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Hip fractures are a frequent cause of hospitalization in the elderly population and can lead to significant morbidity and mortality. As the population continues to age, the incidence of hip fractures is expected to increase. The internist/hospitalist plays a critical role in the care of this population as many patients have multiple medical comorbidities. Management of the fragility hip fracture patient requires knowledge of several perioperative topics including preoperative risk assessment, risk reduction strategies, the optimal timing of surgical repair, venous thromboembolism prevention, and postoperative care considerations such as early mobilization with physical therapy, and osteoporosis treatment., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Vertebral compression fractures (VCFs) are the most common osteoporotic fractures. Only 1/3 of patients with VCFs are clinically diagnosed. In our institution, the Fracture Liaison Service (FLS) was launched in 2017 to improve osteoporosis management for hospitalized patients. (1) To assess osteoporosis awareness among medical providers for emergency department (ED)/hospitalized patients aged 50 or greater; (2) To estimate the rate of FLS consults or referrals to primary care providers (FLS/PCP) by primary teams. A centralized radiology system was used to examine all thoracic and lumbar computed tomography (CT) scans conducted between June 1, 2017 and June 1, 2022. 449 studies were identified with the radiologic impression "compression fracture". 182 studies were excluded after manual chart review. 267 hospitalizations/ED visits with lumbar and/or thoracic spine CT scans were included. Referrals to FLS (26) or PCP (27) were made in 53 cases (~ 20% of the total). In the ED subgroup (131 hospitalizations), only 17 patients had FLS/PCP referrals. The "compression fracture" was mentioned in 227 (85%) discharge notes (any part), while "osteoporosis" was mentioned in only 74 (28%) hospitalizations. A statistically significant difference was found between the two groups when "osteoporosis" was mentioned in the "assessment and plan" section (p = 0.02). Our data show that the overall osteoporosis care for affected patients is suboptimal. Medical providers often overlook the presence of osteoporosis, leading to a lack of consultation with the FLS of referral to PCPs for further evaluation and treatment., (© 2024. The Author(s).)

Aim: To study the association between femoral neck (FN) bone mineral density (BMD) T-score and fracture risk in individuals with and without type 2 diabetes (T2D)., Materials and Methods: We performed a single-centre retrospective cohort study using the Danish National Health Service. BMD of the FN was measured by dual-energy X-ray absorptiometry. Cox proportional hazards regression models were used to study the association between FN BMD T-score and fractures in individuals with and without T2D separately, adjusted for age, comorbidities and comedication. The results from this analysis were used to estimate the 10-year absolute fracture risk., Results: In total, there were 35,129 women (2362 with T2D) and 7069 men (758 with T2D). The FN BMD T-score was significantly associated with risk of any, hip and major osteoporotic fracture in men and women with [adjusted hazard risk ratios (aHR) women, hip: 1.57; 95% confidence interval (CI) 1.24-2.00, incidence rate (IR) 8.7; aHR men, hip: 1.55; 95% CI 1.01-2.36, IR 4.6] and without T2D (aHR women, hip: 1.75; 95% CI 1.64-1.87, IR 7.0; aHR men, hip: 1.97, 95% CI 1.73-2.25, IR 6.3), and its ability to predict fracture risk was similar. Fracture IRs were not significantly different for individuals with or without T2D, nor was the estimated cumulative 10-year fracture risk., Conclusions: The FN BMD T-score was significantly associated with hip, non-spine and major osteoporotic fracture risk in men and women with and without T2D. Fracture risk for a given T-score and age was equal in individuals with and without T2D, as was the ability of the FN BMD T-score to predict fracture risk., (© 2024 The Author(s). Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.)

Purpose: To identify the optimal statistical approach for predicting the risk of fragility fractures in the presence of competing event of death., Methods: We used real-world data from the Dubbo Osteoporosis Epidemiology Study that has monitored 3035 elderly participants for bone health and mortality. Fragility fractures were ascertained radiologically. Mortality was confirmed by the State Registry. We considered four statistical models for predicting fracture risk: (i) conventional Cox's proportional hazard model, (ii) cause-specific model, (iii) Fine-Gray sub-distribution model, and (iv) multistate model. These models were fitted and validated in the development (60% of the original sample) and validation (40%) subsets, respectively. The model performance was assessed by discrimination and calibration analyses., Results: During a median follow-up of 11.3 years (IQR: 7.2, 16.2), 628 individuals (34.5%) in the development cohort fractured, and 630 (34.6%) died without a fracture. Neither the discrimination nor the 5-year prediction performance was significantly different among the models, though the conventional model tended to overestimate fracture risk (calibration-in-the-large index =  - 0.24; 95% CI: - 0.43, - 0.06). For 10-year risk prediction, the multistate model (calibration-in-the-large index =  - 0.05; 95% CI: - 0.20, 0.10) outperformed the cause-specific (- 0.23; - 0.30, - 0.08), Fine-Gray (- 0.31; - 0.46, - 0.16), and conventional model (- 0.54; - 0.70, - 0.39) which significantly overestimated fracture risk., Conclusion: Adjustment for competing risk of death has minimum impact on the short-term prediction of fracture. However, the multistate model yields the most accurate prediction of long-term fracture risk and should be considered for predictive research in the elderly, who are also at high mortality risk. Fracture risk assessment might be compromised by the competing event of death. This study, using real-world data found a multistate model was superior to the current competing risk methods in fracture risk assessment. A multistate model is considered an optimal statistical method for predictive research in the elderly., (© 2024. The Author(s).)

Background: The relationship between osteoporosis and rotator cuff tears has been reported previously. However, the treatment rate of osteoporosis in individuals with rotator cuff tear is still unknown. The aim of this study was to investigate the prevalence and treatment rate of osteoporosis in individuals with rotator cuff tears., Methods: In this cross-sectional study, we enrolled 207 participants. Participants underwent comprehensive assessments, including shoulder ultrasonographic examinations and quantitative ultrasound measurements for bone status evaluation. Osteoporosis diagnosis was predicated on a calcaneus ultrasound bone densitometry, and the cutoff value was set as a T score of -1.455, with reference to a previous report., Results: One hundred fifty-six participants were classified as individuals without rotator cuff tears (group A), and 51 participants were classified as those with (group B). The mean age in group A was significantly lower than that in group B (63 ± 10 vs. 68 ± 9, respectively; P = .003). In terms of the T score examined by quantitative ultrasound, the mean T score in group A was significantly higher than that in group B (-1.4 ± 1.3 vs. -1.9 ± 1.6, respectively; P = .0412). The percentage of subjects with a T score of -1.455 or less in group B was 60.8% (31/51). The proportion of subjects with a T score of -1.455 or less undergoing osteoporosis treatment was 14.5% (12/83) in group A and 12.9% (4/27) in group B, showing no significant difference., Conclusions: Participants with a rotator cuff tear had relatively high prevalence of osteoporosis. Among those with both a rotator cuff tear and osteoporosis, the proportion receiving osteoporosis treatment was l2.9%, a very low rate., (Copyright © 2024 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Background: Patients with chronic liver disease (CLD) frequently suffer from malnutrition and bone diseases, both of which heighten the risk of poor clinical outcomes. This study investigated the relationship between geriatric nutritional risk index (GNRI) and osteoporosis or fracture risk using the fracture risk assessment tool (FRAX) in patients with CLD., Methods: This cross-sectional study included 209 consecutive patients with CLD. The participants were divided into two groups: the all-risk group (GNRI ≤ 98.0) with nutrition-related risk and the no-risk group (GNRI > 98.0) without nutrition-related risk. Osteoporosis was diagnosed according to the World Health Organization criteria. The FRAX was used to estimate the 10-year probabilities of hip fracture (FRAX-HF) and major osteoporotic fracture (FRAX-MOF)., Results: Of the 209 patients, 72 (34.4%) had osteoporosis. The all-risk group had a significantly higher prevalence of osteoporosis than the no-risk group (p < 0.001). Conversely, patients with osteoporosis had significantly lower GNRI than those without osteoporosis (p < 0.001). Multivariate analysis found lower GNRI to be a significant and independent risk factor for osteoporosis (odds ratio [OR], 0.927; p < 0.001) and high fracture risk derived from FRAX (without BMD) (OR, 0.904; p = 0.009). GNRI had a positive correlation with bone mineral density (BMD) at the lumbar spine, femoral neck, and total hip, but a negative correlation with FRAX-HF and FRAX-MOF in the FRAX with and without BMD (p < 0.001 for all). The cutoff value of GNRI for predicting osteoporosis was 104.9, with sensitivity of 0.667 and specificity of 0.657., Conclusions: The GNRI was significantly associated with osteoporosis and FRAX-derived fracture risk in patients with CLD, suggesting that it could be a simple and useful indicator for the management of bone diseases., (© 2024. The Author(s).)

Background: Bilateral pedicle fractures of the lumbar spine are uncommon and are typically associated with strenuous activities, traumatic events, or previous spinal surgery. This study reported a case of bilateral pedicle fracture in a patient with a long history of osteoporosis treatment with bisphosphonate and included a histological evaluation of the bone., Case Presentation: An 82-year-old woman with no history of trauma presented to our hospital with back pain that had worsened over the previous month. Computed tomography and magnetic resonance imaging revealed bilateral pedicle fractures of the third lumbar vertebra. She had osteoporosis and had been taking bisphosphonates for 9 years. The patient underwent posterior lumbar fusion, and her symptoms improved. Bone biopsy results from the spinous process revealed few osteoblasts and an absence of osteoclasts, indicating low bone turnover., Conclusions: Long-term use of bisphosphonates may contribute to the development of atypical bilateral pedicle fractures in patients with osteoporosis., (© 2024. International Osteoporosis Foundation and Bone Health and Osteoporosis Foundation.)

Background: The risk factors for contralateral hip refracture after primary hip fracture are not fully understood; therefore, this study compared the clinical characteristics of patients with first and second hip fractures and explored and analyzed the risk factors for contralateral refracture after hip fracture in elderly individuals to provide a reference for the clinical prevention of postoperative refracture of hip fracture in elderly individuals., Methods: A retrospective study was conducted on 458 elderly patients with hip fractures who underwent surgical treatment and were discharged from our hospital from March 2016 to March 2019. The clinical data of the patients were analyzed retrospectively. Patients were divided into a case group (postoperative refracture) and a control group (no postoperative refracture) based on whether they experienced refracture within five years after surgery. The clinical data of the two groups were compared and analyzed via univariate and multivariate logistic regression analyses and receiver operating characteristic (ROC) regression analysis to identify the risk factors for refractures after hip fracture surgery in elderly patients., Results: Sixty-one patients experienced refracture, with an incidence rate of 13.3%. Age ≥ 80.5 years, female sex, poor knee joint function, FRAX score ≥ 15.5, anemia, visual impairment, osteoporosis, and Alzheimer's disease (AD) were identified as risk factors for refracture after hip fracture surgery in elderly individuals (P < 0.05)., Conclusion: Elderly patients with hip fractures are susceptible to refracture after surgery because of factors such as advanced age, female sex, high FRAX score, poor knee joint function, anemia, osteoporosis, visual impairment, and AD. Targeted interventions should be implemented based on the above risk factors., (© 2024. The Author(s).)

Aim: Patients with osteoporosis who also have sarcopenia are at a high risk for falls and fractures. Early detection of sarcopenia is crucial for these patients. This study aimed to compare the effectiveness of SARC-F, SARC-CalF, and calf circumference (CC) as screening tools for sarcopenia in patients with osteoporosis., Methods: This cross-sectional study was retrospectively conducted on patients who attended the outpatient clinic for Osteoporosis and Sarcopenia at Kyoto Medical Center. Sarcopenia was determined based on low skeletal muscle mass and weak handgrip strength. Sensitivity and specificity analyses were conducted on SARC-F, SARC-CalF, and CC. The diagnostic utility of these three tools was compared using the receiver-operating characteristic (ROC) curves and the area under the ROC curves (AUC)., Results: A total of 225 patients (men/women: 33/192) with a median age of 69.0 years (interquartile range: 61.0‒75.0) were enrolled. The prevalence of sarcopenia was found to be 11.6%. CC had the highest sensitivity (80.8%), while SARC-F had the highest specificity (93.0%) for detecting sarcopenia. ROC analysis revealed that all three tools had significant potential for sarcopenia diagnosis, with SARC-CalF having the highest AUC compared to SARC-F and CC (0.753 vs. 0.619 and 0.700). A multivariate logistic regression, incorporating other confounders as explanatory variables, revealed that SARC-CalF was independently related to sarcopenia (odds ratio: 14.80, 95% confidence interval: 3.83-57.30, p < 0.001)., Conclusion: In patients with osteoporosis, SARC-CalF is more effective in the early detection of sarcopenia than SARC-F and CC., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Ishihara et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Pregnancy and lactation-associated osteoporosis is a rare form of osteoporosis occurring during late pregnancy and early lactation, featuring fragility fractures, primarily involving the vertebral bodies and leading to back pain. Its management involves osteoporosis treatment, complicated by potential drug-related dangerous effects on the fetus. Nevertheless, many controversies remain regarding diagnosis, prognosis, and treatment options. Herein, we propose a multicentric case series to provide a comprehensive neurosurgical, gynecological, and endocrinological perspective on the management of pregnancy and lactation-associated osteoporotic vertebral fractures. A multicenter retrospective study was conducted at the Neurosurgical Department of Università degli Studi di Napoli Federico II, the Neurosurgical Unit of Hopitaux Universitaires de Genève, and the Spine and Spinal Cord Surgery Unit of the University Hospital of Udine, collecting data from January 2014 to December 2022. The study has been approved by the ethical committee of each hospital. N = 11 patients with an overall number of 31 fractures were eligible, with a mean age of 36. N = 5 (16%) fractures in 4 patients (36%) developed during pregnancy, and N = 26 (84%) fractures in 7 (64%) patients occurred during lactation. The mean number of fractures per patient was 2,81. In 10 (90%) patients, fractures occurred at the first pregnancy, and 5 (45%) patients had uneventful subsequent pregnancies. The mean clinical signs and symptoms were back pain (92%), followed by loss of height (75%) and kyphosis (4 patients, 35%). One (9,09%) patient underwent in vitro fertilization (IVF), and one patient (9,09%) was receiving hormonal therapy (ethinylestradiol/drosiprenone). 10 out of 11 (90%) patients were treated conservatively, and 6 of them (60%) were managed with an orthosis. One (9,1%) patient underwent surgery for 5-level kyphoplasty. The mean average reduction of pain after one year of follow-up was 6,7 on the visual analogue scale (p-value 0,04). Pregnancy-related osteoporotic vertebral fractures are an emerging issue in developing countries, for which a conservative strategy ensures the best outcomes. The main goal is to improve bone mineral density through calcium and vitamin D supplementation and bone-active drugs as bisphosphonates or teriparatide. Surgery is warranted only in cases of a risk of severe deterioration of neurological functions., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: It is known that fracture risk is increased in patients with psoriatic arthritis (PsA); however, there is no consensus on the association with osteoporosis. The purpose of this study was to elicit the rate of osteoporosis and the risk factors of osteoporosis in patients with PsA at our institution., Methods: The data in this study were extracted from 163 patients with PsA. Osteoporosis and osteopenia were defined based on the WHO definition. Osteoporosis was also diagnosed when a fragility vertebral compression fracture was observed., Results: The osteoporosis and osteopenia rates for PsA patients were 11.7% and 33.1%, respectively. The rates of osteoporosis and osteopenia in males were particularly high compared to previous reports, at 9.3% and 34.3%, respectively. Trabecular bone score was considered age-appropriate for both males and females. Body mass index and Trabecular bone score were significantly lower in patients with osteoporosis., Conclusions: In patients with PsA, males are at elevated risk of osteoporosis and associated fragility fractures even if they are under 50 years. Body mass index was significantly lower in osteoporotic cases, suggesting the importance of bone mineral density testing and treatment in such cases., (© Japan College of Rheumatology 2024. Published by Oxford University Press.)

Anecdotal evidence from preliminary observations has noted multiple instances where osteoporosis is present in elderly patients before the clinical detection of bowel disease, even in the absence of overt gastrointestinal symptoms. However, any potential association between these conditions remains to be further investigated. This computed tomography (CT) study investigates whether patients with gastrointestinal (GI) perforation have lower bone mineral density (BMD) than age and sex matched controls. BMD was measured by drawing 3D regions of interest in the bone marrow of the L1-L3 vertebral bodies on CT scans of each of 37 GI perforations and matched controls. Spectrometric calibration of Hounsfield units to the mineral scale was performed with density measurements in the paravertebral muscles (erector spinae) and subcutaneous adipose tissue. The mean BMD of patients with GI perforation (135.9 ± 24.3 mg/ml) was significantly lower than that of controls (96.9 ± 27.5 mg/ml, p < 0.05). The calculated T-and Z-scores of bone mineral density were also significantly different between the two groups (p < 0.05 for each) and were - 2.9 (± 0.90) and - 0.8 (± 0.91) in patients with GI perforation and - 1.6 (± 0.83) and 0 (± 0.96) in the control group, respectively. The results imply that patients with gastrointestinal (GI) perforation have lower bone mineral density (BMD) than age-and sex-matched controls, posing the question whether the screening and aggressive management of osteoporosis is high-risk populations for gastrointestinal perforation can prevent gastrointestinal complications in targeted populations., (© 2024. The Author(s).)

Background: The proximal humerus, a common site for osteoporotic fractures, is frequently overlooked in osteoporosis evaluations. This study aimed to evaluate the relationship between the conventional bone mineral density (BMD) measurement (at the lumbar spine and femur) and the BMD measurement at both proximal humeri (the asymptomatic side and the side with a rotator cuff tear [RCT]) in patients with unilateral RCT. Furthermore, we investigated clinical features indicative of osteoporosis in RCT patients and assessed the utility of proximal humerus BMD measurements., Methods: From April 2020 to September 2020, 87 patients who underwent arthroscopic repairs for unilateral RCTs were examined for age, onset, body mass index, menopause duration, passive range of motion, global fatty degeneration index, and RCT and retraction size. The regions of interest (ROIs) for the conventional BMD included the lumbar spine, femur neck, femur trochanter, and total femur. For the proximal humerus BMD, the ROIs included the head, lesser tuberosity, greater tuberosity (medial, middle, and lateral rows), and total humerus., Results: The conventional BMD of the lumbar spine, femur neck, femur trochanter, and femur total were 1.090, 0.856, 0.781, and 0.945 g/cm 2 , respectively. The head, lesser tuberosity, greater tuberosity (medial, middle, and lateral rows), and total BMD of the asymptomatic-side proximal humerus were 0.547, 0.544, 0.697, 0.642, 0.554, and 0.610 g/cm 2 , respectively. The average of proximal humerus BMD was significantly lower than that of conventional BMD ( p < 0.001). All ROIs BMD of the RCT-side proximal humerus were 0.497, 0.507, 0.619, 0.598, 0.517, and 0.560 g/cm 2 . There was no correlation between the conventional BMD and each proximal humerus BMD. All ROI BMD of the RCT-side proximal humerus was not significant in the multiple regression analysis with age, onset, body mass index, passive range of motion, global fatty degeneration index, and RCT and retraction size ( p > 0.05)., Conclusions: The proximal humerus BMD showed a completely different trend from that of conventional BMD and had no significant association with clinical features. Therefore, the proximal humerus BMD needs to be measured separately from the conventional BMD, as it may provide important information before rotator cuff repair surgery., Competing Interests: CONFLICT OF INTEREST: No potential conflict of interest relevant to this article was reported., (Copyright © 2024 by The Korean Orthopaedic Association.)

Purpose: The authors experienced several cases of extra-articular calcaneal fracture accompanied by joint depression involving the entire posterior facet without joint involvement. This type of fracture and its characteristics and treatment outcomes have not been previously reported. The study was performed to analyze the characteristics of extra-articular calcaneal fractures of the joint depression type and their postoperative clinical and radiographic results and complications., Methods: Between February 2013 and March 2021, 23 extra-articular calcaneal fractures of the joint depression type were consecutively treated by a single surgeon. Relationships between fracture characteristics and patient demographics were assessed. Clinical results were quantified using visual analog scale, American Orthopaedic Foot and Ankle Society ankle-hindfoot scale, and Foot Function Index, radiographic results were evaluated using Böhler's angles, and calcaneal widths were determined using calcaneal axial and lateral radiographs obtained preoperatively and at last follow-up., Results: Twenty (87%) of the 23 cases occurred in women, and the mean age of all patients was 65.8 years (43-90). The three men were older than 65. Five (21.7%) patients had osteopenia, and 12 (52.2%) had osteoporosis. Bone mineral density testing could not be performed in the other six patients. Clinical and radiographic results were significantly improved after surgery., Conclusion: Extra-articular calcaneal fractures of the joint depression type are much more common in women and occur at an older age than calcaneal fractures commonly occur. These fractures are also more common in patients with a low bone mineral density., Level of Evidence: Level IV., (© 2024. The Author(s) under exclusive licence to SICOT aisbl.)

Evidence regarding the risk factors and characteristics of those with foot fragility fractures compared to non-foot fragility fractures is limited. Foot fragility fracture patients are more likely to be younger female with a higher BMI. A foot fragility fracture is strongly predictive of a subsequent foot fragility fracture., Purpose: Osteoporosis can clinically result in fragility fractures. Evidence regarding the risk factors and characteristics of foot fragility fractures compared to non-foot fragility fractures is limited. The American Orthopaedic Association's Own the Bone (OTB) is a bone health initiative with a substantial dataset. The purpose of this study was to examine and compare characteristics of patients presenting with isolated foot fragility fracture to those with a non-foot fragility fracture., Methods: Between January 2009 and March of 2022, 58,001 fragility fractures occurred that were included in this cohort. A total of 750 patients had foot fragility fracture(s) and 57,251 patients had a non-foot fragility fracture that included shoulder, arm, elbow, forearm, wrist, spine, ribs, pelvis, hip, thigh, knee, tibia/fibula, and ankle. Demographics, fracture history, bone health factors, medication history, and medication use for each patient were reported in the OTB database. This data was utilized in our secondary cohort comparative analysis of characteristics and the risk of future fractures between foot fragility fracture and non-foot fragility fracture groups., Results: Foot fragility fracture patients have a significantly higher probability to be younger (66.9 years old), female (91.5%), and have a higher BMI (28.3 kg/m 2 ) compared to non-foot fragility fracture (p < 0.0001) patients. Patients with a foot fragility fracture are nine times (OR = 9.119, CI = 7.44-11.18, p < 0.001) more likely to have had a prior foot fragility fracture. Young, female patients with a prior foot fragility fracture are at higher risk of a future foot fragility fracture, and this risk increased as BMI increased., Conclusions: Foot fragility fracture patients are more likely to be female and younger compared to patients with a non-foot fragility fracture. A foot fragility fracture is a sentinel event considering that a prior foot fragility fracture is strongly predictive of a subsequent foot fragility fracture., Level of Evidence: 3 (retrospective cohort)., (© 2024. International Osteoporosis Foundation and Bone Health and Osteoporosis Foundation.)

Background: This study aims to evaluate the prevalence and treatment of osteoporosis in patients undergoing long spinal fusion for adult spinal deformity (ASD) and compare the impact of osteoporosis treatment on surgical and radiographic outcomes., Methods: We conducted a retrospective study of adult patients aged ≥40 years who underwent thoracolumbar ASD surgery at a single academic center between 2015 and 2021. We recorded demographic information, procedural details, and pharmacologic treatments. Primary outcomes included preoperative and postoperative sagittal vertical axis, pelvic incidence-lumbar lordosis mismatch, and postoperative complications such as surgical site infection, pseudarthrosis, proximal junctional kyphosis (PJK), and proximal junctional failure. Patients with osteoporosis were compared to those without., Results: Among 168 patients, the prevalence of osteoporosis was 28.6%. Osteoporotic patients were older and predominantly female. At the time of surgery, 70.8% of osteoporotic patients were receiving pharmacologic treatment. Preoperative pelvic incidence-lumbar lordosis mismatch and sagittal vertical axis did not differ significantly between osteoporotic and nonosteoporotic cohorts. Both cohorts showed similar postoperative improvements. The osteoporotic cohort had a higher rate of PJK (35.4% vs. 17.5%, p=0.01), but no significant difference in proximal junctional failure rates. No significant differences were found between monotherapy and combination therapy outcomes for osteoporotic patients., Conclusions: Osteoporotic patients undergoing ASD surgery exhibited similar surgical outcomes and alignment improvements compared to nonosteoporotic patients, despite a higher rate of PJK. Pharmacological treatment appears beneficial in managing osteoporosis-related surgical risks. These findings highlight the importance of identifying and treating osteoporosis in ASD patients to minimize complications., (Published by Elsevier Inc.)

Background: Most periprosthetic fractures following total hip arthroplasty (THA) are fragility fractures that qualify patients for osteoporosis diagnoses. However, it remains unknown how many patients were diagnosed who had osteoporosis before injury or received the proper evaluation, diagnosis, and treatment after injury., Methods: We identified 171 Vancouver B2 (109) and B3 (62) periprosthetic femur fractures treated with a modular fluted tapered stem from 2000 to 2018 at 1 institution. The mean patient age was 75 years (range, 35 to 94), 50% were women, and the mean body mass index was 29 (range, 17 to 60). We identified patients who had osteoporosis or osteopenia diagnoses, a fracture risk assessment tool (FRAX), bone mineral density (BMD) testing, an endocrinology consult, and osteoporosis medications. Age-appropriate BMD testing was defined as no later than 1 year after the recommended ages of 65 (women) or 70 years (men). The mean follow-up was 11 years (range, 4 to 21)., Results: Falls from standing height caused 94% of fractures and thus, by definition, qualified as osteoporosis-defining events. The prevalence of osteoporosis diagnosis increased from 20% before periprosthetic fracture to 39% after (P < .001). The prevalence of osteopenia diagnosis increased from 13% before the fracture to 24% after (P < .001). The prevalence of either diagnosis increased from 24% before fracture to 44% after (P < .001). No patients had documented FRAX scores before fracture, and only 2% had scores after. The prevalence of BMD testing was 21% before fracture and 22% after (P = .88). By the end of the final follow-up, only 16% had received age-appropriate BMD testing. The proportion of patients who had endocrinology consults increased from 6% before the fracture to 25% after (P < .001). The proportion on bisphosphonate therapy was 19% before fracture and 25% after (P = .08)., Conclusions: Although most periprosthetic fractures following THA are fragility fractures that qualify patients for osteoporosis diagnoses, there remain major gaps in diagnosis, screening, endocrinology follow-up, and treatment. Like nonarthroplasty fragility fractures, a systematic approach is needed after periprosthetic fractures., Level of Evidence: Level III, retrospective cohort study., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Patients with myasthenia gravis (MG), because of their muscle weakness and exposure to corticosteroids treatment, are generally considered to be at increased risk for osteoporosis or fracture. However, clinical evidence of this issue is lacking. In this review, we systematically searched databases, including Cochrane Library, PubMed, Embase, and Airiti library from inception to the end of November 2023 for cohort studies that compared participants with MG and participants without MG for incidence of osteoporosis or fracture. We used the Newcastle-Ottawa Scale for quality assessment. In total, we included 3 studies with 34,865 participants. The pooled meta-analysis using the random effect model demonstrated no significant difference in risk of fracture in the MG group (odds ratio = 1.52; 95% confidence interval = 0.74 to 3.12; I 2  = 93%; between-study variance [τ 2 ] = 0.32) compared with that for the non-MG group. Due to limited studies, we could not perform a quantitative analysis for risk of osteoporosis. In conclusion, we found no robust evidence to support the proposition that patients with MG are at higher risk for fracture than general comparators. The explanations and underlying mechanisms of this finding remain unclear, we therefore conclude that additional studies are warranted., (© 2024. International Osteoporosis Foundation and Bone Health and Osteoporosis Foundation.)

Background: Osteoporotic fractures signal severely compromised bone strength and are associated with a greatly increased risk of refracture. Despite the availability of effective and safe medications that reduce fracture risk, 70-80% of patients are inadequately investigated or treated for osteoporosis following an initial fracture, constituting a significant 'osteoporosis care gap'. Optimal methods of bridging this gap with primary care at the forefront of secondary fracture prevention remain undetermined. This protocol describes a cluster randomised controlled trial to evaluate the effectiveness of a novel integrated model of secondary fracture prevention and management in primary care., Methods: The cluster randomised controlled trial involves multiple branches of a community-based radiology provider (CRP), a hospital-based secondary fracture prevention program (SFPP) and numerous primary care practices in metropolitan Sydney that refer to either the CRP or SFPP. Using natural language processing tools, patients diagnosed with a potential osteoporotic fracture will be identified by automatically screening radiology reports generated at the CRP or SFPP. The primary care practices that these patients attend will be randomised (1:1) to either the intervention or usual care. The intervention consists of (i) electronic and fax alerts informing the practice/primary care physician that their patient has been diagnosed with a potential osteoporotic fracture; (ii) provision of osteoporosis management guidelines and (iii) follow-up surveys at 4 weeks and 6 months. Practices in the usual care (control) group will receive no alerts and provide usual care. The primary outcome is the proportion of patients undergoing a bone density scan and/or filling a prescription for osteo-protective pharmacotherapy within 3 months of the initial diagnostic imaging report. Secondary outcomes are the proportion of patients: (i) undergoing an osteoporosis-related blood test within 3 months of the initial diagnostic imaging report; (ii) initiated on a chronic disease management plan within 3 months of the diagnostic report, and (iii) filling a second prescription for osteo-protective pharmacotherapy within 9 months post initial diagnostic imaging report. Outcomes will be obtained through de-identified linked data from Medical Benefits Schedule and Pharmaceutical Benefits Scheme held by the Australian Institute of Health and Welfare., Discussion: This is the first randomised trial to integrate case-detection of potential osteoporotic fractures in a hospital and community setting with direct alerts to the patient's primary care provider. This study will determine whether such an intervention is effective in improving investigation and/or treatment rates of osteoporosis in patients with a potential osteoporotic fracture., Trial Registration: This study is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12623000658617p., (© 2024. The Author(s).)

What are the fractures associated with osteoporosis in Colombian persons over 50 years of age? Through the analysis of the Ministry of Health databases, Colombians over 50 years of age with osteoporosis fracture the forearm the most, followed by the thoracolumbar vertebrae and then the hip. We describe the differences between men and women., Purpose: The aim of this study was to determine the frequency of all bone fractures among adults aged 50 and above, both with and without osteoporosis, using data from SISPRO (Integrated Information System for Social Protection), the administrative database of the Colombian Ministry of Health., Methods: Information was collected for the years 2017 to 2021 for all bone fractures (except cranial or face fractures), and how many of them occurred in patients who had the diagnosis of osteoporosis. Prevalence ratios (PR) were estimated separately for males and females by dividing the prevalence in those with by the prevalence of those without osteoporosis., Results: For the period from 2017 to 2021, 303,037 adults over 50 years of age (females 279,057, 92.1%) were diagnosed with osteoporosis in Colombia, for a prevalence of 39.4 per thousand women and 4.14 in men; 40,823 of these women (14.6%) presented a fracture in the period, as well as 4020 of men (16.7%). Osteoporosis was present in 7.5% of the 596.618 (females 369.795; 62.0%) who suffered any fracture (1.8% of males and 11.0% of females). Overall PR was 3.4 (males 4.3; females 3.3). In men with osteoporosis, the most frequent fractures were hip (902), followed by lumbar vertebrae (842), ribs (648), and forearm (538), while in women, forearm (11,001), followed by hip (6885), lumbar vertebra (4813), and thoracic vertebra (2701) were the most common. PR in men was 21.9 for dorsal vertebrae fracture, 21.3 for lumbar vertebrae, 11.8 for ribs, and 7.7 for hip fracture. In women, PR was 15.7 for thoracic vertebrae, 13.3 for lumbar vertebrae, 3.3 for hip fracture, and 2.2 for forearm fracture., Conclusion: Osteoporosis is a highly prevalent disease in Colombia where women are more affected. Although fractures were more common in women, men with osteoporosis have a higher PR of associated fractures., (© 2024. International Osteoporosis Foundation and Bone Health and Osteoporosis Foundation.)

Randomized trials have not been performed, and may never be, to determine if osteoporosis treatment prevents hip fracture in men. Addressing that evidence gap, we analyzed data from an observational study of new hip fractures in a large integrated healthcare system to compare the reduction in hip fractures associated with standard-of-care osteoporosis treatment in men versus women. Sampling from 271,389 patients aged ≥ 65 who had a hip-containing CT scan during care between 2005 and 2018, we selected all who subsequently had a first hip fracture (cases) after the CT scan (start of observation) and a sex-matched equal number of randomly selected patients. From those, we analyzed all who tested positive for osteoporosis (DXA-equivalent hip BMD T-score ≤ -2.5, measured from the CT scan using VirtuOst). We defined "treated" as at least six months of any osteoporosis medication by prescription fill data during follow-up; "not-treated" was no prescription fill. Sex-specific odds ratios of hip fracture for treated vs not-treated patients were calculated by logistic regression; adjustments included age, BMD T-score, BMD-treatment interaction, BMD, race/ethnicity, and seven baseline clinical risk factors. At two-year follow-up, 33.9% of the women (750/2,211 patients) and 24.0% of the men (175/728 patients) were treated primarily with alendronate; 51.3% and 66.3%, respectively, were not-treated; and 721 and 269, respectively, had a first hip fracture since the CT scan. Odds ratio of hip fracture for treated vs not-treated was 0.26 (95% confidence interval: 0.21-0.33) for women and 0.21 (0.13-0.34) for men; the ratio of these odds ratios (men:women) was 0.81 (0.47-1.37), indicating no significant sex effect. Various sensitivity and stratified analyses confirmed these trends, including results at five-year follow-up. Given these results and considering the relevant literature, we conclude that osteoporosis treatment prevents hip fracture similarly in both sexes., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Society for Bone and Mineral Research.)

Background: Osteoporosis with pathological fractures is a significant public health issue, contributing to morbidity, disability, diminished quality of life, and increased mortality. Understanding mortality trends related to this condition is crucial for developing effective interventions to reduce mortality and improve healthcare outcomes. This study aimed to analyze trends and causes of death associated with osteoporosis and pathological fractures in the United States using a multi-cause approach., Methods: Annual death and age-standardized mortality rate (ASMR) data from 1999 to 2020 were obtained from the Centers for Disease Control and Prevention (CDC) mortality database. Death certificates listing ICD-10 M82 (osteoporosis with pathological fracture) as an underlying or related cause of death were analyzed. Epidemiological data were analyzed, and the ASMR data were calculated for each year, and trends were assessed using the Cochran-Armitage trend test., Results: From 1999 to 2020, there were 40,441 deaths related to osteoporosis with pathological fractures in the United States, with a female-to-male ratio of 5.6:1. Among these, 12,820 deaths (31.7%) listed osteoporosis with pathological fractures as the underlying cause of death (UCD), yielding a female-to-male ASMR ratio of approximately 5.0-7.7:1. When classified as a non-UCD, the ASMR ratio was approximately 4.8-6.2:1. At the same time, we found that the total number of deaths classified as UCD and multiple causes of death (MCD), but the trend ratio of the two groups in different years did not change statistically significant (P > 0.05), and the ASMR of both groups showed a downward trend. The UCD-to-MCD ratio increased between 1999 and 2007, then decreased from 2007 to 2020. As MCD, the number of female deaths was more than that of male, and both showed a decreasing trend, but there was no statistical significance in the change of trend ratio in different years (P > 0.05). Deaths were predominantly concentrated in individuals over 75 years of age, with those over 84 years being the most affected. The number of deaths in different age groups showed a decreasing trend, and the change of trend ratio in different years was statistically significant (P < 0.05). White individuals had the highest number of deaths. The leading causes of death were heart diseases, chronic lower respiratory diseases, and alzheimer's disease. In addition, the number of deaths of patients with prostate cancer and breast cancer showed a significant downward trend, and the change of trend ratio between the two groups in different years was statistically significant (P < 0.05)., Conclusions: Although mortality from osteoporosis with pathological fractures is decreasing, anti-osteoporosis therapy remains essential for elderly patients. Healthcare providers should remain vigilant for potential complications, including malignant neoplasms, and ensure timely diagnosis and treatment to further reduce mortality in this population., (© 2024. The Author(s).)

Introduction: Although osteoporosis and low bone mineral density is thought to lead to poor fusion outcomes, few studies have adequately addressed the correlation, and they were limited by small sample size at a single institution., Methods: We completed a secondary analysis of 182 patients enrolled at 26 spine centers across the United States in the EXO-SPINE FDA-approved clinical trial with 12-month CT-based fusion status determined by two independent, blinded radiologists. Using previously described CT-based techniques, we measured local and global Hounsfield units (HU) and examined the relationship with radiographic and clinical outcomes., Results: CT scans were available for review from 95 patients, with a mean age of 56.2 years and mean global density of 153.0 HU. No relationship was observed between HU and radiographic fusion status or clinical outcomes. Although 12% of patients had lumbar vertebral body HU measurements consistent with osteoporosis, this classification had no relation with fusion or clinical outcomes. Patients with pseudarthrosis had higher Oswestry Disability Index (22.2 vs. 16.6, P = 0.037) and back pain visual analog scale (7.0 vs. 4.9, P = 0.014) scores than patients with at least unilateral fusion at the 12-month follow-up., Discussion: In this large, multicenter study, lower vertebral body HU was not associated with worse fusion status after single-level instrumented posterolateral lumbar fusion using only local autologous bone graft. However, there was an association between radiographic fusion status and clinical outcomes, validating the importance of determining predictors of successful fusion. Assessment of fusion status with CT scans yielded a much lower fusion success rate with local bone graft than previously reported and may warrant additional investigation., (Copyright © 2024 by the American Academy of Orthopaedic Surgeons.)

Osteoporosis is a global health problem affecting over 200 million people worldwide and 54 million adults in the United States. Approximately half of all postmenopausal women will have an osteoporosis-related fracture during their lifetime. In the United States, the direct medical cost related to osteoporosis is expected to exceed $25 billion by 2025. Management of osteoporosis in vertebral fractures and elective spine surgery is of the utmost concern, given the high prevalence of osteoporosis in the general population and the increased risk of complication in this population. New pharmacologic treatment options such as anabolic medications and diagnostic tools including Hounsfield unit measurements on routine computed tomography scans are available to orthopaedic and spinal surgeons to help best manage this condition. This review serves as an update to diagnosis, management, and treatment of patients with osteoporosis undergoing spinal surgery., (Copyright © 2024 by the American Academy of Orthopaedic Surgeons.)

Mindfulness exercise has shown great benefits for patients with osteoporosis. However, there are various types of mindfulness exercises and no studies have compared their efficacy. The aim of this study was to compare the efficacy of mindfulness exercises on pain and balance in patients with primary osteoporosis. Articles published in 10 English and three Chinese language databases from January 1, 2003, to December 31, 2022, were systematically searched. Twenty-two studies (N = 1,603) of five types of mindfulness exercises (Pilates, Ba Duan Jin, Wu Qin Xi, Tai Chi, and Yi Jin Jing) were eligible for this meta-analysis. Evidence from this review indicated that all five of the mindfulness exercises included in this study effectively reduced pain and improved balance for patients with primary osteoporosis. Pilates had the highest value of surface under the cumulative ranking as the best intervention. Future studies could consider developing a standard guideline for mindfulness exercise to be incorporated into osteoporosis rehabilitation., Competing Interests: The author(s) declare that they have no conflict of interests., (Copyright © 2024 by National Association of Orthopaedic Nurses.)

Background: People with coeliac disease (CD) are at increased risk of osteoporosis and fractures. Currently, baseline dual-energy X-ray absorptiometry (DXA) is recommended for all patients with newly diagnosed CD. We aimed to determine the prevalence of osteoporosis and the clinical utility of the Fracture Risk Assessment Tool (FRAX) in predicting major osteoporotic fractures (MOF) in patients with biopsy-proven CD., Methods: We retrospectively collected data for consecutive adult patients with biopsy-proven CD between 2001 and 2015 who underwent DXA scanning within 1 year of diagnosis and were followed up for a minimum of 7 years. Fracture risk was assessed using FRAX scores, and the incidence of major osteoporotic fractures during the follow-up period was analysed., Results: A total of 593 patients (median age 45.0 years, 68.5% female) were included. The prevalence of osteopenia and osteoporosis were 32.3% and 14.5%, respectively. Increasing age (OR 1.06, p  < .0001), decreasing BMI (OR 0.90, p  = .003), and higher baseline immunoglobulin A-tissue tissue transglutaminase titre (OR 1.04, p  = .03) were significantly associated with increased risk of osteoporosis. The sensitivity, specificity, positive and negative predictive values of the FRAX tool to predict MOF were 21.2%, 91.3%, 16.3%, 93.5%, respectively. A higher risk of fractures was associated with ongoing gluten exposure (OR 1.86, p  = .02), previous fractures (OR 2.69, p  = .005), and older age (OR 1.03, p  < .0001)., Conclusion: Osteoporosis is a common finding in patients with CD. The FRAX tool showed high specificity in predicting osteoporotic fractures and could be used to aid with patient selection for DXA scanning in some cases.

Purpose: To evaluate the outcomes of Oblique lumbar interbody fusion (OLIF)combined with anterolateral screw fixation (AF) and Stress Endplate Augmentation(SEA) versus OLIF-AF in the treatment of degenerative lumbar spondylolisthesis (DLS)with osteoporosis (OP)., Methods: 30 patients underwent OLIF-AF-SEA (SEA group) were matched with 30 patients received OLIF-AF (control group), in terms of sex, age, body mass index (BMI) and bone mineral density (BMD). Clinical outcomes including visual analog scale (VAS) score of the lower back pain (VAS-LBP), leg pain (VAS-LP), and Oswestry Disability Index (ODI) were evaluated at different postoperative intervals and comparedwith their preoperative counterparts. Radiographic outcomes such as disk height (DH), slip distance (SD), lumbar lordosis (LL), segmental lordosis (SL), cage subsidence (CS) rate and fusion rate were evaluated at different postoperative intervals and compared with their preoperative counterparts., Results: SEA group presented to be better at 3-month and 12-month follow-up, the VAS-LBP, VAS-LP and ODI scores of the SEA group were significantly lower than the control group (3-month SEA vs control: 2.30±0.70 vs 3.30±0.75, 2.03±0.72 vs 2.90±0.76,15.60±2.36 vs 23.23±3.07, respectively, all p<0.05. VAS-LBP and ODI 12-month SEA vs control: 1.27±0.74 vs 1.93±0.58, 12.20±1.88 vs 14.43±1.89,respectively, all p<0.05). At 24-month follow-up, both groups showed no difference in fusion rate (83.33% vs 90.00%, p=0.45), while SEA group showed a lower CS rate (13.33% vs 53.33%, p<0.05)., Conclusion: OLIF-AF-SEA was safe with no adverse effects and resulted in lower CS rate and better sagittal balance. OLIF-AF-SEA is a promising surgical method for treating patients with DLS-OP., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: We aimed to comprehensively compile placebo-controlled trials on the efficacy and safety of romosozumab (210 mg, subcutaneously, once monthly) in postmenopausal women and men with osteoporosis., Materials and Methods: PubMed, Google Scholar, and ClinicalTrials.gov were searched for relevant placebo-controlled trials (as of January 1, 2024). Percent change in bone mineral density (BMD), falls, fractures, and adverse events (AEs) after drug administration were collected. Risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated., Results: Six trials (7990 patients; follow-up period, 6-12 months) were included. Compared with placebo, romosozumab significantly increased lumbar spine BMD (MD = 12.69; 95% CI 11.10-14.29), total hip BMD (MD = 4.42; 95% CI 3.03-5.80), and femoral neck BMD (MD = 3.99; 95% CI 2.42-5.57) at 12 months. Romosozumab significantly decreased falls (RR = 0.80; 95% CI 0.68-0.93) and major osteoporotic fractures (RR = 0.37; 95% CI 0.25-0.54), but increased injection-site reactions (RR = 1.83; 95% CI 1.46-2.30) within 12 months. No significant differences were observed in other AEs (including cardiovascular AEs) within 12 months., Conclusion: Romosozumab treatment resulted in a significant BMD gain, reduced falls and major osteoporotic fractures. It was generally well-tolerated, including the cardiovascular aspects. However, clinicians should consider the occurrence of minor AEs (e.g., injection-site reactions)., (© 2024. The Japanese Society Bone and Mineral Research.)

Introduction: Patients undergoing radical cystectomy with urinary diversions (UD) are at increased risk of bone fractures compared to the general population. Although a loss of bone mineral density (BMD) has been described in patients with UD, we still do not know with certainty why these patients follow this tendency., Objective: We performed a systematic review of the available literature to analyze the prevalence of osteoporosis and bone alterations in patients with ileal UD and the possible associated risk factors., Evidence Acquisition: We systematically searched PubMed® and Cochrane Library for original articles published before December 2022 according to PRISMA guidelines., Evidence Synthesis: A total of 394 publications were identified. We selected 12 studies that met the inclusion criteria with 496 patients included. Six of the twelve studies showed decreased BMD values. Prevalence of osteoporosis was specified in three articles, with values ranging ​​from 0% to 36%. Risk factors such as age, sex, body mass index, metabolic acidosis and renal function appear to have an impact on bone tissue reduction, while type of UD, follow-up, 25-hydroxyvitamin D and parathormone had less evidence or contradictory data. The heterogeneity of the studies analyzed could led to interpretation bias., Conclusions: UD are associated with multiple risk factors for osteoporosis and bone fractures. Identifying patients at highest risk and establishing diagnostic protocols in routine clinical practice are essential to reduce the risk of fractures and the resulting complications., (Copyright © 2023 AEU. Published by Elsevier España, S.L.U. All rights reserved.)

Background: Osteoporosis, a metabolic bone disorder, markedly elevates fracture risks, with vertebral compression fractures being predominant. Antiosteoporotic treatments for patients with osteoporotic vertebral compression fractures (OVCF) lessen both the occurrence of subsequent fractures and associated pain. Thus, diagnosing osteoporosis in OVCF patients is vital., Purpose: The aim of this study was to develop a predictive radiographic model using T1 sequence MRI images to accurately determine whether patients with lumbar spine compression fractures also have osteoporosis., Study Design: Retrospective cohort study., Patient Sample: Patients over 45 years of age diagnosed with a fresh lumbar compression fracture., Outcome Measures: Diagnostic accuracy of the model (area under the ROC curve)., Methods: The study retrospectively collected clinical and imaging data (MRI and DEXA) from hospitalized lumbar compression fracture patients (L1-L4) aged 45 years or older between January 2021 and June 2023. Using the pyradiomics package in Python, features from the lumbar compression fracture vertebral region of interest (ROI) were extracted. Downscaling of the extracted features was performed using the Mann-Whitney U test and the least absolute shrinkage selection operator (LASSO) algorithm. Subsequently, six machine learning models (Naive Bayes, Support Vector Machine [SVM], Decision Tree, Random Forest, Extreme Gradient Boosting [XGBoost], and Light Gradient Boosting Machine [LightGBM]) were employed to train and validate these features in predicting osteoporosis comorbidity in OVCF patients., Results: A total of 128 participants, 79 in the osteoporotic group and 49 in the nonosteoporotic group, met the study's inclusion and exclusion criteria. From the T1 sequence MRI images, 1906 imaging features were extracted in both groups. Utilizing the Mann-Whitney U test, 365 radiologic features were selected out of the initial 1,906. Ultimately, the lasso algorithm identified 14 significant radiological features. These features, incorporated into six conventional machine learning algorithms, demonstrated successful prediction of osteoporosis in the validation set. The NaiveBayes model yielded an area under the receiver operating characteristic curve (AUC) of 0.84, sensitivity of 0.87, specificity of 0.70, and accuracy of 0.81., Conclusions: A NaiveBayes machine learning algorithm can predict osteoporosis in OVCF patients using t1-sequence MRI images of lumbar compression fractures. This approach aims to obviate the necessity for further osteoporosis assessments, diminish patient exposure to radiation, and bolster the clinical care of patients with OVCF., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

This study aimed to evaluate the prevalence of osteopenia/osteoporosis in patients with bilateral temporomandibular joint osteoarthritis (TMJ-OA) and its correlations with clinical and radiological findings. A total of 95 patients with bilateral TMJ-OA diagnosed by CBCT were included in the study. Clinical and radiological findings and bone mineral density (BMD) scores were recorded. Descriptive statistics and the Spearman rho correlation tests were performed. Osteopenia/osteoporosis was found in 44 of 95 patients (46.32 %) (30, osteopenia; 14 osteoporosis). Osteopenia/osteoporosis is significantly associated with postmenopausal status and age over 40 years, but it is not associated with clinical and radiological findings of TMJ-OA. Patients with bilateral TMJ-OA have a high prevalence of osteopenia/osteoporosis., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Background: The fractures of patients with osteoporosis represent a major health care burden that requires efficient prevention., Objective: To analyze the efficacy and significance of diverse interventions for preventing falls or fractures in patients with osteoporosis, and to establish a foundation for clinical interventions., Methods: Ten databases were searched for studies published before January 30, 2024. Screening, data extraction, and risk of bias assessment were independently conducted by two researchers using Stata 14.0 software. A network meta-analysis using the frequentist framework was then performed to determine the effectiveness of various interventions for preventing and managing falls and fractures in patients with osteoporosis. The findings were used as basis for the prioritization of interventions., Results: The initial search yielded 3894 studies. After 3878 studies were excluded, 16 studies were finally included. For the prevention of falls in patients with osteoporosis, effective interventions include exercise and exercise plus medication. A combination of exercise, assessment and modifications, quality improvement strategies, social engagement, basic falls risk assessment, and assistive technology may be the preferred recommended intervention. For the prevention of fractures in patients with osteoporosis, no statistically significant disparities were observed among the compared interventions, exercise may be the preferred recommended intervention., Conclusion: Exercise and exercise plus medication are effective in reducing the number of falls in patients with osteoporosis. Although exercise may be the optimal intervention for fracture prevention, the quality of current evidence remains inadequate. Large-scale high-quality randomized controlled trials are necessary to substantiate these findings., Trial Registration: PROSPERO CRD42024507487., Competing Interests: Declaration of competing interest Shanshan Wei, Yaoyu He, Keru Liu, Ruoxian Wang, Yuhuan Wang declare that they have no conflict of interest., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: The relationship between obesity and type 2 diabetes with bone health has always been a topic of debate. The weight-adjusted waist index has become a commonly used indicator for assessing central obesity, fat, and muscle mass. However, currently there is no research reporting the association between weight-adjusted waist index and risk of osteoporosis in populations of type 2 diabetes. Therefore, this study aims to provide new information on the association between weight-adjusted waist index and risk of osteoporosis in type 2 diabetes., Methods: This cross-sectional study involved 963 patients with type 2 diabetes who were admitted to the Department of Endocrinology of Cangzhou Central Hospital. Multivariate logistic regression models were used to assess the association between weight-adjusted waist index and osteoporosis. The potential nonlinear association was evaluated. The effects of interaction between subgroups were assessed using the likelihood ratio test., Results: Weight-adjusted waist index was positively associated with the risk of osteoporosis, regardless of traditional confounding factors. For each 1 unit increased in weight-adjusted waist index, the risk of osteoporosis increased by 67%. Furthermore, there was a nonlinear relationship between weight-adjusted waist index and osteoporosis. The subgroup analysis did not reveal any significant interactions., Conclusions: Our study indicated a positive association between weight-adjusted waist index and the risk of osteoporosis in adult Chinese type 2 diabetes patients, and this relationship was nonlinear., (© 2024. The Author(s).)

Background and Aims: Reduced bone mineral density (BMD) and microarchitectural deterioration contribute to increased fracture risk. Although the effects of anti-fracture medications (AFMs) on BMD are well-documented, their impact on bone material properties (BMPs) remains poorly characterized. Accordingly, we conducted a systematic review and meta-analysis to evaluate the effects of AFMs on BMPs. Based on data availability, we further categorized AFMs into anti-resorptives, bisphosphonates alone, and strontium ranelate subgroups to perform additional analyses of BMPs in osteoporotic patients., Methods: We did a comprehensive search of three databases, namely, PubMed, Web of Science, and Google Scholar, using various permutation combinations, and used Comprehensive Meta-Analysis software to analyze the extracted data., Results: The 15 eligible studies (randomized and non-randomized) compared the following: (1) 301 AFM-treated patients with 225 on placebo; (2) 191 patients treated with anti-resorptives with 131 on placebo; (3) 86 bisphosphonate-treated patients with 66 on placebo; and (4) 84 strontium ranelate-treated patients with 70 on placebo. Pooled analysis showed that AFMs significantly decreased cortical bone crystallinity [standardized difference in means (SDM) -1.394] and collagen maturity [SDM -0.855], and collagen maturity in cancellous bone [SDM -0.631]. Additionally, anti-resorptives (bisphosphonates and denosumab) significantly increased crystallinity [SDM 0.387], mineral-matrix ratio [SDM 0.771], microhardness [SDM 0.858], and contact hardness [SDM 0.952] of cortical bone. Anti-resorptives increased mineral-matrix ratio [SDM 0.543] and microhardness [SDM 0.864] and decreased collagen maturity [SDM -0.539] in cancellous bone. Restricted analysis of only bisphosphonate-treated studies showed a significant decrease in collagen maturity [SDM -0.650] in cancellous bone and an increase in true hardness [SDM 1.277] in cortical bone. In strontium ranelate-treated patients, there was no difference in BMPs compared to placebo., Conclusion: Collectively, our study suggests that AFMs improve bone quality, which explains their anti-fracture ability that is not fully accounted for by increased BMD in osteoporosis patients., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Sharma, Shankar, Rajender, Mithal, Rao and Chattopadhyay.)

Objectives: Rheumatoid arthritis (RA) is associated with an increased risk for osteoporosis and osteoporotic fractures. Since the treatment of RA has improved significantly in recent years, we can expect RA-associated osteoporosis to decrease with good disease control. Therefore, we conducted a retrospective study to investigate whether the frequency of osteoporosis and osteoporotic fractures has changed during 24 years in RA., Methods: We analysed the data of 1.086 RA patients from the time of the first osteological assessment with bone mineral density (BMD) measurement and collection of osteologically important data during the years 1996 and 2019 at our clinic. According to the treatment period, the patients were divided into cohort 1 (investigation between 1996 and 2004; n=539) and cohort 2 (investigation between 2005 and 2019; n=547). The data of the two cohorts were compared, and predictors of BMD were analysed by linear regression analysis., Results: Prevalence of osteoporosis (28.3% vs 48.4%; p<0.001) as well as osteoporotic peripheral fractures (11.5% vs 21%; p<0.001) and vertebral fractures (6.6% vs 10.9%; p=0.011) were significantly lower and treatment with biologicals (19.7% vs 5.0%; p<0.001) significantly more common and glucocorticoid use was significantly less common (p=0.005) in cohort 2. In RA patients with a disease duration of more than 2 years, BMD was significantly higher under treatment with biologicals (p<0.001) despite increased cumulative glucocorticoid dosages (p<0.001)., Conclusion: Our study showed a significant decline in osteoporosis and osteoporotic fractures in RA for 24 years. This positive effect is associated with the more frequent use of biologicals in the years between 2005 and 2019., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Osteoporosis is a prevalent skeletal disorder influenced by age, hormonal changes, medication use, nutrition, and genetics. The relationship between MTHFR and osteoporosis remains unclear, especially in Asians. The aim of our study was to elucidate the impact of MTHFR on osteoporosis and fracture risk. Materials and Methods: Participants were recruited from the Taiwan Precision Medicine Initiative at Taichung Veterans General Hospital. A total of 3,503 subjects with available bone mineral density measurements were selected. Using the Axiom Genome-Wide TWB 2.0 Array, we identified the MTHFR rs1801133 variant. Among these subjects, 1,624 patients carrying the variant were included in the case group, while the remaining 1,879 patients without the variant served as the control group. Results: Overall, individuals carrying the MTHFR rs1801133 variant exhibited a significantly elevated risk of developing osteoporosis. Stratified analysis by different genotypes, the results revealed a statistically significant association between the heterozygous genotype of MTHFR rs1801133 and osteoporosis. However, there was no significant correlation between MTHFR genotypes and fracture risk. Furthermore, subgroup analysis of female patients revealed age, a known risk factor, was associated with both osteoporosis and fractures. Interestingly, the presence of the MTHFR rs1801133 variant did not confer an increased risk of osteoporosis or fractures in females. Conclusion: Our study revealed a notable increase in the prevalence of osteoporosis among individuals carrying the MTHFR rs1801133 variant. Nevertheless, these individuals did not exhibit a heightened risk of major or hip fractures compared to non-carriers. Our findings could be of value in raising awareness of the increased risk of osteoporosis among individuals with this genetic variant., Competing Interests: Competing Interests: The authors have declared that no competing interest exists., (© The author(s).)

Bone and muscle impairment, named osteoporosis and sarcopenia, may co-occur with age, and patients with both disorders might exhibit physical frailty. One-hundred sixty-three patients were included. 14.2% had both disorders and presented more frequent with previous fall, reduced daily activity level, walk/balance challenges, and need of walking aid, indicating overall frailty., Purpose: In older adults, sarcopenia (muscle impairment) and physical frailty may accompany osteoporosis (bone brittleness), yet osteoporosis is typically assessed without evaluating these conditions, even though coexistence may contribute to exacerbated negative health outcomes. We aimed at evaluating the prevalence of sarcopenia and impaired muscle domains in osteoporotic patients and explore the risk of osteosarcopenia from markers of physical frailty., Methods: In Copenhagen, Denmark, osteoporotic patients aged 65 + were assessed cross-sectionally in 2018-2019. Evaluations included muscle mass, strength, and function; bone mineral density; and self-reported physical activity, fall, balance challenges, dizziness, and the need of walking aid. Low bone mass, low-energy fracture, or treatment with anti-osteoporotic medication defined patient with osteoporosis, and sarcopenia was defined by low muscle strength and mass. Osteosarcopenia was defined from the coexistence of both conditions., Results: One-hundred sixty-three patients with osteoporosis were included. Of those, 23 (14.2%) exhibited sarcopenia, hence osteosarcopenia. Hand-grip-strength, 30-s-chair-stand-test, relative-appendicular-lean-muscle-mass, and gait-speed were below cut-off levels in 21.0%, 30.9%, 28.8%, and 23.6% of the patients, respectively. Previous fall, activity level, walk and balance challenges, and need of walking aid were statistically (or borderline) significantly more often affected in the osteosarcopenic group compared with the solely osteoporotic. Logistic regression analysis, however, revealed that only the need for walking aid significantly increased the risk of an osteosarcopenia diagnosis (odds ratio 5.54, 95% CI (1.95-15.76), p < 0.01)., Conclusions: Sarcopenia and impaired muscle domains were frequent in osteoporotic patients, as were markers of physical frailty, indicating the need of thorough examination of osteoporotic patients., (© 2024. The Author(s).)

Background: Osteoporosis and fragility fractures are set to rise with the global ageing population. Prevalence will continue to significantly impact people's quality of life and healthcare expenditure. Emergency nurses are ideally placed to highlight the importance of screening, and treatment, to the public. For emergency nurses to impart information to patients it is essential they have accurate, evidence-based knowledge. This study aims to determine if emergency nurses' knowledge of osteoporosis is sufficient to educate the public., Method: A cross sectional descriptive design of 210 emergency nurses using the 'Osteoporosis Knowledge Questionnaire' (OKQ) was administered in four hospitals in the West of Ireland. Data was analysed using SPSS v28., Results: A 66 % response rate was achieved. The mean score on the OKQ was 12.13 out of a possible 22. This suggests emergency nurses' knowledge of osteoporosis is substandard. Level of education has the greatest impact on participants (p = 0.005). Results indicated that emergency nurses acknowledge their responsibility regarding health promotion but lack the knowledge to undertake the role., Conclusion: Emergency nurses play a pivotal role in reducing osteoporosis and fragility fractures, by disseminating information to patients on prevention and management. This study highlighted that educational initiatives are required to address the deficiencies amongst emergency nurses' understanding of osteoporosis. Enhancing knowledge will inevitably lead to increased public awareness in tackling this global health crisis., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objectives: To assess the biomechanical differences between linked and unlinked constructs in young and osteoporotic cadavers in addition to osteoporotic sawbones., Methods: Intraarticular distal femur fractures with comminuted metaphyseal regions were created in three young matched pair cadavers, three osteoporotic matched pair cadavers, and six osteoporotic sawbones. Precontoured distal femur locking plates were placed in addition to a standardized retrograde nail, with unitized constructs having one 4.5 mm locking screw placed distally through the nail. Nonunitized constructs had seven 4.5 mm locking screws placed through the plate around the nail, with one 5 mm distal interlock placed through the nail alone. Cadaveric specimens were subjected to axial fatigue loads between 150 and 1500 N (R Ratio = 10) with 1 Hx frequency for 10,000 cycles. Sawbones were axially loaded at 50% of the ultimate load for fatigue testing to achieve runout, with testing performed with 30 and 300 N (R Ratio = 10) loads with 1 Hz frequency for 10,000 cycles., Results: In young cadavers, there was no difference in the mean cyclic displacement of the unitized constructs (1.51 ± 0.62mm) compared to the non-unitized constructs (1.34 ± 0.47mm) (Figure 4A), (p = 0.722). In osteoporotic cadavers, there was no difference in the mean cyclic displacement of the unitized constructs (2.46 ± 0.47mm) compared to the non-unitized constructs (2.91 ± 1.49mm) (p =0.639). There was statistically no significant difference in cyclic displacement between the unitized and non-unitized groups in osteoporotic sawbones(p = 0.181)., Conclusions: Linked constructs did not demonstrate increased axial stiffness or decreased cyclical displacement in comparison to unlinked constructs in young cadaveric specimens, osteoporotic cadaveric specimens, or osteoporotic sawbones., Competing Interests: The authors report no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: This study aimed to develop and validate a predictive model for osteoporotic vertebral fractures (OVFs) risk by integrating demographic, bone mineral density (BMD), CT imaging, and deep learning radiomics features from CT images., Methods: A total of 169 osteoporosis-diagnosed patients from three hospitals were randomly split into OVFs (n = 77) and Non-OVFs (n = 92) groups for training (n = 135) and test (n = 34). Demographic data, BMD, and CT imaging details were collected. Deep transfer learning (DTL) using ResNet-50 and radiomics features were fused, with the best model chosen via logistic regression. Cox proportional hazards models identified clinical factors. Three models were constructed: clinical, radiomics-DTL, and fusion (clinical-radiomics-DTL). Performance was assessed using AUC, C-index, Kaplan-Meier, and calibration curves. The best model was depicted as a nomogram, and clinical utility was evaluated using decision curve analysis (DCA)., Results: BMD, CT values of paravertebral muscles (PVM), and paravertebral muscles' cross-sectional area (CSA) significantly differed between OVFs and Non-OVFs groups (P < 0.05). No significant differences were found between training and test cohort. Multivariate Cox models identified BMD, CT values of PVM, and CSA PS reduction as independent OVFs risk factors (P < 0.05). The fusion model exhibited the highest predictive performance (C-index: 0.839 in training, 0.795 in test). DCA confirmed the nomogram's utility in OVFs risk prediction., Conclusion: This study presents a robust predictive model for OVFs risk, integrating BMD, CT data, and radiomics-DTL features, offering high sensitivity and specificity. The model's visualizations can inform OVFs prevention and treatment strategies., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

An 11-month-old female Saanen goat, weighing 12.7 kg, was taken to the Veterinary Hospital of the Federal University of Minas Gerais because of sternal recumbency. On clinical examination, the animal was much smaller than expected and had hair similar to that of puppies and areas of hyperpigmentation on the head and dorsocervical and dorsothoracic cranial regions. Radiographic examination revealed fractures in both femurs and severe generalized osteoporosis. Given the unfavourable prognosis, the animal was euthanized. Necropsy revealed generalized pallor, muscular atrophy of the pelvic limbs and little reserve of subcutaneous adipose tissue. Both femurs had complete and closed diaphyseal fractures. The second lumbar vertebra was severely reduced in length as a result of a fracture, with dorsal displacement of the vertebral body towards the vertebral canal and compression of the spinal cord. Long bones and vertebrae had severe cortical thinning, enlargement of the medullary canal and reduced resistance. The thyroid gland was not in its normal anatomical location. A pale red nodule (1.0 × 0.4 cm) in the serosa of the middle third of the trachea, close to the thoracic entrance, was confirmed as ectopic thyroid tissue. Microscopically, the bones had evidence of growth arrest and severe osteoporosis. The ectopic thyroid nodule was hyperplastic with severe hypertrophy of follicular cells. The spinal cord was compressed by vertebral fractures and had focally extensive and severe myelomalacia. Based on the pathological features, the case was diagnosed as thyroid dysgenesis characterized by eutopic thyroid agenesis and ectopic thyroid tissue, associated with interruption of bone growth with dwarfism, osteoporosis and spontaneous secondary fractures with compression of the lumbar spinal cord., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Study Design: Retrospective study., Objective: To determine the 8-year risk of revision lumbar fusion, pseudoarthrosis, mechanical failure, fragility fracture, and vertebral compression fracture in patients with a prior fragility fracture compared with those without., Summary of Background Data: Osteoporosis is a known modifiable risk factor for revision following lumbar fusion due to inadequate fixation. Patients with prior fragility fractures have been shown to have increased bone health-related complications following various orthopedic surgeries; however, there is a paucity of literature that identifies these complications in patients undergoing lumbar fusion., Patients and Methods: Patients aged 50 years and older who underwent elective lumbar fusion were identified in a large national database and stratified based on whether they sustained a fragility fracture within three years prior to fusion. These patients were propensity-score matched to a control based on age, gender, and Charlson the comorbidity index using a 1:1 ratio. Kaplan-Meier and Cox proportional hazards analyses were used to observe the cumulative incidences and risk of complications within eight years of index surgery., Results: After matching, 8805 patients were included in both cohorts. Patients who sustained a prior fragility fracture had a higher risk of revision [hazard ratio (HR): 1.46; 95% CI: 1.26-1.69; P <0.001), pseudoarthrosis (HR: 1.31; 95% CI: 1.17-1.48; P <0.001), mechanical failure (HR: 2.08; 95% CI: 1.78-2.45; P <0.001), secondary fragility fracture (HR: 6.36; 95% CI: 5.86-6.90; P <0.001), and vertebral compression fracture (HR: 7.47; 95% CI: 7.68-8.21; P <0.001) when compared with the control cohort., Conclusion: Patients who sustain a fragility fracture prior to lumbar fusion have an increased risk of revision, pseudoarthrosis, and mechanical failure within eight years. Surgeons should be aware of this high-risk patient population and consider bone health screening and treatment to reduce these preventable complications., Competing Interests: S.C.T.: Committee member for the American Association of Hip and Knee Surgeons, Editorial or governing board of Arthroplasty Today, Journal of Arthroplasty ; Unpaid consultant for KCI, OrthAlign. A.J.: Paid consultant for DePuy, Globus Medical, Stryker. The remaining authors report no conflicts of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Study Design: Finite element analysis., Objective: To investigate the biomechanical effect of four posterior fixation techniques on stability and adjacent segment degeneration in treating thoracolumbar burst fractures with osteoporosis., Summary of Background Data: In terms of stability and adjacent segment degeneration, there remains no consensus or guidelines on the optimal technique for the treatment of thoracolumbar burst fractures in patients with osteoporosis., Materials and Methods: Images of CT scans were imported into MIMICS and further processed by Geomagic to build three-dimensional models of the T10-L5 region. A v-shaped osteotomy was performed on the L1 vertebral body to simulate a burst fracture in the setting of osteoporosis. Subsequently, four fixation techniques were designed using SolidWorks software. Range of motion (ROM) of the global spine, ROM distribution, ROM of adjacent segment, Von Mises stress on adjacent intervertebral disks, and facet joints were analyzed., Results: Among the four groups, the cortical bone screw fixation (CBT) showed the highest global ROM at 1.86°, while long-segmented pedicle screw fixation (LSPS) had the lowest global ROM at 1.25°. The LSPS had the smallest percentage of ROM of fractured vertebral body to fixed segment at 75.04%, suggesting the highest stability after fixation. The maximum ROM of the adjacent segment was observed in the CBT at 1.32°, while the LSPS exhibited the smallest at 0.89°. However, the LSPS group experienced larger maximum stress on the adjacent intervertebral disks (9.60 MPa) and facet joints (3.36 MPa), indicating an increasing risk of adjacent segment disease., Conclusion: LSPS provided the greatest stability, while CBT provided the smallest amount of stability. However, the elevated stress on adjacent intervertebral disks and facet joints after LSPS fixation increased the possibility of adjacent segment degeneration. Cement-augmented pedicle screw fixation (CAPS) and combined cortical bone screw and pedicle screw fixation (CBT-PS) demonstrated significant biomechanical advantages in providing moderate fixation strength while reducing stress on the intervertebral disks and facet joints., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Objective: This study aimed to identify risk factors for postoperative proximal junctional kyphosis (PJK) with vertebral fracture in adult spinal deformity (ASD) patients. We performed a survival analysis considering various factors, including osteoporosis., Methods: This single-center retrospective study included 101 ASD patients (mean age: 67.2 years, mean follow-up: 8.1 years). We included patients aged ≥50 years with abnormal radiographic variables undergoing corrective long spinal fusion. The main outcome measure was PJK with vertebral fracture, analyzed based on patient data, radiographic measurements, sagittal parameters, bone mineral density, and osteoporosis medication., Results: PJK occurred in 37.6% of patients, with vertebral fracture type 2 accounting for 65% of these cases. Kaplan-Meier analysis indicated a median PJK-free survival time of 60.7 months. Existing vertebral fracture (grade 1 or higher or grade 2 or higher) was a significant risk factor for PJK with vertebral fracture, with hazard ratios of 4.58 and 5.61, respectively. The onset time of PJK with vertebral fracture was 1.5 months postoperatively, with 44% of these cases occurring within 1 month and 64% within 2 months., Conclusions: PJK with vertebral fracture affected 25% of ASD patients, emphasizing the importance of osteoporosis evaluation. Existing vertebral fracture emerged as a significant independent risk factor, surpassing bone mineral density. This study provides valuable insights for spine surgeons, highlighting the need to provide osteoporosis treatment and emphasize potential postoperative complications during discussions with patients., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: This retrospective study assesses the influence of osteoporosis on the short-term clinical outcomes of lateral lumbar interbody fusion (LLIF) surgery in patients with lumbar degenerative diseases (LDDs), focusing on complications, pain intensity, and quality of life (QOL) improvements. The primary aim of this study is to investigate the impact of osteoporosis on the short-term clinical outcomes following LLIF surgery in LDD patients, with a particular focus on the incidence of cage subsidence (CS) and overall patient well-being postoperatively., Methods: A retrospective review was conducted on 73 patients who underwent LLIF for LDD. Patients were categorized into 2 groups based on osteoporosis status determined by dual-energy X-ray absorptiometry scans: those with osteoporosis (n = 20) and those without osteoporosis (n = 53). Data collection included demographics, surgical details, complications, magnetic resonance imaging analysis, pain intensity, and QOL (Japanese Orthopaedic Association Back Pain Evaluation Questionnaire)., Results: The groups had no significant differences regarding operative time, estimated blood loss, and hospital stay duration. However, the incidence of CS was 40% in patients with osteoporosis, compared to 17% in nonosteoporotic patients. Despite this, significant improvements in spinal canal dimensions were observed in both groups. Both groups experienced significant reductions in pain intensity, with notable improvements in functional outcomes assessed by the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire, indicating the overall effectiveness of LLIF in enhancing patient well-being and functionality, irrespective of osteoporosis status., Conclusions: Osteoporosis increases the risk of CS in LLIF surgery for LDD patients but does not affect short-term pain relief and QOL improvements., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objectives: The direct impact of inflammatory conditions and their therapy with corticosteroids contribute to an increased risk of osteoporosis with associated fractures. Familial Mediterranean fever (FMF) is an autoinflammatory disorder not commonly treated with corticosteroids. Evidence regarding FMF association with osteoporosis and femur fractures is anecdotal. We aimed to evaluate the incidence and risk of osteoporosis and femoral neck fracture in FMF patients compared with the general population., Methods: A retrospective cohort study using the electronic database of Clalit Health Services of all FMF patients first diagnosed between 2000 and 2016 and controls was conducted including age- and sex-matched controls in a 1:1 ratio. Follow-up continued until the first diagnosis of osteoporosis or fracture. Risk for these conditions was compared using univariate and multivariate Cox regression models., Results: A total of 9769 FMF patients were followed for a median period of 12.5 years. Of these, 304 FMF patients were diagnosed with osteoporosis compared with 191 controls, resulting in an incidence rate (per 10 000 persons-years) of 28.8 and 17.8, respectively, and a crude hazard ratio of 1.62 (95% CI 1.35, 1.93; P < 0.001). Patients were diagnosed with osteoporosis at a considerably younger age than controls [60.1 (s.d. 12.4) vs 62.5 (s.d. 11.0) years; P = 0.028]. A total of 56 FMF patients were diagnosed with femoral neck fracture compared with 35 controls, resulting in an incidence rate of 5.3 and 3.3, respectively, and a crude HR of 1.60 (95% CI 1.05, 2.44; P < 0.05)., Conclusion: FMF patients are at increased risk for osteoporosis and consequently femur fracture. Our findings emphasize the importance of considering bone health in the management of FMF patients., (© The Author(s) 2023. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Lateral platform collapse in fixations of lateral tibial plateau fractures (TPFs) using either double-lag screws fixation (DSF) or locking-plate fixation (LPF) is not rare. This study aimed to explore the effect of enhancing the interfragmentary compression force (IFCF) on fixation stability in lateral TPFs in normal and osteoporotic bones using finite element analysis. Finite element models of DSF in normal bone and LPF in normal and osteoporotic bones were established to simulate the fixations of lateral TPF. After model validation, axial compressive forces of 500, 1000, 1500, and 2500 N to the tibial plateau along with an IFCF of 0, 100, 200, and 300 N were applied. The maximum axial micromotion of the lateral fragment (MAM-LF), maximal translational micromotion of the lateral fragment (MTM-LF), peak von Mises stress (VMS), and peak equivalent elastic strain of the lateral fragment (EES-LF) were evaluated. The MAM-LF showed a decreasing trend as the IFCF increased in all models. For DSF models, the peak VMS of implants increased as the IFCF increased when the axial loads were 500 and 1000 N. The peak EES-LF decreased as the IFCF increased under axial loads of 1000, 1500, and 2500 N. For the normal and osteoporotic LPF models, the peak VMS of the implants decreased as the IFCF increased. Peak EES-LF decreased as IFCF increased. In conclusion, enhancing IFCF was beneficial in improving the fixation stability of lateral TPF. The optimal IFCF for DSF and LPF should be as high as reasonably feasible., (© 2024 The Authors. Journal of Orthopaedic Research® published by Wiley Periodicals LLC on behalf of Orthopaedic Research Society.)