Sodium-glucose cotransporter-2 (SGLT2) inhibitors have been used as a therapy for type 2 diabetes mellitus, heart failure, and chronic kidney disease (CKD); however, their effects on erythropoiesis, phosphate regulation, and bone turnover are incompletely clarified. Studies report a marked increase in hemoglobin and hematocrit during treatment, suggesting an erythropoietic response rather than simple hemoconcentration. Simultaneously, changes in mineral metabolism, including a modest increase in phosphate, fibroblast growth factor-23 (FGF-23), and parathyroid hormone (PTH), raise questions about the possible consequences for bone quality, mainly in individuals with diabetes or CKD who are at increased risk of fracture. Accordingly, this narrative review was structured through a literature search of PubMed, Scopus and Google Scholar for studies published in English up to November 2025. Keywords included SGLT2 inhibitors, erythropoiesis, bone metabolism, phosphate homeostasis, FGF-23, PTH, vitamin D, bone mineral density (BMD) and fracture. Randomized trials, mechanistic studies, animal experiments, observational cohorts, sub-analysis and reviews were included. Current evidence shows that SGLT2 inhibition promotes erythropoietin production, enhances iron mobilization and modifies the bone marrow environment, while also influencing the FGF- 23-PTH-vitamin D axis through renal phosphate handling. Although canagliflozin has been associated with reduction in hip BMD and possible fracture risk, findings from the drug class remain inconsistent and are often confounded by baseline comorbidities. In conclusion, SGLT2 inhibitors trigger a connected hematologic and mineral changes, but their long-term skeletal impact remains uncertain. Further mechanistic and longitudinal studies are advised to clarify these outcomes.
Background: Data on the link between alcohol intake and prospectively assessed changes in areal bone mineral density (aBMD) are scarce. Our aim was to assess the association of alcohol intake with bone loss and microarchitectural decline prospectively assessed in older men. Methods: In 818 men aged 60 to 87 years, bone microarchitecture was assessed at the distal radius and distal tibia (XtremeCT; Scanco Medical). Areal aBMD was assessed by dual energy X-ray absorptiometry (Hologic Inc.). Both were assessed at baseline, then after 4 and 8 years. Linear mixed models were adjusted for age, body mass index, bioavailable 17β-estradiol, osteoprotegerin, parathyroid hormone, Creactive protein and for grip strength (radius) or for the lower limb physical function score (tibia). Results: At baseline, aBMD and bone microarchitecture measures did not differ across the classes of alcohol intake. During the follow-up, aBMD decrease did not vary differently across the classes of alcohol intake. Men drinking 16 to 112 g alcohol per week had the slowest bone microarchitecture decline (reference group). At the distal radius, trabecular BMD (Tb.BMD) and number (Tb.N) decreased faster in men consuming <16 g/week and in men drinking >224 g/week vs. the reference group. At the distal tibia, cortical thickness (Ct.Thd), cortical area (Ct.Ar), reaction force, and failure load decreased faster in men consuming <16 g/week and in men drinking >224 g/week versus the reference group. Conclusions: Moderate alcohol intake is associated with slower bone decline. Very low and higher alcohol intake were associated with faster bone microarchitecture deterioration in older men when assessed prospectively.
Background: Maternal vitamin D is essential for fetal calcium homeostasis and skeletal development. The long-term impact of maternal vitamin D status during pregnancy on offspring bone health remains unclear, especially in populations with high sun exposure yet persistent deficiency. This systematic review synthesizes cohort study on the association between maternal serum 25-hydroxy-vitamin D (25[OH]D) levels during pregnancy and bone outcomes in offspring.Methods: A total of 19 cohort studies, comprising 12,835 mother-offspring pairs across diverse geographic regions, were systematically reviewed. Offspring bone health indicators included bone mineral content (BMC), bone mineral density (BMD), bone turnover biomarkers, and fracture risk, assessed using dual energy X-ray absorptiometry (DXA), quantitative ultrasound (QUS), and biochemical markers. Heterogeneity in vitamin D thresholds, measurement timing, and follow-up duration was noted.Results: The findings were heterogeneous and often sex-specific. Some studies reported a positive association between higher maternal 25(OH)D levels and increased BMC/BMD, particularly in male offspring. Others showed no significant association after adjusting for maternal and neonatal confounders. Biomarker analyses generally supported an inverse relationship between maternal vitamin D deficiency and fetal bone turnover markers. However, evidence remains inconclusive regarding the benefits of prenatal vitamin D supplementation on long-term skeletal outcomes.Conclusions: Maternal vitamin D status appears to influence offspring bone development in a complex and multifactorial manner. Effects may be modified by child sex, timing of deficiency during gestation, and genetic factors. Future studies should prioritize standardized measurement protocols and expand cohort representation in under-researched regions, notably Southeast Asia, to inform public health guidelines and targeted interventions.
Background: Previous studies have demonstrated a moderate correlation between bone mineral density (BMD) measured by dual energy X-ray absorptiometry (DXA) and Hounsfield units (HU) assessed on diagnostic computed tomography (CT), primarily in the lumbar spine. However, the correlation between HU values and DXA scores in other bones and at different anatomical landmarks remains underexplored. This study aimed to evaluate the relationship between HU values at various cortical and medullary regions and DXA-derived T-scores across multiple skeletal sites.Methods: In this retrospective cross-sectional study, 214 patients who underwent both DXA and diagnostic CT imaging were included. The bones analyzed included the proximal humerus (N=96), distal tibia (N=56), distal femur (N=34), and proximal tibia (N=28). HU measurements were taken at five anatomic landmarks: the medullary center, anteromedial cortex, anterolateral cortex, posteromedial cortex, and posterolateral cortex. Correlations were analyzed between these HU values and the lowest T-score from the DXA scan.Results: Significant moderate correlations were found between medullary HU values and the lowest T-scores in the proximal tibia (r=0.486, P=0.04) and distal tibia (r=0.458, P=0.01). In the proximal humerus, the anteromedial cortex HU also correlated with the lowest T-score (r=0.353, P=0.01). Mean HU values at several cortical and medullary regions significantly differed between osteoporotic and normal BMD groups.Conclusions: There is a moderate correlation between HU values at specific anatomical landmarks and DXA T-scores. These findings suggest that diagnostic CT scans may serve as a supplementary tool in assessing bone quality, especially when DXA is not available.
