Pregnancy and lactation-associated osteoporosis (PLO) is a rare yet debilitating cause of vertebral fractures in young women. Despite its significant clinical impact, PLO remains underdiagnosed, and data on its risk factors and management are limited. In our cohort, vitamin D deficiency, heparin exposure and a family history of osteoporosis emerged as key risk factors. Among anti-osteoporotic medications, teriparatide was the most commonly prescribed, followed by denosumab, alendronate and others. This study aimed to characterize the clinical features of women with PLO and to identify key risk factors using self-reported data from an online patient support group. A cross-sectional study was conducted among 52 women diagnosed with PLO, identified via a patient support group on WhatsApp. Data were collected through an online survey assessing demographics, fracture characteristics, bone mineral density (BMD), treatment approaches, and potential risk factors. Participants were stratified into two groups (with vs. without fractures) for comparative analysis. The mean age of participants was 33.8 ± 4.7 years. Fractures occurred in 78.8

The Build Better Bones website was developed using a robust stakeholder-engaged approach to be a self-management resource for people with osteoporosis and for care partners of people with osteoporosis. The website focuses on providing education and resources for exercise, nutrition, home safety, and advice for care partners. INTRODUCTION:Osteoporosis is a common chronic disease that requires effective self-management, including optimal diet, exercise, and home safety practices. The COVID-19 pandemic disrupted traditional outpatient care and increased the need for remote resources. In response, the International Osteoporosis Foundation (IOF) Rehabilitation Working Group developed a web-based platform "Build Better Bones" to support individuals with osteoporosis and their care providers. METHODS:The website's development followed a design thinking, iterative process informed by input from diverse stakeholders, including patients, healthcare professionals, and design experts. Qualitative feedback from 24 stakeholders across three countries shaped the platform's usability and content. Key features include an evidence-based exercise library, practical nutritional guidance, and home safety recommendations. To ensure inclusivity, the site was designed to accommodate a global audience through translation into five languages and culturally diverse animated characters. RESULTS:Stakeholders emphasized the primacy of site navigation and readability, empowering and inclusive images, and compassionate language. The website provides exercises tailored to the management of osteoporosis, focusing on exercise and nutrition with an emphasis on home safety to minimize the risk of fracture. The inclusion of interactive elements, multilingual support, and visually appealing content was guided by stakeholder input. Patients identified the accordion-style presentation and focus on empowering self-management, while clinicians valued the evidence-based exercise recommendations. Qualitative input highlighted the need for inclusive language, accessibility improvements, and practical guidance for safe practice at home. CONCLUSION:The "Build Better Bones" platform bridges a gap in osteoporosis care by providing evidence-based resources tailored to both clinicians and patients that can be disseminated to a global audience. Iterative stakeholder feedback has ensured that the platform is aligned with user needs, making it scalable and adaptable to real-world conditions. Future efforts will focus on expanding content, improving tailored features, and integrating additional languages to serve a global audience.

Pregnancy- and lactation-associated osteoporosis (PLO) is a syndrome characterized by fragility fractures (most commonly vertebral, often multiple) occurring in late pregnancy or the early postpartum period. This position statement summarizes the current knowledge of PLO, and the recommended procedure for assessment, diagnosis and treatment based on a review of published evidence. As PLO is a rare condition, controlled, comparative clinical studies are limited. Individual studies were reviewed, focusing on design, size, follow-up, evaluation of safety, and factors that impact PLO outcomes. Diagnosis of PLO should include a detailed clinical examination, a review of medical and treatment history, and laboratory tests to rule out secondary osteoporosis. Imaging techniques can be used to inform the appropriate treatment pathway, which will depend on whether the patient is antepartum or postpartum. Management of PLO and fractures includes calcium/vitamin D intake/supplementation, considering stopping breastfeeding, and analgesia, if necessary. Treatment with bone-specific agents should be evaluated on an individual basis to reduce subsequent fracture risk, noting that their use in PLO patients is off label. If pharmacological treatments are used, they must be given alongside effective contraceptive measures. Bisphosphonates can pass the placental barrier and are detectable in bone for years, so adverse effects on future pregnancies, although not yet reported, cannot be excluded. Preferred treatment options are teriparatide/abaloparatide or romosozumab. Second-choice treatments are denosumab followed by bisphosphonates or bisphosphonates alone. This position statement includes a pragmatic approach for identifying women with PLO and suggests developing an individualized treatment plan that might include pharmaceutical intervention.

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.

Background: Women with hormone-responsive breast cancer who receive adjuvant endocrine treatment with aromatase inhibitors (AI) are known to be at higher fracture risk due to a marked increase in bone resorption. In 2017, several interdisciplinary cancer and bone societies involved in the management of women with AI-associated bone loss (AIBL) published a joint position statement comprising evidence-based recommendations and a practical management algorithm for the assessment of fracture risk and optimal treatment of this patient population. Patients and methods: In order to provide updated recommendations that reflect recent advances in the assessment and management of AIBL since publication of the 2017 joint position statement, a systematic literature review was undertaken to identify relevant studies for analysis, including systematic reviews and meta-analyses. Individual trials identified were assessed for their level of evidence based on design, size, follow-up, and evaluation of safety, as well as the impact of bone directed treatments on breast cancer outcomes. Results: New evidence was combined with the existing recommendations to provide an updated joint position statement regarding fracture risk assessment and implementation of bone-directed therapy. Conclusion: Current published literature, including recent clinical trial reports, systematic reviews and meta-analyses, continue to affirm the high risk of fractures in women with breast cancer who are receiving adjuvant AI treatment, a risk which has been observed to increase with the commonly used approach of extended duration AI therapy (>5 years). Risk factors for fracture and risk assessment in this patient population as well as the most suitable treatment modalities have been updated. Finally, the influence of bone protective treatments on breast cancer outcomes such as incidence of bone metastasis and breast cancer related overall survival have been included.

Physical activity (PA) and sedentary behavior (SB) are two key lifestyle factors with profound implications for bone health across the lifespan. While PA is recognized for its positive effects on bone mineral density (BMD) and fracture prevention, emerging evidence highlights the detrimental consequences of prolonged sedentary time, independent of PA levels. This review synthesizes current knowledge on the impact of PA and SB on bone health outcomes, focusing on BMD and fracture risk in children, adolescents, adults, and older populations. A selection of epidemiological studies, systematic reviews, and meta-analyses was analyzed to explore the associations between movement behaviors and bone health indicators across different life stages. Particular attention was given to studies objectively measuring SB and PA and to the substitution effects of sedentary time with light or moderate-to-vigorous PA. In children and adolescents, higher levels of SB are associated with lower BMD, particularly at weight-bearing sites, while participation in weight-bearing and impact-loading PA positively influences bone mass accrual. In adults and older individuals, regular PA, including moderate-to-vigorous intensity weight-bearing PA and resistance training activities, is consistently linked to greater BMD and reduced fracture risk. Conversely, high sedentary time is associated with lower BMD and increased fracture incidence, particularly among frail or pre-frail individuals. Importantly, replacing sedentary time with even light-intensity PA yields measurable benefits for bone health, particularly among older adults and postmenopausal women, and may contribute to a reduced risk of fractures, although evidence remains limited. Promoting PA while minimizing SB should be central to clinical practice and public health policies aimed at maximizing and preserving skeletal health and preventing osteoporotic fractures, across the lifespan. Early intervention, continuous promotion across life stages, and adherence to WHO guidelines offer an effective, evidence-based framework for lifelong bone health maintenance.

The FracTurk database integrates fracture liaison services with cultural and clinical practices in Türkiye, enhancing post-fracture care through digital tools. By tailoring treatment to the local context, it improves patient outcomes and reduces costs, with the potential to serve as a global model for culturally adapted healthcare solutions. Fracture liaison services (FLS) are specialized programs that aim to identify, treat, and manage patients who have experienced fragility fractures, with the overarching goal of preventing future fractures. Recognizing the need for a culturally appropriate and coordinated approach, the Turkish Osteoporosis Society has developed FracTurk, a national digitized FLS database tailored to the unique cultural, socioeconomic, and healthcare landscape of Türkiye. This paper provides an overview of the FracTurk system, detailing its development, potential benefits, and significance while also offering insights into future considerations for this initiative. By prioritizing digitalization and standardization within the FLS system, we aimed to pave a smooth patient pathway, ensuring a seamless journey through post-fracture care. The FracTurk database was developed through a systematic process that involved the standardization and digitalization of patient follow-up forms and clinical practices across various institutions in Türkiye with international guidelines under the supervision of mentors certified by the International Osteoporosis Foundation, Capture the Fracture Initiative, which has been active for over 10 years in many countries. Additionally, the system incorporates clinical decision support tools and is customized to align with the Turkish cultural and healthcare landscape. Since its launch, the FracTurk database has been actively utilized by 25 users across 23 centers, with over 731 registered patients. The system continues to expand, demonstrating high levels of adoption and growth, indicating its increasing relevance and impact within the Turkish healthcare system. During the launch, the major difficulties and limitations encountered by the centers were discussed. FracTurk constitutes a noteworthy step forward in digitizing and adapting FLS to the Turkish context. Although obstacles exist regarding data standardization and ensuring equitable access, the database demonstrates promise in enhancing patient outcomes, lowering healthcare expenditures, and serving as a template for other countries to emulate.

Radiofrequency Echographic Multi Spectrometry (REMS) is a radiation-free, portable technology, which can be used for the assessment and monitoring of osteoporosis at the lumbar spine and femoral neck and may facilitate wider access to axial BMD measurement compared with standard dual-energy x-ray absorptiometry (DXA).There is a growing literature demonstrating a strong correlation between DXA and REMS measures of BMD and further work supporting 5-year prediction of fracture using the REMS Fragility Score, which provides a measure of bone quality (in addition to the quantitative measure of BMD).The non-ionising radiation emitted by REMS allows it to be used in previously underserved populations including pregnant women and children and may facilitate more frequent measurement of BMD.The portability of the device means that it can be deployed to measure BMD for frail patients at the bedside (avoiding the complications in transfer and positioning which can occur with DXA), in primary care, the emergency department, low-resource settings and even at home.The current evidence base supports the technology as a useful tool in the management of osteoporosis as an alternative to DXA.

OBJECTIVES:To evaluate the effect of the presence of a vertebral fracture on balance and physical performance and its contribution to fall and fracture risk in patients with postmenopausal osteoporosis. PATIENTS AND METHODS:Ninety-five individuals with postmenopausal osteoporosis were included in this study. Patients were divided into 2 groups with a history of vertebral fracture (n = 45) and those without (n = 50). The control group consisted of patients without fractures while the study group was subdivided into 2 subgroups: single-level (n = 29) and multiple-level vertebral fractures (n = 16). None of the study participants had a history of non-vertebral fracture. All patients with a history of vertebral fracture were in the chronic phase without any complaints of pain. Thoracolumbar radiograph, computed static posturography, FRAX (fracture risk assessment tool) scores, DXA (Dual-energy x-ray absorptiometry) measurements, serum 25(OH)D values, tandem test, timed up and go test (TUG), Berg balance scale (BBS) were performed. RESULTS:The probability of FRAX-major osteoporotic fracture, lumbar total T-score and TUG time were significantly higher and the BBS score was lower in the study group. The mean TUG time was 11.69 ± 3.81 s in the study group and 9.87 ± 2.57 s in the controls, while the mean BBS score was 52.73 ± 3.80 s in the study group and 55,28 ± 1,59 s in the control group (p < 0,005). The probability of FRAX-major osteoporotic fractures was significantly higher in patients with multiple level fractures compared to the patients with a single level fracture. There was also a moderately negative correlation between TUG and BBS, and between the BBS and fall index. The fall index was 43.73% ± 26.34% in the study group and 34.14 % ± 24.04% in the controls (p: 0.058). CONCLUSION:This study showed that the presence of a vertebral fracture may have a negative impact on balance and physical performance, leading an increase in the risk of falls and fractures in patients with postmenopausal osteoporosis. The risk factors should be evaluated cautiously to prevent the patients from this vicious circle.

Lymphedema praecox is a rare lymphatic vascular anomaly diagnosed before the age of 35, presenting with unilateral involvement of the lower extremities. Paget's Disease of Bone (PDB) is also a rare osteometabolic disorder characterized by an accelerated rate of bone remodeling, and diagnosis of the disease is challenging. Here, we report a 49-year-old woman with primary lymphedema since the age of 33, who presented with pain and swelling in her right leg. Although the volume of the extremity diminished after complete decongestive therapy, the pain continued. Further evaluation with X-ray, bone scan, and biochemical markers supported the diagnosis of PDB. Following the zoledronic acid infusion, the pain score improved. However, there is no published association between these two diseases. Both lymphedema and PDB are associated with vascular disease and have a genetic background. This is the first case reporting the coexistence of lymphedema and PDB in the same extremity.

Although FRAX is used for fracture risk evaluation, this tool does not include balance and fall risk. The association between the predictors of falls and high FRAX scores we found in this study suggests that risk indicators for falls may add substantial value to FRAX by improving fracture risk prediction. This observational, descriptive, and cross-sectional study aimed to assess the fall risk predictors and explore their association with FRAX in Turkish patients with postmenopausal osteoporosis. Two hundred and nine (209) women with postmenopausal osteoporosis referred to the Fracture Liaison Service (FLS) at Istanbul University–Cerrahpaşa were enrolled in the FRACT study (The Fracture Study of Turkey). Clinical risk factors were assessed using the FRAX tool. Tandem stance, Tandem walking, Timed up and go (TUG), and Chair stand tests were performed to assess balance and fall risk. Among patients with a mean age of 67.6 (± 9.7) years, 66 patients (31.6

Pregnancy and lactation-induced osteoporosis (PLO) is a serious and rare condition, which causes substantial physical and emotional distress. The rarity of PLO highlights the importance of alternative information sources such as online patient groups. This study aims to explore the experiences of PLO among members of a WhatsApp patient group and to analyze how participation in the group impacts members’ knowledge about their condition, psychological well-being, and healthcare decisions. This cross-sectional study included forty-six members of the “Smile Please” WhatsApp patient group, diagnosed with PLO. A 9-item survey assessed membership duration, sources of group awareness, knowledge improvement, changes in fears and concerns, and impacts on treatment decisions. Data were collected through structured survey questions for quantitative analysis and an open-ended question to capture qualitative insights. The average age of participants was 33.8 ± 4.8 years, with a mean BMI of 23.2. Their group membership duration was 15.3 ± 16.8 months. Increased knowledge was reported by 46.3

Trabecular bone score (TBS) is a grey-level textural measurement acquired from dual-energy X-ray absorptiometry lumbar spine images and is a validated index of bone microarchitecture. In 2015, a Working Group of the European Society on Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) published a review of the TBS literature, concluding that TBS predicts hip and major osteoporotic fracture, at least partly independent of bone mineral density (BMD) and clinical risk factors. It was also concluded that TBS is potentially amenable to change as a result of pharmacological therapy. Further evidence on the utility of TBS has since accumulated in both primary and secondary osteoporosis, and the introduction of FRAX and BMD T-score adjustment for TBS has accelerated adoption. This position paper therefore presents a review of the updated scientific literature and provides expert consensus statements and corresponding operational guidelines for the use of TBS. An Expert Working Group was convened by the ESCEO and a systematic review of the evidence undertaken, with defined search strategies for four key topics with respect to the potential use of TBS: (1) fracture prediction in men and women; (2) initiating and monitoring treatment in postmenopausal osteoporosis; (3) fracture prediction in secondary osteoporosis; and (4) treatment monitoring in secondary osteoporosis. Statements to guide the clinical use of TBS were derived from the review and graded by consensus using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach. A total of 96 articles were reviewed and included data on the use of TBS for fracture prediction in men and women, from over 20 countries. The updated evidence shows that TBS enhances fracture risk prediction in both primary and secondary osteoporosis, and can, when taken with BMD and clinical risk factors, inform treatment initiation and the choice of antiosteoporosis treatment. Evidence also indicates that TBS provides useful adjunctive information in monitoring treatment with long-term denosumab and anabolic agents. All expert consensus statements were voted as strongly recommended. The addition of TBS assessment to FRAX and/or BMD enhances fracture risk prediction in primary and secondary osteoporosis, adding useful information for treatment decision-making and monitoring. The expert consensus statements provided in this paper can be used to guide the integration of TBS in clinical practice for the assessment and management of osteoporosis. An example of an operational approach is provided in the appendix. This position paper presents an up-to-date review of the evidence base, synthesised through expert consensus statements, which informs the implementation of Trabecular Bone Score in clinical practice.

Objective: The purpose of this study was to identify the most preferred measurement tools for assessing fracture risk and quality of life (QoL) in patients with osteoporosis (OP). Materials and Methods: The QoL questionnaires and risk assessment calculators in OP were investigated based on a questionnaire conducted by the Turkish Osteoporosis Society during WCO-IOF-ESCEO 2023 in Barcelona. One hundred congress participants were included in the study. Basically the participants were questioned which risk assessment calculator they preferred to assess fracture risk and which OP QoL questionnaire they used to evaluate patients' QoL. Results: Twenty-one participants reported that they did not evaluate QoL. Those who completed the QoL assessment were found to prefer the OP QoL questionnaire the most (32.6%). We found that participants most preferred Fracture Risk Assessment Tool (FRAX) (81.0%) to assess fracture risk at the OP.Conclusion: FRAX was found to be significantly preferable in the assessment of fracture risk, despite the fact that healthcare professionals did not have a substantial consistency in QoL questionnaires.

Oral bisphosphonates are a key intervention in the treatment of osteoporosis and in reducing the risk of fragility fractures. Their use is supported by over 3 decades of evidence; however, patient adherence to oral bisphosphonates remains poor in part due to complex dosing instructions and adverse events, including upper gastrointestinal symptoms. This problem has led to the development of novel oral bisphosphonate formulations. Buffered, effervescent alendronate is dissolved in water and so seeks to reduce upper gastro-intestinal adverse events, and gastro-resistant risedronate aims to reduce the complexity of dosing procedure (e.g. fasting prior to consumption) whilst still maintaining the efficacy of fracture risk reduction. Clinical trials and real-world data have been employed to demonstrate some benefits in terms of reduced upper gastro-intestinal adverse events, adherence, persistence and health economic outcomes. This report describes the result of an ESCEO (European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis) expert working group, which explores where oral bisphosphonates sit in current clinical practice guidelines, review their risk-benefit profile and the consequences of poor adherence before exploring novel oral bisphosphonate formulations and their potential clinical and health economic impact. Further research is required but there are signs that these novel, oral bisphosphonate formulations may lead to improved tolerance of oral bisphosphonates and thus, improved adherence and fracture outcomes.

Purpose: Lymphedema is an important situation that causes physical and psychological life-threatening problems. This study researches kinesiophobia in lower extremity patients and scrutinizes the relationship between kinesiophobia, physical performance and balance. Methods: This cross-sectional controlled study included 40 individuals diagnosed with lower extremity lymphedema with a mean age of 42.58±10.30 years and 31 healthy individuals with a mean age of 40.65 ± 9.53 years. The evaluation of patients with unilateral lymphedema without cognitive and visual problems and those without orthopedic and neurological disorders that would prevent walking and those without heart disease and hypertension was carried out between November 2018 and March 2019. Static balance was evaluated with standing on One leg Balance Test, fear of movement was evaluated with Tampa Scale Kinesiophobia and functional levels were evaluated with Timed Up and Go test. Results: Static balance and physical performance of lower extremity lymphedema patients were found to be statistically different than healthy individuals (p

BACKGROUND:Although there are some retrospective studies to present musculoskeletal findings of the COVID-19, still the muscle strength and fatigue has not been studied in detail.AIM:To reveal the symptoms of musculoskeletal system in COVID-19 patients, to evaluate myalgia, arthralgia and physical/mental fatigue, to assess handgrip muscle strength, and to examine the relations of these parameters with the severity and laboratory values of the disease.DESIGN:This study was designed as a cross-sectional, single-center case series.SETTING:This study took place from May 15, 2020, to June 30, 2020 at the Istanbul University-Cerrahpasa, Cerrahpasa Pandemia Services.POPULATION:Hospitalized 150 adults with laboratory and radiological confirmation of severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) according to WHO interim guidance were included in the study.METHODS:The disease severity 2007 IDSA/ATS guidelines for community acquired pneumonia was used. Myalgia severity was assessed by numerical rating scale (NRS). Visual analog scale and Chalder Fatigue Scale (CFS) were used for fatigue severity determination. Handgrip strength (HGS) was measured by Jamar hand dynamometer.RESULTS:One hundred three patients (68.7%) were non-severe, and 47 patients (31.3%) were severe. The most common musculoskeletal symptom was fatigue (133 [85.3%]), followed by myalgia (102 [68.0%]), arthralgia (65 [43.3%]) and back pain (33 [22.0%]). Arthralgia, which was mostly notable at wrist (25 [16.7%]), ankle (24 [16.0%]) and knee (23 [15.3%]) joints, was significantly higher among the severe group. Severe myalgia was prevalent among myalgia sufferers regardless of COVID-19 severity. The physical fatigue severity score was significantly higher in severe cases, whereas this difference was not significant in mental fatigue score. Female patients with severe infection had "lower" grip strength, whereas grip strength among males did not differ significantly between non-severe and severe COVID-19 cases. Nevertheless, the mean values in both genders and in age decades were below the specified normative values. CRP, ferritin, and LDH levels were significantly higher in women with "lower" grip strength compared to the "normal" group.CONCLUSIONS:Aside from other multisystemic symptoms, musculoskeletal symptoms are quite common in patients with COVID-19. Patients have severe ischemic myalgia regardless of disease activity. Although there is a muscle weakness in all patients, the loss of muscle function is more of a problem among women in connection with disease severity. Muscular involvement in Coronavirus disease is a triangle of myalgia, physical fatigue, and muscle weakness.CLINICAL REHABILITATION IMPACT:Muscle involvement in COVID-19 patients does not mean only myalgia but also a combination of physical fatigue and muscle weakness, and this should be considered in planning the rehabilitation strategies of COVID-19 patients.