Osteoporosis has seen a rapid rise in Taiwan due to its aging population. The pathogenesis of low bone mineral density (BMD) differs between women and men, highlighting the critical need to explore sex-specific biological predictor variables-an area with significant knowledge gaps. This study aimed to identify sex-specific predictors using a population database through machine learning. We conducted a retrospective cross-sectional study of 19,868 individuals aged 40 and above from the Taiwan Biobank database who had no cancer diagnosis and underwent BMD examinations between 2020 and 2022, with available demographic, laboratory, and physical examination data. The Extreme Gradient Boosting (XGBoost) model was employed to identify patterns of predictor variables for low BMD. SHapley Additive exPlanations (SHAP) were applied to visualize and interpret the contribution of each predictor to low BMD in women and men. Among participants, 63% (n = 12,565) were women and 44% had low BMD (35% osteopenia and 9% osteoporosis), with a mean age of 54 years (SD = 9.6; range 40-88). The area under the curve values were 0.75 for women and 0.63 for men. Age, postmenopausal status, and BMI were the most significant predictors of low BMD in women, whereas age, BMI, and waist circumference were the strongest predictors in men. In addition, hematological factors (WBC, RBC, platelet count, hemoglobin), metabolic indicators (body fat percentage, triglycerides, and blood pressure), uric acid, and liver (gamma-GT) and renal (eGFR) function markers were also associated with BMD. These predictors differed in their relative importance between women and men, highlighting clear sex-specific patterns in factors associated with low BMD. Recognizing these determinants is essential for prevention and early intervention strategies, while further research is needed to better understand the complex mechanisms underlying bone metabolism.
Background/Objectives:The objective of this study is to investigate the determinants of subsequent osteoporotic fractures (OPF) in elderly patients with Type 2 diabetes mellitus (T2DM) who have sustained an initial fracture and to construct and validate a multivariable predictive model for estimating individual recurrence risk. Methods:A total of 373 patients with OPF attributed to T2DM who received treatment at four public medical institutions in southwest China between June 2019 and July 2022 were included as the derivation cohort for model development. Demographic, lifestyle, and disease-related data were collected, and recurrent fracture outcomes were monitored. Model performance was evaluated using the optimism-corrected consistency index (C-index, 200 bootstrap resamples), time-dependent receiver operating characteristic (ROC) curves with area under the curve (AUC) (95% confidence interval [95% CI]; Heagerty method), calibration plots (deciles of predicted risk at 12, 24, and 36 months; slope and intercept), decision curve analysis (DCA), and a nomogram. Sensitivity analysis adjusting for hospital heterogeneity was performed. For external validation, an independent cohort of 140 patients from a different hospital (2023-2025) was used to assess model generalizability, based on the same key variables and follow-up outcomes. Results:The final multivariable model identified several independent predictors of recurrent fracture in patients with OPF and T2DM, including gender, treatment, alcohol consumption, postdischarge medication duration, fall risk, calcitonin, alkaline phosphatase, and homocysteine. Internal validation yielded an optimism-corrected C-index of 0.792, with time-dependent AUC at 12, 24, and 36 months of 0.815 (95% CI 0.770-0.859), 0.869 (95% CI 0.829-0.910), and 0.941 (95% CI 0.891-0.990), respectively. Calibration slopes (intercepts) at the same time points were 0.9 (0.03), 1.0 (0.01), and 1.19 (-0.12), and DCA showed net benefit superior to the treat-all and treat-none strategies across clinically relevant thresholds. In external validation, the model achieved a C-index of 0.692 and time-dependent AUC of 0.701 (95% CI 0.603-0.799), 0.654 (95% CI 0.536-0.772), and 0.803 (95% CI 0.467-1.000) at 12, 24, and 36 months, respectively; calibration slopes (intercepts) were 0.5 (0.06), 0.75 (0.07), and 0.44 (0.56). DCA remained favorable across clinically relevant threshold probabilities. Sensitivity analysis adjusting for hospital heterogeneity confirmed model robustness. Conclusions:The final model incorporated key modifiable predictors, showing excellent internal performance and clinical utility. Although external validation revealed moderate discrimination with miscalibration, the model remained robust after adjusting for hospital heterogeneity. Recalibration is recommended for absolute risk prediction in different populations; nonetheless, it offers a clinically applicable and generalizable solution for risk stratification in elderly patients with T2DM and OPF.
Transient osteoporosis of the hip (TOH), regional migratory osteoporosis (RMO), and bone marrow edema syndrome (BMES) are increasingly recognized as manifestations of the same underlying condition. Hallmark features include joint pain, bone marrow edema on MRI, and localized demineralization. However, densitometry data in this context are fragmented and difficult to interpret. This study screened 561 publications and identified 188 patients with quantifiable bone mineral density (BMD) data-Z-, T-scores (for patients under 50), or raw values-obtained during active disease and unaffected by treatment. Mixed-effects modeling and linear regression showed significant BMD reductions in symptomatic hips: marginal mean Z/T-scores of -2.12 (95% CI -2.4 to -1.88, n = 48). In pairwise analyses, symptomatic hips had lower BMD than asymptomatic hips: marginal mean Z/T-score difference -1.2 (95% CI -1.7 to -0.8, n = 16) and raw score difference of -0.173 g/cm2 (21% lower; 95% CI -0.214 to -0.132, n = 19). Despite few reports of back pain, spine BMD was also reduced: mean Z/T-score of -1.83 (95% CI -2.1 to -1.6, n = 65). Among perinatal women, spine BMD reached -2.2 (95% CI -2.6 to -1.8, n = 22). No BMD differences emerged between osteoporosis- and edema-related terminology groups, supporting a shared disease mechanism.
Objective:To analyze temporal trends, regional disparities, and the economic impact of in-hospital mortality due to femoral fractures among older adults in Brazil between 2008 and 2024. Methods:This ecological study was based on data from the Hospital Information System of the Brazilian Unified Health System (SIH/SUS). In-hospital mortality rates were calculated per 100,000 inhabitants and stratified by age groups (60-64, 65-69, 70-74, 75-79, and ≥ 80 years) and geographic regions. Temporal trends were assessed using simple linear regression. Results:During the study period, 45,405 deaths due to femoral fractures among older adults were recorded during the first hospital admission. The national in-hospital mortality rate increased from 0.87 per 100,000 inhabitants in 2008 to 1.10 per 100,000 inhabitants in 2024. The ≥ 80-year age group exhibited the highest mortality rates (mean: 60.7 ± 8.69), whereas the 60- to 64-year group showed the lowest values (0.59 ± 0.36). The Southeast and South regions presented the highest age-adjusted mortality rates, with marked regional heterogeneity and wider confidence intervals observed in the North and Northeast regions. A sustained upward trend in mortality was identified, particularly among the oldest-old population, concomitant with a substantial increase in hospital-related costs. Conclusion:In-hospital mortality due to femoral fractures among older adults in Brazil demonstrates a rising trend, significant regional inequalities, and a considerable economic burden. These findings suggest that, in the context of rapid population aging, Brazil remains insufficiently prepared to address the growing epidemic of femoral fractures, underscoring the need for integrated public health policies, structured care pathways, and multidisciplinary protocols focused on geriatric trauma care.
Introduction:Intervertebral bridging ossification (IBO) occasionally occurs after balloon kyphoplasty (BKP) for osteoporotic vertebral fractures (OVFs), contributing to stabilization. However, the predisposing factors remain unclear. This study aimed to identify preoperative factors associated with IBO formation. Methods:This was a retrospective cohort study of patients who underwent BKP for OVFs. Radiological evaluations included the location of the fractured vertebra, number of preexisting vertebral fractures, endplate damage, intervertebral disc injury, presence of diffuse idiopathic skeletal hyperostosis, lateral wedge angle and regional kyphosis angle, and were assessed using radiography, computed tomography and magnetic resonance imaging (MRI). Clinical outcomes were evaluated via the visual analogue scale (VAS) and Oswestry Disability Index (ODI) preoperatively and at 1 month and 1 year postoperatively. Results:Patients with IBO showed higher rates of thoracolumbar junction fractures (T11-L1) (p < 0.001), more preexisting vertebral fractures (p < 0.001), proximal endplate injury (p < 0.001), increased T2-weighted signal intensity of the adjacent intervertebral disc (p = 0.015) and larger lateral wedge angles in supine (p = 0.008) and sitting positions (p = 0.001). At 1 month, VAS scores were higher in the IBO group (4.2 ± 1.8 vs. 2.6 ± 2.0, p = 0.001). Multiple regression analysis revealed preexisting vertebral fractures (p < 0.001) and proximal endplate injury (p = 0.002) as independent predictors of IBO formation. VAS scores at 1 month postoperatively were worse in the IBO group (p = 0.001), but no significant differences were observed at 1 year. Conclusion:Preexisting vertebral fractures and proximal endplate injury are key predictors of IBO formation after BKP. Although associated with higher short-term pain, IBO appears to contribute to long-term stabilization and pain relief, providing insights into postoperative outcomes and treatment strategies.
Background: Bone mineral density (BMD) is a quantitative measurement of the amount of inorganic minerals which are present in a particular volume of bone. Variations in BMD are dependent on a variety of factors including age, sex, race, family history, age at menarche and menopause, and the presence of any other health conditions. This study aims to determine the association between categories of BMD among individuals referred to the department of radiodiagnosis for dual-energy x-ray absorptiometry (DEXA) scan and associated clinico-epidemiological factors. Methods: A record-based cross-sectional study was used to collect the data of 335 individuals who presented to the department of radiodiagnosis at Thumbay University Hospital, Ajman, UAE., for DEXA scan from 2015 to 2022. SPSS Version 28 was used for analysis. Inferential statistics like chi-square was performed to establish the association between variables, and a p-value less than or equal to 0.05 was taken to be statistically significant. Results: Among 335 individuals, 64.8% were females and 35.2% were males. Majority of the participants belonged to the 40-59 age group at 54.3%, were of African origin at 53.7%, and were classified as overweight/obese at 86.3%. The left hip T score was statistically significant with geographical origin (p < 0.001) and menopausal status (p < 0.01) as well as a history of disc disorders (p = 0.05). The spine T score was statistically significant in terms of its association with age (p = 0.04), geographical origin (p < 0.001), and menopausal status (p < 0.001). The combination T score taken based on both spine and hip T scores was found to be statistically significant in terms of association with sex (p = 0.05), age (p < 0.001), geographical origin (p < 0.001), and body mass index (p = 0.003). Conclusion: Our study, aimed at determining the association between different categories of BMD and clinicoepidemiological factors of the participants, found that increasing age, underweight/normal weight category, being male, and belonging to the African region were significantly associated with the combination T scores.
Objective:To assess the effectiveness of intercostal nerve block (INB) for treating osteoporotic vertebral compression fractures (OVCFs) with associated costal pain. Methods:We reviewed clinical data from patients with thoracic OVCF and costal pain admitted to our hospital between January 2021 and January 2024. Patients were divided into an observation group, receiving percutaneous vertebroplasty (PVP) and INB, and a control group, receiving PVP alone. Baseline data, intraoperative parameters, deformity improvement (anterior vertebral body height [AVH] and local Cobb angle), and clinical symptom improvement (visual analog scale [VAS] scores for back and costal pain) were compared between the groups. Risk factors for residual costal pain within the control group were analyzed using multivariable logistic regression, and receiver operating characteristic (ROC) curves were constructed to determine threshold values for the identified risk factors. Results:The study included 305 patients, 150 in the observation group and 155 in the control group. The groups were statistically comparable in baseline data. Compared with the control group, the observation group had a longer operative time (40.7 ± 5.5 vs. 32.4 ± 3.8 min, p < 0.001) and required more intraoperative C-arm fluoroscopies (30.4 ± 6.3 vs. 21.5 ± 3.9, p = 0.034). Intraoperative bleeding was similar between groups. Both groups showed similarly significant improvements in AVH, local Cobb angle, and thoracic back pain VAS scores one day postoperatively and at the final follow-up. The respective costal pain VAS scores in the control and observation groups were as follows: preoperatively, 7 (6, 8) and 7 (6, 7); one day postoperatively, 4 (2, 5) and 2 (1, 2); and at the final follow-up, 1 (1, 2) and 1 (0, 2). Univariate analysis within the control group identified disease duration, fractured vertebral body width, reduced intervertebral foramen area, and cortical breakdown of the vertebral body's posterior wall as risk factors for residual costal pain. Multivariable analysis confirmed disease duration as an independent risk factor for residual costal pain, with an area under the curve of 0.863. The threshold for self-resolution of costal pain was established at 15.5 days, with a sensitivity of 93.9% and a specificity of 70.0%. Costal pain relief was strongly correlated with disease duration (r = 0.518, p < 0.001). Conclusions:OVCF-related costal pain can be effectively alleviated by PVP combined with INB; however, INB lengthens operative time and increases radiation exposure. PVP alone can relieve costal pain in patients with a disease duration of ≤ 15.5 days; otherwise, concomitant INB is recommended.
Bone disorders can have a devastating impact on an individual’s quality of life. The main objective of our study was to analyze various demographic disparities between various bone disorders in the demographically unique Rio Grande Valley region. We hypothesized that osteoporosis would be the most prevalent condition and that the demographics between the various conditions would vary depending on age, sex, BMI, and ethnicity but not on marital status. This was a retrospective chart review using the University of Texas Rio Grande Valley UTHealth electronic database from January 1, 2017, to January 1, 2024. Any relevant individuals seen at a UTRGV affiliated institution were included. We analyzed medical charts, via ICD‐10 codes, of individuals who were diagnosed with osteoporosis, osteomalacia, rickets, Paget bone disease, and osteonecrosis. Bivariate and binary logistic regression analyses were performed to analyze the data. Hispanic ethnicity showed a decreased risk of bone disorder (estimate = −0.2814), bordering on significance ( p = 0.053). Female participants had significantly higher odds of bone disorder (estimate = 0.7861, p < 0.001). Obese individuals (estimate = −0.7837, p < 0.001) and overweight individuals had lower odds (estimate = −0.3328, p = 0.047) of bone disorder. Underweight individuals showed higher odds of bone disorder (estimate = 0.9605, p = 0.002). The odds of bone disorder increased with age (estimate = 0.0581, p < 0.001). Our results increase the knowledge of orthopedics in this region, and specifically, the bone disorders are discussed. The results may also allow physicians to better identify at‐risk individuals in this community and others alike to improve the management of bone disorders. This study warrants further research on at‐risk demographics to further improve the orthopedic knowledge and care of medically underserved individuals.
Introduction: This study assessed patient demographic factors associated with nonattendance for osteoporosis evaluation after being referred to our Bone Health Clinic (BHC), a hospital-based outpatient Fracture Liaison Service (FLS), for a fragility fracture. Methods: 507 patients sustaining a fragility fracture were referred to the BHC over a 39-month period. Retrospective chart review was conducted to capture osteoporosis evaluation attendance rates and demographic factors (age, gender, race, area deprivation index, insurance type, and fracture type). A post-fracture follow-up visit with either the BHC or another provider in which osteoporosis was noted in the assessment was considered attendance for osteoporosis evaluation. Nonattendance was determined at a cutoff of one year after the fracture date. Results: Of the 507 patients referred to the BHC following a fragility fracture, 177 patients attended osteoporosis evaluation with either the BHC or a primary care provider. Nonattendance was associated with older age (p=0.0075), having private health insurance (p=0.0434), and recent hip fracture (p < 0.0001). Attendance was associated with having government health insurance (p=0.0103). Conclusion: Inpatient evaluation and treatment for osteoporosis should be considered in patients who are older or have sustained a hip fracture as they may have more difficulty attending post-fracture appointments.
Osteoporosis treatment plays a crucial role in preventing fractures, particularly in bedridden patients. We conducted a questionnaire survey presenting hypothetical clinical cases in 2015 and 2020 to investigate trends over a 5-year period. The target population included physicians working in clinics and hospitals within our neighbourhood. The cases were presented, and the questionnaire was administered in a confidential format. The orthopaedic surgeons were matched for age and practice, resulting in 74 cases being included in the analysis. Comparing the 2015 and 2020 results, we observed a notable increase in physicians who would perform “bone mineral density measurements of the lumbar spine and hip.” Furthermore, there was a significant rise in the percentage of respondents willing to test for bone metabolic markers, such as serum type I collagen cross-linked N-telopeptide (NTX), procollagen I N-terminal propeptide (P1NP), and tartrate-resistant acid phosphatase 5b (TRACP-5b). Regarding therapeutic agents, bisphosphonates decreased in usage, whereas parathyroid hormone and romosozumab witnessed an increase. In conclusion, the percentage of physicians requesting bone mineral density measurements of the lumbar spine and hip increased over the five-year period. In addition, more physicians chose to utilise bone metabolic markers due to their ease of measurement through blood tests and reduced diurnal variation. Finally, there was a marked trend towards the administration of drugs capable of rapidly and effectively increasing bone mineral density at an early stage of treatment.
Rationale. Although romosozumab is one of the most effective treatments for osteoporosis by increasing bone mineral density in the lumbar spine and femur and recommended for denosumab as switch therapy, these effects regarding its prior treatment have not yet been evaluated clearly. This study focused on the effects of switch therapy from romosozumab to denosumab in regard to prior treatment of osteoporosis including bone mineral density and bone turnover marker and other related factors. Patient Concerns. 15 osteoporotic patients were assigned to the naïve group, 15 were assigned to the teriparatide group, and 10 were assigned to the bisphosphonate group. Interventions. Patients who were treated as outpatients for osteoporosis with romosozumab for 1 year and switched to denosumab between 2020 and 2022 at our hospital were examined. Our hospital registry included 40 osteoporotic patients who were over 65 years of age with bone mineral density (bone mineral density): T score <−2.5 standard deviations (SDs) and fracture assessment tool (FRAX) score >20%. Outcomes. The naïve group had the highest increase in LS BMD among these three groups during switch therapy from romosozumab to denosumab, while there were no significant differences about adverse drug events and serum Ca concentration among them. There was no incidence of fracture. Conclusion. These findings indicate that the effects of osteoporotic treatment of switch therapy from romosozumab to denosumab were likely to affect prior treatment of osteoporosis.
Background. Osteoporosis is a preventable disease that is simple and cost-effective to screen based on clinical practice guidelines, yet many patients go undiagnosed and untreated leading to increased burden of the disease. Specifically, racial and ethnic minorities have lower rates of dual energy absorptiometry (DXA) screening. Inadequate screening may lead to an increased risk of fracture, higher health care costs, and increased morbidity and mortality disproportionately experienced by racial-ethnic minority populations. Purpose. This systematic review assessed and summarized the racial and ethnic disparities that exist for osteoporosis screening by DXA. Methods. Using terms related to osteoporosis, racial and ethnic minorities, and DXA, an electronic search of databases was performed in SCOPUS, CINAHL, and PubMed. Articles were screened using predefined inclusion and exclusion criteria which dictated the final articles used in the review. Full text articles that were selected for inclusion underwent quality appraisal and data extraction. Once extracted, data from the articles were combined at an aggregate level. Results. The search identified 412 articles. After screening, a total of 16 studies were included in the final review. The overall quality of the studies included was high. Of the 16 articles reviewed, 14 identified significant disparities between racial minority and majority groups and determined that the eligible patients in racial minority groups were less likely to be referred to DXA screening. Conclusion. There is a significant disparity in osteoporosis screening among racial and ethnic minorities. Future efforts should focus on addressing these inconsistencies in screening and removing bias from the healthcare system. Additional research is required to determine the consequence of this discrepancy in screening and methods of equitizing osteoporosis care.
Aging leads to several geriatric conditions including osteoporosis (OP) and associated frailty syndrome. Treatments for these conditions are limited and none target fundamental drivers of pathology, and thus identifying strategies to delay progressive loss of tissue homeostasis and functional reserve will significantly improve quality of life in elderly individuals. A fundamental property of aging is the accumulation of senescent cells. Senescence is a cell state defined by loss of proliferative capacity, resistance to apoptosis, and the release of a proinflammatory and anti-regenerative senescence-associated secretory phenotype (SASP). The accumulation of senescent cells and SASP factors is thought to significantly contribute to systemic aging. Senolytics—compounds which selectively target and kill senescent cells—have been characterized to target and inhibit anti-apoptotic pathways that are upregulated during senescence, which can elicit apoptosis in senescent cells and relieve SASP production. Senescent cells have been linked to several age-related pathologies including bone density loss and osteoarthritis in mice. Previous studies in murine models of OP have demonstrated that targeting senescent cells pharmacologically with senolytic drugs can reduce symptomology of the disease. Here, we demonstrate the efficacy of senolytic drugs (dasatinib, quercetin, and fisetin) to improve age-associated degeneration in bone using the Zmpste24−/− (Z24−/−) progeria murine system for Hutchinson–Gilford progeria syndrome (HGPS). We found that the combination of dasatinib plus quercetin could not significantly mitigate trabecular bone loss although fisetin administration could reduce bone density loss in the accelerated aging Z24−/− model. Furthermore, the overt bone density loss observed in the Z24−/− model reported herein highlights the Z24 model as a translational model to recapitulate alterations in bone density associated with advanced age. Consistent with the “geroscience hypothesis,” these data demonstrate the utility of targeting a fundamental driver of systemic aging (senescent cell accumulation) to alleviate a common condition with age, bone deterioration.
Purpose. This pilot study aimed to explore the feasibility of scanning the human distal radius bone marrow in vivo to detect osteoporosis-related changes using magnetic resonance and evaluate whether the radius may serve as an accessible probing site for osteoporosis. This may lead in the future to the use of affordable means such as low-field MRI scanners for the monitoring of disease progression. Methods. A clinical trial was performed using a 3T MR scanner, including 26 women assigned into three study groups: healthy-premenopausal (n = 7; mean age 48.6 ± 3.5 years), healthy-postmenopausal (n = 10; mean age 54.5 ± 5.6 years), and osteoporotic-postmenopausal (n = 9; mean age 61.3 ± 5.6 years). Marrow fat composition was evaluated using T2 maps, a two-compartment model of T1, and a Dixon pulse sequence. Results. The osteoporotic group exhibited higher fat content than the other two groups and lower T2 values than the healthy-premenopausal group. Conclusions. Osteoporosis-related changes in the composition of the distal radius bone marrow may be detected in vivo using MRI protocols. The scanning protocols chosen here can later be repeated using low-field MRI scanners, thus offering the potential for early detection and treatment monitoring, using an accessible, affordable means that may be applied in small clinics. This trial is registered with MOH_2018-05-23_002247, NCT03742362.
Gaucher disease is a rare, genetic lysosomal disorder leading to lipid accumulation and dysfunctions in multiple organs. Bone involvement is one of the most prevalent aspects of Gaucher disease. Pain, disability, and reduced quality of life remain the most frequent characteristics of bone involvement in Gaucher patients. Patients and Method. In this study, we will take into consideration data from 24 patients diagnosed with type 1 Gaucher disease. We followed them closely for six years in progress. At baseline, all patients started therapy with taliglucerase alfa at a mean dosage of 45 UI/kg; later, during the study, two of them switched their cure toward velaglucerase alfa. Before baseline evaluations, 12 patients had been treated with imiglucerase at variable duration times. At baseline, we performed an X-ray of long bones and the spine, and each year, different standard assessments were performed, such as bone pain, MRI of the vertebral spine and pelvis, and DEXA for bone density. Four patients left the study for various reasons, two of them at baseline and two others during year 3 (FU3). Results. At baseline, we had 8 children and 16 adults. The average age was 28.7 ± 16.5 SD years. The most frequent skeletal manifestations in our patients were reduction of tibial femoral space (40%), osteonecrosis (36%), and body vertebral reduction (32%). At baseline, 15 patients presented with bone pain to different degrees. Over the years, bone pain in our patients had a gradual improvement. The most dramatic bone pain improvement was seen in a patient who presented bone crises. Another impressive finding was a significant BMD improvement during six years of treatment. Our study showed a significant improvement in BMD comparing FU5 and baseline values (p = 0.0007). Especially children demonstrated a significant improvement in BMD (p = 0.00061) compared to adults (p = 0.3673). Mean BMD change was more indicative in switched patients (p = 0.0142) compared to naïve patients (p = 0.147). Conclusions. Skeletal manifestations are very different in Gaucher type 1 patients. In our study, as a result of long-term evaluations, it was noticed that the most frequent skeletal manifestation was a reduction of tibiofemoral space. Bone pain has gradually improved in all patients. Also, BMD values have been enhanced over six years of treatment, especially in children.
Exercise is a recognized component in the prevention and therapy of osteoporosis. The present systematic review and meta-analysis aimed to determine the effect of Vitamin D (Vit-D) added to exercise versus exercise alone on bone mineral density (BMD) at the lumbar spine (LS) or hip in older adults. A systematic review based on six literature databases according to PRISMA included (a) exercise trials, with an exercise (EX) and a combined exercise + Vit-D group (EX + Vit-D), (b) intervention ≥ 6 months, and (c) BMD assessments at LS or hip. Effects sizes (MD) and 95%-confidence intervals (95%-CI) were calculated using a random-effect model that includes the inverse heterogeneity model (IVhet). Five studies with 281 participants in the EX and 279 participants in the EX + Vit-D were included. No significant differences between EX versus EX + Vit-D were observed for BMD-LS (MD: 0.002, 95%-CI: −0.033 to 0.036) or BMD-hip (MD: 0.003, 95%-CI: −0.035 to 0.042). Heterogeneity between the trial results was moderate-substantial for LS (I2 = 0%) and moderate for hip-BMD (I2 = 35%). The funnel plot analysis suggests evidence for a publication/small study bias for BMD-LS and hip results. In summary, this present systematic review and meta-analysis were unable to determine significant positive interaction of exercise and Vit-D on LS- or hip-BMD. We predominately attribute this finding to (1) the less bone-specific exercise protocols of at least two of the five studies and (2) the inclusion criteria of the studies that did not consequently focus on Vit-D deficiency. This issue should be addressed in more detail by adequately powered exercise trials with promising exercise protocols and participants with Vit-D deficiency. This trial is registered with the International Prospective Register of Systematic Reviews (PROSPERO) ID: CRD42022309813.
Background Type 4 osteoporotic fracture (OF4), according to the classification system of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU), is unstable and requires fixation as per the guidelines of the same group. We evaluated the use of stand-alone vertebral body augmentation (VBA) in pain control of OF4. Methods This is a single-centre, in two hospitals, comparative study to evaluate the effectiveness of percutaneous vertebroplasty (PVP) and kyphoplasty (KP) in pain control of OF4. OF4 patients treated with VBA were compared to a conservatively treated control group. The two groups of OF4 were then compared to similar cohort of OF2 and OF3 patients who were treated by either VBA or expectantly. Results A total of 78 cases were studied. VBA of OF4 showed a statistically significant better pain control than conservative treatment. The response of this group of fractures to VBA was similar to that of OF2 and 3. Conclusion VBA can provide satisfactory pain control for OF4 patients.
In previous study, we showed that nucleolar protein 66 (NO66) is a chromatin modifier and negatively regulates Osterix activity as well as mesenchymal progenitor differentiation. Genetic ablation of the NO66 (RIOX1) gene in cells of the Prx1-expressing mesenchymal lineage leads to acceleration of osteochondrogenic differentiation and a larger skeleton in adult mice, whereas mesenchyme-specific overexpression of NO66 inhibits osteochondrogenesis resulting in dwarfism and osteopenia. However, the impact of NO66 overexpression in cells of the osteoblast lineage in vivo remains largely undefined. Here, we generated osteoblast-specific transgenic mice overexpressing a FLAG-tagged NO66 transgene driven by the 2.3 kB alpha-1type I collagen (Col1a1) promoter. We found that overexpression of NO66 in cells of the osteoblast lineage did not cause overt defects in developmental bones but led to osteoporosis in the long bones of adult mice. This includes decreased bone volume (BV), bone volume density (bone volume/total volume, BV/TV), and bone mineral density (BMD) in cancellous compartment of long bones, along with the accumulation of fatty droplets in bone marrow. Ex vivo culture of the bone marrow mesenchymal stem/stromal cells (BMSCs) from adult Col1a1-NO66 transgenic mice showed an increase in adipogenesis and a decrease in osteogenesis. Taken together, these data demonstrate a crucial role for NO66 in adult bone formation and homeostasis. Our Col1a1-NO66 transgenic mice provide a novel animal model for the mechanistic and therapeutic study of NO66 in osteoporosis.
Objectives. Both diabetes mellitus (DM) and osteoporosis are very common in older adults who reside in long-term care (LTC) facilities. Nevertheless, few studies have examined the relationship between diabetes and bone quality in this population. The purpose of this study is to determine if bone mineral density (BMD) or trabecular bone score (TBS) is a better measure of bone quality and skeletal health, in LTC residents with and without a history of DM. Methodology. In this longitudinal cohort study, we examined baseline BMD (lumbar spine, total hip, and femoral neck), TBS, DM, and functional status in 511 LTC residents who were enrolled in two ongoing randomized placebo-controlled osteoporosis clinical trials. Results. On average, participants were older than 80 years and majority were prefrail or frail. Women with DM had greater lumbar spine BMD (1.106 vs 1.017, adjusted difference ± standard error = 0.084 ± 0.023 g/cm2, p=0.0003) and femoral neck BMD (0.695 vs 0.651, 0.027 ± 0.013 g/cm2, p=0.0463), but lesser lumbar spine TBS (1.211 vs 1.266, −0.036 ± 0.016, p=0.0299) compared to women without DM. Total hip BMD was also higher based on descriptive statistics (0.780 vs 0.734, p=0.6255) in diabetic women, although the difference was not statistically significant. Men had similar but attenuated findings. Conclusions. Among LTC residents, those with DM have greater BMD but lower bone quality measured by TBS. TBS should be considered in assessing older patients with DM. However, further studies are required to confirm the findings with respect to fractures.
