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Background: Although the Neer and AO/OTA classifications have been widely accepted, observer reliability studies of these two classifications have questioned their reliability and reproducibility to date. We developed an entirely new classification, the Mitsuzawa classification, for dislocated and displaced proximal humeral fractures and tested all three classifications for their intra- and interobserver reliability. Methods: Two experienced shoulder surgeons and two orthopedic residents independently evaluated the Xray (xR) values of 100 proximal humeral fractures (PHFs). The inclusion criteria for PHFs were (1) fracture-dislocation of the glenohumeral joint, (2) severely displaced fracture that required arthroplasty, such as hemi-arthroplasty or reverse shoulder arthroplasty, and (3) age > 18 years. Four reviewers classified all 100 fractures according to the Neer, AO/OTA, and Mitsuzawa classifications on two occasions. The intraobserver reliability was calculated using a Cohen κ statistic, while the interobserver reliability was calculated using a Fleiss κ statistic. Results: The average intraobserver agreements for the Neer, AO/OTA, and Mitsuzawa classifications were 0.57 (moderate), 0.67 (substantial), and 0.77 (substantial), respectively. The average interobserver agreements for the Neer, AO/OTA, and Mitsuzawa classifications were 0.49 (moderate), 0.56 (moderate), and 0.73 (substantial), respectively. The most common fracture type in each classification was an anterior dislocated fracture with a greater tuberosity fragment, which corresponded to A3a (57 cases) in the Mitsuzawa classification. Conclusions: The Mitsuzawa classification of PHF incorporates different perspectives regarding glenohumeral compatibility, assessment before and after shoulder dislocation reduction, and the degree of displacement of the proximal stump of the humeral shaft. Compared with the Neer and AO/OTA classifications, our new classification system adopted a user-friendly flowchart format and provided satisfactory intra- and interobserver reliability. Level of evidence: Level IV. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Method Results Conclusion Despite several surgical options, there has yet to be a consensus on the best treatment for femoral neck fracture (FNF) due to higher complication rates compared to other bone fractures. This study aims to examine the possible consequences and solution suggestions of changing screws during surgery for various reasons in FNF surgical treatment from a biomechanical perspective.FNF and treatment materials were analyzed biomechanically using a package program based on the finite element method (FEM). This study created a solid model with images of femur bone tomography. Dynamic hip screws (DHS), cannulated screws (CCS), and medial buttress plates (MBP) were obtained by making three‐dimensional designs. The required elements for the models were assigned, and the material properties of the elements were defined. The solutions were obtained as crack distance and deformation results after defining the boundary conditions and applying the necessary loading.The strain and crack distance values created by six models on the fracture line under different parameters were obtained, and the numerical results were evaluated. The DHS and CCS models produced the highest crack distance and deformation values when all screws were loose. The lowest values were obtained in the intact‐85 model when all CCS were tight. When the results are evaluated, it is seen that the MBP has a decreasing effect on the results. Mechanical evaluation of six different options used in femoral neck fractures was performed. 85 mm CCS applied to our standard model gave the best results, while the use of 80 mm CCS in the same model showed promising results compared to other models. It is understood that CCS have the best stability even in loosening models with the medial support plate. Different models are from intact‐85 mm DHS+1CS+MBP to DHS+1CS, which was worked with LSR+USR‐2, according to decreasing stability.This study offers various biomechanical solutions to possible intraoperative problems in FNF treatment. The following results were obtained from the study data. When the CCS needs to be lengthened or replaced, it is appropriate to use the CCS with the MBP. A single anti‐rotation screw is sufficient for lag screw extensions of the DHS plate, and the MBP may be a savior procedure in surgery. [ABSTRACT FROM AUTHOR]

Purpose: Reverse shoulder arthroplasty (RSA) is a common surgical procedure for elderly patients with proximal humerus fractures. Cement fixation of the humeral stem is considered the gold standard for this procedure. Due to the high prevalence of osteoporosis in this patient population, the risk of intraoperative fractures is increased when uncemented stems are used. Stem loosening is another concern of uncemented stems. However, the use of cement is associated with the risk of cement embolisation, impairment of tuberosity healing, and technical difficulties for later revisions. This study aimed (i) to evaluate the clinical and radiological outcomes of patients treated with uncemented RSA for proximal humerus fractures at two years postoperatively, and (ii) to compare these outcomes between patients with and without decreased low bone quality as measured by the deltoid tuberosity index. Methods: The single-centre prospective study included 54 shoulders (52 patients) with a proximal humerus fracture between 2019 and 2022. Enrolled were patients aged 65 and older with acute or secondary displaced three- or four-part fractures or head-split fractures treated with RSA using the same uncemented system and tubercula refixation. At 24 months post-surgery, clinical evaluations included range of motion (ROM), Constant-Murley Score (CS), Subjective Shoulder Value (SSV), and American Shoulder and Elbow Surgeons (ASES) Score. Radiological assessments evaluated scapular notching, radiolucent lines, and greater tuberosity healing. Results: The mean age was 79 years (± 8), 87% were female, and 69% had osteoporotic fractures. At the two-year follow-up, the median SSV was 90% (IQR 80–95), the median CS Score was 76.5 (IQR 72–81), and the median ASES Score was 89.9 (IQR 82–93). The ROM measurements were: median active forward flexion 140° (IQR 120–160), median external rotation 30° (IQR 20–40), and median active internal rotation 6 (IQR 4–8). The greater tuberosity healing rate was 94.5%. Although osteoporotic fractures occurred more often in older patients (mean 81 vs. 72 years, respectively), no other significant differences were detected between the groups. One case of aseptic stem loosening occurred in the non-osteoporotic group. Conclusion: Even in osteoporotic proximal humerus fractures, cementless stems combined with tubercula refixation resulted in favourable outcomes and were not associated with increased complications. [ABSTRACT FROM AUTHOR]

Background: Benign bone lesions are a common incidental finding in athletes during workup for musculoskeletal complaints, and athletes are frequently advised to halt participation in contact sports. There are no current guidelines to assist clinicians in referring patients with these lesions to a subspecialist or in advising athletes on the safety of returning to sport. Purpose: To assist sports medicine physicians in appropriate referral for patients with benign bone lesions through presentation of a literature review and the case of an adolescent athlete with a benign bone lesion in a location with a significant fracture risk. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic literature review was performed using the PubMed database. Search terms included "enchondroma,""unicameral bone cyst,""UBC,""simple bone cyst,""SBC,""aneurysmal bone cysts, "ABC,""nonossifying fibroma,""NOF,""non-ossifying fibroma,""chondroblastoma,""osteochondroma,""exostosis,""chondromyxoid fibroma,""periosteal chondroma," and "fibrous dysplasia" combined with "fracture,""sports,""sport,""contact sport,""football," or "rugby." Randomized controlled trials, case series, and prospective and retrospective studies were all included. Abstracts were excluded. Results: In total, 42 separate articles were reviewed. The strength of evidence for each lesion was determined using the total number of patients described in the literature with the pathology. Unicameral bone cysts, aneurysmal bone cysts, and fibrous dysplasia, particularly in the spine, are associated with a high risk of fracture; therefore, subspecialist referral is warranted before returning to sport. Osteochondromas (exostosis), juxtacortical chondromas, nonossifying fibromas, chondromyxoid fibromas, and enchondromas were associated with low fracture risk, and decisions regarding referral can be made on a case-by-case basis. Conclusion: The presence of a benign bone lesion does not always necessitate immediate, absolute restriction from participation in contact sports. After appropriate workup and diagnosis, the risk of return to sport should be evaluated based on the pathology present, and the patient and clinician should engage in a shared decision-making process. The guidelines in this paper provide context for stratifying risk and the importance of specialist referral. For athletes with a confirmed diagnosis of an asymptomatic benign bone lesion with a low risk of fracture, return to play without restrictions or referral is often safe. [ABSTRACT FROM AUTHOR]

Purpose: There is paucity of guidelines with inadequate data available about the extent and prevention of bone and joint disease in beta-thalassemic patients in Indian population. This study aims to determine bone and joint involvement in beta-thalassemic patients. It evaluates serum biochemical parameters of bone formation and resorption and correlates with the symptomatology in these patients. The study also determines their daily physical activity and find a correlation if any with bone mineral density. Methods: The study was carried out on 40 regularly transfused beta thalassemic patients between 5 and 18 years of age under regular follow-up at our centre from June 2012 to June 2014. All patients were interviewed as per a well-structured proforma for symptoms relating to bone and joint disease as described by the patient/parents in past 1 year and physical activity by QAPACE questionnaire. Venous blood samples were drawn under aseptic conditions and used for estimation of biochemical parameters (calcium, phosphorus, alkaline phosphatase, vitamin D, parathyroid hormone and serum ferritin). Enrolled subjects were scanned for bone mineral density (BMD) at femur neck, trochanter and Ward's angle using dual-energy X-ray absorptiometry. Results: A total of 40 patients were enrolled in the study (Male:Female = 80:20). Half the patients (n = 20) had symptoms pertaining to bone and joint disease. The most common symptom was leg pain (42.50%), followed by backache (22.50%). Asymptomatic patients had greater mean serum vitamin D as compared to the symptomatic patients (22.2 vs 15.08 ng/ml) (p = 0.225). Five patients were detected to have osteopenia, all above 10 years of age. The mean BMD in symptomatic patients at femur neck, trochanter and ward's angle was 0.781, 0.639 and 0.735 g/cm2, respectively, as compared to 0.754, 0.635 and 0.722 g/cm2 in asymptomatic patients. The difference was not statistically significant. Patients with low BMD had lower mean pre-transfusion Hb (< 9 g/dl) (p = 0.01). Eighty percent of osteopenic patients had sedentary lifestyle as compared to 44% of patients with normal BMD. Bone mineral density did not have any correlation with vitamin D levels, serum ferritin and type of chelation therapy. Conclusion: Pre-transfusion hemoglobin of more than 9 gm/dL has a protective role in maintaining good bone health and bone mineral density. Engaging thalassemia patients in physical activity has a positive effect on bone mineral density. Low vitamin D levels contribute to symptoms of bone and joint involvement in thalassemia and the same needs to be determined and supplemented. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the prevalence of frailty and its predictors among Taiwanese patients with atrial fibrillation (AF). A cross-sectional study was conducted, enrolling 188 AF patients aged over 20 years from a medical center in northern Taiwan. Participants were recruited from September 1 to December 30, 2022. Structured questionnaires were used to gather data on demographics, disease characteristics, Study of Osteoporotic Fractures Index, Short Portable Mental Status Questionnaire, Mini Nutritional Assessment Short-Form, Chinese Version Pittsburgh Sleep Quality Index, and Hospital Anxiety and Depression Scale. Among Taiwanese AF patients, over two-thirds were at risk of frailty, with susceptibility increasing with age. Key potential predictors included sex, cognitive function, nutritional status, sleep quality, and depression, jointly explaining 47.6% of the variation, with nutritional status being the most significant. These findings underscore the importance of comprehensive assessment and management strategies to address frailty in AF patients and improve overall health outcomes. [ABSTRACT FROM AUTHOR]

Romosozumab is a potent treatment for osteoporosis, with significant effects on bone density and fracture prevention. This study evaluated the cardiovascular safety of romosozumab in a real-world cohort of postmenopausal women at high fracture risk. We retrospectively evaluated postmenopausal women who initiated treatment with romosozumab between January 1, 2020, and June 30, 2023. We examined the occurrence of a major adverse cardiovascular event (MACE) across two distinct segments during the treatment period and after its conclusion. After applying inclusion and exclusion criteria, 847 women were followed for a median of 729 days (IQR: 445-1060). The incidence rate of MACE was 24.0 (95% CI 17.7-32.5) per 1000 person-years during the study period. The change in the rate of MACE from 0-90 days and 90-365 days post-treatment initiation was 0.04 and 0.06 events per 1000 days, respectively. The difference in the rate between these intervals was not statistically significant (p  = .09). After 1 yr of treatment, the slope of MACE increased to 0.10, differing significantly from the preceding 12 mo on treatment (p <.001). The incidence of MACE was higher in those with a background of previous cardiovascular disease or diabetes at all timepoints, as expected. The consistency in event rates during treatment suggests that romosozumab is not associated with an increase in MACE in postmenopausal women. This finding challenges reports suggesting an increase in cardiovascular events within the first year of romosozumab treatment. [ABSTRACT FROM AUTHOR]

Preventing subsequent fractures after vertebral augmentation is a critical clinical concern. The purpose of this study was to compare the effect of romosozumab and bisphosphonate administration on the occurrence of subsequent vertebral fractures after balloon kyphoplasty (BKP) and to identify factors associated with the occurrence of subsequent vertebral fractures. The study compared 24 patients who underwent BKP and received romosozumab with 58 control patients who underwent BKP and received bisphosphonates, all within 2 months of acute osteoporotic vertebral fracture and showing unfavorable magnetic resonance imaging prognostic factors. The primary outcome was the occurrence of subsequent fracture, and the secondary outcomes were improvement in back pain visual analog scale (VAS) score. Furthermore, logistic regression analysis was conducted to adjust for confounding factors and assess the effect of osteoporosis treatment type on subsequent vertebral fractures following BKP. Subsequent vertebral fractures occurred in 16 patients in the bisphosphonate group and in 1 patient in the romosozumab group (p  = .02). There were no significant differences between the 2 groups in VAS scores and their change from preoperatively to 6 months after surgery. The multivariable logistic regression analysis identified the type of osteoporosis treatment as an independent factor associated with the occurrence of subsequent vertebral fractures (Odds ratio, 18.30, p  = .02). This prospective, multicenter study demonstrates that romosozumab is more effective than bisphosphonates in preventing subsequent vertebral fractures within 6 months after BKP. Romosozumab's superior efficacy in reducing subsequent vertebral fractures may lead to improved long-term outcomes and quality of life, potentially making it a preferred treatment option over bisphosphonates for patients undergoing BKP. [ABSTRACT FROM AUTHOR]

Introduction: Road traffic accidents (RTAs) are a leading cause of mortality and serious injury worldwide, with skull fractures frequently emerging as a significant consequence of such incidents. The pattern and distribution of skull fractures can provide valuable insights into the mechanisms of injury and the severity of accidents. Understanding these patterns is crucial for improving both preventive measures and clinical responses. Materials and Methods: This is a retrospective cross-sectional study of one year duration. All the cases of road traffic accident death with skull fracture were included in the present study. A total of 342 cases of death due to fatal RTA were present and 140 cases had skull fractures. Results: The commonest site of fracture was the vault, observed in (64.28%) of cases. In fractures involving single bones of vault, Frontal bone fractures were seen in the highest number of cases, in 29 cases (32.22%). In fractures involving the base of the skull, the highest number of fractures were seen in MCF, in (7.14%) of the cases. Conclusion: A high number of fatalities due to road accidents occur in India every year. Its effect extends to the society at large. The financial burden produced on the family and healthcare system can be substantial. There can be adverse effect on the economic output of the country as well. Therefore, measures should be sought to reduce the road traffic accidents as a number of lives can be saved, as most of these are avoidable. [ABSTRACT FROM AUTHOR]

Objective: To describe and study retrospectively the combination of elastic nails and cementoplasty to stabilize pathological fractures in the upper limb and present the results on pain and mobility. Materials and Methods: Between January 2022 and April 2024, six patients with a median age of 65 were treated with elastic nailing and cement injection. Pathological fractures were located in the clavicle (n = 3), humerus (n = 1) and radius (n = 2). Displacement at the fracture site was noted in two cases. Results: All nails were inserted successfully. Two nails were used for the humerus (n = 1) and the radius (n = 2), and a single nail was used for the clavicle (n = 3). A median volume of 6.5 cc of PMMA was injected. Median duration of the procedure was 155 min. Median pain score dropped from 8/10 the day before intervention to 3.5/10 at 10 days of follow-up and 3/10 at one-month follow-up. Three patients could move their upper limb without limitation. For the five patients for whom imaging was available, no fracture displacement was recorded at a median last follow-up of 3 months. There was no delayed complication. Conclusion: The combination of elastic nail and cementoplasty is feasible and allows to reduce pain and restore limb function. It may offer an alternative to patients suffering from pathological fractures in the upper limb and who are not candidates for surgery. [ABSTRACT FROM AUTHOR]

A bone fracture is a medical condition characterized by a partial or complete break in the continuity of the bone. Fractures are primarily caused by injuries and accidents, affecting millions of people worldwide. The healing process for a fracture can take anywhere from one month to one year, leading to significant economic and psychological challenges for patients. The detection of bone fractures is crucial, and radiographic images are often relied on for accurate assessment. An efficient neural network method is essential for the early detection and timely treatment of fractures. In this study, we propose a novel transfer learning-based approach called MobLG-Net for feature engineering purposes. Initially, the spatial features are extracted from bone X-ray images using a transfer model, MobileNet, and then input into a tree-based light gradient boosting machine (LGBM) model for the generation of class probability features. Several machine learning (ML) techniques are applied to the subsets of newly generated transfer features to compare the results. K-nearest neighbor (KNN), LGBM, logistic regression (LR), and random forest (RF) are implemented using the novel features with optimized hyperparameters. The LGBM and LR models trained on proposed MobLG-Net (MobileNet-LGBM) based features outperformed others, achieving an accuracy of 99% in predicting bone fractures. A cross-validation mechanism is used to evaluate the performance of each model. The proposed study can improve the detection of bone fractures using X-ray images. [ABSTRACT FROM AUTHOR]

Context It is unknown if isolated low bone mineral density (BMD) "osteoporosis" at the radius is associated with increased fracture risk, not only at the wrist but elsewhere, and whether it reflects more generalized skeletal fragility. Objective This work aimed to review the association of radius BMD and fracture risk, the epidemiology of wrist fractures, isolated osteoporosis at the radius, and the concordance between radial BMD and femoral neck BMD. Methods We completed a narrative literature review on radius BMD and fracture risk and current recommendations for measurement of radial BMD. We updated results of radial BMD and fracture results from the Study of Osteoporotic Fractures over 20 years and examined the concordance of BMD at the distal and proximal radius with femoral neck BMD T scores. Results Radius BMD is a robust predictor of all types of fractures including hip and wrist but there is insufficient evidence to suggest that radius BMD predicts wrist fractures better than fractures at other sites. Fractures of the wrist tend to occur in younger, healthier women compared with hip and spine fractures. Nevertheless, wrist fractures are associated with an increased risk of future fractures and represent a missed opportunity for intervention. On a population level, the discordance between radius BMD and femoral neck BMD is small. But women with isolated osteoporosis at the radius had biochemical and microarchitecture deterioration that were similar to women with hip osteoporosis. Conclusion Future research should address the clinical implications of isolated osteoporosis at the radius and whether treatment is warranted. [ABSTRACT FROM AUTHOR]

ABSTRACT As the aging population continues to grow, the incidence of osteoporotic fractures increases and is compounded by our lack of therapeutic strategies that increase bone formation. Although exercise and physical activity play a key role in maintaining bone mass throughout our lives, the loads and exertion required to elicit an anabolic response becomes exceedingly difficult to achieve with age. Based on previous work, the P2Y2 receptor offers a unique therapeutic target to increasing bone mass by modifying the mechanotransduction. Others have also shown P2Y2 to have a negative effect on osteoblast function. However, the extent to which inhibiting P2Y2 pharmaceutically improves bone mass or the mechanotransduction of bone remains unknown. Our central hypothesis for this study states that inhibiting P2Y2 activity can enhance the anabolic response to loading in an aging population. To test this hypothesis, the anabolic response to exercise was examined by treating adult mice, which typically display a minimal response, with the P2Y2 inhibitor AR‐C118925XX (ARC). Our findings from this study demonstrate that ARC treatment of adult mice increases periosteal bone formation in response to exercise. The enhanced response to exercise was characterized by a reduction in osteocytes' induction of osteoclast activity. Endocortical bone formation also increased with treatment independently of exercise, providing gains in mechanical strength and tissue level properties. Overall, inhibiting P2Y2 activation has a beneficial effect on bone formation and the anabolic response to loading, namely by limiting osteoclast activation. [ABSTRACT FROM AUTHOR]

Background: Recently researches have reported that miRNA and its target genes are associated with osteoporosis. MiRNA and mRNA might be potential diagnostic markers for osteoporosis. Purposes: The aim of this study is to explore the potential miRNA and mRNA markers by bioinformatics method and clinical analysis. Patients and methods: The miRNA expression profiles were obtained from GSE74209, GSE64433 and GSE115773 in Gene expression Omnibus (GEO). The mRNA expression profiles were obtained from GSE100609. Wayne intersection were used to explore the different expressed miRNAs (DE-miRs). Select the miRNA with the highest Fold Change for subsequent research. Screening of miRNA target genes using TargetScan and miRDB tools. GO and KEGG analyses of target genes (TGs) function were performed. Validate the selected TGs in the GSE100609. We collected female patients with femural intertrochanteric fractures from July 1, 2023 to October 31, 2023. Patient's bone marrow and clinical data were collected. MiRNA and the target mRNA differentially expressed in bone marrow were verified through RT-qPCR. All data were subjected to Shapiro-Wilk test. Using Pearson or Spearman test to detect the correlation between various indicators, and then incorporating indicators related to bone density into multiple linear regression equations. Partial correlation analysis was used to analyze the correlation between the final indicators and bone density. Results: A total of 140 DE-miRs were identified. Set the fold change to ">1" and ultimately include 5 miRNAs. Using miR-595 (highest |log2 FC|) as the subject of subsequent research. 3542 targeted mRNAs were predicted from TargetScan and 362 were from miRDB. 337 TGs were intersected, which were mainly enriched in nucleus. Only Cldnd1 were identified using the GSE100609 dataset. We found that miR-595 was highly expressed in patients with high bone mass, while Cldnd1 was downregulated. There was a strong collinearity between miR-595 and Cldnd1. Further multiple linear regression analysis showed a high correlation between miR-595 and bone density. Conclusions: These data suggest that miR-595 and Cldnd1 might be related factors for decreased bone mass. [ABSTRACT FROM AUTHOR]

Although conservative treatment is commonly used for osteoporotic vertebral fracture (OVF), some patients experience functional disability following OVF. This study aimed to develop prediction models for new-onset functional impairment following admission for OVF using machine learning approaches and compare their performance. Our study consisted of patients aged 65 years or older admitted for OVF using a large hospital-based database between April 2014 and December 2021. As the primary outcome, we defined new-onset functional impairment as a Barthel Index ≤ 60 at discharge. In the training dataset, we developed three machine learning models (random forest [RF], gradient-boosting decision tree [GBDT], and deep neural network [DNN]) and one conventional model (logistic regression [LR]). In the test dataset, we compared the predictive performance of these models. A total of 31,306 patients were identified as the study cohort. In the test dataset, all models showed good discriminatory ability, with an area under the curve (AUC) greater than 0.7. GBDT (AUC = 0.761) outperformed LR (0.756), followed by DNN (0.755), and RF (0.753). We successfully developed prediction models for new-onset functional impairment following admission for OVF. Our findings will contribute to effective treatment planning in this era of increasing prevalence of OVF. [ABSTRACT FROM AUTHOR]

This population-based cohort study aimed to evaluate the risk of osteoporosis and fractures associated with higher-potency statin use compared to lower-potency statin use in patients with stroke, using data from the Health Insurance and Review Assessment database of South Korea (2010–2019). Patients who received statin within 30 days after hospitalization for a new-onset stroke (n = 276,911) were divided into higher-potency (n = 212,215, 76.6%) or lower-potency (n = 64,696, 23.4%) statin initiation groups. The primary outcome was a composite of osteoporosis and osteoporotic fractures. Secondary outcomes were individual components of the primary outcome, including osteoporosis, vertebral fracture, hip fracture, and non-hip non-vertebral fracture. Cox proportional hazard models weighted by standardized morbidity ratios were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs). The risk of the composite outcome (HR 0.95, 95% CI 0.93–0.97), osteoporosis (0.93, 0.90–0.96), vertebral fracture (0.95, 0.91–0.99), and hip fracture (0.89, 0.84–0.95) were significantly lower in higher-potency statin users, while the risk for non-hip non-vertebral fracture was not significant (0.98, 0.95–1.02). The use of higher-potency statins compared to lower-potency statins was associated with a lower risk of osteoporosis, vertebral fracture, and hip fracture in patients with stroke. [ABSTRACT FROM AUTHOR]

Osteoporotic fractures are characterized by abnormal inflammation, deterioration of the bone microenvironment, weakened mechanical properties, and difficulties in osteogenic differentiation. The chronic inflammatory state characterized by aging macrophages leads to delayed or non‐healing of the fracture or even the formation of bone defects. The current bottleneck in clinical treatment is to achieve strong fixation of the comminuted bone fragments and effective regulation of the complex microenvironment of aging macrophages. Inspired by cement and gravel in concrete infrastructure, a biomimetic bone glue with poly(lactic‐co‐glycolic acid) microspheres is developed and levodopa/oxidized chitosan hydrogel stabilized on an organic‐inorganic framework of nanohydroxyapatite, named DOPM. DOPM is characterized via morphological and mechanical characterization techniques, in vitro experiments with bone marrow mesenchymal stromal cells, and in vivo experiments with an aged SD rat model exhibiting osteoporotic bone defects. DOPM exhibited excellent adhesion properties, good biocompatibility, and significant osteogenic differentiation. Transcriptomic analysis revealed that DOPM improved the inflammatory microenvironment by inhibiting the NF‐κB signaling pathway and promoting aging macrophage polarization toward M2 macrophages, thus significantly accelerating bone defect repair and regeneration. This biomimetic bone glue, which enhances osteointegration and reestablishes the homeostasis of aging macrophages, has potential applications in the treatment of osteoporotic bone defects. [ABSTRACT FROM AUTHOR]

Background and rationale: Thyroid dysfunction in older adults often mimics the signs of aging, impacting metabolism and overall physiological balance. While age-related chronic conditions have been extensively studied, the relationship between thyroid function and frailty remains underexplored. Objective: This study aimed to evaluate the effects of thyroid dysfunction on frailty among individuals aged 65 years and older. Thyroid-stimulating hormone (TSH), free triiodothyronine (fT3), free thyroxine (fT4), and thyroid peroxidase antibody (anti-TPO) levels were analyzed. The study further examined the correlation between thyroid dysfunction, chronic diseases, sociodemographic factors, and optimal TSH levels in relation to frailty, using the Study of Osteoporotic Fractures (SOF), Edmonton Frail Scale (EFS), and FRAIL scales. Methods: This cross-sectional study included 220 older adults with either treated or untreated thyroid dysfunction. Comprehensive geriatric assessments were conducted, including detailed medical histories, sociodemographic data collection, and thyroid function tests. Frailty was assessed using the SOF, EFS, and FRAIL scales. Multivariate logistic regression analyses were performed to identify significant associations between thyroid parameters and frailty. Results: The median age of participants was 73 years, and 68.2% (n = 150) were women. Frailty prevalence was significantly higher in individuals with abnormal TSH levels (outside the 0.5–6 mIU/L range). Lower fT3 levels and the fT3/fT4 ratio were significantly associated with frailty, particularly as assessed by the SOF and EFS scales. In contrast, the FRAIL scale revealed a significant association between increased frailty and lower fT3 levels only. Subgroup analysis indicated that in individuals aged ≥ 80 years, a lower fT3/fT4 ratio was consistently associated with frailty across all frailty scales, whereas in those aged < 80 years, lower TSH levels showed a strong association with frailty as assessed by the FRAIL scale. These findings underscore age-specific variations in the relationship between thyroid function and frailty. Conclusion: This study highlights the significant impact of thyroid dysfunction on frailty in older adults. Lower fT3 levels and the fT3/fT4 ratio emerged as key indicators of increased frailty, particularly on the SOF and EFS scales. Subgroup analysis further emphasized the importance of age-specific assessments, with a lower fT3/fT4 ratio being a critical indicator of frailty in individuals aged ≥ 80 years, while lower TSH levels were significant in those aged < 80 years. Abnormal TSH levels were strongly associated with frailty on the SOF scale, suggesting the need to consider thyroid dysfunction as a modifiable risk factor. Additionally, factors such as age, sex, education, thyroid medication use, and comorbidities influenced frailty status. Incorporating thyroid function tests into frailty assessments could enhance early identification and targeted interventions for at-risk older adults, particularly when age-specific thresholds are applied. Key Summary Points: Aim: To investigate the impact of thyroid function on frailty in geriatric patients using the Edmonton Frail Scale (EFS), Study of Osteoporotic Fractures (SOF) scale, and FRAIL scale. Findings: The study identified significant correlations between altered thyroid function parameters and increased frailty scores across the EFS, SOF, and FRAIL scales, highlighting the substantial influence of thyroid dysfunction on geriatric health. Message: Thyroid function plays a critical role in determining frailty status among older adults, emphasizing the need for targeted monitoring and management to improve health outcomes in this population. [ABSTRACT FROM AUTHOR]

The IncRNA Malat1 was initially believed to be dispensable for physiology due to the lack of observable phenotypes in Malat1 knockout (KO) mice. However, our study challenges this conclusion. We found that both Malat1 KO and conditional KO mice in the osteoblast lineage exhibit significant osteoporosis. Mechanistically, Malat1 acts as an intrinsic regulator in osteoblasts to promote osteogenesis. Interestingly, Malat1 does not directly affect osteoclastogenesis but inhibits osteoclastogenesis in a non-autonomous manner in vivo via integrating crosstalk between multiple cell types, including osteoblasts, osteoclasts, and chondrocytes. Our findings substantiate the existence of a novel remodeling network in which Malat1 serves as a central regulator by binding to ß-catenin and functioning through the β-catenin-OPG/Jagged1 pathway in osteoblasts and chondrocytes. In pathological conditions, Malat1 significantly promotes bone regeneration in fracture healing. Bone homeostasis and regeneration are crucial to well-being. Our discoveries establish a previous unrecognized paradigm model of Malat1 function in the skeletal system, providing novel mechanistic insights into how a lncRNA integrates cellular crosstalk and molecular networks to fine tune tissue homeostasis, remodeling and repair. [ABSTRACT FROM AUTHOR]

The demand for systemic treatment of osteoporotic fractures to reduce recurrence is increasing, but current anti‐osteoporosis medications exhibit unsatisfactory efficacy due to adverse events and limited effects on fracture healing. Herein, a bone‐targeting zeolitic imidazolate framework‐8 (ZIF)‐based hydrogen sulfide (H2S) delivery system (ZIF‐H2S‐SDSSD) is designed to simultaneously promote fracture healing and alleviate osteoporosis. With bone‐targeting peptide SDSSD grafted on the surface, ZIF‐H2S‐SDSSD nanoparticles release H2S in bone tissues without affecting the serum H2S level, thereby mitigating potential risks of systematic H2S delivery. Upon cellular uptake, the acidic environment in lysosomes drives the release of H2S from the encapsulated zinc sulfide in conjunction with the degradation of ZIF. The synergistic effects of released Zn2+ and H2S promote macrophage metabolic reprogramming by suppressing succinate accumulation and mitochondrial reactive oxygen species (mtROS) production, and further regulate osteoblast‐osteoclast coupling. Overall, this strategy holds great promise in the clinical treatment of osteoporotic fractures and broadens the application of nanomedicine therapy for orthopedic diseases. [ABSTRACT FROM AUTHOR]

Bone fractures are a substantial health concern affecting approximately 2.7 million individuals annually across six European countries: France, Germany, Italy, Spain, Sweden, and the UK. If left untreated, this issue carries significant health risks, including fatality. It is crucial to accurately identify the types of fractures, especially subtle hairline fractures to mitigate long-term consequences. These fractures are characterized by small breaks where the bone fragments are aligned, and there is no visible displacement. Unfortunately, detecting hairline fractures is a significant challenge in the medical field. This is mainly attributed to the intricate nature of these fractures adding complexity, posing difficulties for both human and machine detection. Additionally, there is a lack of easily accessible datasets focused on hairline fractures. This paper introduces the iA-HLD model, a novel and enhanced approach for detecting hairline fractures. Through architectural modifications, this model exhibits superior capabilities in identifying hairline fractures across all types of human bones using deep learning and stands as the pioneering solution of its kind. A comprehensive comparative analysis is conducted, assessing the performance of the proposed model against established models, including ResNet-50, AlexNet, and convolutional neural network. Evaluation metrics, including accuracy, precision, recall, and F1-score, are used to compare the models. iA-HLD achieved an accuracy rate of 97.6%, highlighting its superior capabilities. In addition, it scored 98% in precision, recall, and F1-score, which surpasses all other models. These results show its improved capabilities as well as its potential for use in real-world applications across many fields. The research is a significant stride in advancing hairline fracture detection and addresses a critical gap in current medical diagnostic methods. [ABSTRACT FROM AUTHOR]

With the increasing prevalence of vertebral fractures, accurate diagnosis and prognostication are essential. This study assesses the effectiveness of AI in diagnosing and predicting vertebral fractures through a systematic review and meta-analysis. A comprehensive search across major databases selected studies utilizing AI for vertebral fracture diagnosis or prognosis. Out of 14,161 studies initially identified, 79 were included, with 40 undergoing meta-analysis. Diagnostic models were stratified by pathology: non-pathological vertebral fractures, osteoporotic vertebral fractures, and vertebral compression fractures. The primary outcome measure was AUROC. AI showed high accuracy in diagnosing and predicting vertebral fractures: predictive AUROC = 0.82, osteoporotic vertebral fracture diagnosis AUROC = 0.92, non-pathological vertebral fracture diagnosis AUROC = 0.85, and vertebral compression fracture diagnosis AUROC = 0.87, all significant (p < 0.001). Traditional models had the highest median AUROC (0.90) for fracture prediction, while deep learning models excelled in diagnosing all fracture types. High heterogeneity (I² > 99%, p < 0.001) indicated significant variation in model design and performance. AI technologies show considerable promise in improving the diagnosis and prognostication of vertebral fractures, with high accuracy. However, observed heterogeneity and study biases necessitate further research. Future efforts should focus on standardizing AI models and validating them across diverse datasets to ensure clinical utility. [ABSTRACT FROM AUTHOR]

Background: Appropriate management of fractures is crucial for restoring natural bone function and preventing long-term complications. Previous research on animal models indicates that trehalose can improve bone fracture healing by inhibiting the inflammatory cascade. We hope that trehalose can accelerate bone fracture healing in humans, alleviate pain, and ultimately enhance the individual's quality of life. Methods: This randomized, double-blind clinical trial will be conducted at Taleghani Hospital in Tehran, Iran. Sixty-four patients admitted to the orthopedic ward will be enrolled based on eligibility criteria. The participants will be randomly allocated based on the permuted block randomization into two groups: those receiving trehalose (32 patients) or placebo (32 patients). The patients in the trehalose and placebo groups will receive 3.3 g of trehalose or placebo for 12 weeks, respectively. A consent form, general questionnaire, as well as the Visual Analog Scale (VAS), Harris Hip Score (HHS), and radiological analyses will be used to assess fracture healing quality. The intention-to-treat principle will form the basis of the statistical analysis. Discussion: The trial results may provide a convenient and safe adjuvant treatment option for the Pertrochanteric Fractures population. Trial registration: Iranian Registry of Clinical Trials. IRCT20240605062013N1. URL of the trial registry record: https://irct.behdasht.gov.ir/trial/77212. Registration date: 16 June 2024. [ABSTRACT FROM AUTHOR]

Backgroud: Osteoporotic vertebral compression fractures (OVCF) cascades (OVCFcs) repeatedly cause vertebral compression to involve multiple vertebra. This study aimed to introduce an accelerated form of OVCFcs: acute multiple OVCF (amOVCF). Methods: OVCF patients with multiple vertebral augmentations in a spine center between June 2016 and October 2020 were retrospectively studied. Demographics, spine trauma, anatomical distribution, and distribution pattern of OVCF in OVCFcs and amOVCF were summarized and compared. Results: 429 patients with multiple vertebral augmentations in 1164 vertebra were included. There were 210 OVCFcs accumulating 622 OVCF and 219 amOVCF simultaneously involving 542 vertebra. The OVCFcs progressed at 0.48 fractures and 0.56 vertebra per year. Both OVCFcs and amOVCF demonstrated asymmetrical bimodal distribution in spine and most frequently involved L1. The incidence of adjacent OVCF was 40.14% in amOVCF with 2 OVCF and 84.72% in amOVCF with ≥ 3 OVCF, and the distribution pattern of OVCF was not significantly different between amOVCF and OVCFcs. The female/male ratio was 5.56 in OVCFcs and not different from that of 4.34 in amOVCF. The age of females (73.41 ± 8.08 and 76.29 ± 8.25 years old) but not males (77.20 ± 10.13 and 79.75 ± 10.21 years old) was significantly increased from initial to last OVCF in OVCFcs. amOVCF had similar age (72.26 ± 10.09 years old) as OVCFcs at initial OVCF (73.99 ± 8.51 years old) and were significantly younger than OVCFcs at last OVCF (76.82 ± 8.64 years old). 54.29% in OVCFcs and 48.4% in amOVCF reported no evident trauma, and the ratio of apparent spine trauma was higher in amOVCF (43.38%) than in OVCFcs (28.54%). Conclusions: amOVCF are accelerated form of OVCFcs showing similar anatomical distribution and distribution pattern of OVCF in spine. Both amOVCF and OVCFcs cause multiple fragility fractures without significant spine trauma. [ABSTRACT FROM AUTHOR]

Objective: To examine the effects of Jintiange on enhancing the healing of osteoporotic fractures in aged rats. Methods: An osteoporotic fracture model of femur was established using 70 SD rats (aged > 12 months), which were randomly numbered and divided into an experimental group and a control group, each with an equal sample size (n = 35). The experimental group received Jintiange capsule ingredients via intragastric administration, while the control group received an equal volume of saline via the same method. X-ray examinations were conducted at the 4th and 12th weeks to evaluate fracture healing in the rats. After 12 weeks, micro-CT scanning was employed to assess the microstructure of the healthy femurs, and the parameters of the experimental and control groups were compared. Results: After 4 weeks, the mean fracture healing scores were 0.78 ± 0.43 in the experimental group and 0.56 ± 0.51 in the control group. After 12 weeks, the mean scores were 1.50 ± 0.71 in the experimental group and 0.96 ± 0.68 in the control group. The scores in the experimental group were higher than those in the control group (P < 0.05). Micro-CT examination of the femurs showed an improvement trend in bone microarchitecture in the experimental group, indicated by increased bone volume fraction (BV/TV), trabecular number (Tb. N), and trabecular thickness (Tb. Th). However, these improvements were not statistically significant. A negative correlation with statistical significance was observed between trabecular separation (Tb. Sp) and fracture healing scores. Conclusions : Jintiange may promote osteoporotic fracture healing in aged rats by enhancing bone microstructure. [ABSTRACT FROM AUTHOR]

Background: Physical trauma is a significant contributor to morbidity and mortality worldwide. In Saudi Arabia, RTAs are the leading cause of injuries, with fractures being a critical aspect of trauma care. To address this prevalent healthcare burden, a detailed analysis of the costs associated with surgical interventions to optimize resource allocation and improve healthcare planning is crucial. Method: This retrospective cost analysis was conducted at King Saud University Medical City between January 2016 and March 2022. A total of 2689 orthopaedic trauma surgeries were analysed. The cost data were converted to US dollars (1 USD = 3.75 SR). Statistical analysis was conducted via SPSS, with comparisons of costs by sex, age group, procedure type, and other relevant factors. Results: The total cost of trauma surgeries over the study period was $8,548,749.90. The most common procedure was ORIF, which was performed 1415 times, accounting for $5,660,000.00 of the total cost. Males represented 65.7% of the patients, incurring $5,647,976.44 in expenses. Patients under the age of 21 had the highest number of cases by age (43.5%), and the total cost was $3,276,293.44. Scheduled surgeries had higher average costs than emergent procedures did, and lower extremity surgeries accounted for more cases but had lower average costs than upper extremity surgeries did. Conclusion: The cost of orthopaedic trauma care is significantly influenced by factors such as procedure type, age, and sex. When certain cost patterns are identified and analysed, an approach toward cost effectiveness while maintaining high-quality healthcare delivery can be achieved. Projected trends show an increase in the number of cases by 2030, indicating increased costs. Future studies should consider additional factors, such as rehabilitation costs, and explore cost-saving opportunities in surgical interventions. [ABSTRACT FROM AUTHOR]

Summary This report describes the application of a resorbable implant (Resorb‐Vet) made of poly‐(DL) lactide (PDLLA) for the repair of a maxillary fracture in one horse and a nasal bone fracture in another. The horses were positioned in lateral recumbency and the fracture was reduced. An absorbable plate was moulded to the bone and fixed with PDLLA pins, which were attached to an ultrasonic device and inserted into predrilled holes by ultrasonic vibrations. Once the pins contacted the bone, the ultrasonic vibrations caused liquefication of the PDLLA, which infiltrated the bone and solidified after the ultrasonic vibrations ceased. Immediate primary stability was achieved with this technique. Both horses recovered well, were discharged without complications and returned to their previous level of activity. [ABSTRACT FROM AUTHOR]

Trabecular bone, a porous and spongy kind of bone tissue composed of a lattice of connecting rods and/or plates, is crucial for the transfer of weight in crucial joints including the spine, hip, and knee. It is impacted by a variety of metabolic bone illnesses, such as osteoporosis, which result in bone loss, reduced bone strength, and an elevated risk of bone fracture. To promote osseointegration due to the permeable porous, we suggest, in this study, a new approach to design a femoral permeable porous implant to achieve suitable stiffness, lightweight, and biocompatibility for the bone. Accordingly, data are collected from a digital bio-model to design a femoral implant for mimics segmental bone defect (SBD) with a biocompatible material Ti6Al4V (Ti64). To do this, three lattice structures (LSs) are compared and derived from implicit surface modeling called a triply periodic minimal surface (TPMS) to obtain the LS suitable to create it within the solid inner volume of the tibia implant. Thus, performed the finite element analysis (FEA) method for the enhanced Designs and compare them in terms of stress, deformation, and lightweight. [ABSTRACT FROM AUTHOR]

In this paper, a novel H-slot resonator of size 30 mm×20 mm×1.56 mm for fracture detection, backed with a perfect electric conductor (PEC), designed at 2.54 GHz is presented, and its performance is evaluated. Concurrently, an equivalent circuit model of the resonator is developed, and its performance coherently agrees with the CST model. The design is tested using a hybrid tissue phantom based on a second-order Debye dielectric tissue model. The detection of fractures of several thicknesses with a minimum width of 2 mm and a maximum of 10 mm was compared. Overall, the proposed design improves the detection of fractured regions in a bone with a 2 mm crack width as the smallest detectable crack size. [ABSTRACT FROM AUTHOR]

Normal pregnancy and lactation have a marked physiological impact on maternal bone metabolism. This impact is usually temporary and reversible, but some women sustain fragility fractures whilst pregnant or lactating, termed pregnancy and lactation-associated osteoporosis (PLO). These fractures have severe negative consequences on their quality of life, at what is a crucial stage in a mother's life. Identifiable risk factors include a low body mass index (BMI), reduced physical activity during adolescence, a strong family history of osteoporosis, and genetic variations in the LRP5 and WNT1 genes. However, due to the rarity of PLO and the limited awareness surrounding it, there has been slow progress in understanding its pathophysiology and identifying the most effective treatments. Indeed, the data available primarily originates from observational and case studies, resulting in little clear guidance on a comprehensive and multidisciplinary approach. This mini-review synthesises the latest data on incidence, pathophysiology, and management in PLO, providing current and future perspectives and highlights the need for evidence-based guidelines to improve both short-term and long-term outcomes for women with PLO. [ABSTRACT FROM AUTHOR]

The goal of this study was to develop an image analysis algorithm for quantifying the effects of remodelling on cortical bone during early fracture healing. An adaptive thresholding technique with boundary curvature and tortuosity control was developed to automatically identify the endocortical and pericortical boundaries in the presence of high-gradient bone mineral density (BMD) near the healing zone. The algorithm successfully detected boundaries in more than 47,000 microCT images from 12 pairs of healing ovine osteotomies and intact contralateral tibiae. Resampling techniques were used to achieve data dimensionality reduction on the segmented images, allowing characterisation of radial, circumferential, and axial distributions of cortical BMD. Local (transverse slice) and total (whole bone) remodelling scores were produced. These surrogate measures of cortical remodelling derived from BMD revealed that cortical changes were detectable throughout the region covered by callus and that the localised loss of cortical BMD was highest near the osteotomy. Total remodelling score was moderately and significantly correlated with callus volume and mineral composition (r > 0.64, p < 0.05), suggesting that the cortex may be a source of mineral needed to build callus. [ABSTRACT FROM AUTHOR]

Objective: Adult spinal deformity (ASD) with osteoporotic vertebral fractures (OVF) often requires vertebral body resection and replacement. However, postoperative mechanical complications (MC) have been unsolved issues. This study retrospectively investigated the risk of MC following anterior-posterior spinal fusion (APF) with vertebral body resection and replacement for OVF with ASD. Methods: Among 91 cases undergoing APF with vertebral body resection and replacement, 43 cases met the deformity criteria. The mean age was 74.2 years, and the mean number of fused segments was 5.7. Pre and postoperative spinal alignments were measured, and the risk of MC occurrence, including PJK, DJK, and cage sinking, was determined through multivariate analysis. The AUC and cutoff values were calculated through ROC analysis. Results: The incidence of MC, PJK, and DJK were 28%, 12%, and 14%, respectively. Multivariate analysis for MC revealed postoperative PI-LL and operative time (cutoff: 40.5 degrees, 238 min) as significant risk factors, while postoperative PI-LL was a significant risk factor for PJK (cutoff: 42.4 degrees). Evaluation considering only thoracolumbar level showed postoperative local kyphosis as a significant MC risk factor (cutoff: 11 degrees). There was a positive correlation between operative time and preoperative local kyphosis, with a cutoff value of 238 min being equivalent to 21 degrees. Conclusion: The postoperative mismatch over 40 degrees and preoperative local kyphosis over 21 degrees were considered as a high risk for MCs. The postoperative kyphosis of 11 degrees was the risk factor of MC in the thoracolumbar level. The meticulous preoperative assessment, including local and global alignment, and local flexibility as well as detailed surgical planning of fixation range and the requirement of osteotomy, are crucial. [ABSTRACT FROM AUTHOR]

Background: Osteoporosis-related fragility fractures are increasing worldwide. An assessment of the prevalence of fragility fractures in Bahrain is needed to determine proper action and preventive strategies. The main objective of this study was to conduct a retrospective cross-sectional study to investigate the prevalence of fragility fractures in adult Bahraini patients. Another objective was to explore the relationship of fragility fracture risk with BMD, age, sex, BMI, vitamin D status, and therapy. Methods: To investigate the fragility fractures, we retrospectively reviewed the dual-energy X-ray absorptiometry (DEXA) data of patients who underwent scans for the diagnosis of osteoporosis between 2016 and 2018. The data were collected from four large centers in Bahrain. The patients' medical records were reviewed for the fragility fracture data, BMD, sex, age, BMI, vitamin D status, and therapy. Results: Among a total of 4572 patients who visited the radiology departments during the 3-year study period, only 412 patients with fragility fractures were considered for the current study. The mean age of the patients in this cohort was 63.9 ± 12.2 years. There were 393 females (95.6%). Among the 431 fragility fractures, there were 175 (40.6%) belonging to three common fracture sites: vertebral (86, 20.9%), femur (60, 14.6%), and distal radius (Colles) fractures (29, 7%). Other fragility fractures were hand (7%), radius and ulna (3.7%), humerus (6.5%), tibia and fibula (5.6%), foot/ankle (27.9%), ribs (3.0%), and pelvis (1.6%). Our results revealed a significant association between the fragility fractures and BMD (χ2 = 6.7, p = 0.035). We reported a significant association of fragility fracture with sex (p = 0.006) and with denosumab therapy (p < 0.001). Conclusions: This study reported a reduced BMD and an increased prevalence of fragility fractures among Bahraini subjects. The highest frequencies of fragility fractures among our cohort were foot/ankle, vertebral, and hip fractures, respectively. We showed a statistically significant association between fragility fractures and BMD. The current study indicated that not only patients with low BMD but also patients with fragility fractures were undertreated. Thus, the immediate initiation of treatment and the synthesis of local osteoporosis treatment guidelines are warranted. [ABSTRACT FROM AUTHOR]

In this study, we address interpersonal violence during the transition between the Middle and the Late Formative periods in the Central Andes, a critical period of political disintegration, hypothesized population pressure, and reorganization of the belief systems that is poorly known from a bioarchaeological viewpoint. Our objective is to understand the nature of the violence and associated factors in this context based on a detailed description of skeletal trauma in 67 well-preserved individuals (20 adolescents and adults and 47 subadults) recovered from Quebrada Chupacigarro cemetery (500–400 BC); this site is located in the middle valley of Supe on the Peruvian north-central coast. To detect patterns and potential causes, we registered the prevalence of traumatic injury according to age, sex, anatomic location, mechanisms (blunt, sharp, mixed, etc.), timing (antemortem or perimortem), and manner (inflicted or accidental). The results show a high prevalence of fractures in the whole population, but especially in adolescents and adults. Eighty percent of the adolescents and adults perished due to the intentional trauma and show patterns that suggest repetitive episodes of interpersonal violence. Perimortem injuries in the skull, face, and thorax are compatible with lethal interpersonal violence. The findings support a probable scenario of intercommunity violence in the middle valley of Supe around 500–400 BC. [ABSTRACT FROM AUTHOR]

Background: Osteoporotic fractures are a common clinical sign of Cushing syndrome (CS). However, Cushing diagnosis can occur years after this clinical manifestation. Methods: Herein, we present the case of a 45-year-old woman who was referred to our department for further diagnosis and treatment. Results: The patient was already under treatment for arterial hypertension and osteoporosis and was recently diagnosed with dyslipidemia and type 2 diabetes. She reported several previous fractures starting already 8 years before presentation. An adrenal CS was diagnosed, and the patient was treated with laparoscopic adrenalectomy, with a subsequent complete remission of her hypercortisolism. This case report presenting a particularly long time gap between initial osteoporosis signs and the final diagnosis underlines the need for an investigation into secondary osteoporosis in low-energy fractures also in the peripheral skeleton. In this context, we performed a literature review, including case reports with fragility fractures that were attributed to endogenous CS. Conclusions: In summary, a delayed diagnosis of CS in patients with a previous accumulation of such fractures is a worrisome observation and should be considered in everyday clinical practice in order to improve the timely diagnosis and treatment of CS. [ABSTRACT FROM AUTHOR]

It is crucial to recognize upper extremity fragility fractures as sentinel events that allow healthcare professionals the opportunity to identify and address underlying factors contributing to poor bone health, thereby reducing the risk of future fragility fractures. This study seeks to evaluate the extent of understanding and factors influencing osteoporosis in older adults with upper extremity fragility fractures, aiming to establish a foundation for enhancing their comprehension. A total of 1443 participants in 31 provinces were included in this study as survey subjects from September to November 2023. A general information questionnaire and an osteoporosis knowledge assessment tool were used for a cross‐sectional survey. The univariate analysis and logistic regression were used to analyze the risk factors. The score of osteoporosis knowledge assessment tool of participants was 10.00 (7.00, 12.00), with only 24.95% scoring above 12 points. Being in an eastern hospital, suffering from chronic obstructive pulmonary disease, being diagnosed as severe osteoporosis, having bone mineral density testing, receiving osteoporosis health education, and receiving health education by phone were associated with higher knowledge of osteoporosis. The osteoporosis knowledge of older adults with upper extremity fragility fractures needs to be improved. To help the secondary prevention of osteoporosis, the standardized osteoporosis health education should be strengthened, and attention should be paid to key groups. [ABSTRACT FROM AUTHOR]

Remote diagnosis enables healthcare professionals to evaluate and diagnose patients from a distance using telecommunication technologies, enhancing healthcare delivery by improving accessibility, especially for those in remote or underserved areas. One of the significant sustainability challenges in remote medical diagnostics is offering timely assistance to vulnerable groups like the elderly, disabled, mentally impaired individuals, and wounded military personnel in combat zones. This becomes particularly difficult in emergencies when rapid analysis of medical records is needed, especially if the data is stored on secure blockchain networks. The proposed work addresses these challenges by deploying a comprehensive framework for large-scale analysis, utilizing both document and image classification for dual validation. It integrates advanced techniques such as Inception V3, VGG-16, VGG-19, RESNET-50, and Densenet-201 for bone fracture detection, with Inception V3 achieving the highest accuracy of 95.1%. In addition, a Document Classification Analysis (DCA) method is proposed, which automatically classifies the severity of fractures. Object detection techniques are also introduced for detecting minor fractures using region-based image segmentation, ensuring precise diagnosis even for subtle injuries. This pioneering integration of technologies provides a holistic solution for remote medical diagnostics. [ABSTRACT FROM AUTHOR]

Background/Objectives: Musculoskeletal aging can clinically hardly be distinguished from degenerative disease, especially if symptoms are nonspecific, like lower back pain and reduced physical resilience. However, age-related changes are considered to be physiological until they cause osteoporotic fractures or sarcopenia-related restrictions. This radio-anatomic investigation examines whether findings in lumbar magnetic resonance imaging (MRI) mirror age- and sex-related musculoskeletal differences that help to identify the onset of sarcopenia. Methods: Lumbar MRI investigations from 101 women and 101 men were retrospectively evaluated for vertebral and muscular cross-sectional diameter sizes and T2-signal intensities ("T2-brightness") in axial sections in the L5-level. The results were correlated with the individual's age to find specific alterations that were indicative of sarcopenia or attributable to the aging process. Results: In women (average age 62.6 (34–85) years), musculoskeletal cross-sectional area sizes and diameters were significantly smaller (p < 0.00001) compared to those in men (average age 57.0 (21–90) years). The most pronounced structural age-related change was the increasing mean posterior paravertebral muscle brightness (MPPVB), which exceeded the mean vertebral brightness (MVB) earlier and to a greater extent in women than in men (p < 0.00001). The brightness difference (∆MVB − MPPVB) was found to indicate (pre-)sarcopenia at values below 25. Conclusions: Significant age-related deterioration in muscle quantity and quality was more obvious in women, correlated with the onset of menopause, and progressed to lower levels during aging. [ABSTRACT FROM AUTHOR]

Objective: Secondary osteoporosis is a condition when the underlying disease or its treatment causes the bone mass to decrease and the bone structure to deteriorate, increasing the risk of fracture. The importance of diagnosis and treatment during childhood and adolescence is due to the long-term negative effects. In this study, our objectives were to determine the diagnostic findings, treatment efficacy, and follow-up characteristics of children with secondary osteoporosis. Methods: Patients diagnosed with secondary osteoporosis between January 2000 and January 2021 were included. The research was a cross-sectional and descriptive study. Study participants had to be under 18 years of age when the primary underlying disease was diagnosed and had received treatment for secondary osteoporosis. Patient data were collected from patient files. Statistical analysis was performed using Statistical Package for the Social Sciences, version 20.0 (IBM Corp, Armonk, NY, USA). Results: Sixty-one patients (28 female; 45.9%) were evaluated. The most common underlying primary diseases were inflammatory diseases (57.7%), neuromuscular diseases (26.2%), immunodeficiency (13.1%), acute lymphoblastic leukemia (8.2%), metabolic diseases (8.2%), solid organ transplantation (8.2%), bone marrow transplantation (6.6%) and epilepsy (6.6%). The mean±standard deviation chronological age when secondary osteoporosis was diagnosed was 11.89±4.88 years. Patients were evaluated for osteoporosis at a mean of 6.39±5.13 years after the onset of the underlying primary chronic diseases. Most (78.7%) had a history of one or more chronic drug use, including systemic steroids (59%), chemotherapeutics (23%), immunomodulatory drugs (19.7%), antiepileptic drugs (8.2%), inhaled steroids (4.9%), intravenous immunoglobulin (1.6%), and antituberculosis drugs 1.6%.Bone pain was detected in 49.2%. All patients had vertebral fractures before treatment. Bisphosphonate treatment was given to 45 (73.8%). There was a significant increase in mean bone mineral density (BMD) and bone mineral content six months after treatment (both p<0.001). There was a significant increase in BMD Z-score values for chronological and height age (both p<0.001). Overall mean BMD values increased by 31.15% with treatment. Following bisphosphonate treatment, there was a significant reduction in both fracture number and bone pain (p<0.01). Similar benefits from bisphosphonate treatment were evident in those who did or did not receive steroid treatment. Conclusion: Secondary osteoporosis is a condition that is influenced by many factors, such as the primary disease causing osteoporosis and chronic medication use, especially steroids. If left untreated, osteoporosis may lead to clinically important morbidity (bone pain, fractures, immobilization) and reduced linear growth of bone. When used to treat childhood secondary osteoporosis, bisphosphonates significantly improve BMD and reduced fracture risk. [ABSTRACT FROM AUTHOR]

Pulsed electromagnetic fields (PEMF) have been used in bone fracture healing for many years. However, it is still not clear which frequencies are more effective. Therefore, the aim of this study was to investigate the effect of single frequency of 4 Hz and a package of multiple frequencies (220 Hz, 727 Hz, 880 Hz and 10 kHz) on bone fractures of rats. Rats were randomly divided into three groups: sham, R4 and RM. A transverse osteotomy was created in the right medial tibias diaphysis of each rat under anesthesia. The right tibia of the rats in the R4 and RM groups was exposed to 4 Hz, and a package of multiple frequencies, respectively. The rats in both irradiation groups were exposed to a pulsed magnetic field with an amplitude of 10 mT for 1 h/day during 1 month under anesthesia with ketamine (90 mg/kg, i.p.) and xylazine hydrochloride (9 mg/kg, i.p.). The rats in the sham group were kept under the same experimental conditions without any field exposure. At the end of the study, the right tibia of each rat was removed and bone healing was evaluated histopathologically and radiologically, and the concentrations of some elements were measured, such as Na, Mg, K, Cr, Mn, Fe, Zn, Se, Ca and P. The results showed that 4 Hz exposure was more effective in bone fracture healing than the other frequencies in this study. Further studies need to be conducted to determine the mechanisms underlying the effect of 4 Hz PEMF. [ABSTRACT FROM AUTHOR]

Distal femur physeal fractures in children, particularly Hoffa fractures, are rare and prone to complications. This study aims to evaluate the outcomes of surgical intervention in children presenting with delayed intra-articular distal femur physeal fractures. A multicentric retrospective study involved six pediatric patients with delayed presentation of distal femur physeal fractures. Five patients underwent surgical intervention involving osteotomy and anatomical re-fixation of the malunited fragments. One patient opted for conservative management. The age at presentation, time since injury, surgical procedures, and clinical and radiological outcomes were evaluated at the final follow-up. Fixation with lag screws was sufficient in three patients, while two required additional plate stabilization. The mean age of patients was 12.2 years, comprising four boys and two girls. The average delay in presentation was 30.8 months (ranging from 3 months to 8 years). For the surgical group (n = 5), the knee range of motion improved from an average of 16°–66° preoperatively to 6°–128° post-operatively at a mean follow-up of 60 months. The mean limb shortening was 3 cm (range 0.5–5 cm). Two patients required additional procedures for distal femur varus malalignment. The conservatively managed patient showed no improvement in knee movements at the 12-month follow-up, serving as a control. Surgical intervention involving osteotomy and anatomical reduction for malunited intra-articular Salter–Harris-type III and IV fractures of the distal femur in children yields good to excellent outcomes. Limb length discrepancy and malalignment, if present, can be addressed separately. Longer follow-up until skeletal maturity is necessary to evaluate final outcomes in these patients. Level of evidence: Level IV (case series). Therapeutic. [ABSTRACT FROM AUTHOR]

Background: Continuous compression implants (CCIs) can provide continuous compression across a fracture site. They are mainly used in foot/ankle surgery, with very limited descriptions in the literature of their potential for trauma. The aim of this study was to describe the use and associated outcomes of CCIs in modern day trauma practice. Methods: This was a single-centred case series with a retrospective analysis of a prospectively maintained database of any patients who were treated with a CCI across 4 years. The primary outcome was to determine the mode of the CCIs and secondary outcomes were unplanned returns to theatre. Results: 60 patients were eligible with a mean age of 44.2 and 122 CCIs were used. 51 patients were treated for acute fractures, 9 were treated for non-unions, and 27 patients had open injuries. 42 of the 122 CCIs were used as definitive fixation (midfoot dislocations, an iliac wing fixation and isolated medial malleolus fixation), and the rest as adjuncts for fixation; of this remainder, 39 were used in reduction mode, 38 for fixation of key fragments, and 3 for compression. Ten patients returned to theatre, two for metalwork failure, two for infection and 6 for non-unions—three were acute fractures and three originally non-unions. Conclusion: This paper demonstrates a novel technique for the use of CCIs in UK trauma practice as either definitive fixations or in three different modes as adjuncts to fixation. They do not replace tradition implants but do have equivalent rates of complications. They may be a useful tool in the arsenal for trauma surgeons. [ABSTRACT FROM AUTHOR]

Transient osteoporosis of the hip is an uncommon bone marrow oedema syndrome of unknown pathophysiology affecting previously healthy pregnant women and young to middle-aged men. The disorder is characterised by hip pain, reduced mobility, and the risk of fracture, which is significantly higher in pregnant than in non-pregnant individuals. Diagnosis is by magnetic resonance imaging. Other than a single case-control study, published literature is limited to case series and case reports, with no evidence to guide management, risk of fracture, mode of delivery, safety of breastfeeding and risk of recurrence. An international pregnancy registry may be useful to try to answer some of these questions. [ABSTRACT FROM AUTHOR]

Osteoporotic vertebral compression fractures (OVCFs) are common fragility fractures. Patients who undergo surgical treatment for their initial OVCFs warrant particular attention because there is an elevated risk of subsequent vertebral fractures and other types of fragility fractures. However, the optimal osteoporosis treatment for this specific patient group is less investigated. This study compares the risk of subsequent osteoporotic fractures and mortality rate for patients who are initiated with denosumab and bisphosphonates and determines the effect of adherence to treatment. Retrospective nationwide cohort study. A total of 2,858 patients who had surgically-managed osteoporotic vertebral compression fractures. The risk of osteoporotic fractures, vertebral fractures, nonvertebral fractures and death. This is a retrospective nationwide cohort study that uses the National Health Insurance Research Database. Patients aged ≥50 years who were admitted for surgical interventions for OVCF between 2012 and 2016 and subsequently received denosumab or bisphosphonates for one year were included. Patients were stratified according to their antiosteoporosis medications and adherence to treatment. A multivariable, time-varying Cox proportional hazards model was used to determine the risk of osteoporotic fractures, vertebral fractures, nonvertebral fractures and death. A total of 2,858 patients were included in this study: 1,123 patients in the denosumab group and 1,735 patients in the bisphosphonates group. Compared to persistent denosumab users, the nonpersistent denosumab users, persistent bisphosphonate users and nonpersistent bisphosphonate users had a greater risk of osteoporotic fractures, with respective hazard ratios of 1.64 (95% confidence interval [CI], 1.16–2.32), 1.74 (95% CI, 1.25–2.42) and 1.53 (95% CI, 1.14–2.06). If osteoporotic fractures were divided into nonvertebral and vertebral fractures, none of the groups exhibited an increased risk of vertebral fractures compared to persistent denosumab users, with an HR of 1.00 (95% CI: 0.54–1.88) for nonpersistent denosumab users, 1.64 (95% CI: 0.96–2.81) for persistent bisphosphonate users and 1.52 (95% CI: 0.95–2.43) for nonpersistent bisphosphonate users. However, there was a significantly greater risk of nonvertebral fracture, with respective hazard ratios of 2.04 (95% CI, 1.33–3.11), 1.80 (95% CI, 1.18–2.76) and 1.56 (95% CI, 1.06–2.27) for nonpersistent denosumab users, persistent bisphosphonate users and nonpersistent users. Noteworthy, nonpersistent denosumab users exhibited a significantly greater risk of mortality than persistent denosumab users, with a hazard ratio of 3.12 (95% CI, 2.22–4.38). In terms of patients with OVCFs who require hospitalization and surgical intervention, those who receive ongoing denosumab treatment exhibit less risk of developing subsequent osteoporotic fractures than those who receive bisphosphonates or nonpersistent denosumab treatment. However, discontinuation of denosumab is associated with a significantly increased risk of subsequent fractures and mortality. Therefore, adherence to the treatment is crucial for patients who are initiated with denosumab. [ABSTRACT FROM AUTHOR]

Domino osteoporotic vertebral fractures (OVFs) involve multiple OVFs occurring simultaneously or sequentially, before healing of the initial OVFs. However, the risk factors and long-term clinical outcomes of domino OVFs are unclear. To identify the risk factors associated with domino OVFs and to assess their impact on patients' quality of life (QOL). Multicenter prospective observational cohort study. Patients (n = 190) treated conservatively for acute OVFs in 8 hospitals with 12-month follow-up. Clinical outcomes were assessed using the visual analog scale (VAS), Oswestry Disability Index (ODI), and Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ). Multivariate analyses were performed to identify risk factors for domino OVFs. All patients underwent magnetic resonance imaging (MRI) at 3 months to detect subsequent domino OVFs. Domino OVF group included initial domino OVFs (multiple acute OVFs at baseline) and subsequent domino OVFs at 3 months. Paraspinal muscle assessment was performed using the lumbar indentation value and Goutallier classification. Patient characteristics, bone quality, paravertebral muscle degeneration, nutritional status, radiographic parameters, and QOL scores were compared between the nondomino and domino OVF groups. We evaluated 50 (26.3%) patients with domino OVFs (34 with initial domino OVFs; 20 with subsequent domino OVFs). Walking ability was poorer in the domino than in the nondomino OVF group, from baseline to the 12 months follow-up. Groups with 3 or more adjacent domino OVFs showed worse VAS and ODI scores. Multivariate logistic regression analysis revealed that severe fatty degeneration of the paraspinal muscle was an independent risk factor for domino OVFs. Severe paraspinal muscle fatty degeneration is an independent risk factor for domino OVFs. Our study showed that the quality, rather than the quantity, of paraspinal muscles had an impact on domino OVFs. Early assessment of fatty degeneration in the paraspinal muscles is essential for predicting the development of domino OVFs. [ABSTRACT FROM AUTHOR]

• We studied effectiveness of orthotics for osteoporotic vertebral fracture (OVF). • Orthotic treatment for OVF could contribute to the stabilization of fractured vertebra. • It could reduce the imminent vertebral fracture risk immediately after onset of OVF. Orthotic treatment is a common option for the conservative treatment of osteoporotic vertebral fractures (OVF). However, there is insufficient evidence of its clinical benefit. To investigate the effectiveness of orthotic treatment for OVF. Retrospective cohort study with data from two prospective studies. This study included 160 patients with fresh OVF enrolled in 2012 and 2020 prospective cohort studies. The visual analog scale (VAS) score for low back pain was used for clinical outcomes, and radiographic parameters included the percent height of the vertebra and angular change of the vertebral body. Moreover, the occurrence of secondary vertebral fractures was followed-up over time. The patients were divided into brace and no-brace groups and were matched according to propensity score for age, sex, anterior percent height at the initial examination, and presence of old OVFs. Hazard ratio for the cumulative incidence of secondary vertebral fractures with and without bracing were calculated and analyzed using the generalized Wilcoxon test. In addition, the brace group was divided into soft and rigid brace groups and compared with the no-brace group. Each group had 61 cases after propensity score matching. There were no significant differences in the VAS improvement for low back pain and the change in percent height of the anterior and posterior walls from initial examination to 6 months after injury (p=.87, p=.39 and p=.14, respectively, mixed-effect models). Meanwhile, the mean angular change of fractured vertebrae was 4.3° / 3.2° initially and 1.2° / 2.5° at 6 months (the brace group / no-brace group, respectively; p=.007, mixed-effect models). A significant difference was also observed between the rigid brace group and the no-brace group (p=.008, mixed effect models). The incidence of secondary vertebral fractures was 1.6% / 11.4% at 1 month, indicating a significant difference (the brace group / no-brace group, respectively; p=.028). The hazard ratio for the cumulative incidence of secondary fractures due to orthotic treatment was 0.47 (95% confidence interval 0.20–1.09, p=.054). Although orthotic treatment for fresh OVF did not relieve pain, it might contribute to the stabilization of the fractured vertebra, especially using a rigid brace. Moreover, it might influence a reduction of the imminent vertebral fracture risk immediately after the onset of OVF. Clinical study [ABSTRACT FROM AUTHOR]

H vessels are an essential link in angiogenic-osteogenic coupling and orchestrate the process of bone healing. H vessels are critically deficient in the setting of radiation-induced fractures, which have been reported to occur in up to 25% of patients undergoing radiotherapy. By increasing H-vessel proliferation, Deferoxamine (DFO) revitalizes the physiologic response to skeletal injury and accelerates irradiated fracture repair. H-vessel quantification is therefore an important outcome measure in histologic analysis of bone healing. However, an optimized protocol for staining H vessels in formalin-fixed paraffin-embedded (FFPE) tissue sections has not been reported. With this protocol, we describe a method of staining FFPE bone samples with minimal background fluorescence and high signal-to-noise ratio. We examined mandibular specimens in a rat model of bone healing from a range of fracture conditions, including healthy bone (Fx), irradiated bone (XFx), and irradiated bone with DFO treatment (XFx-DFO). Quantitative analysis revealed a significant increase of H vessels in the XFxDFO group compared to both the Fx and XFx groups. By optimizing immunofluorescent staining of H vessels in FFPE samples across a range of fracture conditions, we offer investigators an efficacious means of producing reliable imaging for quantitative analysis of H vessels in an irradiated fracture callus. [ABSTRACT FROM AUTHOR]

Objective: To investigate the relationship between glycosylated Hemoglobin (HbA1c) levels and bone mineral density (BMD) in individuals with varying glycemic statuses, including diabetes, prediabetes, and controls. Methods: This cross-sectional study conducted in Bengaluru, India, included 336 participants aged 20 to 60. Blood samples were taken to assess fasting blood glucose, HbA1c, and lipid profile. Participants were divided into tertiles based on HbA1c levels: low(HbA1c ≤ 5.5%), moderate(HbA1c > 5.5–6.0%), and high(HbA1c ≥ 6.1%).Dual energy-X-ray absorptiometry(DXA) measured hip, spine, and total BMD as indicators of bone health. Results: Intermediate and high HbA1c tertiles had a significantly higher hip and total BMD compared to low HbA1c tertiles (p < 0.001 and p = 0.006 for hip and total BMD). Spine BMD was comparable between the three groups. After adjusting for age, gender and BMI, a potential independent effect of glycemic control on hip BMD was observed (Low vs. intermediate and high glycemic status: β: 0.041, 95% C.I.: 0.003, 0.078, p = 0.034). Conclusion: Elevated HbA1c might be associated with higher hip and overall BMD as observed through DXA. Nonetheless, this doesn't necessarily imply better bone health; further evaluation is advised to prevent fractures. [ABSTRACT FROM AUTHOR]