Screen time is increasing and may influence lifestyle factors relevant to bone health. In this study, more screen time was related to lower physical activity amongst males and individuals aged 21–52, and higher BMI amongst individuals aged 60–69. Greater screen time may increase the risk of poor bone health and obesity. Screen time, whether through remote working or leisure pursuits, is rising in the adult population across all ages. Here, we consider how this relates to lifestyle factors important for bone health. Overall, 67 males and 136 females, aged 21–69, were analysed. BMI was derived from self-reported height and weight. Physical activity was ascertained using the International Physical Activity Questionnaire. Participants completed a food frequency questionnaire; a diet quality score was derived using principal component analysis. Screen time (past 7 days), smoking, alcohol intake, educational attainment, and comorbidities were self-reported. Screen time in relation to BMI, physical activity, diet quality, ever smoking, and high alcohol intake (> 14 units/week) was examined using linear and logistic regression as appropriate, with adjustment for education and number of comorbidities, and stratified by sex and age tertiles. Standard deviation (SD) differences in continuous outcomes (odds ratios for binary outcomes) per SD increase in screen time are reported. Median (lower quartile, upper quartile) age was 56 (42, 60) years; corresponding statistics for screen time were 249 (152, 377) min/day. More screen time was related to lower physical activity, especially amongst males (−0.58 (95

Rheumatoid arthritis (RA) affects approximately 1

BACKGROUND:Falls, especially recurrent, cause significant morbidity. Research on falls generally focuses on older adults but patterns of falling may start earlier in life. This study aimed to quantify the prevalence of falls and recurrent falls among late middle-aged community-dwelling adults and identify the socio-demographic, lifestyle and health-related factors associated with recurrent falls. METHODS:The Health and Employment After Fifty (HEAF) study is a longitudinal cohort of men and women aged 50-64 years recruited in 2013-14 from across England. At baseline and each of five approximately annual follow-ups, participants reported falls in the preceding year. Participants were categorised as recurrent fallers if they experienced more than one fall on at least two occasions, non-fallers if they never reported a fall, or intermediate fallers otherwise. Multinomial logistic regression explored associations between fall category and potential risk factors, presented as relative risk ratios with 95%CI. RESULTS:Among 8134 participants, 7051 were eligible for this analysis. The prevalence of any falls ranged from 14-18% across follow-ups. Overall, 437 (6%) were recurrent fallers, 2738 (39%) intermediate and 3876 (55%) non-fallers. Independent predictors of recurrent falls included female gender, unpartnered, unemployed or retired and lack of home ownership. Health-related factors included obesity, fair/poor self-rated health, depression, poor sleep, slow walking speed and memory problems. The final model correctly classified 60% of participants. CONCLUSIONS:Recurrent falls in mid-life were relatively common. Both socio-economic and health-related characteristics, alongside female gender, were identified as predictors, suggesting potential targets for early identification and risk mitigation in this age group.

Osteoarthritis (OA) is the most common form of arthritis. OA becomes more prevalent in women around the age of menopause, and it has been suggested that the decrease in estrogen at menopause may be important in the pathophysiology of OA development. The association between estrogen exposure and OA is complex; a recent meta-analysis suggested that menopause hormone therapy use may be associated with an increased risk of joint replacement, bringing this research area back into focus. This narrative review used a systematic process, adopting a life-course approach to consider relationships between reproductive factors and OA, identifying 15 papers published over a 26-year period. Increased parity, use of the oral contraceptive pill, abortion, breastfeeding and inter-menstrual years were all considered but findings varied widely between studies. We note that progesterone is rarely considered, despite animal work suggesting its importance. These data highlight the need for further research with careful measurements of confounding variables, and consideration of the role for progesterone in OA etiology.

Abstract Background/Aims Paget’s disease of bone is a chronic metabolic bone disease that predominantly affects older adults and is linked to bone pain and pathological fracture. A clinical guideline prepared on behalf of the Paget’s Association, the European Calcified Tissue Society and the International Osteoporosis Foundation was published on February 25th 2019. Here, we present an audit, reporting performance against these guidelines for all University Hospital Southampton departments, including rheumatology and medicine for the elderly. Methods All patients with a diagnosis of Paget’s disease of bone treated at University Hospital Southampton from 25th February 2019 to 2025 were identified from electronic patient records, where Paget’s disease had been included in diagnostic coding. Relevant information was extracted from electronic clinical records. Management was audited across a wide variety of domains, including documentation of alkaline phosphatase (ALP), X-rays, isotope bone scanning and treatment. Results A total of 143 patient records were audited. The mean age of patients was 86 years; no patient was under 50 years, and 60.8% were male. Pain was the presenting symptom in 27.3% cases, but in 25.2% of cases, Paget’s disease was an incidental radiological finding. The most common site affected was the pelvis (95 cases, 66.4 %), followed by the femur and lumbar spine. Targeted X-rays or CT scans were available to establish the extent of disease in almost all cases (127/143, 88.8 %), with only 1 patient not having a radiograph; we were unable to retrieve all imaging for the other 18 patients (12.6%). A radionuclide bone scan was performed in 38.4% cases, with much higher rates in those seen in rheumatology than in other departments only (68.3% vs 22.6%). Of patients diagnosed after the release of the new guidelines (n = 30), only those seen by rheumatology (n = 6) were more likely to have a bone scan performed (60% before vs 83% after). ALP levels were available in all rheumatology patients, and 88.7% patients were seen in other departments. Zoledronate was the most commonly prescribed bisphosphonate; 36.1% of patients had bisphosphonates prescribed, with much higher rates of prescription in rheumatology than other departments (73.3% vs 9.4%). In the majority of cases (65.4%), bisphosphonates were prescribed to alleviate symptoms rather than for ALP reduction. Conclusion Our results highlight missed opportunities in the investigation and management of Paget’s disease of bone in older adults, especially outside of hospital rheumatology departments. Targeted education to all specialties that may manage these patients, with dissemination of guidelines and re-audit, would be valuable. Disclosure P. Vahisan: None. E. Dennison: None. J. Zhang: None.

Knee osteoarthritis (OA) is a common musculoskeletal condition associated with chronic pain and reduced mobility. This paper presents the co-design and development of a wearable e-textile garment, created in collaboration with eight healthcare professionals and ten individuals with knee OA, to support non-pharmacological pain management and muscle exercise. The garment integrates embedded dry electrodes that deliver transcutaneous electrical nerve stimulation for knee pain relief and neuromuscular electrical stimulation to strengthen the quadriceps and hamstrings, thereby further supporting the knee joint. Development activities included focus groups, interviews, e-garment design and fabrication, and lab-based fitting and testing sessions to iteratively refine garment design, sizing, and electrode positioning. Initial testing provided early indications of safety, usability, durability, and functional performance. This research demonstrates the potential of e-textile-based wearable healthcare devices in the management of knee OA and lays the foundation for further home usability testing and clinical evaluation.

Hyaluronic acid (HA) is a linear polysaccharide which occurs naturally as a constituent of synovial fluid. The HA concentration in the joint decreases inexorably during the progression of knee osteoarthritis (OA) and so, for nearly five decades, HA has been trialled and used in the treatment of knee OA. There are strong data from clinical trials, meta-analyses and umbrella reviews to support the use of intra-articular hyaluronic acid (IAHA) in the treatment of patients with knee OA, though not in patients with acute, active OA experiencing a flare. The majority of the literature suggests that IAHA has a positive safety profile despite a few meta-analyses suggesting an increased risk of serious adverse effects. Further qualitative analysis integrating patient preferences for multi-modal and/or non-surgical management is required in order to further explore these findings. IAHA has been combined with a number of additional agents, including mannitol, sorbitol, chondroitin sulphate, tranexamic acid, polynucleotides and hybrid IAHA formulations. These show variable performance beyond the baseline effect of their constituents. It is crucial to consider the patient’s preference when considering treatments for knee OA. Specific to IAHA, patients seek minimally invasive, lower-risk, and non-steroidal options with at least moderate efficacy and advantageous safety profiles. Hyaluronic acid is a naturally occurring constituent of synovial fluid and there are strong studies supporting its use in the treatment of osteoarthritis (outside the context of disease flares). The majority of literature supports a highly advantageous safety profile for hyaluronic acid in terms of adverse effect profile. Intra-articular hyaluronic acid (IAHA) can be injected in combination with other agents; including mannitol, sorbitol, chondroitin sulphate, tranexamic acid, polynucleotides and hybrid IAHA formulations, which show potential efficacy beyond their constituents alone.

Objectives: To develop and evaluate a wearable, garment-integrated transcutaneous electrical nerve stimulation (TENS) system for relieving osteoarthritis knee pain, emphasizing safety, usability, and readiness for home and clinical deployment. Methods: We designed an IEC 60601 compliant TENS system that embeds flexible electrodes into a close-fitting, machine-washable textile. A seven-day, home-based usability evaluation was conducted with 11 participants with osteoarthritis. Outcomes included self-reported pain (baseline vs. post-use) and usability metrics (ease of setup and comfort). The system received Medicines and Healthcare products Regulatory Agency (MHRA) and Health Research Authority (HRA) approvals for a subsequent clinical investigation. Results: Participants reported strong user acceptance, ease of use and comfort. Average pain decreased by 54.79% over the evaluation period, indicating a meaningful short-term analgesic benefit in a home setting. No serious adverse events were observed. Conclusion: Integrating electrodes into a wearable garment addresses key limitations of conventional adhesive-pad TENS, improving placement consistency, comfort, and ease of use while supporting safe operation under IEC 60601. These preliminary findings support the feasibility of garment-based TENS for osteoarthritis management at home and justify a follow-on clinical trial to rigorously quantify pain relief, functional outcomes, and user satisfaction in a larger cohort. Clinical impact: The use of a washable TENS garment, compliant with IEC 60601, resulted in reduced osteoarthritis pain in a home setting. Its integration into home care is facilitated by an easy to use device with reusable textile electrodes.

Introduction Osteoarthritis (OA) is a common chronic condition requiring long-term management, for which shared decision-making is increasingly recognised as an important component of care. Stated preference (SP) methods, including discrete choice experiments (DCE), conjoint analysis (CA) and best-worst scaling (BWS), are increasingly used to quantify patient preferences for treatment attributes and to inform clinical and policy decisions. However, evidence from SP studies in OA has not been comprehensively synthesised. This protocol describes a systematic review aiming to identify, appraise and synthesise evidence on the relative importance of treatment attributes for patients with OA.Methods and analysis A comprehensive search will be conducted in PubMed, Embase, CINAHL, Scopus, Dimensions and OpenAlex from database inception to January 2026. Eligible studies will include quantitative SP studies-encompassing DCE, CA and BWS-evaluating patient preferences for pharmacological, non-pharmacological or surgical treatments in OA. Two reviewers will independently screen studies, extract data using a standardised form and assess methodological quality using the Purpose, Respondents, Explanation, Findings and Significance (PREFS) checklist, the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Good Research Practices for CA and DCE and the DIscrete choice experiment REporting ChecklisT (DIRECT) checklist for reporting quality. A structured narrative synthesis will summarise and categorise key treatment attributes (eg, efficacy, safety, cost and mode of administration). Where studies are sufficiently comparable in attributes and outcome reporting, a random-effects meta-analysis may be conducted to pool preference estimates, such as relative importance or willingness-to-pay values.Ethics and dissemination Ethical approval is not required, as this review will use published data only. Findings will be disseminated through peer-reviewed publication and conference presentations.PROSPERO registration number CRD420251181273.

Studies have linked lower birth weight to development of radiographic osteoarthritis (OA). We examined early life factors in relation to subsequent knee pain among individuals with radiographic OA. 143 participants from the UK Hertfordshire Cohort study were included. Birth weight and weight at one year (WA1) were ascertained from health ledgers and used to derive conditional infant weight gain (CIWG). At baseline and follow-up, heath questionnaires (including knee pain) and knee radiographs were collected. Only those with radiographic knee OA at baseline were analysed. Logistic regression was used to examine early life factors in relation to pain. Pain at follow-up was common (men 41.3%, women 50%). Greater WA1 and greater CIWG were related to reduced risk of knee pain at follow-up after adjustment for sex and follow-up time. CIWG was protective against knee pain at follow-up, with this association attenuated after adjustment for follow-up osteophyte score. Validation in larger studies is required.

Background: Low peak bone mass (PBM) is a major contributor to later osteoporosis risk. This study sought to understand young people’s knowledge of factors associated with bone health. Methods: Young people in Aotearoa New Zealand were approached. Eight focus groups (26 participants in total, aged 11 to 17 years) were conducted using a semi-structured approach with open-ended questions and prompts. Transcripts were thematically coded using an inductive content analysis approach. Results: Knowledge of factors associated with good bone health was limited. There was a general awareness of the positive and negative impacts of many lifestyle behaviours on health generally, but not specifically PBM. Dairy intake was commonly mentioned as being beneficial for bone health. Some participants reported potential benefits of sport, but most did not know that weight bearing activity specifically was beneficial. Conclusions: Knowledge of osteoporosis and lifestyle factors that impact PBM was limited. Educational interventions involving promotion of bone health knowledge and supporting weight bearing physical activity in adolescents may be an important contributor to public health strategies.

Osteoarthritis (OA) is one of the most prevalent musculoskeletal conditions and a major contributor to years lived with disability. Obesity is an established risk factor for OA. Although OA patients are advised to maintain a healthy weight, this is often challenging, especially when pain limits activity. We examined relationships between obesity and functional outcomes in older community-dwelling adults with radiographic knee OA. We studied 101 men and 115 women, aged 71-80, from the UK Hertfordshire Cohort Study. Participants completed a questionnaire that ascertained information on health-related quality of life (EuroQol-5D) and pain (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]). Knee radiographs were taken and classified according to Kellgren and Lawrence (K&L) criteria; analysis was restricted to individuals with radiographic knee OA (K&L score ≥2 on either knee). Balance, walking, and chair rise scores were assigned, depending on performance, and used to derive the Guralnik physical performance score. Logistic and ordinal logistic regression were used to examine obesity status in relation to functional outcomes after adjustment for age and sex. Prevalence of obesity (BMI≥30kg/m2) was 26.7% among men and 44.3% among women. Odds of having a higher Guralnik score were lower among obese participants compared to those who were not (p < 0.001). Obesity (yes vs no) was associated with greater odds of reporting at least some problems in the following EuroQol domains: mobility (odds ratio [95% CI]: 4.73 [2.52, 8.85], p < 0.001); self-care (3.40 [1.44, 8.02], p = 0.005); usual activities (4.38 [2.31, 8.30], p < 0.001); and pain (2.27 [1.24, 4.15], p = 0.008). Obesity was also related to increased odds of having a WOMAC pain score > 0 (2.21 [1.24, 3.95], p = 0.007). These findings highlight the strong relationships between obesity and functional outcomes in individuals with OA. These results stress the crucial need for support in managing excess adiposity, to reduce the potential degree of resulting disability. F. Laskou: Grants/research support; NIHR Southampton Biomedical Research Centre, Nutrition, and the University of Southampton. L. Westbury: None. F. Kirkham-Wilson: None. G. Bevilacqua: None. N.O. Fuggle: None. E. Dennison: Consultancies; Pfizer, UCB and Lilly.

This population study investigated the association between birth characteristics and fracture risk in 11,099 young adults (aged 19–54 years). Our findings indicate that birth weight, gestational age, and birth weight for gestational age were not associated with fractures in the wrist, humerus, hip, and spine in this population. Skeletal development starts during fetal life, and it is estimated that most bone formation occurs in the 3rd trimester. This study examined the association between birth characteristics and fractures of the wrist, humerus, hip, and spine, in young adults (19–54 years). 11.099 participants in the 3rd survey of the HUNT Study (2006–2008) were linked with the Medical Birth Registry of Norway and hospital records. Fractures of the wrist, humerus, hip, and spine were identified using ICD9/10 codes between 1988 and 2021. Follow-up was from date of participation in HUNT until a first fracture, emigration, death, or end of study. Cox regression was used to estimate hazard ratios (HR) of fracture associated with birth characteristics (95

Pain is the most common symptom of Paget’s disease of bone (PDB), but its underlying mechanisms are poorly understood. Notably, bone pain does not correlate well with metabolic activity or treatment response. This study aimed to assess whether sensory processing is altered in skin overlying Pagetic bone using quantitative sensory testing (QST). We conducted a cross-sectional study of 156 people with PDB attending secondary care referral centres in the UK. We conducted quantitative sensory testing of the skin overlying affected sites and compared the data with unaffected sites as a control. The modalities used were hot and cold rollers, pinprick, vibration and von-Frey filaments to test both spinothalamic and lemniscal pathways. There was a consistent trend for sensory perception to be increased over affected sites versus control sites in the study population. The differences were significant for vibration detection threshold (p = 0.009), pain threshold (p = 0.010) and both single and multiple pinprick testing methods (both p < 0.001). Subgroup analysis revealed similar trends when analysis was restricted to those with pain thought to be due to bone deformity or increased metabolic activity and those with and without musculoskeletal pain. Sensory processing is altered in skin overlying Pagetic bone, independent of current pain symptoms. We speculate that this may be due to abnormalities of bone shape, bone structure or metabolic abnormalities in the affected bone. The mechanisms are unclear but deserve further study.

Previous studies suggest social support is associated with musculoskeletal health in later life. We explored this relationship further in community-dwelling older adults, by considering associations between different aspects of social support and musculoskeletal health in community-dwelling adults. Participants from the Hertfordshire Cohort Study reported level of confiding/emotional, practical, and negative support using the Close Persons Questionnaire. Muscle strength was measured by grip strength dynamometry, and physical capability by timed up-and-go, chair rises, and walking speed tests. Bone mineral density (BMD) was assessed using dual-energy x-ray absorptiometry. Linear regression, adjusted for age, sex, body mass index (BMI), alcohol, smoking, physical activity, social class, and diet, was used for analysis. 1842 men and women (mean age 65.7 years) participated. Low emotional support correlated with weaker grip strength and poorer physical capability tests, although estimates were not robust to adjustment for confounders. Low practical support was linked to shorter timed up-and-go (β − 0.171, 95

Objectives Physical activity is important for health, but the influence of structured, supervised aerobic exercise sessions on habitual physical activity in healthy older adults is unclear.Methods We evaluated habitual physical activity in the Hertfordshire Physical Activity Trial, where healthy older adults were randomised to 36 supervised 1-hour gymnasium sessions on a cycle ergometer at moderate intensity over 12 weeks or to a control group with no intervention. We estimated physical activity energy expenditure (PAEE) and time spent in sedentary behaviour and light and moderate or vigorous physical activity over 7 days at three time points (before, during and immediately after the intervention) with individually calibrated combined heart rate and movement sensing.Results Of 100 randomised participants (44% female, aged 67–76 years), 96% completed follow-up. Midway through the intervention, neither overall PAEE nor time spent at different intensities were different between groups. However, on the 3 days of the week that the structured exercise sessions occurred (Monday, Wednesday, Friday), the exercise group had a 9.1 kJ kg-1 day-1 ((2.5, 15.7), p=0.007) increase in PAEE, a reduction in sedentary time and increased time spent at light and moderate or vigorous physical activity, compared with the control group.Conclusions Three 1-hour bouts per week of structured aerobic exercise increased daily physical activity on the days they occurred, but not overall physical activity across the whole week. Population-wide strategies such as better cycling and walking infrastructure may increase physical activity in healthy older adults more effectively than treatment with structured exercise programmes.Trial registration number ISRCTN60986572.

Objective In this study we evaluated associations between nutritional factors, including calcium supplementation, and outcomes of fracture and cardiovascular mortality. We chose to report both outcomes as an illustration of the importance of nutritional factors in midlife to heart disease as this may be more impactful for supporting behavior change strategies, particularly in men.Methods This study was nested in the Hertfordshire Cohort Study, a community dwelling cohort of 2,997 adults (47% women) who were extensively phenotyped at baseline and followed up for 20 years using Hospital Episode Statistics linkage.Results Mean (SD) age at baseline was 65.7 (2.9) among men and 66.6 (2.7) among women. There was some evidence that better diet quality was related to reduced risk of hip fracture after adjustment for sex (hazard ratio (95% CI): 0.82 (0.67, 1.00) per SD higher prudent diet score). Dietary calcium intake was not associated with either any fracture or hip fracture. Taking calcium supplements was associated with an increased risk of any fracture, possibly because of reverse causality as calcium supplements will typically be prescribed following an osteoporotic fracture. A higher dietary calcium intake was protective against cardiovascular-related mortality, while taking calcium supplements led to no excess risk (p = 0.870). Higher prudent diet scores, indicative of better diet quality, were related to other beneficial lifestyle choices such as reduced odds of ever smoking [odds ratio (95% CI) per SD higher diet score: 0.69 (0.63,0.74)], and higher physical activity (SD difference in physical activity score per SD higher diet score: 0.06 (0.02,0.10)).Conclusion We have demonstrated the commonality of lifestyle factors to adverse clinical outcomes of fracture and heart disease in older adults. These data might be used in behavior change strategies aimed to improve nutrition and linked factors in midlife.

Osteoporosis and osteoarthritis are key diseases of musculoskeletal ageing and are increasing in prevalence and burden with the progressively ageing population worldwide. These conditions are thus particularly common in 'the oldest old', and there are complexities of managing them within the context of extensive multimorbidity, physical and mental disability, and polypharmacy, the rates for all of which are high in this population. In this narrative review, we explore the epidemiology of osteoporosis and osteoarthritis in the oldest old before examining trials and real-world data relating to the pharmacological treatment of these diseases in older adults, including anti-resorptives and bone-forming agents in osteoporosis and symptomatic slow-acting drugs for osteoarthritis, paracetamol, and non-steroidal anti-inflammatory drugs in osteoarthritis, recognising that the oldest old are usually excluded from clinical trials. We then review the potential benefits of nutritional interventions and exercise therapy before highlighting the health economic benefits of interventions for osteoporosis and osteoarthritis. The high prevalence of risk factors for both disease and adverse events associated with treatment in the oldest old mean that careful attention must be paid to the potential benefits of intervention (including fracture risk reduction and improvements in osteoarthritis pain and function) versus the potential harms and adverse effects. Further direct evidence relating to such interventions is urgently needed from future research.

OBJECTIVES:To investigate the longitudinal associations between tobacco use (smoking and snuff) and bone mineral density (BMD) at femoral sites and in the total body in a Norwegian adolescent cohort, aged 16-27 years. DESIGN:Prospective longitudinal cohort study. SETTING:A population-based study in Norwegian adolescents from the general population. PARTICIPANTS:In total, 722 adolescents (385 females and 337 males) with a mean age of 16 years (SD: 0.5) from the Fit Futures Study (FF) were included at FF1 (2010-2011), with follow-up measures at age 18 years (FF2 (2012-2013)) and 27 years (FF3 (2021-2022)). Inclusion criteria were completed dual-energy X-ray absorptiometry (DXA) scans, serum vitamin D blood samples and information on smoking, snuff use, physical activity, height, alcohol intake, hormonal contraceptive use and puberty status, all at baseline (FF1). PRIMARY AND SECONDARY OUTCOME MEASURES:Associations between self-reported smoking and snuff use (categorised as never, sometimes or daily) and changes in BMD (g/cm²) at the total hip, femoral neck and total body, measured using DXA. RESULTS:Total hip BMD (mean (g/cm2), 95% CI) slightly increased from FF1 (females: 1.066, 95% CI 1.054 to 1.079; males: 1.121, 95% CI 1.105 to 1.136) to FF2 (females: 1.076, 95% CI 1.063 to 1.089; males: 1.141, 95% CI 1.126 to 1.157; p<0.001), but thereafter decreased to FF3 (females: 1.050, 95% CI 1.036 to 1.063; males: 1.091, 95% CI 1.074 to 1.107; females and males, both p<0.001). Similar patterns were observed for the femoral neck, while total body BMD increased from FF1 through FF3 (p<0.001). We observed interactions between time and smoking and between time and snuff use in all models (all p<0.001). However, we generally observed no statistically significant differences in BMD levels across smoking and snuff use groups at different time points (all p>0.07), except in females at 18 years (FF2), where those who never smoked had higher total hip BMD than those who sometimes and never smoked (p<0.001). CONCLUSIONS:We found no statistically significant associations between smoking or snuff use and BMD levels in Norwegian adolescents from a median age of 16 to 27 years. Notably, only 2.6% of females and 3.9% of males reported smoking daily. However, in this study, moderate tobacco use did not appear to negatively influence bone growth from adolescence to young adulthood.