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Osteoporosis is a systemic skeletal disorder characterized by reduced bone density and an increased risk of fractures, particularly prevalent in the aging population. Osteoporotic complications, including vertebral compression fractures, hip fractures, and distal forearm fractures, affect over 8.9 million individuals globally, placing a significant economic strain on healthcare systems. Recent advances have expanded our understanding of the mechanisms underlying osteoporosis, particularly the intricate regulatory networks involved in bone metabolism. A central player in these processes is ubiquitin-mediated proteasomal degradation, a crucial post-translational modification system that involves ubiquitin, the ubiquitin-activating enzyme (E1), ubiquitin-conjugating enzyme (E2), ubiquitin ligase (E3), deubiquitinating enzymes, and the proteasome. Among the various E3 ligases, the NEDD4 family has emerged as a key regulator of both bone development and osteoporotic pathology. This review delineates the role of NEDD4 family in osteoporosis and identifies potential drug targets within these pathways, offering insights into novel therapeutic approaches for osteoporosis through targeted intervention. [ABSTRACT FROM AUTHOR]

Objective: To assess the prevalence of geriatric syndromes (GSs) and evaluate service satisfaction among older patients attending a comprehensive geriatric check-up clinic (CGCC) at Siriraj Hospital. Materials and Methods: A cross-sectional study was conducted at the CGCC from December 2021 to November 2022. Participants aged 60 years and older were screened using a two-step approach; short screening by a standard questionnaire followed by an in-depth assessment. GSs were identified through standardized tools, and patient satisfaction was assessed using a structured questionnaire. Results: Of 159 participants, 67.9% were women, with a mean age of 66.6 ± 6 years. In step 1, 43.7% showed cognitive impairment, 29.1% had a risk of falls, and 76% reported oral health issues. Step 2 confirmed cognitive impairment in 40.6%, malnutrition risk in 93.3%, and sarcopenia in 78%. The mean satisfaction score was 33.3 ± 2.5 out of 35 points. Total service time averaged 104.2 ± 36.9 minutes. Conclusion: In a health check-up clinic where GSs are often under-recognized, GSs, particularly cognitive impairment, fall risk, and oral health issues, are prevalent. Despite extended service times, patient satisfaction remained high, highlighting the importance of comprehensive screening in geriatric care. [ABSTRACT FROM AUTHOR]

Background context: As lumbar degenerative diseases become more prevalent in an aging population, there is an increasing demand for surgical interventions, such as posterior lumbar interbody fusion (PLIF). However, cage subsidence (CS), observed in 23.9–54% of cases postoperatively, remains a significant complication. Several factors, including age, bone quality, and endplate damage, contribute to the risk of CS, with bone quality being among the most critical determinants. Although DEXA and QCT are widely employed to assess bone density, their routine use in preoperative evaluations is restricted by cost considerations and radiation exposure. Recent studies suggest that MRI-based vertebral body quality (VBQ) and endplate bone quality (EBQ) score offer a viable, non-invasive alternative for evaluating bone quality; however, there is limited research comparing their predictive value for CS. Methods: In this retrospective study, 165 patients undergoing single-level PLIF surgery were included. MRI-based VBQ and EBQ score were calculated using T1-weighted images, and preoperative QCT was employed as a clinical standard. Cage subsidence was assessed based on postoperative imaging at 12-month follow-up. Statistical analyses, including t-tests, chi-square tests, and ROC curve analyses, were used to evaluate the predictive accuracy of VBQ and EBQ for CS. Results: The study's findings demonstrated that both VBQ and EBQ scores were significantly correlated with QCT measurements, thereby validating their utility as indicators of bone quality. ROC analysis revealed that VBQ had superior predictive value for CS (AUC = 0.814) compared to EBQ (AUC = 0.719), with both scores demonstrating significant clinical utility in identifying patients at risk for CS. Notably, VBQ exhibited a stronger correlation with preoperative clinical outcomes compared to EBQ, underscoring its greater reliability as a predictor. Conclusions: This study highlights the effectiveness of MRI-based VBQ and EBQ score as practical, non-invasive tools for assessing bone quality preoperatively, with VBQ demonstrating superior predictive performance for CS risk. The findings underscore the potential of integrating these MRI-based assessments into routine preoperative planning to improve patient outcomes and minimize complications associated with PLIF surgery. [ABSTRACT FROM AUTHOR]

Osteoporosis and osteopenia are frequently found in patients undergoing shoulder surgery, especially rotator cuff repair, and it is anticipated that this link will become more common as more elderly people have operations on their shoulders. For orthopedic surgical candidates who are at high risk, preoperative screening may identify those who might benefit from early intervention and prevent any associated adverse events. The major complications include repair failure and revision surgery. Antiresorptive medication preoperatively has shown good results in vivo. However, when used in the clinical setting, the efficacy remains controversial. Surgical management may include repair augmentation and placing the anchors in the posteromedial part of the greater tuberosity. Level of evidence: IV. [ABSTRACT FROM AUTHOR]

Vitamin D is a key molecule in calcium and phosphate homeostasis; however, increasing evidence has recently shown that it also plays a crucial role in the immune system, both innate and adaptive. A deregulation of vitamin D levels, due also to mutations and polymorphisms in the genes of the vitamin D pathway, determines severe alterations in the homeostasis of the organism, resulting in a higher risk of onset of some diseases, including osteoporosis. This review gives an overview of the influence of vitamin D levels on the pathogenesis of osteoporosis, between bone homeostasis and immune system. [ABSTRACT FROM AUTHOR]

Introduction Due to an aging population, the number of elderly patients with cervical spondylosis, a condition that is often accompanied by osteoporosis, is increasing. Many of these patients undergo degenerative changes in the cervical spine, which may be in need of cervical fixation and fusion surgery. Studies have found that 2% of patients undergoing surgery for cervical spondylosis are associated with osteoporosis, of whom the rate of anterior cervical spine surgery is 63.35% and the postoperative revision rate is 3.57%, which is significantly higher than those without osteoporosis. 1 With the development and improvement in cervical cage technologies, anterior cervical discectomy and fusion (ACDF) is currently widely used and is considered the gold standard for the treatment of cervical spondylosis. 2 , 3 Among them, the bridge-type ROI-C interbody fusion device can reduce operation time, blood loss, postoperative dysphagia, adjacent segment degeneration, and other complications. Thanks to its precise clinical curative effect, it has been widely applied in clinical use. 4 , 5 Up to the present, no studies have reported on the use of bridge-type ROI-C interbody fusion cages for anterior cervical fusion with osteoporosis. This study retrospectively analyzed 24 patients with cervical spondylosis treated with ACDF using the bridge-type ROI-C interbody fusion cage system in our hospital from August 2013 to January 2015. The clinical results are reported in the following sections. Patients and methods Research objectives In total, 24 patients with cervical spondylosis, accompanied with osteoporosis, were treated with the ROI-C interbody fusion cage in our hospital from August 2013 to January 2015. All patients gave written informed consent for participation in this study. This study was approved by the research ethics board of the First Affiliated Hospital of Nanjing Medical University. All patients were diagnosed with osteoporosis by double-energy X-ray absorptiometry (DEXA). Among them, there were nine cases of cervical spondylotic myelopathy, 13 cases of cervical spondylopathy, and two cases of mixed cervical spondylosis. The patients consisted of nine males and 15 females, with an average age of 58.2 years (ranging from 53 to 76 years). The average duration of postoperative follow-up was 27.4 months (ranging from 21 to 36 months). All cervical lesions were at the C3–7 level and included 19 cases of lesions in a single segment, four in double segments, and one in three segments. There were five cases of lesions in the C3–4 segment, ten in the C4–5 segment, 12 in the C5–6 segment, and three in the C6–7 segment (Table 1). One patient underwent cervical fusion surgery in the adjacent segment, and this lesion was in the upper segment of the fused segment. All patients underwent cervical spine X-ray, computed tomography (CT), and magnetic resonance imaging (MRI) before surgery. Table 1 Descriptive data, bone density, and operation details of patients Note: Data shown as number or mean ± standard deviation. Inclusion criteria Inclusion criteria were as follows: the presence of MRI and other imaging examination evidence to suggest that the spinal cord or nerve roots were compressed; presentation with obvious corresponding clinical symptoms, such as neck and shoulder pain, numbness, tightness in the chest, limb weakness, walking instability, foot cotton, and other symptoms; a bone density examination revealing osteoporosis (T ≤ −2.0); symptoms that were not significantly relieved and still affected normal life after 6 months of regular conservative treatment; and complete medical records and imaging data. Patients with severe cervical instability, cervical fracture and dislocation, spinal stenosis, tumor, and severe osteoporosis were excluded from the study. Clinical evaluation indicators The clinical outcomes were assessed using the Japanese Orthopedic Association (JOA) scores 6 and Cervical Dysfunction Index (NDI) scores 7 before and after the surgery. Odom's method was used to determine the efficacy of the surgery and was ranked as follows: excellent, postoperative symptoms and signs disappeared; good, most of the symptoms and signs were relieved and normal functioning was returned; fair, symptoms and signs were partially improved, but they could not function properly; poor, symptoms and signs were basically the same as before surgery. According to the Bazaz score, 8 the severity of postoperative dysphagia was graded as follows: none, no swallowing problems; mild, almost no dysphagia; moderate, occasional dysphagia; and severe, frequent dysphagia. Radiological assessment All patients underwent standard cervical radiography before surgery, 3 months after surgery, and at the time of last follow-up. The C2–C7 Cobb angle, 9 segmental angle (SA), and height of operation segment (HOS) were measured, and Borden's method was used for the measurement of the cervical vertebral bow depth (Figure 1). The Vaccaro standard was used to evaluate the status of interbody fusion. 10 The fusion criteria were as follows: displacement angle of the cervical vertebral motility position adjacent to the vertebral body did not exceed 2°; height of the intervertebral space was recovered without collapse; bone trabecular and upper and lower vertebrae possessed bony connection; no translucent line was visible between the bone area and the upper and lower edges of the vertebral body. Figure 1 Methods of measuring cervical radiographic parameters (T=−2.7). Notes: (A) Height of the operation segment, measured as the distance between the midpoint of the upper end plate and the midpoint of the lower end plate. (B) The cervical C2–C7 Cobb angle is the angle between the perpendicular line of the inferior end plate of the C2 and C7 vertebrae. A positive value denotes lordosis, and a negative value denotes kyphosis. (C) The SA is the angle between the perpendicular line of the superior end plate of the cranial vertebrae and the inferior end plate of the caudal vertebrae. (D) The cervical vertebral bow depth is measured as the line between the upper edge of the posterior odontoid process and the posterior and lower edge of the C7 vertebra, connecting the posterior margin of the vertebrae to the arc and the vertical distance from the arc top to the front line. Abbreviation: SA, segmental angle. Materials The curved area above the ROI-C fusion cage (LDR, Troyes, France) follows the natural vertebral anatomy (Figure 2). Its leading edge is higher than the posterior edge, bringing the bone and the implant in close contact with each other. It can effectively restore and maintain the height of the intervertebral space and the cervical physiological curvature. It also provides a large cross-sectional area, increases contact area between the bone graft and the upper and lower vertebral bodies, promotes fusion, and reduces the risk of collapse. The outer bearing surface is large, and its serrated appearance and anatomical form increase the initial stability. Different models and specifications are available which are suitable for different anatomical features of the spine, so that it can be more perfectly matched with cervical anatomy. Polyetheretherketone (PEEK) composites permit the penetration of X-rays, allowing for the evaluation of bone growth and fusion. 11 , 12 Figure 2 The bridge-type ROI-C interbody fusion cage system. Notes: (A) Oblique view. (B) Anterior view. (C) Superior view. (D) Lateral view. Surgical methods With the patient in a supine position, the classic Robinson and Cloward anterior cervical approach and technique 13 were used. After completion of decompression, a bridge ROI-C fusion cage of suitable size was installed. Postoperative fluid analgesia and regular anti-osteoporosis treatment were performed. Two days after surgery, the drainage tube was removed. When the patient was able to get out of bed, a cervical collar was worn for 3 months after the operation. Statistical methods SPSS 20.0 software (IBM Corporation, Armonk, NY, USA) was used for statistical analysis of the data. Results of cervical radiological parameters are expressed as mean ± standard deviation. A paired-sample t-test was used to compare changes in JOA scores, NDI scores, and radiological parameters before and after surgery. P-value of ≤0.05 was regarded as statistically significant. Results General conditions of patients Anesthesia for all patients was satisfactory, and operations were carried out successfully without any injury to the trachea, esophagus, dura mater, or spinal cord. No hoarseness of voice, dyspepsia, dyspnea, or other complications, such as deep vein thrombosis of the lower extremity, arose after the operation. All patients were discharged 3–5 days after operation and showed good incision healing. During the follow-up period, symptoms of spinal cord and nerve compression were significantly relieved compared with the preoperative state. At 3 months post operation, only two cases had poor bone graft fusion and the bone fusion rate was 91.7%. At the final follow-up, all patients had achieved bone fusion, and no blade fractures, cage subsidence, or loosening was observed. Clinical and radiological results Twenty-four patients were diagnosed with osteoporosis by DEXA before the operation, with an average T-value of −2.6. The average operation time was 57±19 minutes on a single-segment case, 93±27 minutes on a double-segment case, and 128 minutes on the single three-segment case. The patients were followed up for 21–36 months, for an average of 27±5.7 months. The JOA score increased from the preoperative measurement (9.2±1.8) to the time of final follow-up (13.8±1.6) and NDI scores decreased from preoperative measurement (36.9±11.7) to the time of final follow-up (7.9±3.1). The JOA and NDI scores at 3 months postoperatively and at the time of final follow-up were significantly different from those before surgery (Table 2 ; P<0.05). The effect of surgical treatment was determined by Odom's method, with 95.8% rated as excellent or good. Two patients suffered from mild dysphagia after surgery, which disappeared after 3–5 days of symptomatic treatment. The C2–C7 Cobb angle, SA, cervical vertebral bow depth, and HOS were significantly improved at 3 months post operation (Table 3 ; P<0.05). At the final follow-up, the C2–C7 Cobb angle, SA, cervical vertebral bow depth, and HOS were well maintained, with no significant difference observed compared with the values obtained at 3 months post operation (Table 3 ; P>0.05). Table 2 The JOA and NDI scores of patients at different time points Notes: b compared with a: P<0.05. Data shown as mean ± standard deviation. Abbreviations: JOA, Japanese Orthopedic Association; NDI, Cervical Dysfunction Index. Table 3 Radiographic outcomes of patients at different time points: cervical curvature, SA, cervical vertebral bow depth, and HOS measurements Notes: b compared with a: P<0.05. Data shown as mean ± standard deviation. Abbreviations: HOS, height of operation segment; SA, segmental angle. Typical cases were as follows: 1) a 66 year-old male patient was admitted to the hospital showing numbness of the limbs and walking instability for 2 years. The symptoms worsened over 3 months. DEXA results showed that the T-value of the lumbar spine bone density was −2.5. Radiological data before and after surgery and upon follow-up are shown in Figures 3 – 5. 2) A 64 year-old male patient, who underwent anterior cervical surgery 3 years ago, suffered from degeneration of adjacent spinal segments after surgery. The diagnosis was cervical spondylotic myelopathy and adjacent segment degeneration of the cervical spine. The preoperative T-value was −2.3. The imaging data before and after surgery are shown in Figures 6 and 7. Figure 3 Preoperative imaging examination. Notes: (A) X-ray image showing degeneration of the cervical vertebrae, narrowing of the intervertebral space, and decreased physiological bending of the cervical vertebrae. (B , C) MRI showing C3–C4 intervertebral disk herniation and significant compression of the dura mater. Abbreviation: MRI, magnetic resonance imaging. Figure 4 Imaging examination at 3 months post operation. Notes: (A , B) X-ray image showing that the fusion device was in place in a satisfactory position. The lordosis of the cervical spine was well maintained. (C , D) MRI showing satisfactory decompression at the C3–C4 segment. Abbreviation: MRI, magnetic resonance imaging. Figure 5 Imaging examination at 3 years post operation. Notes: (A , B) X-ray image showing satisfactory position of the cage and good maintenance of cervical lordosis. (C , D) MRI showing satisfactory decompression at the C3–C4 segment and no increase in degeneration in the adjacent segment. Abbreviation: MRI, magnetic resonance imaging. Figure 6 Preoperative imaging examination. Notes: (A , B) X-ray image showing degeneration of the cervical vertebrae and narrowing and progressive aggravation of the intervertebral space in the adjacent segment. (C , D) MRI showing C4–C5 disk herniation in the segment adjacent to the operation with dura mater compression and spinal stenosis. Abbreviation: MRI, magnetic resonance imaging. Figure 7 Postoperative imaging examination. Notes: (A , B) X-ray imaging showing the satisfactory position of the fusion device at 3 days post operation. (C , D) X-ray imaging showing the satisfactory position of the fusion cage after 3 months. The cervical lordosis was well maintained. Discussion Osteoporosis, one of the most common human bone diseases, is characterized by reduced bone mass and deterioration of bone tissue and structure. 14 The number of people with osteoporosis in USA is estimated at 10 million, and it is expected to increase to 20 million by 2020. 15 In China, among people over 50 years old, approximately 69.44 million people suffer from osteoporosis. Among them, the prevalence rate of women reached 20.7%, and that of men was 14.4%. 16 In 1994, the WHO proposed diagnostic criteria for osteoporosis, which were based on data from white postmenopausal women. The criteria were as follows: a bone mineral density (BMD) at the affected site of 2.5 SD lower than that of the average – meaning a T-value of ≤−2.5 SD. If accompanied by a brittle fracture, it is termed as severe osteoporosis. This standard is based on the T-value, which is calculated according to the following formula: Thus, the selection criteria of the normal reference population are key; the BMD of the normal reference population varies according to region, lifestyle, and dietary habits; thus, the diagnostic criteria do not fully apply to the Chinese population. In 1999, the Diagnostic Group of the Osteoporosis Committee of the Chinese Gerontology Society suggested that the diagnostic criterion for osteoporosis should be a loss of 25% of bone mass, or 2.0 SD, a standard that is more in-line with China's physical characteristics. Hee et al 17 reported on the complications of 21 cases of osteoporotic multi-segmental cervical spondylosis treated with an anterior titanium mesh graft with titanium plate fixation. They achieved 95% bone graft fusion, but up to 33% of cases had complications, with the main cause of complications being a failure of the intervertebral cage and titanium mesh. Yan et al 18 conducted a single-center study on the use of titanium mesh and dynamic titanium plates in the treatment of subtotal vertebral resection in osteoporotic patients of varying degrees. They found no difference in neurological recovery and postoperative cervical curvature, but found striking differences in the degree of osteoporosis subsidence, with all patients showing satisfying bone fusion. Of course, regular anti-osteoporosis treatment based on the specific patient characteristics is necessary during the perioperative period, and the anti-osteoporosis treatment program should be adjusted according to the follow-up results. Wang et al 19 studied the anterior fusion surgery of cervical spondylotic myelopathy with osteoporosis and assessed the effect of anti-osteoporosis treatment on the overall curative effect. Their results confirmed that anti-osteoporosis treatment could further improve cervical curvature and fusion segment intervertebral height and was also more effective in alleviating pain in the upper extremities. All patients in our study received regular anti-osteoporosis treatment, and all had symptoms that were remarkably alleviated. The JOA and NDI scores were significantly improved, and the efficacy was well maintained during the follow-up period of up to 3 years. Bone fusion was achieved in all surgical segments. The curvature of the cervical spine and intervertebral height were effectively maintained, and there was no failure of internal fixation. This indicates that interbody fusion cage treatment of cervical spondylosis combined with osteoporosis anterior fusion surgery can achieve a satisfying surgical outcome. ACDF is a classical surgical treatment for cervical spondylosis. It can directly alleviate decompression, effectively restoring cervical lordosis through distraction of the intervertebral space and rebuilding the stability of the diseased segment, resulting in clinically satisfactory results. 2 In traditional cervical anterior surgery, fusion cage and titanium plate fixation systems are widely used. The use of titanium plates can increase the stability of the cervical spine, reduce the looseness of the fusion cage, and increase the interbody fusion rate. 20 However, the use of titanium plates has also increased the range of anterior longitudinal ligament dissection, thus increasing the risk of esophageal or tracheal injury, nerve injury, and dysphagia. 21 The bridge-type ROI-C interbody fusion cage, which is used in the clinic at present, consists of two teeth-like inserts and a PEEK composite cage. An ACDF that uses the bridge ROI-C fusion device can simplify the surgical procedure, eliminating the need for screw drilling, tapping, and other steps in the anterior titanium plate surgery, thus saving surgical time and reducing surgical bleeding. 5 In addition, there is no need for titanium plate fixation in front of the vertebral body, which has a smaller range of surgical exposure, leading to reduced pulling of the trachea, esophagus, and nerves, and a reduction in the incidence and severity of postoperative dysphagia. 4 Regarding biomechanical stability, the bridge-type ROI-C fusion cage has the same efficacy as the fusion cage plus titanium plate. 22 The bridge-type ROI-C fusion device is relatively simple to implant and brings certain advantages to anterior cervical angioplasty, such as reduced removal of soft tissue and no need to replace screws and titanium plates. Based on the results of this study, we found that there was no sinking of the fusion cage, and the final surgical outcome was satisfactory in all cases. This demonstrates that the use of the bridge-type ROI-C interbody fusion cage system is safe and reliable, and even in cases of anterior fusion surgeries with osteoporosis in cervical spondylosis a satisfactory effect of bone graft fusion can be achieved, with the short- and mid-term curative effects still well maintained. Osteoporosis is the most common degenerative human skeletal disease. Spinal surgeons will inevitably perform surgery on patients with osteoporosis, with surgery indications for elderly people at risk of osteoporosis similar to those without osteoporosis, including cervical nerve root, cervical spondylotic myelopathy, and cervical disk herniation. 23 Due to the difficulty of the surgery and potential complications, such as nonunion fractures, adjacent horizontal fractures, and instrument failure, the treatment of patients with spinal osteoporosis is challenging. Currently, no studies have reported on the use of the bridge-type ROI-C interbody fusion cage system for cervical anterior fusion surgery with osteoporosis. Several previous studies 5 , 21 , 24 have used the bridge-type ROI-C interbody fusion cage system in middle-aged and elderly patients. Although osteoporosis alone was not proposed in these studies as a prognostic factor, bone fusion was achieved in almost all cases, and internal fixation-related complications were extremely low. All these factors indirectly implicate the safety of the bridge-type ROI-C fusion cage system applied to anterior cervical fusion surgery with osteoporosis. In addition, the ROI-C fusion device, which uses a new type of intervertebral bridge-type self-stabilizing technology, has a unique interface between the fusion device and the insert, a stress separation between the fusion device and the fixed plate, and the ability to lock the double inserts in one step. The large cross-sectional area increases the contact area between the bone graft and the upper and lower vertebral bodies, which promotes fusion and reduces the risk of collapse. The outer bearing surface is large, and the saw-tooth shape and anatomy can enhance initial stability. Even if loosening of the insert is caused by osteoporosis, it will not affect the stability of the cage; on the contrary, it can help reduce the risk of sinking of the cage and improve the safety of use. Osteoporotic fractures are associated with BMD – many prospective studies have shown that for every 1 SD reduction in BMD, the risk of osteoporotic fractures is increased from 1.5 to 3.0 times. 25 Therefore, it is not recommended to use this fusion device in elderly patients with severe osteoporosis, as loosening and sinking of the cage may occur due to poor bone quality. It also cannot be applied to patients with severe cervical instability and fracture dislocation, as the ligaments and bony structures are impaired, and the stability of the cervical segment cannot be guaranteed. Conclusion The use of the bridge-type ROI-C interbody fusion cage system in the treatment of cervical spondylosis with osteoporosis in anterior cervical surgery is safe and effective. It can improve the curvature of the cervical spine, the cervical vertebral bow depth, the curvature, and intervertebral height of the surgical segment, in addition to other benefits. However, the main drawback of this study is that the results were not compared with a control series of non-osteoporotic cervical spondylosis patients. An additional limitation of this study is that the nature of the analysis was retrospective and may be subject to bias. Further research is needed to avoid selection bias, and the long-term follow-up studies are needed to provide the best clinical data to determine the efficacy of the bridge-type ROI-C interbody fusion cage in the treatment of cervical spondylosis with osteoporosis during ACDF. Acknowledgment This study was sponsored by the Wu Jieping Foundation (grant no. 320-2745-16-117), and the "333 High Level Talents Project" in Jiangsu Province, China (grant no. BRA2016512). Disclosure The authors report no conflicts of interest in this work. References 1. Guzman JZ, Feldman ZM, McAnany S, Hecht AC, Qureshi SA, Cho SK. Osteoporosis in Cervical Spine Surgery. Spine. 2016;41(8):662–668. 2. Mummaneni PV, Haid RW. The future in the care of the cervical spine: interbody fusion and arthroplasty. Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004. J Neurosurg Spine. 2004;1(2):155–159. 3. Nabhan A, Ahlhelm F, Shariat K, et al. The ProDisc-C prosthesis: clinical and radiological experience 1 year after surgery. Spine. 2007;32(18):1935–1941. 4. Bucci MN, Oh D, Cowan RS, et al. The ROI-C zero-profile anchored spacer for anterior cervical discectomy and fusion: biomechanical profile and clinical outcomes. Med Devices. 2017;10:61–69. 5. Lu Y, Bao W, Wang Z, et al. Comparison of the clinical effects of zero-profile anchored spacer (ROI-C) and conventional cage-plate construct for the treatment of noncontiguous bilevel of cervical degenerative disc disease (CDDD): A minimum 2-year follow-up. Medicine. 2018;97(5):e9808. 6. Yonenobu K, Abumi K, Nagata K, Taketomi E, Ueyama K. Interobserver and intraobserver reliability of the Japanese orthopaedic association scoring system for evaluation of cervical compression myelopathy. Spine. 2001;26(17):1890–1894. 7. Vernon H, Mior S. The Neck Disability Index: a study of reliability and validity. J Manipulative Physiol Ther. 1991;14(7):409–415. 8. Bazaz R, Lee MJ, Yoo JU. Incidence of dysphagia after anterior cervical spine surgery: a prospective study. Spine. 2002;27(22):2453–2458. 9. Mummaneni PV, Burkus JK, Haid RW, Traynelis VC, Zdeblick TA. Clinical and radiographic analysis of cervical disc arthroplasty compared with allograft fusion: a randomized controlled clinical trial. J Neurosurg Spine. 2007;6(3):198–209. 10. Vaccaro AR, Carrino JA, Venger BH, et al. Use of a bioabsorbable anterior cervical plate in the treatment of cervical degenerative and traumatic disc disruption. J Neurosurg. 2002;97(4 Suppl):473–480. 11. Ferguson SJ, Visser JM, Polikeit A. The long-term mechanical integrity of non-reinforced PEEK-OPTIMA polymer for demanding spinal applications: experimental and finite-element analysis. Eur Spine J. 2006;15(2):149–156. 12. Kulkarni AG, Hee HT, Wong HK, Cage S. Solis cage (PEEK) for anterior cervical fusion: preliminary radiological results with emphasis on fusion and subsidence. Spine J. 2007;7(2):205–209. 13. Whitecloud TS. Anterior Surgery for Cervical Spondylotic Myelopathy. Spine. 1988;13(7):861–863. 14. Cosman F, de Beur SJ, LeBoff MS, et al. Clinician's Guide to Prevention and Treatment of Osteoporosis. Osteoporos Int. 2014;25(10):2359–2381. 15. Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A. Incidence and economic burden of osteoporosis-related fractures in the United States, 2005–2025. J Bone Miner Res. 2007;22(3):465–475. 16. Takahara K, Kamimura M, Moriya H, et al. Risk factors of adjacent vertebral collapse after percutaneous vertebroplasty for osteoporotic vertebral fracture in postmenopausal women. BMC Musculoskelet Disord. 2016;17:12. 17. Hee HT, Majd ME, Holt RT, Whitecloud TS, Pienkowski D. Complications of multilevel cervical corpectomies and reconstruction with titanium cages and anterior plating. J Spinal Disord Tech. 2003;16(1):1–8. 18. Yan D, Wang Z, Deng S, Li J, Soo C. Anterior corpectomy and reconstruction with titanium mesh cage and dynamic cervical plate for cervical spondylotic myelopathy in elderly osteoporosis patients. Arch Orthop Trauma Surg. 2011;131(10):1369–1374. 19. Wang M, Meng X, Li Y, Feng Y, Chang Z, Hai Y. Effects of anti-osteoporosis treatment in the elderly with anterior cervical discectomy and fusion. Acta Orthop Traumatol Turc. 2016;50(2):186–190. 20. Matz PG, Ryken TC, Groff MW. Joint Section on Disorders of the S, Peripheral Nerves of the American Association of Neurological S, and Congress of Neurological S. Techniques for anterior cervical decompression for radiculopathy. J Neurosurg Spine. 2009;11:183–197. 21. Liu Y, Wang H, Li X, et al. Comparison of a zero-profile anchored spacer (ROI-C) and the polyetheretherketone (PEEK) cages with an anterior plate in anterior cervical discectomy and fusion for multilevel cervical spondylotic myelopathy. Eur Spine J. 2016;25(6):1881–1890. 22. Scholz M, Reyes PM, Schleicher P, et al. A new stand-alone cervical anterior interbody fusion device: biomechanical comparison with established anterior cervical fixation devices. Spine. 2009;34(2):156–160. 23. Chin DK, Park JY, Yoon YS, et al. Prevalence of osteoporosis in patients requiring spine surgery: incidence and significance of osteoporosis in spine disease. Osteoporos Int. 2007;18(9):1219–1224. 24. Wang Z, Jiang W, Zhang Z, et al. Comparison of ROI-C and traditional cage with anterior plating for anterior cervical discectomy and fusion. Zhonghua Wai Ke Za Zhi. 2014;52(6):425–430. 25. Melton LJ, Thamer M, Ray NF, et al. Fractures attributable to osteoporosis: report from the National Osteoporosis Foundation. J Bone Miner Res. 1997;12(1):16–23. [ABSTRACT FROM AUTHOR]

Copyright of Chinese Journal of Tissue Engineering Research / Zhongguo Zuzhi Gongcheng Yanjiu is the property of Chinese Journal of Tissue Engineering Research and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: This study was to examine the association between inflammation‐related indexes SII (systemic immune‐inflammation index), NLR (neutrophil‐to‐lymphocyte ratio), PPN (product of platelet count and neutrophil count), and PLR (platelet‐to‐lymphocyte ratio), and the occurrence of vertebral fractures in older Americans. Methods: Patients ⩾60 years of age from the 2013–2014 NHANES database were selected for this study. Restricted cubic spline models and weighted logistic regression models were used to assess the association between inflammation‐related indexes and the occurrence of vertebral fractures in older Americans. The predictive value of the inflammation‐related indexes on the occurrence of vertebral fractures was assessed using receiver operating characteristic curves (ROC). To examine the robustness of the main findings, a sensitivity analysis was conducted. Results: A total of 1281 patients were included in the analysis, of whole 120 suffered vertebral fractures. Fully adjusted logistic regression showed a significant linear relationship between NLR and the occurrence of vertebral fracture in older Americans (p <.05), but no relationship was found between SII, PLR, and the occurrence of vertebral fracture in older Americans. Meanwhile, NLR was slightly better than other indicators in predicting vertebral fracture. Conclusions: This study found that NLR, as a novel inflammatory marker, can predict the risk of vertebral fracture in older Americans, which is of clinical significance for the prevention and treatment of vertebral fracture in older adults. [ABSTRACT FROM AUTHOR]

Background: Osteoporosis has been recognized as a significant health issue in Thailand. Pharmacological interventions are important way to prevent fracture. However, one of the main challenges in selecting a medication is high cost, particularly for brand-name drugs. Data on generic bisphosphonate use in Thai are still lacking. Therefore, our study aimed to assess the efficacy and safety of generic risedronate in postmenopausal Thai women with osteoporosis. Methods: This prospective study was conducted at King Chulalongkorn Memorial Hospital, Bangkok, Thailand, from December 2022 to January 2024. Serum C-terminal cross-linking telopeptide of type I collagen (CTX) and procollagen type I N-propeptide (P1NP) were measured at baseline. All participants subsequently received 35 milligrams of oral risedronate once weekly for 52 weeks. Serum CTX and P1NP were remeasured at different time points. BMD was reevaluated at 52 weeks after risedronate treatment initiation. Results: A total of 80 participants were included. The mean age was 65.2 ± 6.6 years. The mean body mass index (BMI) was 23.45 ± 3.49 kg/m2. The median (IQR) serum CTX level at 12 weeks was significantly lower than that at baseline (0.28 (0.16–0.46) ng/mL versus 0.44 (0.26–0.64) ng/mL, respectively; p value < 0.01). The suppression of serum CTX was confirmed at 52 weeks after treatment initiation. Compared with those at baseline, the serum P1NP levels were significantly lower at 24 weeks after treatment initiation (30.33 (19.19–39.58) ng/mL versus 41.90 (30.33–68.67) ng/mL, respectively; p value < 0.01). In terms of the BMD assessment at 52 weeks, significant improvements were observed in both areal BMD (g/cm2) and T scores at all measured sites compared with baseline. The lumbar spine, femoral neck, and total hip BMD increased from baseline by 4.76%, 3.84% and 4.54%, respectively. Conclusion: Postmenopausal women with osteoporosis who were treated with generic risedronate demonstrated significant suppression of the bone remodelling process at 3, 6, and 12 months after treatment initiation. Additionally, significant improvements in the lumbar spine, femoral neck, and total hip BMD were observed at 12 months of therapy. These findings suggest that generic risedronate could be considered a reasonable and interesting option for treating postmenopausal women with osteoporosis in Thailand. [ABSTRACT FROM AUTHOR]

Osteoporosis (OP), a systemic skeletal disease, is characterized by low bone mass, bone tissue degradation and bone microarchitecture disturbance. Bazi Bushen, a Chinese patented medicine, has been demonstrated to be effective in attenuating OP, but the pharmacological mechanism remains predominantly unclear. In this study, the senescence‐accelerated mouse prone 6 (SAMP6) model was used to explore bone homeostasis and treated intragastrically for 9 weeks with Bazi Bushen. In vivo experiments showed that Bazi Bushen treatment not only upregulated the levels of bone mineral density and bone mineral content but also increased the content of RUNX2 and OSX. Furthermore, the primary culture of bone mesenchymal stem cells (BMSCs) in SAMP6 mice was used to verify the effects of Bazi Bushen on the balance of differentiation between osteoblasts and adipocytes, as well as ROS and aging levels. Finally, the pharmacological mechanism of Bazi Bushen in attenuating OP was investigated through network pharmacology and experimental verification, and we found that Bazi Bushen could significantly orchestrate bone homeostasis and attenuate the progression of OP by stimulating PI3K‐Akt and inhibiting apoptosis. In summary, our work sheds light on the first evidence that Bazi Bushen attenuates OP by regulating PI3K‐AKT and apoptosis pathways to orchestrate bone homeostasis. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to investigate whether there is a difference in hand bone mineral density (BMD) between patients with traumatic hand injuries and healthy volunteers during the immobilization process, as well as to examine the change in BMD during follow‑up and the effect of denervation on BMD. In addition, we aimed to compare the BMD in the dominant and nondominant hands. Methods: The study involved patients aged 18–55 years who had undergone surgery for hand tendon injuries (TIs), with or without accompanying nerve injury, and subsequently sought rehabilitation at our outpatient clinic. The study groups were comprised patients with TI, those with tendon and nerve injury (TNI), and healthy volunteers. Results: The study examined 24 patients with TI, 23 with TNI, and 31 healthy volunteers. In the healthy control group, the BMD of the dominant hand was significantly higher than that of the nondominant hand (P < 0.001). At 4 weeks, there was no significant decrease in BMD observed in the TI and TNI groups compared to controls (P > 0.05). However, at the 4th month, both groups showed a significant decrease in BMD, with the TNI group exhibiting higher changes (P < 0.05). Injuries to the dominant hand did not result in significant changes in BMD at 4 weeks and 4 months (P > 0.05). However, a significant decrease in BMD was observed in injuries to the nondominant hand compared to controls at 4 months (P < 0.05). Notably, nondominant hand TNI patients experienced a significant reduction in BMD during the 4th month compared to the 4th week (P < 0.05). In addition, a significant correlation (r = 0.567) was found between grip strength and BMD value in the 4th month of patients with hand injuries. Conclusion: In patients with traumatic hand injuries, nondominant hand injury and/or nerve injury may lead to a decrease in BMD in addition to immobilization. [ABSTRACT FROM AUTHOR]

Background & objective: Osteoporosis is a growing public health concern, particularly among the aging population. This study aimed to evaluate the association between osteoporosis and quality of life (QoL) in a sample of older adults. Methods: This cross-sectional study utilized data from all the participants of Bushehr Elderly Health program (BEHP), phase 2. QoL was assessed using the 12-Item Short Form Survey (SF-12 Questionnaire), and participants were classified as having osteoporosis or not based on the WHO diagnostic criteria. The physical (PCS) and mental (MCS) component summaries of QoL were estimated. The association between osteoporosis and QoL was evaluated separately for men and women, considering various health and lifestyle factors using linear regression analysis. Results: The study included 2,399 participants (average age 71.27 ± 7.36 years). 1,246 were women and 1,153 were men. Osteoporosis was present in 59% of women and 23% of men. Participants with osteoporosis had significantly lower PCS scores compared to those without osteoporosis (women: 38.1 vs. 40.2, p < 0.001; men: 44.3 vs. 45.8, p: 0.002). However, there was no statistically significant difference in MCS scores. Stratified by sex, osteoporosis was significantly associated with PCS in women [β = -2.14 (-3.13, -1.15)] and men [β = -1.53 (-2.52, -0.54)]. After accounting for relevant variables, the association remained significant in women [β=-0.95 (-1.87, -0.03)], but not in men [β=-0.63 (-1.55,0.28)]. Conclusion: This study highlights the significant association between osteoporosis and the physical component of QoL in both older men and women, particularly among women. Further research and interventions focusing on enhancing physical QoL in individuals with osteoporosis are warranted to promote healthier aging. [ABSTRACT FROM AUTHOR]

Objective: Fibroblast growth factor 21 (FGF21) is a secreted protein that regulates body metabolism. In recent years, many observational studies have found that FGF21 is closely related to bone mineral density and osteoporosis, but the causal relationship between them is still unclear. Therefore, this study used two-sample, mediated Mendelian randomization (MR) analysis to explore the causal relationship between FGF21 and osteoporosis and bone mineral density. Methods: We conducted a two-sample, mediator MR Analysis using genetic data from publicly available genome-wide association studies (GWAS) that included genetic variants in the inflammatory cytokine FGF21, and Total body bone mineral density, Heel bone mineral density, Forearm bone mineral density, Femoral neck bone mineral density, osteoporosis. The main analysis method used was inverse variance weighting (IVW) to investigate the causal relationship between exposure and outcome. In addition, weighted median, simple median method, weighted median method and MR-Egger regression were used to supplement the explanation, and sensitivity analysis was performed to evaluate the reliability of the results. Results: MR Results showed that FGF21 overexpression reduced bone mineral density: Total body bone mineral density (OR=0.920, 95%CI: 0.876-0.966), P=0.001), Heel bone mineral density (OR=0.971, 95%CI (0.949-0.993); P=0.01), Forearm bone mineral density (OR=0.882, 95%CI(0.799-0.973); P=0.012), Femoral neck bone mineral density (OR=0.952, 95%CI(0.908-0.998), P=0.039); In addition, it also increased the risk of osteoporosis (OR=1.003, 95%CI (1.001-1.005), P=0.004). Sensitivity analysis supported the reliability of these results. The effect of FGF21 overexpression on osteoporosis may be mediated by type 2 diabetes mellitus and basal metabolic rate, with mediating effects of 14.96% and 12.21%, respectively. Conclusions: Our study suggests that the overexpression of FGF21 may lead to a decrease in bone mineral density and increase the risk of osteoporosis, and the effect of FGF21 on osteoporosis may be mediated through type 2 diabetes and basal metabolic rate. This study can provide a reference for analyzing the potential mechanism of osteoporosis and is of great significance for the prevention and treatment of osteoporosis. [ABSTRACT FROM AUTHOR]

Objective: The prevalence of type 2 diabetes mellitus (T2DM) and bone metabolism disorders increase with age. Diabetic kidney disease (DKD) is one of the most serious microvascular complications of T2DM, and bone metabolism disorders are closely linked to the occurrence of DKD. The relationship between bone turnover markers(BTMs) and the kidney disease in elderly patients with T2DM remains unclear. Therefore, this study aims to investigate the association between common BTMs and DKD in a large sample of elderly patients. The goal is to provide a basis for early identification of high-risk individuals for DKD among elderly T2DM patients from a bone metabolism perspective. Methods: In this cross-sectional study, BTMs were collected from a cohort of 2,051 hospitalized Chinese patients. The relationships between 25-hydroxyvitamin D (25-OH-D), β-CrossLaps (β-CTX), osteocalcin (OSTEOC), intact parathyroid hormone (iPTH), and total type I collagen N-terminal propeptide (TP1NP), and DKD, as well as urinary albumin-to-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR) were analyzed using regression analysis and restrictive cubic spline (RCS) curves. Results: Higher 25-OH-D levels were independently linked to a lower incidence of DKD and decreased UACR. The RCS curves showed a linear association of 25-OH-D and DKD, approaching the L-shape. β-CTX was independently and positively correlated with UACR. There is an independent positive correlation between OSTEOC and UACR and a negative correlation with eGFR. iPTH is independently and positively correlated with DKD incidence and UACR, and negatively correlated with eGFR. Additionally, the RCS curves showed a non-linear association of OSTEOC and iPTH and DKD, approaching the J-shape, and the point of inflection is 10.875 ng/L and 34.15 pg/mL respectively. There is an independent positive correlation between TP1NP and UACR incidence, and a negative correlation with eGFR. Risk estimates significantly increase with higher TP1NP levels in the RCS model. Conclusion: BTMs are closely associated with kidney disease in elderly patients with T2DM. These discoveries potentially assist clinicians in establishing more preventive measures and targeted treatment strategies for elderly patients with T2DM. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to investigate the levels of knowledge and awareness of osteoporosis (OP) in patients with rheumatoid arthritis (RA). Patients and methods: The cross-sectional study included 100 RA patients (26 males, 74 females; mean age: 51.3±11.4 years; range, 28 to 67 years) who had not been diagnosed with OP and a control group of 50 healthy subjects (16 males, 34 females; mean age: 53.2±11.1 years; range, 29 to 70 years) between February 2022 and June 2022. The demographic data of age, sex, and education level of all the participants were recorded. Disease duration and the drugs used were recorded for the RA patients. The revised Osteoporosis Knowledge Test and the Osteoporosis Health Belief Scale questionnaires were completed by the participants. Results: There was no significant difference determined between the RA patients and the control group in OP knowledge levels. A positive correlation was determined between education level and OP knowledge level and between disease duration and OP awareness level. RA patients with a family history of OP, those in the postmenopausal period, and those using biological disease-modifying drugs thought they were at risk of OP at a higher rate. Conclusion: While the levels of knowledge and awareness of OP were determined to be similar in the RA patients and the control group, the vast majority of RA patients did not know that they were at risk of developing OP. In addition, when the data obtained in this study are taken into consideration, there appears to be a need for health strategies such as educational programs and informing RA patients about OP. [ABSTRACT FROM AUTHOR]

Low-back pain is frequent, especially in the active adult population after an osteoporotic vertebral fracture. Several orthopaedic conditions can cause low back pain, significantly worsening the quality of life. The treatments vary from drugs, physical therapy, kinesiology, and local infiltration. TECARs have a crucial role in treating the inflammatory causes of pain, with several studies demonstrating the efficacy of 0.5 Mh radio frequency longwave therapy in treating low-back pain. We treat twenty consecutive patients with low back pain after a vertebral amielic spinal fracture with or without leg pain, using a combination of painkillers, orthosis, and half of them tecar therapy. The patients were treated three times a week, every other day, for 20 sessions. We evaluated clinical outcomes using the visual analogic scale for individual pain. Tests started before the beginning of therapies and eight weeks after the end of the treatment. Visual analogic scale (VAS) score significantly improved from an average value pretreatment to a 50% reduction average value eight weeks posttreatment. Patients denoted a more significant improvement in VAS and empiric patient satisfaction in the group with low back pain also treated with TECAR. Acute back pain is a relatively common clinical situation. The treatments for this condition are different, and they can give 2 a crucial role in diathermia, shortwave, microwave, and tecar therapy. This study concludes that the association between painkillers, orthosis, exercises, and tecar therapy in treating low-back Pain after an amyelic vertebral spine fracture type genant, with or without leg pain, can significantly reduce pain and improve the quality of life. ''Highlights'' Diathermy Tecar is an almost new and updated physical therapy that uses electromagnetic waves to treat muscle and joint pain through capacitive and resistive pads. It provides good pain relief for several sharp pains. The physiotherapist should be trained to use them appropriately in acute settings. Clin Ter 2024; 175 (5):291-295 doi: 10.7417/CT.2024.5133 [ABSTRACT FROM AUTHOR]

Copyright of Ahi Evran Medical Journal is the property of Ahi Evran University and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: This study aims to evaluate the effect of osteoporosis education on osteoporosis knowledge level (OKL) and behavioral changes in daily life in patients with Parkinson's disease (PD). Patients and methods: Between May 2019 and December 2019, a total of 54 patients (34 males, 20 females; median age: 68.5 years; range, 50 to 87 years) were included in the study. We randomly assigned in a 1:1 ratio, patients with PD to receive either only the brochure or in addition to this a verbal osteoporosis education. The patients were randomized into the control (n=27) and intervention groups (n=27). Seven of the patients (two in the control group and five in the intervention group) were lost to follow-up. The patients were assessed at baseline and Week 12. The primary outcomes were Physical Activity Scale for the Elderly (PASE) score (0-400) and daily calcium intake (DCI). The secondary outcomes were revised 2011 osteoporosis knowledge test (rOKT) score (0-32), frequency of falls, smoking and alcohol use at Week 12. Results: The median total PASE score was 81 (range, 0 to 205) for the intervention group, compared to 61 (range, 0 to 242) for control group at Week 12. There was no statistically significant difference between the groups at Week 12, except for the medians of the frequency of falls that was significantly lower in the intervention group (p<0.05). A significant improvement from baseline was observed in the median rOKT scores (control group 16 (range, 6 to 21) to 19 (range, 11 to 25); intervention group 13 (range, 6 to 24) to 18 (range, 9 to 24); p<0.001) and DCI (control group 855 (range, 420 to 1,640) to 890 (range, 550 to 1,660); intervention group, 870 (range, 400 to 1,385) to 1,020 (range, 400 to 1,940) mg/day; p<0.01) in both groups. Also, a significant improvement in the leisure activities (PASE subgroup) was observed in the intervention group (p<0.05). Conclusion: Osteoporosis education had some positive effects in patients with PD, even when only given the brochure. With additional verbal education, more benefits can be obtained. [ABSTRACT FROM AUTHOR]

Copyright of Saudi Medical Journal is the property of Saudi Medical Journal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

"The 2024 Guidelines for Osteoporosis - Korean Society of Menopause: Part II" provides information on the pharmacologic therapy of osteoporosis. The article discusses various treatments, including hormone replacement therapy (HRT), selective estrogen receptor modulators (SERMs), bisphosphonates, denosumab, and romosozumab. It highlights the effectiveness of these treatments in reducing fractures and increasing bone mineral density. The article also touches on the topics of osteopenia, sarcopenia, and medication-related osteonecrosis of the jaw (MRONJ), providing insights into diagnosis, treatment, and prevention. The document includes a comprehensive list of references for further research on osteoporosis and its treatment options. [Extracted from the article]

Background: Gender differences in the diagnosis and treatment of osteoporosis is a relatively common phenomenon, particularly amongst those patients under 80 years of age presenting with fragility fractures. The clinical implications of these findings are that strategies, which tend to focus on osteoporosis management in women, should also pay enough attention to osteoporosis in men. However, there have been questions whether there is a gender difference when setting intervention thresholds for osteoporosis management. This work was carried out aiming to determine the fracture probabilities calculated by FRAX at which therapeutic intervention in older men and women can be considered. Results: Assessment of fracture risk probability thresholds in men revealed that for hip fractures, ROC was 0.754 (95% CI: 0.69–0.817). The sensitivity was 80.5% for threshold probabilities of 2.5%. For the major osteoporosis fracture, ROC was 0.828 (95% CI: 0.694–0.963). The sensitivity was 87.5% for threshold probabilities of 10%. Assessment of fracture risk probability threshold in women ROC was 0.760 (95% CI: 0.691–0.83). The sensitivity was 76.1% for threshold probabilities of 3%. For major osteoporosis fracture, ROC was 0.848 (95% CI: 0.784–0.912). The sensitivity was 87.3% for threshold probabilities of 15%. Conclusion: Operational aspects of osteoporosis management should consider gender specific fracture thresholds. Interventional thresholds were found to be different in men compared to women. This helps to optimise fracture prevention in older men. [ABSTRACT FROM AUTHOR]

Background: Patients with Type 2 diabetes mellitus (T2DM) have decreased bone health. We aimed to investigate serum levels of bone turnover markers (BTMs) (markers of bone formation and bone resorption) and bone mineral density (BMD) at three sites (lumber, neck femur, and total femur) in middle-aged men with type 2 diabetes and to analyze the relationship between them. Also to evaluate serum osteoglycin as a novel marker and its relation to BTMs, BMD, and diabetic status. Methods: We recruited seventy-eight patients with T2DM and thirteen non-diabetic, male volunteers as a control group. BMD was measured using a DEXA scan. BTMs (carboxy-terminal crosslinking telopeptide of type 1 collagen [CTX] and procollagen type 1 N propeptide [P1NP]), osteoglycin, PTH, and vitamin D were estimated. Data was compared among subjects and statistical analysis was performed. Results: Most of the patients were having normal BMD with no significant difference between patients and the controls. BTMs and osteoglycin were significantly higher and vitamin D was significantly lower in the diabetic patients. Serum osteoglycin was positively correlated with DEXA Neck Femur (r = 0.233; p-value < 0.05). Conclusion: Body mass index and Serum osteoglycin have a significant positive effect on BMD. Both markers of bone formation and bone resorption were increased indicating a state of increased bone turnover in T2DM. [ABSTRACT FROM AUTHOR]

Background: Osteoporosis is one of the major public health problems from which more and more people in the world are suffering. There is evidence suggesting that osteoporosis knowledge is one contributor to osteoporosis preventive behavior. Aim of the Study: To assess the knowledge regarding osteoporosis risk factors, prevention, and management in women of reproductive ages. To identify any association between knowledge and studied factors. Methodology: A cross-sectional study was carried out in three primary health-care centers (Al-Takia, Al-Saray, and Al-Mustafa primary health-care centers) from January 1, 2019, to November 31, 2019. A convenient sample of 400 women of reproductive age was selected. The data were collected using Osteoporosis Knowledge Assessment Tool through a direct interview with the women that included personal data, knowledge regarding osteoporosis risk factors, prevention, and management. Results: The majority of participants (56%) had moderate adequate knowledge about osteoporosis. The young age, being highly educated, and good economic status were significantly associated with good knowledge. Conclusion: Moderate adequate level of knowledge about osteoporosis was found among included subjects, the majority of subjects obtained their knowledge from Internet and physician. Thus, educational programs at all health-care facilities needed to improve the knowledge of women regarding osteoporosis. [ABSTRACT FROM AUTHOR]

Finite element models built from quantitative computed tomography images rely on element-wise mapping of material properties starting from Hounsfield Units (HU), which can be converted into mineral densities upon calibration. While calibration is preferably carried out by scanning a phantom with known-density components, conducting phantom-based calibration may not always be possible. In such cases, a phantomless procedure, where the scanned subject's tissues are used as a phantom, is an interesting alternative. The aim of this study was to compare a phantom-based and a phantomless calibration method on 41 postmenopausal women. The proposed phantomless calibration utilized air, adipose, and muscle tissues, with reference equivalent mineral density values of -797, -95, and 38 mg/cm3, extracted from a previously performed phantom-based calibration. A 9-slice volume of interest (VOI) centred between the femoral head and knee rotation centres was chosen. Reference HU values for air, adipose, and muscle tissues were extracted by identifying HU distribution peaks within the VOI, and patient-specific calibration was performed using linear regression. Comparison of FE models calibrated with the two methods showed average relative differences of 1.99% for Young's modulus1.30% for tensile and 1.34% for compressive principal strains. Excellent correlations (R2 > 0.99) were identified for superficial maximum tensile and minimum compressive strains. Maximum normalised root mean square relative error (RMSRE) values settled at 4.02% for Young's modulus, 2.99% for tensile, and 3.22% for compressive principal strains, respectively. The good agreement found between the two methods supports the adoption of the proposed methodology when phantomless calibration is needed. [ABSTRACT FROM AUTHOR]

Introduction: Although there has been abundant evidence of the association between dyslipidemia as a single factor and osteoporosis, the non-linear relationship between osteoporosis and the Atherogenic Index of Plasma (AIP) has not yet been thoroughly investigated. This study aimed to investigate the complex relationship between AIP and bone mineral density (BMD) to elucidate their interrelationship. Methods: An analysis of 2007–2018 National Health and Nutrition Survey (NHANES) data was conducted for this study. The study enrolled 5,019 participants. Logarithmically multiplying triglycerides and high-density lipoprotein cholesterol yields the AIP (base 10). The measured variables consisted of BMD in the total femur (TF), femoral neck (FN), and lumbar spine (LS). The association between AIP and BMD was examined using a range of statistical models, such as weighted multivariable logistic regression, generalized additive model, etc. Results: It was found that AIP was positively associated with BMD after adjusting for age, gender, race, socioeconomic status, degree of education, income, Consuming alcoholic beverages, osteoporosis status (Yes or No), ALT, AST, serum creatinine, and total calcium levels. Further studies supported the association link between elevated BMD and AIP. Furthermore, compared to men, females had a higher positive connection between AIP and BMD. In general, there was a curve in the reverse L-shape seen, with a point of change around 0.877, indicating a relationship between AIP and TF BMD. Moreover, a curve exhibiting an L-formed pattern, with a point of inflection at around 0.702, was seen between AIP and FN BMD. In addition, a J-shaped curve was seen, with a point of inflection at 0.092, which demonstrates the association between AIP and LS BMD. Conclusion: The AIP and TF BMD curves resemble inverted L shapes, as do the AIP and FN BMD curves. The relationship between AIP and LS BMD was further demonstrated by a J-shaped curve. The results indicate a possible association between AIP and bone mineral density, which should be explored in more detail. [ABSTRACT FROM AUTHOR]

Background: Machine learning (ML) has shown exceptional promise in various domains of medical research. However, its application in predicting subsequent fragility fractures is still largely unknown. In this study, we aim to evaluate the predictive power of different ML algorithms in this area and identify key features associated with the risk of subsequent fragility fractures in osteoporotic patients. Methods: We retrospectively analyzed data from patients presented with fragility fractures at our Fracture Liaison Service, categorizing them into index fragility fracture (n = 905) and subsequent fragility fracture groups (n = 195). We independently trained ML models using 27 features for both male and female cohorts. The algorithms tested include Random Forest, XGBoost, CatBoost, Logistic Regression, LightGBM, AdaBoost, Multi-Layer Perceptron, and Support Vector Machine. Model performance was evaluated through 10-fold cross-validation. Results: The CatBoost model outperformed other models, achieving 87% accuracy and an AUC of 0.951 for females, and 93.4% accuracy with an AUC of 0.990 for males. The most significant predictors for females included age, serum C-reactive protein (CRP), 25(OH)D, creatinine, blood urea nitrogen (BUN), parathyroid hormone (PTH), femoral neck Z-score, menopause age, number of pregnancies, phosphorus, calcium, and body mass index (BMI); for males, the predictors were serum CRP, femoral neck T-score, PTH, hip T-score, BMI, BUN, creatinine, alkaline phosphatase, and spinal Z-score. Conclusion: ML models, especially CatBoost, offer a valuable approach for predicting subsequent fragility fractures in osteoporotic patients. These models hold the potential to enhance clinical decision-making by supporting the development of personalized preventative strategies. [ABSTRACT FROM AUTHOR]

The risk of developing chronic illnesses and disabilities is increasing with age. To predict and prevent aging, biomarkers relevant to the aging process must be identified. This paper reviews the known molecular, cellular, and physiological biomarkers of aging. Moreover, we discuss the currently available technologies for identifying these biomarkers, and their applications and potential in aging research. We hope that this review will stimulate further research and innovation in this emerging and fast-growing field. [ABSTRACT FROM AUTHOR]

Background: Osteoporosis is the most common metabolic bone disease and can cause fragility fractures. Despite this, screening utilization rates for osteoporosis remain low among populations at risk. Automated bone mineral density (BMD) estimation using computed tomography (CT) can help bridge this gap and serve as an alternative screening method to dual-energy X-ray absorptiometry (DXA). Methods: The feasibility of an opportunistic and population agnostic screening method for osteoporosis using abdominal CT scans without bone densitometry phantom-based calibration was investigated in this retrospective study. A total of 268 abdominal CT-DXA pairs and 99 abdominal CT studies without DXA scores were obtained from an oncology specialty clinic in the Republic of Korea. The center axial CT slices from the L1, L2, L3, and L4 lumbar vertebrae were annotated with the CT slice level and spine segmentation labels for each subject. Deep learning models were trained to localize the center axial slice from the CT scan of the torso, segment the vertebral bone, and estimate BMD for the top four lumbar vertebrae. Results: Automated vertebra-level DXA measurements showed a mean absolute error (MAE) of 0.079, Pearson's r of 0.852 (P<0.001), and R² of 0.714. Subject-level predictions on the held-out test set had a MAE of 0.066, Pearson's r of 0.907 (P<0.001), and R² of 0.781. Conclusion: CT scans collected during routine examinations without bone densitometry calibration can be used to generate DXA BMD predictions. [ABSTRACT FROM AUTHOR]

The article discusses total thyroidectomy, highlighting the removal of both thyrocytes and C-cells from the thyroid gland. It explores the role of calcitonin produced by C-cells and its potential impact on post-thyroidectomy complications like osteoporosis and weight gain. The text suggests a need for further research to understand the relationship between calcitonin deficiency and these complications, potentially leading to a reevaluation of total thyroidectomy indications. The article also touches on the anti-obesity effects of calcitonin replacement therapy, emphasizing the importance of considering diverse perspectives in thyroid surgery. [Extracted from the article]

Introduction: The dysregulation of cell fate toward osteoprecursor cells associated with most GNAS-based disorders may lead to episodic de novo extraskeletal or ectopic bone formation in subcutaneous tissues. The bony lesion distribution suggests the involvement of abnormal differentiation of mesenchymal stem cells (MSCs) and/or more committed precursor cells. Data from transgenic mice support the concept that GNAS is a crucial factor in regulating lineage switching between osteoblasts (OBs) and adipocyte fates. The mosaic nature of heterotopic bone lesions suggests that GNAS genetic defects provide a sensitized background for ectopic osteodifferentiation, but the underlying molecular mechanism remains largely unknown. Methods: The effect of GNAS silencing in the presence and/or absence of osteoblastic stimuli was evaluated in the human L88/5 MSC line during osteodifferentiation. A comparison of the data obtained with data coming from a bony lesion from a GNAS-mutated patient was also provided. Results: Our study adds some dowels to the current fragmented notions about the role of GNAS during osteoblastic differentiation, such as the premature transition of immature OBs into osteocytes and the characterization of the differences in the deposed bone matrix. Conclusion: We demonstrated that our cell model partially replicates the in vivo behavior results, resulting in an applicable human model to elucidate the pathophysiology of ectopic bone formation in GNAS-based disorders. [ABSTRACT FROM AUTHOR]

Background: Parkinson's disease (PD) is the second most common neurodegenerative illness and has the highest increase rate in recent years. There is growing evidence to suggest that PD is linked to higher osteoporosis rates and risk of fractures. Objective: This study aims to estimate the prevalence and factors associated with osteoporosis as defined by the National Osteoporosis Foundation (NOF) and World Health Organization in patients with mild to moderate PD. Methods: We performed a cross-sectional study at a tertiary public hospital in Fortaleza, Brazil, dating from May 2021 until April 2022. The study sample was comprised of patients with mild to moderate PD who were at least 40 years old and who had the ability to walk and stand unassisted. Bone Mineral Density (BMD) of both the hip (neck of the femur) and the lumbar spine were obtained via properly calibrated Dual Energy X-ray Absorptiometry (DXA) scanning. The FRAX (Fracture Risk Assessment Tool) score was used to determine a person's 10-year risk of major osteoporotic fracture. The Revised European Working Group on Sarcopenia in Older People (EWGSOP 2) was used as a basis to confirm a sarcopenia diagnosis with the following parameters: low muscle strength gauged by handgrip strength and low muscle quantity by DXA. Physical performance was carefully evaluated by using the Short Physical Performance Battery test. Osteoporosis and osteopenia were diagnosed following the NOF guidelines and WHO recommendations. Results: We evaluated 107 patients in total, of whom 45 (42%) were women. The group's mean age was 68 ± 9 years, and the mean disease time span was 9.9 ± 6.0 years and mean motor UPDRS was 43 ± 15. We found that 42.1% and 34.6% of the sample had osteopenia and osteoporosis following NOF criteria, respectively, and 43% and 33.6% following the WHO recommendations. Lower lean appendicular mass was associated to osteopenia and osteoporosis in multinomial logistic regression analysis in both diagnostic criteria. Conclusion: Our findings provide additional evidence for the protective role of lean mass against osteoporosis in patients with PD. [ABSTRACT FROM AUTHOR]

Osteoporosis leads to a number of problems, such as falls and fractures. Therefore, it is very important to identify the problems and prevent these risks. With the aging of the world population, senile osteoporosis has gained importance. The aim of this study was to investigate sarcopenia risk, physical activity level, fall risk, kinesiophobia and quality of life in older people with and without osteoporosis. Demographic characteristics of individuals over 65 years of age with and without osteoporosis were noted. The Physical Activity Scale for the Elderly (PASE) questionnaire for the physical activity status of the participants, the Tampa Kinesiophobia Scale (TKS) for fear of movement, the Berg Balance Scale (BBS) for the postural control assessment, the Functional Reach Test (FRT) for the functional balance assessment, the Timed Up and Go Test (TUGT) for functional mobility assessment, the Strength, Assistance, Rise, Climb, Falls (SARC-F) questionnaire for sarcopenia risk, and the QUALEFFO-41 scale for quality of life assessment were used. A total of 71 participants were included in our study. While BBS and FRT results were significantly lower in the osteoporotic group (p=0.02, p=0.01, respectively), SARC-F scores were significantly higher than in the non-osteoporotic group (p=0.03). There was no significant difference in PASE, TKS, TUGT, and QUALLEFO-41 scores between the two groups (p>0.05). In the elderly population, the presence of osteoporosis was associated with the risk of balance impairment and sarcopenia but not with kinesiophobia. [ABSTRACT FROM AUTHOR]

Falls and osteoporosis are risk factors for fragility fractures. Bone mineral density (BMD) assessment is associated with better preventative osteoporosis care, but it is underutilized by those at high fracture risk. We created a novel electronic medical record (EMR) alert-driven protocol to screen patients in the Emergency Department (ED) for fracture risk and tested its feasibility and effectiveness in generating and completing referrals for outpatient BMD testing after discharge. The EMR alert was configured in 2 tertiary-care EDs and triggered by the term "fall" in the chief complaint, age (≥65 years for women, ≥70 years for men), and high fall risk (Morse score ≥ 45). The alert electronically notified ED study staff of potentially eligible patients. Participants received osteoporosis screening education and had BMD testing ordered. From November 15, 2020 to December 4, 2021, there were 2,608 EMR alerts among 2,509 patients. We identified 558 patients at high-risk of fracture who were screened for BMD testing referral. Participants were excluded for: serious illness (N  = 141), no documented health insurance to cover BMD testing (N  = 97), prior BMD testing/recent osteoporosis care (N  = 58), research assistant unavailable to enroll (N  = 53), concomitant fracture (N  = 43), bedridden status (N  = 38), chief complaint of fall documented in error (N  = 38), long-term care residence (N  = 34), participation refusal (N  = 32), or hospitalization (N  = 3). Of the 16 participants who had BMD testing ordered, 7 scheduled and 5 completed BMD testing. EMR alerts can help identify subpopulations who may benefit from osteoporosis screening, but there are significant barriers to identifying eligible and willing patients for screening in the ED. In our study targeting an innovative venue for osteoporosis care delivery, only about 1% of patients at high-risk of fracture scheduled BMD testing after an ED visit. Adequate resources during and after an ED visit are needed to ensure that older adults participate in preventative osteoporosis care. [ABSTRACT FROM AUTHOR]

Background: Osteoporosis is a prevalent condition leading to an increased risk of bone fractures. Osteoporosis poses a worldwide public health concern, impacting over 200 million individuals and resulting in a staggering 1.66 million hip fractures each year. Opportunistic osteoporosis screening can be employed during CT scans to assess bone mineral density (BMD) through Hounsfield units (HU) without the need for additional imaging, radiation exposure, or appointments. This study aimed to investigate a CT scan's diagnostic value in the opportunistic osteoporosis screening through L1 vertebra densitometry and compare it with dual-energy x-ray absorptiometry (DXA) findings. Results: One hundred forty-nine patients with an average age of 67.70 ± 10.94 years were included in the study. The age of osteoporotic patients was significantly higher than osteopenic (p = 0.001) and normal individuals (p < 0.001). The HU of osteoporotic patients was found to be significantly lower compared to both osteopenic (p = 0.023) and normal individuals (p < 0.001). According to the ROC curve for osteoporosis prediction using the HU (AUC = 0.793 and p < 0.001), with a cut-off of 103 HU, the CT scan had a sensitivity of 69% and a specificity of 74% for the diagnosis of osteoporosis. Conclusion: Individuals with osteoporosis exhibit a significantly lower average HU compared to both osteopenic and healthy individuals. A CT scan can serve as an effective predictor of osteoporosis in patients. The CT images obtained for reasons unrelated to osteoporosis diagnosis can be employed to discern patients with osteoporosis without incurring the added cost or radiation exposure. [ABSTRACT FROM AUTHOR]

Introduction: Osteoporosis is common among postmenopausal women, and can affect their health and quality of life. However, it can be managed by physical activity. The present study aims to investigate the combined effect of core stability and dynamic resistive exercises on bone mineral density (BMD) in postmenopausal women. Material and methods: Sixty postmenopausal women diagnosed with osteoporosis, age 50 to 60, BMI < 30 kg/m², were randomly divided into two equal groups: the study group received core stability and dynamic resistance exercise (two sessions per week) in addition to 70 mg Alendronate (one tablet) per week for four months, while the control group only received 70 mg Alendronate (one tablet) per week (n = 30 each group). Both groups were assessed for BMD (dual-energy x-ray absorptiometry; DEXA), and quality of life (Oswestry Disability Index; ODI), both pre- and post-treatment. Results: Both groups demonstrated a significantly greater bone mineral density in the lumbar spine and left femoral neck and improved quality of life post-treatment compared to pre-treatment (p < 0.001). However, comparing groups, the study group demonstrated significantly higher lumbar spine (Z value = -5.588) and left femoral neck bone mineral density (Z value = -4.794), and significantly lower ODI score (F value = 243.686), compared to the control group (p < 0.001). Conclusions: Core stability and dynamic resistance exercise appear to be safe and effective methods in the treatment of osteoporosis in post-menopausal women. [ABSTRACT FROM AUTHOR]

Introduction: in recent years, there has been considerable interest in vitamin D, both regarding its physiological aspects and its deficiency, the need for supplementation, recommended doses, and even the type of metabolite that should be used. Material and Methods: given the lack of universally accepted criteria among all scientific societies and the significant heterogeneity observed in clinical practice regarding these issues, we conducted a survey of a sample of 698 doctors in Spain from the specialties of Primary Care, Internal Medicine, Rheumatology, Traumatology, Endocrinology, Gynecology, and Geriatrics to understand their opinions on various aspects of vitamin D management. Results: there is a notable disparity in the responses to the 8 questions related to their usual clinical practice, both in the likelihood of requesting a vitamin D determination and in how it is prescribed. Conclusion: finally, the recommendations of the expert panel that developed the survey and analyzed its results are presented. [ABSTRACT FROM AUTHOR]

Osteoporosis is a common condition affecting the elderly population. Most of the time, it is diagnosed only after an individual suffers from a fracture. In addition to the fracture and its complications, the patients and their families must also bear the psychological and financial consequences of the disease. There are multiple risk factors associated with osteoporosis, hence it requires a multimodal approach in management as well. This narrative review aims to provide a comprehensive insight into the classification, prevalence, pathophysiology, signs and symptoms, risk factors, screening tools, management, differential diagnosis, prognosis, complications, and recent advances in osteoporosis. [ABSTRACT FROM AUTHOR]

Objective(s): Calcium phosphates, particularly hydroxyapatite, are the main inorganic compounds of vertebrate bone. In this study, nanohydroxyapatite was prepared using kombucha Symbiotic Culture of Bacteria and Yeast (SCOBY), and its effect was investigated on osteoporosis in ovariectomized rats. Materials and Methods: Kombucha-nanohydroxyapatite was synthesized by adding phosphoric acid to the kambucha scoby. Characterization of the nanoparticle was performed through X-ray diffraction, X-ray fluorescence, and transmission electron microscopy techniques. Female rats were divided into 5 groups: control, ovariectomized groups, and three ovariectomized groups treated with concentrations of 25, 50, and 100 mg/kg of nanoparticles. At the end of the treatment period, the levels of calcium, phosphorus, parathyroid hormone, and activity of alkaline phosphatase were measured in the blood samples. Calcium and phosphorus levels were also measured in bone and liver. The bone was evaluated histopathologically. Results: The synthesis of nanohydroxyapatite with particle size of 30 nm was confirmed through the use of X-ray diffraction (XRD) and TEM techniques. A significant increase in calcium and phosphorus levels in the femur bone was observed in the ovariectomized group, which received the highest nanoparticle concentration compared to the ovariectomized group. Parathyroid hormone and alkaline phosphatase activity inhibition were increased in ovariectomized rats following treatment with the highest nanoparticle concentration. In the mentioned group, bone trabeculae proliferation and increased lacuna-containing osteocytes were also observed. Conclusion: This study suggested that the highest concentration of kombucha-nanohydroxyapatite could be partially absorbed into bone tissues and recover the bone-destructive changes caused by ovariectomy, although additional experiments are needed for confirmation. [ABSTRACT FROM AUTHOR]