 0.90, 95
Solid organ transplant recipients face high fracture risk with limited evidence guiding anabolic therapy. In this real-world cohort, teriparatide was associated with significant improvements in bone mineral density and acceptable safety without adverse graft effects. These findings support selective anabolic treatment in high-risk transplant recipients and highlight the need for prospective studies. Solid organ transplant (SOT) recipients are at high risk for osteoporosis and fragility fractures due to pre-existing organ dysfunction and long-term immunosuppressive therapy, particularly glucocorticoids. However, evidence supporting the use of anabolic osteoporosis therapy in this population remains limited. We conducted a retrospective cohort study at a large transplant center including adult kidney, lung, and liver transplant recipients selected for teriparatide treatment based on clinical indications for severe post-transplant osteoporosis for at least 3 months. Bone mineral density (BMD), incident fractures, biochemical parameters, renal function, and adverse events were evaluated during treatment and follow-up. Thirty-nine SOT recipients (33
A standardized osteoporosis alert in fracture radiology reports boosted osteoporosis care from 17 to 57
Stroke or transient ischemic attack (TIA) leads to unfavorable structural changes in the bones. The underlying pathophysiological process is unclear. We provide a detailed characterization of the structural and biochemical properties of bone in a stroke/TIA cohort. Our findings lay the foundation for a comprehensive understanding of post-stroke osteopathy and its clinical implications. Patients who have suffered a stroke or transient ischemic attack are at high risk of fractures, which increase mortality and reduce health-related quality of life. Previous studies showed that ischemic stroke leads to unfavorable structural changes in the bones, but the underlying pathophysiological process is still unclear. Our aim was to analyze biomarkers and bone structure with high-resolution peripheral quantitative computed tomography (HR-pQCT) in a stroke/TIA cohort. This cross-sectional study analyzes the baseline data of a prospective cohort. Patients underwent HR-pQCT scans of the radius and tibia, alongside biochemical bone marker evaluation, within the first days after the acute cerebrovascular event. Women had lower total, cortical, and trabecular volumetric bone mineral density (vBMD) and lower values for most other HR-pQCT parameters. Patients with increasing age had lower total and cortical vBMD, but no difference in trabecular parameters. Active or former smokers had lower total and trabecular vBMD. Higher BMI was associated with greater cortical and trabecular bone areas and higher trabecular density. A positive correlation was found between sclerostin levels and trabecular parameters. Higher osteoprotegerin levels were associated with lower cortical area and thickness. Osteocalcin showed a negative correlation with total vBMD and cortical thickness. This study is the first to combine HR-pQCT imaging with bone biomarkers to provide a detailed characterization of the structural and biochemical properties of bone in a stroke/TIA cohort. Our findings lay the foundation for a comprehensive understanding of post-stroke osteopathy and its clinical implications.
Osteoporosis in patients awaiting total hip arthroplasty remains undiagnosed. Although hip radiographic indices have been proposed for screening, they have not been compared. We compared the diagnostic accuracy of eight indices for osteoporosis. The canal–bone ratio measured 7 cm below the lesser trochanter may be a useful screening tool. Osteoporosis increases the risk of perioperative and postoperative fractures in patients undergoing total hip arthroplasty (THA). However, osteoporosis remains undiagnosed and untreated preoperatively. Several indices measured on hip anteroposterior radiographs have been proposed to screen for osteoporosis. Nevertheless, few studies have compared these indices, necessitating investigations to identify a practical and effective radiographic index. Osteoporosis prevalence was assessed in 317 female patients who underwent dual-energy X-ray absorptiometry before primary THA. The screening performance of eight radiographic indices was evaluated using anteroposterior hip radiographs for patients without previous diagnosis or treatment of osteoporosis: canal flare index (CFI), morphological cortical index (MCI), canal–bone ratio (CBR) at 2, 7, and 10 cm below the lesser trochanter and canal–bone area ratio (CBAR) measured at 2–7, 2–10, and 7–10 cm segments. Receiver operating characteristic analyses were performed, and the areas under the curve (AUCs) were calculated and compared among indices. Osteoporosis was identified in 129 patients (40.7
The study presents osteoporotic fracture risk in postmenopausal women established by FRAX, Garvan and POL-RISK algorithms for next 10 years. In studied group, a relatively high level of fracture risk was shown. These findings emphasize the importance of increasing treatment to reduce the expected rise in fracture rate in the future. The aim of the study was to assess the 10-year osteoporotic fracture risk of postmenopausal women using the FRAX, Garvan, and POL-RISK algorithms and to compare those tools in terms of identification of high-risk subjects. The study group consisted of 508 consecutive postmenopausal women recruited in three osteoporotic outpatient clinics. Mean age was 69.8 ± 7.5 years. Data on clinical risk factors were collected. Bone status was assessed at the hip using a Lunar Prodigy device. Fracture risk was established by FRAX, Garvan, and POL-RISK algorithms for the next 10 years. Mean risk for major fractures for FRAX was 8.85 ± 5.43
Osteoporosis weakens bones and increases the risk of fractures. Denosumab is a medication that reduces bone loss and increases bone mineral density (BMD). In this real-world study, we followed patients who received denosumab every 6 months for 10 years. We found that bone density continued to improve throughout treatment. People who had taken bisphosphonates before starting denosumab responded just as well in the long term. Blood tests showed stable reduction of bone turnover markers. Denosumab produces durable BMD gains and low fracture rates in clinical trials, but long-term real-world evidence is limited, especially on the effect of prior bisphosphonate exposure and characteristics of patients who fracture during therapy. We conducted a 10-year single-center real-world retrospective study including patients receiving continuous denosumab 60 mg every 6 months. Clinical, biochemical, and densitometric data were extracted from an institutional electronic database. Longitudinal changes in BMD at total hip, lumbar spine, and femoral neck were analyzed using linear mixed-effects models adjusted for baseline BMD, age, baseline severe vertebral fractures, and glucocorticoid exposure. Bone turnover markers (CTX, ALP, PTH) were analyzed with mixed-effects models adjusted for renal function. A total of 145 patients were included (mean age 70.9 years; 95.9
In a 1-year longitudinal study of 34 patients with stage 3 CKD and stable bone turnover markers there was no deterioration of bony quality. However, HR-pQCT identified impaired bone density in 73.5
Fall-related vertebral fractures increased substantially in Ecuador from 1990–2021, with rising incidence and disability beyond population aging. Improved detection and secondary prevention are essential. Vertebral fractures are a major complication of bone fragility and a leading cause of chronic pain and disability in aging populations. Long-term national data are essential for guiding prevention efforts and healthcare system planning. To describe trends in the incidence and prevalence of fall-related vertebral fractures, as well as years lived with disability (YLDs), of fall-related vertebral fractures among adults aged ≥ 50 years in Ecuador between 1990 and 2021 by using estimates from the Global Burden of Disease 2021 study. An ecological time-series analysis was conducted using modeled epidemiological estimates from the Global Burden of Disease (GBD) 2021 study. The incidence, prevalence, and YLDs were evaluated as absolute numbers and age-standardized rates (ASRs) per 100,000 population, stratified by sex and age. Temporal trends were assessed using Joinpoint regression to estimate annual percentage change (APC) and average annual percentage change (AAPC). Between 1990 and 2021, the age-standardized incidence, prevalence, and YLD rates of fall-related vertebral fractures among adults aged ≥ 50 years increased from 65.8 to 97.4, 28.9 to 43.9, and 3.03 to 4.59 per 100,000, respectively. The absolute number of cases more than quadrupled. Men consistently showed higher ASRs, whereas women demonstrated sustained growth across all indicators. Disability was unevenly distributed among adults aged ≥ 70 years, especially those aged ≥ 80 years. Joinpoint analyses revealed early increases followed by stabilization in men and continuous upward trends in women. The incidence and disability rates of fall-related vertebral fractures in Ecuador have increased substantially over the past three decades, beyond demographic aging alone. Given the growing burden on older adults, fracture detection, secondary prevention, and integrated strategies for osteoporosis management need to be improved.
Low bone mineral density contributes to fractures and injury-related disability. Using Global Burden of Disease 2023 estimates for Mexico (1990–2023), we found rising total burden but declining age-standardised rates, with disability becoming increasingly important and a recent uptick in non-fatal outcomes. Strengthening fracture prevention is needed in ageing populations. Low bone mineral density (LBMD) is a modifiable risk factor for fractures and other injury-related outcomes; however, contemporary national estimates for Mexico remain limited, constraining policy planning and prevention priorities. We conducted a secondary analysis of Mexico-specific Global Burden of Disease (GBD) 2023 estimates obtained from the IHME GBD Results Platform for adults aged ≥ 40 years from 1990 to 2023. We summarised all-age counts and age-standardised rates (ASRs) per 100,000 for deaths, disability-adjusted life years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs). Population exposure to LBMD was assessed using the summary exposure value (SEV). Temporal trends were evaluated using joinpoint regression, reporting annual percentage change (APC) and average APC (AAPC) with 95
Chronic kidney disease–associated osteoporosis (CKD-OP) is a highly prevalent—yet frequently underrecognized—condition in patients with advanced CKD. The assessment of bone turnover, mineralization, and volume remains challenging in clinical practice, often requiring bone histomorphometric analysis. Using data from the Brazilian Registry of Bone Biopsies (REBRABO), we identified clinical characteristics associated with these histomorphometric parameters. These findings may help clinicians better characterize the underlying bone phenotype and support a more individualized approach to the diagnosis and management of CKD-associated osteoporosis. Chronic kidney disease–associated osteoporosis (CKD-OP) is characterized by impaired bone quality, and management of bone fragility in CKD partially relies on evaluating bone turnover (T), mineralization (M), and volume (V), through bone biopsy. However, bone biopsy data from large population-based cohorts are limited, making it challenging to identify clinical parameters that are associated with TMV patterns. This cross-sectional study is based on data from the Brazilian Registry of Bone Biopsy (REBRABO) and includes 374 iliac crest bone biopsies from adult patients with CKD5D (median age 51 y), collected between August/15 and December/21. Each biopsy was classified according to bone turnover (low/normal vs. high), mineralization (normal vs. abnormal), and trabecular volume (normal vs. low). Demographic and laboratory parameters were also analyzed. No significant differences in TMV classification were observed based on ethnicity, sex, or diabetes status. Higher turnover was independently associated with younger age, hemodialysis modality, elevated parathyroid hormone (PTH), and alkaline phosphatase (ALP) levels, in a model adjusted for dialysis vintage, prior parathyroidectomy (PTX), and phosphate. Abnormal mineralization was independently associated with age, prior PTX, and lower serum calcium and phosphate, after adjustment for body mass index (BMI), PTH, and ALP. Low trabecular volume was independently associated with older age and lower BMI, in a model adjusted for PTH and history of fractures, and cannot be reliably inferred from biochemical markers. Notably, most patients with adynamic bone also presented with low trabecular volume. Our findings suggest that younger patients undergoing hemodialysis with elevated PTH and ALP levels may benefit from a more intensive approach to the management of hyperparathyroidism. In contrast, older and more frail patients with relatively low PTH levels may be more likely to exhibit low bone volume and turnover and could potentially benefit from therapies aimed at stimulating bone formation, such as anabolic agents.
Osteoporosis treatment does not normalize BMD. We hypothesized cyclic romosozumab dosing might provide greater BMD increases. Cyclic therapy (six romosozumab monthly doses then one denosumab dose) produced broadly similar BMD increases as previously reported for 12 romosozumab doses. A second cycle further increased spine and hip BMD but with a blunted response. Evaluating novel osteoporosis medication approaches to maximize BMD is reasonable. A bone remodeling-based cyclic approach, i.e., activate, depress, free and repeat (ADFR), has been proposed. We hypothesized that short course romosozumab followed by denosumab represents an appropriate cycle. This exploratory retrospective case series reports six months of romosozumab treatment then one denosumab dose, followed by a second identical cycle. Women at very high fracture risk were offered cyclic therapy. DXA was obtained at baseline, 1 and 2 years. Data from 41 women treated for 1, and 18 for 2 years are reported. Percent BMD change from baseline was evaluated by ANOVA. Patient mean (SD) age and BMI were 68.8 (6.6) years and 25.6 (5.0) kg/m2 respectively. Mean total hip T-score was -2.5, FRAX estimated hip fracture risk was 6.9
Biologic treatments demonstrate long-term clinical benefits for patients with osteoporosis, but their cost is prohibitive, and access can be limited, particularly in low-income countries. This analysis determined the cost impact of introducing biosimilar denosumab for the treatment of osteoporosis in Malaysia and Thailand. A budget impact model was developed to compare the cost of treating female patients aged ≥ 50 years with osteoporosis with biosimilar versus reference denosumab (60 mg/mL every 6 months) from a healthcare payer perspective in Malaysia and Thailand over 5-years. Model inputs included previously published, country-specific prevalence, incidence, mortality, and treatment data, supplemented by expert clinical advice where evidence was limited. Drug acquisition cost was assumed to cost 25
A national reimbursement scheme aimed to enhance secondary fracture prevention after hip fracture. Although prevention processes improved substantially, early secondary fracture incidence did not clearly decline. Differential effects by hospital payment system suggest that financial incentives alone may be insufficient and that organizational readiness and care pathways may influence impact. In 2022, Japan introduced a reimbursement scheme to promote secondary fracture prevention (SFP) after hip fracture. We examined whether this implementation was associated with a reduction in secondary major osteoporotic fractures within 6 months after hip fracture surgery at the national level. We conducted a nationwide interrupted time series analysis including adults aged 60 years or older who underwent surgery for hip fracture between April 2017 and February 2023. The primary outcome was the monthly estimated 6-month cumulative incidence of secondary major osteoporotic fractures. Process measures included osteoporosis assessment, initiation of guideline-recommended osteoporosis medication, and receipt of both during the index hospitalization. Effect modification by hospital payment system (Diagnosis Procedure Combination [DPC] versus non-DPC) was examined. Among 127,676 patients, the introduction of the SFP management fee was associated with substantial immediate and sustained increases in osteoporosis assessment and medication initiation during the index hospitalization. However, no clear immediate change or change in trend in the 6-month cumulative incidence of secondary fractures was observed at the national level. In contrast, a greater post-introduction decline in secondary fracture incidence was observed in DPC hospitals compared with non-DPC hospitals. Although the SFP reimbursement scheme improved in-hospital SFP processes after hip fracture, it was not associated with a clear national-level reduction in secondary fractures within 6 months. Differences by hospital characteristics suggest that organizational capacity and established care pathways may influence how reimbursement incentives translate into clinical benefit.
BMD loss is common after denosumab discontinuation, and longer treatment is associated with greater BMD loss. Serum crosslaps (sCTX) can predict BMD loss at the lumbar spine after discontinuation. Keeping sCTX below the lower half of the ULN during the first year is needed to avoid BMD loss at 2 years. After denosumab discontinuation (DD), elevated serum crosslaps (sCTX) is associated with bone mineral density (BMD) loss over 2 years. Bisphosphonates reduce but do not always prevent this loss. To define an sCTX threshold below which BMD is maintained after DD. Postmenopausal women receiving ≥ 2 denosumab doses and followed ≥ 2 years after DD with regular BMD and sCTX measurements were included retrospectively. Linear regression analysis and ROC curves were performed to define sCTX threshold (
Pharmacist-led interventions significantly improved denosumab adherence in patients with osteoporosis at an academic medical center, reducing non-adherence from 20.8 to 4.9
Weight-bearing exercise intensity in older Nigerian women with osteoporosis was mainly determined by age, not sociodemographic factors. Higher intensity was associated with better physiotherapy outcomes, highlighting the need for age-targeted rehabilitation strategies to improve bone health outcomes. This study examined the association between weight-bearing exercise intensity and physiotherapy outcomes and identified associated factors of high-intensity exercise among older Nigerian women with osteoporosis. A multicenter cross-sectional study was conducted in 18 physiotherapy clinics across Nigeria (April 2025–March 2026). Women aged ≥ 50 years with clinically confirmed osteoporosis (n = 447) were recruited using multistage sampling. Data were collected using a structured interviewer-administered questionnaire (WBI-OQ) incorporating validated physical activity instruments (BPAQ, IPAQ). The primary outcome was physiotherapy satisfaction (satisfied vs dissatisfied). The exposure variable was weight-bearing exercise intensity (high vs low). Sociodemographic and clinical variables were assessed as covariates. Associations were tested using chi-square analysis and binary logistic regression (p < 0.05). Mean age was 58.7 years; 57.1
This study determined the proportions of fall-related and insufficiency-related vertebral fractures among 325 older hospitalized patients. The fracture etiology was determined by a comprehensive interview focusing on the circumstances at the onset of fracture-related pain. Falls were a markedly more frequent cause of vertebral fractures than insufficiency. The majority of vertebral fractures in older adults occur either as insufficiency fracture or as a consequence of a fall. The objective of this study was to determine the proportions of fall-related and insufficiency-related fractures among patients hospitalized with clinically symptomatic vertebral fractures. This cross-sectional study included 325 hospitalized patients aged ≥ 65 years with vertebral fractures from three hospitals. The fracture etiology (fall-related vs. insufficiency-related) was determined using a comprehensive clinical interview that focused on the circumstances surrounding the initial onset of fracture-related pain. The proportion of these two etiologies was analyzed for all fractures, across different fracture locations, and within various strata of personal and functional parameters. The mean age was 83 ± 6 years and 73
Vertebral fragility fractures (VFFs) are underdiagnosed despite increasing future fracture risk. In 307 hip fragility fracture patients, 28.0
