Background Like many other chronic conditions, osteoporosis has been proposed to follow a social gradient where socio-economic disadvantage is associated with a higher diagnosis and fracture risk. While evidence for this association has come from biomedical research, and independent observations from studies on ancient human remains, the relationship between measured socioeconomic status (SES) and various parameters of ‘bone health’ appears inconsistent across different populations, methods, and timeframes. In this review article, we apply a comprehensive social and evolutionary framework to assess the spatial and temporal variation of SES on bone health. Methods A systematic review of the current biomedical and archaeological literature examined the association between SES and bone health. Peer reviewed articles were obtained through Google Scholar and PubMed. Four quantitative indicators of bone health were considered: bone mineral density (BMD), cortical index, osteoporotic fractures, and histomorphometry. Results Forty articles were identified, of which 30 reported a significant association between low SES and low BMD and/or high fracture risk. The earliest evidence for socially patterned osteoporosis was possibly in Ancient Egypt (2687–2191 BCE). Conclusion The examined literature generally supported the association between social disadvantage and poor bone health outcomes, following the social gradient. However, we found that research on both modern and archaeological skeletal samples does not always account for intraskeletal variability or use comparable methods when assigning SES, creating between-study inconsistencies. We highlight the contributions of archaeological studies on social conditions and bone fragility, emphasising that socially patterned osteoporosis is not a solely modern-day occurrence.
Background Youth with Duchenne muscular dystrophy (DMD) are at high risk of osteoporosis due to progressive muscle weakness and chronic glucocorticoid (GC) therapy. Current guidelines recommend routine vertebral fracture screening leading to earlier antiresorptive initiation. Medication-related osteonecrosis of the jaw (MRONJ) is a well-established complication of antiresorptives in adults but is exceedingly rare in youth, with no reported cases in children or adolescents with DMD. Methods We describe two adolescents with DMD who developed MRONJ following dental extraction during antiresorptive therapy for GC-induced osteoporosis. Results Case 1: A 15-year-old on long-term deflazacort began zoledronic acid at age 11.8 years for a vertebral fracture. MRONJ developed at age 15 post dental extraction, seven months after their last infusion. Case 2: An 18-year-old receiving bisphosphonates from age 8 years, was switched to denosumab at age 18 years. MRONJ occurred six months later, following tooth extraction. In both cases, antiresorptives were suspended and conservative management led to complete healing of MRONJ. Antiresorptives were later resumed for pain and fracture prevention, with no recurrence after one year. Review of more than 1000 pediatric patients treated with bisphosphonates or denosumab identified no prior reports of MRONJ in children or adolescents with DMD. Conclusions To our knowledge, these are the two youngest reported cases of MRONJ in patients with DMD. They highlight a potential vulnerability related to prolonged GC exposure combined with long-term antiresorptive therapy. Although pediatric MRONJ risk remains extremely low, clinicians should be aware of this complication, particularly when invasive dental procedures are planned.
Objectives Osteogenesis imperfecta (OI) is a rare genetic disorder marked by bone fragility and increased fracture risk, adversely affecting quality of life (QoL). The overall fracture burden remains incompletely defined. This systematic review synthesised evidence on fracture characteristics (onset, frequency, anatomical location, risk factors) and outcomes (healing time and downstream signs, symptoms, and events [SSEs]). Methods We sought English-language cohort studies, patient surveys, and trials enrolling ≥10 individuals with OI, reporting fracture characteristics and fracture outcomes, published in or after 2000. We searched MEDLINE, Embase, Cochrane CENTRAL, PsycINFO, ClinicalTrials.gov, ICTRP, and CPCIS-S through March 15, 2024 and relevant congresses through December 31, 2024. Outcomes were qualitatively synthesised. Results Most included studies (n = 87) were retrospective. First fractures typically occurred in early childhood, with earlier onset in those with Type III versus Type I. Annual fracture rates ranged from 0 to >10, varying by OI type; one to several fractures per year were typical. Fractures affected long bones, vertebrae, and other bones without a predominant location, likely reflecting heterogeneous reporting. Fracture rates were slightly higher in children than adults, and highest in those with Type III across ages. Few healing-time data were available. Downstream SSEs included pain, impaired functioning and QoL, and risk of same-site refracture. Discussion OI is associated with an early-onset, lifelong fracture burden, with considerable individual variability. Interpretation is limited by heterogeneous study designs, inconsistent fracture recording, and limited prospective data. Findings highlight a heavy fracture burden and a considerable unmet need for effective interventions to prevent OI-related fractures.Registration: PROSPERO (CRD42024536760).
