This study assessed variation of automated CT-based L1 trabecular attenuation for opportunistic CT screening across multiple U.S.-based healthcare systems. L1 HU measurements demonstrated similar behavior among the five sites, including relative relationships according to age, sex, race, and CT scanner, and < 100 HU was generalizable for practical opportunistic CT screening and diagnosis. To assess variability of automated population-based L1 trabecular attenuation (HU) measurement at abdominal CT among five US-based medical systems and consider a practical 100 HU threshold for opportunistic CT-based osteoporosis screening and diagnosis. Heterogeneous adult patient cohorts undergoing abdominal CT evaluation for any indication at five US medical systems were included for L1 vertebral body trabecular attenuation (L1 HU) assessment using a validated AI pipeline that places a fully automated ROI. Exclusion criteria included IV contrast, non-120 kVp setting, and non-physiologic outliers. All results were normalized to White patient ranges after age and sex matching. Thresholds of 100 HU and 120 HU were considered. The final multi-center cohort included 123,001 adults (51.1
Among 606,449 adults aged 60–74 years, the claims-based frailty index categories predicted hospitalisation for hip fractures: beneficiaries classified as pre-frail or frail were at higher risk (hazard ratios, 2.17 and 3.50, respectively). The CFI can help identify individuals who can benefit from targeted interventions to prevent hip fractures. Although the claims-based frailty index (CFI) may aid early identification of older adults at high risk of hip fractures, little is known about the association between the CFI and the incidence of hip fractures. The aim of this study was to examine the association between the CFI and hospitalisation for hip fractures among adults aged 60–74 years in Tokyo, Japan. This retrospective cohort study used linked health checkup and medical claims data in Tokyo between April 2015 and March 2023. Beneficiaries of the National Health Insurance aged 60–74 years who underwent an annual health checkup between April 2017 and March 2018 were identified. Beneficiaries were followed up for hospitalisation for hip fractures through March 2023. Cox proportional hazards models, adjusted for Fracture Risk Assessment Tool (FRAX)-related variables, osteoporosis, and self-reported health status and habits, were used to examine the association between the CFI and hospitalisation for hip fractures. Harrell’s C-statistics were compared between models with and without the CFI to assess the CFI's discriminative ability. Among 606,449 beneficiaries, 553,747 (91.3
Denosumab is administered as a fixed 60-mg subcutaneous injection every 6 months, regardless of body weight. In a retrospective cohort of 2123 patients with osteoporosis, the GAM-predicted duration of CTX reduction after each injection was about two months shorter at 80 kg than at 40 kg, but still exceeded the 6-month interval across the evaluated weight range. These findings support body-weight-aware CTX monitoring in heavier patients, not a change to the approved dosing interval. Denosumab is administered as a fixed 60-mg subcutaneous injection every 6 months, but the duration of bone turnover reduction may vary with body weight. We investigated whether body weight affects the duration of bone turnover marker reduction and whether this association could inform body-weight-aware monitoring. We retrospectively analyzed data from 2123 adults with osteoporosis treated with denosumab between 2020 and 2025. Serial serum measurements of beta-isomerized C-terminal telopeptide of type I collagen (CTX) and total procollagen type I N-terminal propeptide (P1NP) were modeled using generalized additive models and random forests to estimate the time from injection until prespecified operational thresholds (CTX > 0.28 ng/mL; P1NP > 35 ng/mL) were crossed. Predicted threshold-crossing times were summarized by body weight. The cohort contributed 4257 CTX and 4477 P1NP measurements. For CTX, the generalized additive model predicted threshold-crossing times that decreased from 262 days (8.7 months; 95
The reporting rate of vertebral fractures (VFs) identified on routine thoracic and abdominal CT scans was evaluated. Only 14.7
Medication-related osteonecrosis of the jaw (MRONJ) is a challenging complication associated with antiresorptive and antiangiogenic therapies. Prolonged suppression of bone remodeling has been implicated as a key mechanism in its pathophysiology. Teriparatide, an osteoanabolic agent that restores coupled bone remodeling, has been proposed as a potential therapeutic strategy. This review aimed to synthesize reported clinical outcomes of teriparatide use in MRONJ within a systemic remodeling-based framework. We conducted a structured descriptive review based on a systematic literature search and reported in accordance with PRISMA 2020. Studies reporting therapeutic use of teriparatide in established MRONJ were included regardless of the triggering medication. Data were extracted on patient characteristics, MRONJ stage, lesion site, antiresorptive exposure, teriparatide regimen, antiresorptive interruption, antiresorptive type, and clinical outcomes. Because of substantial heterogeneity in study design, patient populations, co-interventions, and outcome reporting, evidence was synthesized qualitatively. Thirty-four publications including 207 patients were included. Clinical outcomes were available for 201 patients: complete coverage/healing was reported in 163, partial improvement in 24, no change in 12, and worsening in 2. Teriparatide discontinuation or dropout after treatment initiation was reported in 13 patients. Stage 2 disease predominated among stageable cases, mandibular involvement was the most frequent anatomical site, and daily teriparatide dosing was more commonly reported than weekly regimens. Bisphosphonate exposure predominated, whereas denosumab-associated cases were fewer; therefore, differential effectiveness by antiresorptive class could not be determined. Published reports describe frequent clinical improvement after teriparatide use in MRONJ. However, the evidence remains descriptive, heterogeneous, and commonly confounded by concomitant therapies. These findings support a biologically plausible remodeling-based interpretation but do not establish efficacy or define teriparatide as standard therapy.
Pelvic fractures result in prolonged pain and immobility. In a randomized controlled trial of patients with pelvic fracture, whether abaloparatide (ABL) vs. placebo (PBO) improves healing at 3 months was evaluated. There was no significant difference in CT radiologic healing, physical performance, or change in pain in ABL vs. placebo. To determine if abaloparatide (ABL) vs. placebo (PBO) improves radiologic healing, pain, and functional outcome at 3 months in patients with pelvic fracture. Postmenopausal women and men ≥ 50 years old, enrolled within 4 weeks of pelvic fracture (n = 48), were randomized to blinded ABL vs. PBO. The primary endpoint, fracture healing at 3 months, was assessed by two radiologists using a 5-point scale for cortical bridging from CT images comparing groups by Jonckheere-Terpstra test. The odds of healing (3 or 4 cortices bridged) were analyzed with Mantel–Haenszel relative risks (RR). Pain was assessed monthly by Numeric Rating Scale (NRS). The Short Physical Performance Battery (SPPB; walk speed, chair stands, and balance) evaluated functional mobility. Groups were balanced with a mean age = 82, 93
This systematic review and meta-analysis of nine randomized controlled trials assesses whether weighted vests enhance bone health and reduce body fat in middle-aged and older adults. Vest plus exercise significantly increased bone mineral density and reduced body fat compared to usual activity. Adding a vest to existing exercise provided additional fat reduction but no significant benefit to bone health. Weighted vests may improve bone health and body composition in middle-aged and older adults, but evidence is heterogeneous, and additive effects beyond exercise remain unclear. To evaluate the effects of weighted vest interventions on bone mineral density (BMD), bone turnover markers, and body fat mass in middle-aged and older adults, comparing vest plus exercise versus usual activity and versus exercise alone. We searched PubMed, Embase, Cochrane Library, Web of Science, and Scopus from inception to March 9, 2026, and supplemented with manual searches (PROSPERO: CRD420261335254). Meta-analyses used fixed-effect models where feasible; otherwise narrative synthesis. GRADE assessed certainty. Nine RCTs (368 participants) were included. Vest plus exercise significantly improved femoral neck BMD (SMD = 0.59, 95
This population-based cohort study investigated the associations of parity, age at first birth, and breastfeeding duration with risk of major osteoporotic fractures in Norwegian women. Higher parity, higher age at first birth, and longer breastfeeding duration were associated with modestly reduced fracture risk. Reproductive factors may influence long-term bone health, yet studies on their associations with fracture risk have yielded inconsistent results. This study examined associations between parity, age at first birth, and lifetime breastfeeding duration with risk of major osteoporotic fractures in Norwegian women. We included 41,274 women aged ≥ 45 years in the Trøndelag Health Study (HUNT) linked with the Medical Birth Registry of Norway and hospital-based fracture records. We used Cox proportional hazards regression to estimate hazard ratios (HRs) with 95
Among acute osteoporotic vertebral fractures with poor prognostic MRI findings, early balloon kyphoplasty did not improve 12-week pain compared with bracing after propensity score matching. However, kyphoplasty better preserved vertebral body height, suggesting that its main early benefit in this subgroup may be structural rather than analgesic. The optimal management for acute osteoporotic vertebral fractures (OVFs) with radiological signs suggesting a poor prognosis remains controversial. This study aimed to compare 12-week clinical and radiographic outcomes of early balloon kyphoplasty (BKP) versus brace treatment in acute OVFs with poor prognostic magnetic resonance imaging (MRI) findings. We compared a prospective BKP cohort (n = 82) with historical brace-treated controls (n = 62) from a prior randomized trial. Eligible patients were aged ≥ 65 years, had acute OVFs with fluid or diffuse low-intensity signal on T2-weighted MRI, and had back pain visual analog scale (VAS) scores ≥ 4/10. The primary outcome was 12-week back pain VAS; the secondary outcome was anterior vertebral body compression percentage (AVBCP). The primary analysis involved a direct comparison of these 12-week post-treatment measurements between the BKP and brace groups. One-to-one propensity score matching was performed using age, sex, and the anatomical location of the fracture (thoracic, thoracolumbar junction, or lumbar). Back pain improved significantly from baseline to 12 weeks within both the BKP group (from 73.6 ± 27.3 to 21.8 ± 19.5, p < 0.0001) and the brace group (from 74.9 ± 23.9 to 30.2 ± 23.3, p < 0.0001). In the crude analysis, BKP was associated with lower VAS scores (21.8 ± 19.5 vs. 30.2 ± 23.3, p = 0.047) and higher AVBCP (67.4 ± 12.3
AI-derived opportunistic screening using routine chest radiographs was evaluated in 6,028 adults and internally validated against DXA in a subset of participants. AI-derived T-scores identified marked age- and sex-associated skeletal differences, particularly among women aged 50–59 years, a population often underrepresented in current DXA-based screening strategies. Osteoporosis is associated with substantial fracture-related morbidity, yet many individuals with low bone mineral density (BMD) remain undetected during midlife, when routine dual-energy X-ray absorptiometry (DXA) is not commonly performed. We evaluated whether AI-derived opportunistic screening using routine chest radiographs could identify age-associated skeletal patterns and potential high-risk periods for osteoporosis evaluation. In this retrospective cross-sectional study, 6,028 adults aged ≥ 50 years underwent chest radiographs with AI-derived lumbar spine BMD estimation using a validated deep learning model. Participants were stratified by sex and 5-year age cohorts to assess age-associated differences in AI-derived T-scores and osteoporosis prevalence. In an internal validation subset (n = 446), AI-derived T-scores were compared with DXA measurements using correlation, diagnostic performance, and Bland–Altman agreement analyses. The mean AI-derived T-score was − 1.64 ± 1.08; women exhibited significantly lower T-scores than men (− 2.15 ± 0.97 vs. − 1.19 ± 0.96; P < 0.001). Lower mean T-scores and higher osteoporosis prevalence were observed with advancing age in both sexes. Osteoporosis prevalence increased from 10.3
Regional differences affect the reliability of the AO Spine-DGOU Osteoporotic Fracture Classification. European participants showed the highest agreement. This study underscores the need for addressing regional factors to improve the system’s global clinical utility. To evaluate the influence of geographic region on the reliability and reproducibility of the AO Spine-DGOU Osteoporotic Fracture Classification System. This study included 320 participants from various global regions who classified 27 cases of osteoporotic vertebral fractures using the AO Spine-DGOU system which categorizes the fractures to 5 subtypes (OF 1–OF 5). Participants underwent training via an online webinar. Interobserver reliability and intraobserver reproducibility were assessed using Fleiss’ kappa coefficient, and agreement with a gold standard committee was evaluated. The classification system showed moderate to substantial agreement with the gold standard globally (initial kappa 0.58, improving to 0.61). European participants had the highest agreement (kappa 0.64 and 0.66). OF4 fractures were most accurately classified, while OF3 fractures showed the least agreement. Intraobserver reliability was highest among European participants. Post hoc analysis indicated significantly better reliability among German-speaking participants compared to other Europeans (kappa 0.79 vs. 0.70, p = 0.0026). The AO Spine-DGOU Osteoporotic Fracture Classification System demonstrates moderate to substantial reliability and reproducibility, with regional differences influenced by factors such as training and clinical experience. This underlines the necessity of proper education adapted to the regional particularities.
Bone mineral density measures are not the sole determinant whether a patient suffers fragility fractures. We tested the hypothesis that changes in bone organic matrix quality indices strongly associate with Fx occurrence. Fx-suffering patients have altered quantitative and qualitative organic matrix attributes, offering new insights into the pathogenesis of Fx. Fragility fractures present a considerable socioeconomic burden. We tested the hypothesis that organic matrix attributes associate with fragility fracture occurrence independent of BMD. We used Raman microspectroscopy to analyze iliac crest biopsies from age- and BMD-matched postmenopausal women that either sustained (n = 60) fragility fractures or not (n = 60) in the cortical and cancellous compartments at specific tissue ages. The measured indices were mineral/matrix, mineral crystallinity, nanoporosity, glycosaminoglycan, and pyridinoline contents. Tissue-age unadjusted data were compared by 2-way ANOVA with anatomical compartment and fracture incidence as the two factors, while tissue-age-adjusted data by 2-way ANOVA with tissue age and patient group as the two factors. Tissue-age-unadjusted data indicated differences between anatomical compartments but no differences between the two patient groups. Tissue-age-adjusted data showed that the fracture-sustaining patients had higher mineral/matrix values in both compartments (in cortical, this was due to lower organic matrix content). At forming cortical surfaces, they had higher nanoporosity and lower pyridinoline content. They also had higher glycosaminoglycan content in the interstitial bone of the cancellous compartment. The results indicate that fracture-suffering patients have altered quantitative and qualitative organic matrix attributes. The elevated mineral/matrix in fracture-suffering patients may imply stiffer, thus of decreased toughness, bone, while the decreased pyridinoline content at cortical actively forming surfaces would decrease collagen fiber stiffness. The data of the present study offer new insight into the pathogenesis of fragility fractures. Fragility fractures present a considerable socioeconomic burden. We tested the hypothesis that organic matrix attributes associate with fragility fracture occurrence independent of BMD. We used Raman microspectroscopy to analyze iliac crest biopsies from age- and BMD-matched postmenopausal women that either sustained (n=60) fragility fractures or not (n=60) in the cortical and cancellous compartments at specific tissue ages. The measured indices were mineral/matrix, mineral crystallinity, nanoporosity, and glycosaminoglycan, and pyridinoline contents. Tissue-age unadjusted data were compared by 2way ANOVA with anatomical compartment and fracture incidence as the two factors, while tissue-age adjusted data by 2way ANOVA with tissue age and patient group as the two factors. Tissue-age-unadjusted data indicated differences between anatomical compartments but no differences between the two patient groups. Tissue-age-adjusted data showed that the fracture-sustaining patients had higher mineral / matrix values in both compartments (in cortical, this was due to lower organic matrix content). At forming cortical surfaces, they had higher nanoporosity and lower pyridinoline content. They also had higher glycosaminoglycan content in the interstitial bone of the cancellous compartment. The results indicate that fracture-suffering patients have altered quantitative and qualitative organic matrix attributes. The elevated mineral / matrix in fracture-suffering patients may imply stiffer, thus of decreased toughness, bone, while the decreased pyridinoline content at cortical actively forming surfaces would decrease collagen fiber stiffness.
Evidence on romosozumab use in very old adults managed in FLS remains limited. In this descriptive real-world cohort, patients receiving romosozumab had a higher baseline fracture risk phenotype than those receiving antiresorptive therapies, reflecting indication-based prescribing in routine care. Monthly romosozumab showed high 12-month scheduled-treatment completion, whereas completion was lower with daily administered teriparatide. These findings, although exploratory, support the use of romosozumab as a practical option for patients at very high risk. To describe baseline treatment-allocation profiles and 12-month scheduled-treatment completion among older adults initiating romosozumab and other osteoporosis therapies in routine fracture liaison service (FLS) care and to explore clinical, functional, laboratory, and densitometric trajectories over follow-up. Retrospective, single-center observational cohort study (Hospital Universitario de Navarra FLS, 2022–2024). Patients at imminent fracture risk (≥ 1 fragility fracture within 24 months before baseline) initiating romosozumab were identified; for each, one patient initiating denosumab, zoledronic acid, and teriparatide was selected by calendar time (same month ± 3 months). Outcomes were assessed at 3 and 12 months. Between-group comparisons used Kruskal–Wallis tests (continuous variables) and Fisher–Freeman–Halton exact tests (categorical variables); when significant, Dwass–Steel–Critchlow–Fligner pairwise tests were performed with Holm–Bonferroni correction. Given the small sample size and non-random treatment allocation, analyses were considered descriptive and hypothesis-generating. Sixty-eight patients were included (n = 17/group). Baseline profiles differed across treatments, consistent with indication-based prescribing; estimated fracture risk (FRAX/QFracture) was higher in anabolic-treated groups. At 12 months, scheduled-treatment completion was 100
Duchenne muscular dystrophy (DMD) is an X-linked recessive disorder that is due to mutations in the dystrophin gene which encodes the dystrophin protein. Many patients face an increased risk of bone fragility and develop secondary osteoporosis as a result of the combined effects of progressive muscle weakness, immobilization, and the osteotoxic properties of glucocorticoids (GCs). The present study showed that the prevalence of low BMD and fracture in DMD patients reached as high as 0.62 and 0.38, respectively, with contributing risk factors extending beyond GCs and loss of ambulation to include older age, vitamin D deficiency, fat mass accumulation, and hormonal imbalances. Therefore, clinical trials of bone-protective therapies and strategies to improve bone health in boys with DMD are urgently warranted. Poor skeletal health, characterized by rapid bone mineral density decline, causes substantial morbidity in patients with Duchenne muscular dystrophy (DMD). The present systematic review and meta-analysis aimed to review comprehensive findings on the prevalence and risk factors of low bone mineral density (BMD) and fractures in DMD. PubMed, Embase, Cochrane library, and Web of Science databases were systematically searched for studies reporting prevalence of fractures, low BMD, or data on risk factors in DMD patients. Random‑effects meta‑analyses estimated pooled prevalence of low BMD and fractures. Subgroup analyses examined variations by region, GCs use, fracture location, and ambulatory stage. A total of 43 studies involving 4940 patients were reviewed. The prevalence of low BMD from 0.16 to 0.93, with an overall prevalence of 0.62 (95
Among older adults hospitalized after a fall, receiving a DXA scan was associated with a decreased hazard of sustaining a hip fracture within 2 years. Older age, female sex, dementia, parkinsonism, mental health disorder and intermediate frailty were associated with a higher hazard of having a hip fracture post-discharge. Identify factors associated with increased hazard of having a hip fracture within 2 years of discharge following a fall-related hospitalization. We conducted a retrospective cohort study of all Ontario adults aged 65 + hospitalized after a fall between November 1, 2015 and October 31, 2020 using administrative health databases. We compared individuals who did or did not experience a hip fracture within 2 years of discharge based on socio-demographics, frailty, comorbidities, receipt of a dual-energy X-ray absorptiometry (DXA) scan, and family physician or geriatrician visits. We performed a Cox proportional hazard regression to identify factors associated with having a subsequent hip fracture, accounting for death as a competing risk. Among the 88,140 individuals who were discharged after a fall-related hospitalization, 4.6
We assessed the effectiveness and efficiency of the Osteoporosis Refracture Prevention Initiative, which involved widespread Fracture Liaison Service (FLS) implementation throughout New South Wales (NSW), Australia’s most populous state. Systemwide FLS implementation was cost-effective and associated with a reduction in minimal trauma refractures requiring hospital admission. The Osteoporosis Refracture Prevention (ORP) Initiative involved widespread Fracture Liaison Service (FLS) implementation throughout New South Wales (NSW), Australia’s most populous state. To determine the effectiveness and efficiency of the NSW Osteoporosis Refracture Prevention (ORP) Initiative. Linked administrative data on inpatient admissions, outpatient attendances, Emergency Department (ED) presentations, deaths, and cost was performed. Business-as-usual projections for the expected number of refractures and health service utilisation were generated by extrapolating historical trends. Cost data was measured as National Weighted Activity Units, and an economic analysis included a cost-benefit analysis. Following ORP implementation in financial year (FY) 2017–2018, 5 years later, in FY 2022–2023, there were 1246 fewer minimal trauma refractures that year which required hospital admission (17
In this prospective cohort of 1,410 community-dwelling Iranian older adults, a history of falls in the previous year was the strongest independent predictor of incident falls over one-year follow-up, supporting routine fall-history assessment as part of fracture-risk stratification. Osteoporosis and falls are closely interlinked, particularly among aging populations, leading to increased risks of fragility fractures and disability. Identifying fall-related risk factors is essential for guiding prevention strategies. This study aimed to investigate the incidence of falls and associated risk factors among community-dwelling older adults in Iran over a one-year follow-up period. Individuals aged ≥ 50 years, who participated in the Iranian Multicenter Osteoporosis Study were followed. Baseline data included demographics, medical history, functional assessments, and laboratory findings. Falls were tracked prospectively over 12 months through phone calls. Statistical analyses included chi-square tests for categorical variables, independent t-tests for numerical comparisons, and Cox proportional hazards regression to identify predictors of falls. Variables with p < 0.20 in univariable analyses were entered into the multivariable model. Among 1,450 participants at baseline, 1,410 (54.6
