Objective: Hip fractures are commonly associated with disability, and muscle strength is an independent prognostic factor for functionality and walking ability. Handgrip strength (HGS) measurement represents an easy and economical strategy for estimating muscle strength and establishing a functional prognosis in elderly patients with hip fractures. Currently, there are no HGS thresholds in the Mexican population to ascertain functional outcomes, such as independent walking ability. The objective was to determine a cut-off point associated with independent walking ability. Materials and Methods: Prospective cohort study that included hospitalized patients older than 60 years for hip fracture. HGS was measured next day of surgery. Cognitive, functional, and nutritional status were also assessed, as well as comorbidities and walking ability. Logistic regression was employed to confirm the association with independent walking. Results: We included 185 patients, 61 men and 124 women, with 34 individuals (18.3%) capable of independent walking. Participants with high HGS were younger, had lower comorbidity scores, and displayed higher functional pre-fracture scores. The thresholds for predicting independent walking were >= 12 kg for women and >= 19 kg for men. High HGS and lower comorbidity scores were independently associated with independent walking. Conclusion: HGS in the Mexican population predicts independent walking after hip fracture surgery.

OBJECTIVE:We aimed to conduct an educational needs assessment for practicing primary care clinicians using Project ECHO® (Extension for Community Healthcare Outcomes), a platform for telementoring healthcare professionals in rural and under-resourced areas. METHODS:We conducted 12 weekly and monthly, 1-hour sessions comprised of brief didactics and facilitated discussions of real, deidentified cases. Didactic topics included perimenopause, mood, hormone and nonhormone therapies, genitourinary symptoms, and skeletal health. Feedback was obtained by preprogram, postprogram, and weekly surveys via REDCap. Participants rated the faculty-selected curriculum and discussions with Likert items. Qualitative assessment of participant comments, questions, case presentations, and chat discussions was performed to identify needs for additional educational topics. RESULTS:Participants included 54 physicians and advanced practitioners from 17 of Oregon's 36 counties, 1 urban, 7 urban/rural, 8 rural, and 1 frontier. The didactic content and case discussions were rated highly, with Likert scores of 5.3-5.5 (scale, 1-6), for being evidence-based, objective, and relevant. Confidence in performing targeted activities relating to menopause care was improved from scores of 2.0-2.6 (scale, 1-5) before the program to 3.7-3.9 after the program, P<0.01 for each comparison. We identified several topics for future curricula, including breast health, sexual dysfunction, weight management and abnormal vaginal bleeding. CONCLUSION:For these practicing primary care clinicians, the basic menopause curriculum was highly relevant, but greater depth and complexity were needed to address the characteristics of patients in their practices. The ECHO model was successful in addressing the menopause knowledge gap for diverse types of health care professionals.

With the goal of preventing more hip fractures, a next generation of the VirtuOst Biomechanical Computed Tomography (BCT) test was developed that integrates measurements from a clinical CT scan related to fall risk, impact force, and femoral strength, the three main determinants of hip fracture. Here, we introduce the test and validate it against BMD and FRAX. Our source population from a large healthcare system comprised of 341364 patients (≥65 yr) with an abdominal-pelvic CT during care. Using data from 3035 patients (1790 with hip fracture), we developed a "BCT Risk Score" (range: 0-100) having input risk factors of age, femoral strength, ratio of trabecular/cortical BMD, muscle area, intramuscular fat, FN volume, hip width, and posterior fat thickness. In a geographically distinct set of 2124 patients (1293 with hip fracture), we then compared the BCT Risk Score against a DXA-equivalent hip BMD T-score (lowest hip value, measured from the CT scan by VirtuOst) and FRAX hip fracture risk (with BMD but without parental fracture history) for predicting a first incident hip fracture within 5 yr. For the women, the c-statistic for predicting fracture was higher for BCT (0.89, 95% CI: 0.87-0.90) than for BMD (0.81, 0.79-0.84) or FRAX (0.85, 0.83-0.87). Using binary thresholds to identify high-risk patients, sensitivity for BCT (Risk Score ≥ 75) was higher than for BMD (T-score ≤ -2.5) and FRAX (hip risk ≥ 3.0%): 81.4% vs 47.8% vs 75.9%, respectively; positive predictive values confirmed comparable high-risk status (BCT 13.6% vs BMD 15.3% vs FRAX 12.7%). Similar trends were observed for the men, 2-yr outcomes, and identifying very-high-risk patients. We conclude that, compared to both BMD and FRAX, the integrative BCT test better predicted hip fracture and its high sensitivity should improve fracture prevention.

Treatment decisions are being made for a 74-yr-old woman with multiple and recent vertebral fractures. Romosozumab therapy is considered because of its superior efficacy compared to other osteoporosis therapies. However, because of her age, well-controlled hypertension, and mild hyperlipidemia, she is, according to a risk calculator, at high risk for cardiovascular (CV) disease. Romosozumab is contraindicated for patients at very high risk of CV disease, and clinicians are advised to consider the skeletal benefits vs the potential CV risks in patients with CV risk factors. The background information leading to that contraindication and recent real-world evidence about the relationship between romosozumab and CV risk is reviewed to aid in the discussion with the patient and her primary care provider.

The 2025 Santa Fe Bone Symposium (SFBS) was a combined in-person and virtual "hybrid" meeting based in Santa Fe, New Mexico, USA, on August 8-9, 2025. There were an equivalent number of in-person and remote attendees from throughout the USA and other countries. The SFBS was immediately preceded, on August 6-7, 2025, by the 2-day Endocrine Fellows Foundation-Santa Fe Bone Symposium Workshop on Metabolic Bone Diseases. This preceptorship included basic bone biology, osteoporosis, parathyroid and rare bone diseases. Most of the fellows attended the SFBS, for a total of 4 days of non-stop education in skeletal health. The topics covered at the SFBS included controversies and consensus in the use of dual-energy X-ray absorptiometry; management of osteoporosis medication side-effects; lessons learned from bone biopsies; osteoporosis in men and premenopausal women; update on treatment of rare bone diseases; parathyroid hormone and skeletal health; periprosthetic fractures; update on Bone Health ECHO; and much more. Ancillary events addressed issues such as bone health through the menopause transition, hypophosphatasia, X-linked hypophosphatemia, and osteoanabolic therapy for postmenopausal women with osteoporosis. This report of the proceedings of the 2025 SFBS summarizes the highlights and clinical insights of the plenary presentations.

Osteoporosis requires life-long management. This involves the use of different drugs in various sequences followed by long-term maintenance therapy. This review highlights the important transitions among osteoporosis therapies and outlines a strategy of intermittent bisphosphonate therapy for long-term maintenance. Over the past few years, the effects and limitations of long-term treatment with bisphosphonates and denosumab have become apparent as have several key factors in the sequential use of anti-remodeling drugs and osteoanabolic agents. Strategies for transitions from estrogen, bisphosphonates, denosumab and the bone-forming drugs will be discussed, based on extant evidence, clinical experience and expert opinion. By appropriate selection of both the initial and subsequent drugs for the prevention and treatment of osteoporosis, therapeutic benefits can be optimized and safety issues minimized. Developing a strategy for long-term maintenance of the benefits of the initial therapies can provide a life plan for managing patients with osteoporosis.

EndoBridge 2023 took place on October 20–22, 2023, in Antalya, Turkey. Accredited by the European Council, the 3-day scientific program of the 11th Annual Meeting of EndoBridge included state-of-the-art lectures and interactive small group discussion sessions incorporating interesting and challenging clinical cases led by globally recognized leaders in the field and was well attended by a highly diverse audience. Following its established format over the years, the program provided a comprehensive update across all aspects of endocrinology and metabolism, including topics in pituitary, thyroid, bone, and adrenal disorders, neuroendocrine tumors, diabetes mellitus, obesity, nutrition, and lipid disorders. As usual, the meeting was held in English with simultaneous translation into Russian, Arabic, and Turkish. The abstracts of clinical cases presented by the delegates during oral and poster sessions have been published in JCEM Case Reports. Herein, we provide a paper on highlights and pearls of the meeting sessions covering a wide range of subjects, from thyroid nodule stratification to secondary osteoporosis and from glycemic challenges in post-bariatric surgery to male hypogonadism. This report emphasizes the latest developments in the field, along with clinical approaches to common endocrine issues. The 12th annual meeting of EndoBridge will be held on October 17–20, 2024 in Antalya, Turkey.

Osteopenia was originally a qualitative term denoting bone that appeared to be less dense on radiographs. Since 1994, it has also had the quantitative meaning of a bone mineral density (BMD) T-score between -1·0 and -2·5. More than 60% of White women older than 64 years are osteopenic. Although fracture risk is often lower in osteopenic women than in those with osteoporosis, their greater number means that most fractures occur in osteopenic individuals. Fracture risk varies widely in the osteopenic range, depending on factors including BMD, age, fracture history, and nationality and ethnicity. Therefore, the diagnosis of osteopenia is not an indication for either intervention or reassurance, but BMD is a risk factor that should be incorporated into a quantitative fracture risk calculation. Evidence from trials shows that oral and intravenous bisphosphonates cost-effectively reduce fractures in older osteopenic women. Major osteoporotic fracture risks of 10-15% could be acceptable indications for treatment with generic bisphosphonates in patients older than 65 years motivated to receive treatment. This Review assesses the evidence relating to the management of older adults with osteopenic bone densities.

Abstract Study question How does the benefit/risk profile compare in women with endometriosis-associated pain who initiated relugolix combination therapy (Relugolix-CT) vs relugolix monotherapy with transition to Relugolix-CT? Summary answer Initiation with Relugolix-CT showed a more favourable benefit/risk profile than relugolix monotherapy: similar efficacy, lower rate of vasomotor symptoms and clinically significant bone loss. What is known already Treatment of endometriosis with a gonadotropin-releasing hormone antagonist monotherapy may be associated with vasomotor symptoms (e.g. hot flushes) and bone mineral density (BMD) loss. Relugolix-CT (relugolix 40 mg, estradiol 1 mg, norethisterone acetate 0.5 mg) was developed to minimise these hypoestrogenic adverse effects. In the pivotal SPIRIT 1 and 2 studies and long-term extension (LTE), once-daily Relugolix-CT demonstrated improved dysmenorrhoea early in treatment that was sustained for the duration of therapy over 104 weeks, with BMD loss <1%. This analysis evaluates the benefit of initiation with Relugolix-CT vs relugolix monotherapy and transition to Relugolix-CT on the 104-week benefit/risk profile. Study design, size, duration In the 24-week SPIRIT 1 and 2 studies, premenopausal women with endometriosis and moderate-to-severe pain at baseline were randomised 1:1:1 to placebo, Relugolix-CT, or delayed Relugolix-CT (relugolix 40 mg monotherapy then Relugolix-CT; 12 weeks each). Study completers were eligible to enrol in the open-label, 80-week LTE study where all women received once-daily Relugolix-CT. Efficacy and safety data over 104 weeks from the SPIRIT studies were assessed in this ad hoc analysis. Participants/materials, setting, methods Efficacy and safety were analysed as cumulative proportions, evaluating time to benefit and time to harm. Time to benefit was defined as median time to minimal-to-no dysmenorrhoea (Numerical Rating Scale score ≤1), time to harm as time to first vasomotor symptoms (hyperhidrosis, feeling hot, hot flush, night sweats and flushing), and time to lumbar spine BMD loss from baseline to > 3% among those meeting protocol-specified BMD criteria. Median time was not estimable for safety. Main results and the role of chance In total, 1251 women were treated in the SPIRIT 1 and 2 studies. Of 418 and 417 women in the Relugolix-CT and delayed Relugolix-CT groups, time to minimal-to-no dysmenorrhoea was 8 weeks in 56.3% and 75.7% of women, respectively, increasing to 82.5% and 86.4% at Week 24, 94.5% and 95.9% at Week 52, and 95.3% and 95.9% at Week 104. In both groups, median time to minimal/no dysmenorrhea-associated pain occurred within two menstrual cycles. Cumulative proportion of patients with first vasomotor symptoms in the Relugolix-CT and delayed Relugolix-CT groups was 4.1% and 16.8%, respectively, at Week 4, 13.5% and 35.3% at Week 24, 16.4% and 38.3% at Week 52, and 16.8% and 38.8% at Week 104. Cumulative proportion of patients with first BMD loss >3% in the Relugolix-CT and delayed Relugolix-CT groups was 1.1% and 5.9%, respectively, at Week 12, 10.2% and 23.5% at Week 24, 15.5% and 29.4% at Week 52, and 21.5% and 32.1% at Week 104. Given similar time to pain improvement with higher risk of vasomotor symptoms or clinically significant BMD loss with delayed Relugolix-CT treatment, these findings support the benefit of initiation of Relugolix-CT to mitigate hypoestrogenic adverse events. Limitations, reasons for caution The 80-week, open-label SPIRIT LTE did not have a control group. This evaluation was an ad hoc investigation of SPIRIT data and was not part of the prespecified statistical analysis plan. Comparisons between groups were qualitative, and no statistical inferences were generated. Wider implications of the findings Although Relugolix-CT and relugolix monotherapy showed similar efficacy benefit, monotherapy was associated with a higher risk of vasomotor symptoms and clinically significant BMD loss. The more favourable Relugolix-CT benefit/risk profile vs monotherapy helps fulfil an unmet need for long-term, effective, and well-tolerated hormonal treatment of symptoms of endometriosis. Trial registration number SPIRIT 1 (ClinicalTrials.gov: NCT03204318; EudraCT: 2017–001588–19); SPIRIT 2 (NCT03204331; 2017–001632–19); SPIRIT LTE (NCT03654274; 2017-004066-10)

Romosozumab, a specific inhibitor of sclerostin, is a unique approach to therapy for postmenopausal osteoporosis and related disorders. The elucidation of sclerostin deficiency as the molecular defect of syndromes of high bone mass with normal quality, and the pivotal role of sclerostin as a mediator of osteoblastic activity and bone formation, provided the platform for the evaluation of inhibitors of sclerostin to activate bone formation. An extensive preclinical program and 2 large fracture endpoint trials with romosozumab, a sclerostin-binding antibody, have been completed. This review will highlight the results of those studies and describe the current status of romosozumab as a potential therapy for osteoporosis.