Background: Osteoporosis and fragility fractures in individuals over 50 years of age are a public health concern. Although their prevalence is higher in postmenopausal women, other gender identities also face risks that have historically been overlooked in research and clinical care. Objective: To analyze the integration of a gender perspective in clinical studies on osteoporosis and fractures, identifying methodological gaps and structural biases. Materials and methods: A systematic review was conducted using PubMed, Cochrane Library, and TripDatabase (2000-2025), including 22 relevant studies without restriction by study design, focused on sex and gender differences in diagnosis, treatment, and outcomes. Results: Inequities in diagnosis and treatment were identified, particularly affecting individuals outside the cisgender female model. The lack of gender-disaggregated data and the absence of contextual variables limit the applicability of findings. Studies employing gender-sensitive approaches show improvements in risk estimation and therapeutic equity. Conclusions: Including a gender perspective beyond the binary enhances scientific validity and promotes health equity. It is essential to adopt methodological guidelines that ensure this integration at all stages of the research process.

A country-specific FRAX® model for Costa Rica was developed using national hip fracture data from 2015–2019. Hip fracture incidence increased with age, was consistently higher in women, and exceeded rates reported in neighboring Latin American countries. Costa Rica also demonstrated higher 10-year major osteoporotic fracture probabilities at older ages compared with regional FRAX® models. An estimated 3,176 hip fractures occurred in 2020, with projections indicating an increase to 9,946 cases by 2050. These findings underscore the growing burden of hip fractures in Costa Rica and the need for targeted prevention strategies. To describe the epidemiology of hip fractures in Costa Rica and to develop a country-specific FRAX® model calibrated with national fracture and mortality data. All hip fractures (ICD-10 S72.0, S72.1, S72.2) recorded in the Caja Costarricense de Seguro Social registry from 2015–2019 were included. Age- and sex-specific incidence rates were combined with United Nations mortality data to construct a Costa Rica–specific FRAX® model. Ten-year fracture probabilities were estimated and compared with those from other Latin American countries with calibrated FRAX® models. National projections for hip fracture burden in 2020 and 2050 were derived using United Nations population forecasts. Age-specific FRAX® assessment and intervention thresholds were developed following established international methodology. Hip fracture incidence increased with age and was consistently higher in women than in men. Compared with other Latin American countries, Costa Rica demonstrated higher age-specific hip fracture rates and higher 10-year major osteoporotic fracture probabilities at older ages. An estimated 3,176 hip fractures occurred in adults aged ≥ 50 years in 2020, with a projected increase to 9,946 by 2050. Age-specific FRAX® threshold curves showed widening separation with advancing age, reflecting increasing fracture probability in older age groups. Costa Rica exhibits a comparatively high burden of hip fractures and fracture risk, which is expected to rise substantially with population aging. The newly developed Costa Rica–specific FRAX® model provides an essential tool for improving fracture risk assessment and guiding evidence-based osteoporosis management in clinical practice.

Introduction: A healthy diet is crucial for healthy growth and development during childhood and adolescence. Although evidence in this field is expanding rapidly, the focus has been on disease-oriented nutrition rather than on nutrition for healthy children and adolescents; thus, we aimed to identify key research gaps to guide future studies and policy development. Methods: For this scoping review, we systematically searched systematic reviews, clinical guidelines, and position papers. The literature search covered publications from the last eight years to provide the latest information on pediatric nutrition. A basic critical appraisal was performed to assess the quality of the evidence. Results: We included 14 studies. Six major topics were identified as the most frequently reported: healthy dietary patterns, sustainable dietary patterns, macronutrients and micronutrients, sugar intake, beverages and sugary drinks, and dairy products. Conclusions: Current information on healthy diets for children and adolescents focuses mainly on dietary patterns. However, regionalized information is lacking, as few health agencies report on specific dietary modifications, especially in developing or transition countries.

Background Postmenopausal bone loss affects both cortical and trabecular compartments, with oxidative stress implicated in its pathogenesis. Tibolone is a tissue-selective hormone therapy with potential skeletal and antioxidative effects, but its structural impact compared to estrogen is understudied. This study evaluated the effects of tibolone on cortical and trabecular bone parameters in postmenopausal women, compared with estrogen therapy and placebo, using three-dimensional dual-energy X-ray absorptiometry (3D-DXA). Methods This 12-month, randomized, open-label trial included postmenopausal women aged 45–59 years, assigned to one of three groups: tibolone (2.5 mg/day), conjugated estrogens (0.625 mg/day) plus medroxyprogesterone acetate, or placebo. Bone parameters were measured at baseline, 6, and 12 months using 3D-SHAPER software. Oxidative stress markers were assessed concurrently. Longitudinal changes were analyzed using mixed-design (two-way repeated-measures) ANOVA. Results Of 92 randomized participants, 71 completed the study (tibolone n=22, estrogen n=27, placebo n=22). Changes in areal BMD did not exceed the least significant change of DXA measurements. Numerical increases in trabecular volumetric BMD and cortical thickness were observed in the tibolone group over 12 months, whereas numerical declines were noted in the placebo group and variable changes in the estrogen group; however, no statistically significant between-group differences were detected. Lipid peroxidation decreased in the tibolone and estrogen groups, while other oxidative stress markers remained largely unchanged. Adverse events were mild, with no statistically significant differences across groups. Conclusion In this exploratory randomized study, no statistically significant between-group differences in cortical or trabecular bone parameters were detected over 12 months, and the observed changes in areal BMD did not exceed the least significant change of conventional DXA measurements. Therefore, the present study cannot establish clinically meaningful skeletal changes with tibolone. The numerical patterns observed with 3D-DXA should be considered hypothesis-generating and require confirmation in larger, adequately powered, and longer-term studies.

To critically evaluate the current evidence on the role of vitamin D in inflammatory rheumatic diseases, including its association with disease activity, potential immunomodulatory effects, and the clinical impact of supplementation. A narrative review was conducted based on a comprehensive search of MEDLINE, Cochrane Library, and Epistemonikos databases up to October 2025. Eligible studies included randomized controlled trials, observational studies, systematic reviews, and meta-analyses evaluating vitamin D status and/or supplementation in adult patients with inflammatory rheumatic diseases. Evidence was synthesized qualitatively, prioritizing study design and level of evidence. Vitamin D deficiency is highly prevalent across inflammatory rheumatic diseases and is associated with higher disease activity, fatigue, and poorer musculoskeletal outcomes. Experimental data support immunomodulatory effects; however, clinical evidence remains heterogeneous. Randomized controlled trials demonstrate that supplementation effectively corrects deficiency and is safe, with modest improvements in disease activity and fatigue mainly in patients with low baseline 25(OH)D levels. In contrast, large trials and Mendelian randomization studies do not support a causal role of vitamin D in disease onset or sustained remission. Meta-analyses show small and inconsistent benefits, limited by heterogeneity in study design, dosing regimens, and populations. Vitamin D deficiency is a common and clinically relevant finding in inflammatory rheumatic diseases. While supplementation reliably restores adequate levels and may provide modest clinical benefits in deficient patients, current evidence does not support a causal or disease-modifying role. Maintaining serum 25(OH)D ≥30 ng/mL remains advisable for skeletal health, whereas its immunological benefits require further investigation through well-designed randomized trials.

Cirrhosis is characterized by progressive metabolic vulnerability, yet early indicators of clinical decompensation remain limited. Zinc, a key cofactor in ammonia detoxification and protein metabolism, may reflect and contribute to metabolic frailty when deficient. We aimed to determine whether zinc deficiency and sarcopenia jointly define a metabolic frailty phenotype that predicts overt hepatic encephalopathy (OHE) and mortality in cirrhosis. In this 12-month prospective cohort, 109 adults with cirrhosis were followed to evaluate OHE incidence and survival. Serum zinc, dietary intake, and nutritional parameters were assessed at baseline and 3, 6, and 12 months. Sarcopenia was defined by dual-energy X-ray absorptiometry and handgrip strength. Logistic regression identified independent predictors of OHE, and Kaplan-Meier analysis evaluated survival. OHE occurred in 27.5

Objetivo. Describir el proceso de desarrollo y las características principales de los Protocolos Nacionales de Atención Médica (PRONAM), una estrategia nacional para estandarizar la práctica clínica en el primer nivel de atención en México. Material y métodos. Proceso metodológico liderado por el Consejo de Salubridad General, que incluyó priorización de temas, integración de grupos multidisciplinarios de expertos, revisión de evidencia científica, construcción de consensos, revisión técnica e interinstitucional, aprobación y publicación. Resultados. Se desarrollaron seis protocolos clínicos dirigidos al primer nivel de atención: hipertensión arterial sistémica, diabetes mellitus tipo 2 y síndrome metabólico, sobrepeso y obesidad, enfermedad renal crónica, los primeros 1 000 días de vida y vacunación a lo largo del curso de vida. Más de 80 especialistas participaron en su elaboración. Conclusión. Los PRONAM constituyen una herramienta nacional para fortalecer la atención de primer nivel y promover la estandarización de la práctica clínica basada en evidencia en México.

This study applied statistical shape modeling to 284 DXA hip scans from Mexican women, identifying proximal femur morphotypes characterized by long, narrow necks and valgus orientation. These shape patterns showed directionally lower regional BMD in vulnerable areas, although associations were modest. The findings describe femoral configurations that resemble those previously associated with fracture risk in international cohorts, supporting the potential role of morphometric analysis as a complementary, population-specific approach to skeletal fragility assessment.PurposeHip fractures are a major cause of disability and mortality in older adults, particularly among women with osteoporosis. Bone mineral density (BMD) is a cornerstone of fracture risk assessment but does not fully capture biomechanical and structural vulnerability. This study is aimed at characterizing proximal femur morphology in Mexican women using statistical shape modeling and at examining its relationship with regional BMD.MethodsIn this exploratory cross-sectional analysis, 284 dual-energy X-ray absorptiometry (DXA) hip scans were processed with BoneFinder software to generate morphometric profiles. Active Shape Models (ASM) identified the main modes of shape variation, which were analyzed in relation to site-specific BMD.ResultsSeventeen femoral configurations were identified, with three representative morphotypes: long, narrow necks with valgus alignment, short and wide necks, and intermediate morphologies. Shape patterns characterized by long, narrow, valgus-oriented femoral necks showed directionally lower regional BMD in the superior neck and Ward's triangle-sites critical for fracture initiation-although associations were modest in regression analyses. Automated morphometry identified structural traits linked to mechanical disadvantage beyond traditional cortical indices.ConclusionThis is the first study to apply statistical shape modeling to Latin American women, identifying recurring femoral shape patterns that resemble morphologies previously associated with fracture risk in international cohorts. While prospective validation with fracture outcomes is needed, this exploratory study provides foundational evidence for anatomically informed, population-specific approaches to skeletal fragility assessment.

The International Osteoporosis Foundation (IOF) and the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) have proposed procollagen type I N propeptide (PINP) and β isomerized C-terminal telopeptide of type I collagen (β-CTX-I) as reference bone turnover markers (BTMs) for osteoporosis. This report examines the published literature since the 2011 IOF-IFCC position paper in order to determine the clinical potential of the reference BTMs and newer markers for the prediction of fracture risk and monitoring the treatment of osteoporosis. Evidence for the relationship between BTMs and subsequent fractures was gathered from prospective studies through literature review of the Medline database from years 2011 to May 2024. The impact of treatment on BTMs was also studied by examining publications in that period. Studies of the accuracy of BTMs in the assessment of bone turnover in the setting of advanced chronic kidney disease were also examined. Increased BTM concentrations are associated with higher fracture risk in postmenopausal women. PINP and β-CTX-I measured in blood are associated with fracture risk but their interaction with other risk factors has not been sufficiently studied limiting their incorporation into fracture risk algorithms. Treatment-induced changes in PINP and β-CTX-I account for a substantial proportion of fracture risk reduction and are useful for improving adherence; they are recommended for inclusion in studies to examine adherence in individual patients. However, total PINP (tPINP) and β-CTX-I may be elevated in CKD due to renal retention. Bone alkaline phosphatase (BALP), intact PINP (iPINP), and tartrate resistant acid phosphatase 5b (TRACP5b) show the most promise in discriminating high and low turnover bone diseases in patients with advanced CKD and for predicting fracture risk, monitoring treatment response, and assessing the risk of treatment-related complications. We re-affirm the use of serum/plasma tPINP and plasma β-CTX-I as reference BTMs with appropriate patient preparation and sample handling and measurement by standardized/harmonized assays in clinical studies to accumulate further data, and for monitoring treatment of osteoporosis in the setting of normal renal function in clinical practice. BALP and TRACP5b, measured by standardized assays, are recommended as reference BTMs for CKD-associated osteoporosis and should be included in observational and intervention studies to ascertain their utility for risk-evaluation, treatment initiation, and assessment of treatment response in CKD-associated osteoporosis.

Childhood obesity is an increasing public health problem with heterogeneous metabolic health outcomes. In children, distinguishing differences in body composition between individuals with metabolically healthy obesity (MHO) and those with metabolic syndrome (MS) may be useful for understanding the impact of body composition on metabolic health. This cross-sectional study included 193 children aged 6-10 years with obesity (BMI > 95th percentile). Fat and lean mass distributions were measured by dual-energy X-ray absorptiometry to assess body composition. Among the study population, 45.1% were classified as MHO, while 25% presented MS. Compared with children with MHO, those with MS had significantly greater fat mass and lean mass. Body composition was strongly correlated with metabolic dysfunction, including insulin resistance, hypoalphalipoproteinaemia, and hypertriglyceridaemia. These findings reveal a definitive association between body composition indices and metabolic syndrome status in children with obesity. However, not all children with obesity develop metabolic abnormalities, highlighting the importance of detailed body composition analysis in assessing metabolic health risk.

Conduct an overview of systematic reviews of the current fracture risk prediction tools in use. We included systematic reviews (SRs) that assessed the predictive ability of any tool, score, algorithm, or other instrument for fracture risk. The primary outcome measure was the area under the curve (AUC) representing predicted fracture risk within a specified timeframe obtained from receiver operating characteristic (ROC) analysis. We included SRs that studied both men and women with fractures in the general adult population. The review identified 26 different tools currently in use to predict fracture risk. Within these tools a total, 21,717 different prediction variables were found. Among the different tools, a different number of factors were used ranging from the BWC model that used a single predictor variable to the GSOS tool that incorporated 21,717 predictor variables in its model (including many individual SNPs). Regarding the performance of the tools, AUC ranging from 0.58 to 0.90. None of the models had a prediction capacity greater than 90

BACKGROUND:During the coronavirus disease 2019 (COVID-19) pandemic, pediatric inpatients frequently received at least one antibiotic, and several antimicrobial stewardship programs (ASPs) strategies were disrupted. In Mexico, no published data are available on antibacterial consumption in children. The aim of this study was to evaluate antibacterial consumption levels and trends before, during, and after the COVID-19 pandemic in a tertiary care pediatric hospital in Mexico, and to forecast future antibacterial consumption. METHODS:This was a secondary analysis based on time series data of monthly antibacterial consumption from January 2016 to June 2024 in a tertiary care pediatric hospital. Antibacterial consumption was retrospectively measured for the pre-pandemic, pandemic, and post-pandemic periods. Consumption was expressed as days of therapy (DOT) per 1000 patient-days (pd). RESULTS:The mean antibacterial consumption at the Hospital Infantil de México Federico Gómez (HIMFG) from 2016 to 2024 was 789.3 (95% CI, 756.1-822.5) DOT/1000 pd. In the medical pediatric intensive care unit (M-PICU) and surgical pediatric intensive care unit (S-PICU), mean consumption was 1305.3 DOT/1000 pd (95% CI: 1119.1-1491.6) and 1634.5 DOT/1000 pd (95% CI: 1444.2-1824.9), respectively. Before the pandemic, the hospital-wide mean consumption was 848.8 DOT/1000 pd (95% CI: 811.3-886.2); during the pandemic, it was 709.6 DOT/1000 pd (95% CI: 650.3-769.0); and after the pandemic, 799.2 DOT/1000 pd (95% CI: 698.1-900.3). Overall, consumption rates oscillated around the mean, and no patterns were observed. CONCLUSIONS:The COVID-19 pandemic did not affect trends of antibacterial consumption across the hospital or in the pediatric intensive care unit. Although the prior authorization component of the ASP maintained antibacterial consumption around the mean, the implementation of additional ASP strategies -such as education and persuasive interventions- alongside current restrictive measures may help further optimize antibacterial consumption in pediatric units.

Background: The association between milk-derived or dairy product intake (DPI) and the body composition (BC) of children and adolescents continues to be controversial. Objective: This study sought to evaluate the association between the quantity and quality of DPI and the BC of Mexican children and adolescents. Methods: A secondary data analysis of a cross-sectional population-based sample of 2104 children and adolescents (aged 4–18 years) recruited from schools in Mexico City was performed. To assess the association between the quantity and quality of DPI, evaluated by questionnaire, and BC, dual X-ray densitometry (DXA) and surrogate parameters of the fat mass index (FMI) and lean mass index (LMI) were used. The adequacy of the quantity and quality of DPI was classified according to age-specific recommendations and the sugar, sodium and fat contents of the products consumed. Relationships were assessed by means of lineal regressions adjusted for age, sex, physical activity, sleep time and screen hours. Results: We included a total of 1840 participants aged 4.5–18 years, 52% of whom were female. Average daily DPI was 4.0 ± 2.4 servings/day, with a predominance of milk without sugar (42.7% of DPI). The quantity and quality of DPI significantly reduced the FMI (beta = −0.1 kg/m2, 95% CI −0.17 to −0.06, p < 0.001 and beta = −0.17 kg/m2, 95% CI −0.26 to −0.07, p < 0.001). No significant relationships were seen with the LMI. Conclusions: Higher quantities of good-quality DPI are associated with lower adiposity in Mexican children and adolescents.

Introduction After a decade since AUDIT LATAM 2012, an executive committee of the International Osteoporosis Foundation of Latin America (LATAM-IOF) updated the data on the epidemiological burden of osteoporosis and fragility fractures in Latin America to generate greater awareness about osteoporosis and prevent fragility fractures. Objective To describe the burden of osteoporosis and fragility fractures, their management and treatment, and the availability of health resources in Latin America over a 10-year period. Materials and methods A two-phase study was designed. Phase 1 collected demographic data from 2015 to 2019, described the current infrastructure for Healthcare Systems osteoporosis related as well as the related health care policies on osteoporosis. We assessed the availability of diagnosis tools and pharmacological treatment. Phase 2 focused on the incidence of major fragility fractures in men and women aged 50 and over, as well as the costs of these fractures when available. Results Nineteen countries completed phase 1. More than 40% of the population is over 50 years-old and life expectancy is on average 75.8 years. The availability of densitometry (DXA) is 0.68 per 100,000 inhabitants. Seven countries have FRAX® calibrated with their own epidemiological data. Bisphosphonates are the primary treatment option for osteoporosis. A larger number of countries have conducted calcium and vitamin D intake surveys. There are 68 active medical and/or patient societies involved in activities related with osteoporosis. Phase 2 included fewer countries, representing a significant gap in osteoporosis information in the region. Our rates of hip fractures are intermediate ranging between 108 and 276.2 per 100,000 inhabitants being the highest in Colombia and the lowest in Mexico. The costs of hip fracture range from USD 4959 to USD 8261. Conclusions Regional data from Latin America revealed that healthcare assistance and global awareness has improved in comparison to the 2012 figures. The hip fracture rates in Latin America remains at intermediate levels compared to other regions. There is a scarcity of cost studies, however, high costs of osteoporotic fractures were confirmed to have a negative impact on healthcare systems of the region.

This study proposes age- and sex-specific trabecular bone score (TBS) reference curves for Mexican children and adolescents. Using the latest software version, results highlight significant pubertal changes and provide reference data for assessing pediatric bone health, paving the way for a wider use of this technology in children and adolescents. Trabecular Bone Score (TBS) is a grey scale texture measure that correlates with bone microarchitecture derived from dual-energy X-ray absorptiometry (DXA). While extensively studied in adults, limited data exist for pediatric populations. This study aims to develop age- and sex-specific reference curves for TBS adjusted for abdominal soft tissue thickness in healthy children and adolescents from Mexico City. This cross-sectional study reanalyzed data from 1552 healthy participants (5–18 years) who underwent lumbar spine DXA scans using Lunar iDXA and TBS iNsight 4.0 (Core Module 19.4.0), which accounts for soft tissue thickness. Generalized Additive Models for Location, Scale, and Shape (GAMLSS) were employed to construct smoothed percentile curves. TBS values were stratified by age, sex, and Tanner stage, with descriptive statistics and outlier exclusions. TBS showed distinct age- and sex-related trajectories, with steep increases during puberty. Girls demonstrated a sharper rise in TBS starting at age 9, peaking by age 16, while boys exhibited a more gradual increase starting at age 10–11, peaking by age 18. Differences were also observed between Tanner stages, with the most significant changes occurring from stages 2 to 3. This study proposes the first TBS reference curves for Mexican children and adolescents using the latest software version. This data may prove to be a valuable tool for assessing bone health in pediatric populations. Yet further research to explore TBS’s utility in predicting bone fragility in pediatric population as well as its life-course trends.

Background and Aims This study evaluates three-dimensional dual-energy X-ray absorptiometry (3D-DXA) parameters that determine the cortical and trabecular compartments in patients with type 2 diabetes (T2D) compared to nondiabetic subjects, with the aim of identifying their determinants. Methods Patients with T2D were diagnosed according to ADA criteria. Anthropometric measurements were taken, and body mass index (BMI) was calculated. Bone densitometry (DXA) images were analyzed with 3D Shaper software. Volumetric bone mineral density (vBMD), bone mineral content (BMC), and volume were calculated in various regions of the femur, along with cortical thickness. Data analysis was performed using SPSS 27.0, a Student t-test and ANCOVA. Results A total of 125 subjects were recruited: 51 healthy controls and 74 patients with T2D (70.3 % women), with an average age of 53.9 and 53.6 years, respectively. The average disease duration in the T2D group was 11.4 years. Significant vitamin D deficiencies (levels <20 ng/mL) were found in 56 % of the control group and in 64 % of the T2D group. No significant differences in aBMD were observed between the two groups. 3D-DXA analysis showed consistently lower vBMD in patients with T2D vs. controls, with significant differences in the trochanter, femoral neck, and average cortical thickness. A positive correlation was observed between waist circumference, BMI, and higher bone density in all regions. Conclusions This study demonstrates the potential of 3D-DXA to detect cortical and trabecular bone differences in patients with T2D, undetectable by aBMD. Women with T2D showed lower bone parameters in the trochanter and femoral neck, consistent with research linking long-term T2D and poor glycemic control to compromised bone quality.

INTRODUCTION/BACKGROUND:The acquisition and maintenance of bone and lean mass health are significantly influenced by the mechanical environment of the skeleton, with physical activity emerging as an important factor. Our hypothesis proposes that high-impact physical activity improves bone mineral content and lean mass relationship in healthy adolescents depending on gender, pubertal maturity and skeletal location. METHODOLOGY:We assessed the relation between bone mineral content, and lean mass in whole-body and limbs and leisure-time physical activity in Mexican children and adolescents. We conducted an analysis using data from the "Reference values of body composition in Mexican children and adolescents' study", which is a population-based, cross-sectional study. Using standardized protocols, Lunar iDXA instrumentation was used to measure whole-body bone mineral content and lean mass. Using a validated questionnaire, adapted for the Mexican population, the leisure-time physical activity level and the "inactive" condition were determined. ANOVA test was conducted to evaluate curve fitness and produce best-fit equations. Additionally, we used ANCOVA test to evaluate the differences between slopes and intercepts of the curves. RESULTS:All relationships between bone mineral content and lean mass across various regions were highly significant for all Tanner stages (P < 0.001), irrespective of the type of physical activity. Examining all regions (whole-body bone mineral content vs. whole-body lean mass and lower limbs bone mineral content and lean mass, and upper limbs bone mineral content and lean mass) intercepts were significantly higher in Tanner stage 3-5 compared to Tanner stage 1-2 for both genders (P < 0.001). CONCLUSION:These results underscore the nuanced impact of leisure-time physical activity and Tanner stage on the observed relationships, suggesting potential benefits of engaging in specific physical activities during adolescence for bone health during the later stages of puberty.