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In December 2022, the Guidelines for the Diagnosis and Treatment of Primary Osteoporosis (2022) were released. The guidelines have updated the latest epidemiological data of osteoporosis in China and given recommendations for the diagnosis and treatment of osteoporosis by combining evidence-based medical testimony and clinical practice in this field. This article interprets the key points of the guidelines to help healthcare workers better understand and follow the guidelines.

Objective To explore how to integrate the history of Peking Union Medical College (PUMC) into the teaching of diabetes in internal medicine, in order to develop an ideological and political theory-based course with PUMC characteristics. Methods The students in '4+4' medical doctor program of PUMC were enrolled into this study. Diabetes mellitus course combined with ideological and political theories course (including the history of insulin development, the life and contribution of Prof. WU Xian and Prof. LIN Kesheng, and the contributions of Prof. CHI Zhisheng, Prof. PAN Xiaoren and Prof. XIANG Hongding to the prevention and treatment of diabetes) was used for the teaching. Feedback (including the level of the political teaching knowledge before and after the course, the effectiveness of the political teaching by students after the course) was collected by questionnaire online, and statistical analysis was conducted. Results A total of 62 students (32 in grade 2020 and 30 in grade 2021) were included in the '4+4' pilot class of clinical medicine at PUMC. A total of 58 questionnaires were collected (30 in grade 2020 and 28 in grade 2021), with a rate of 93.5%(58/62). Before teaching, 55.2%~100% of the students had no knowledge of the course, and after teaching, all students had a general understanding, with the level of understanding significantly better than before (P < 0.001). According to the survey, 82.8% of the students thought that the course increased their interest in learning, 86.2% of the students were satisfied with the overall effect of the course, 89.7% thought that it allowed them to better understand the history of PUMC, 77.6% thought it deepened their understanding of the spirit of medical science, 82.8% thought it increased their understanding of the spirit of professional service to the country and patriotism, and 72.4% thought it increased their sense of social responsibility. Conclusions Integrating the history of PUMC into clinical medicine education is the unique advantage of PUMC medical education. It is conducive to students understanding of ideological and political theories, inculcation of correct values, method ology and humanistic qualities, and cultivation of the truth-seeking and pragmatic spirit of medical science.

The overarching goal of osteoporosis management is to prevent fractures. A goal-directed approach to long-term management of fracture risk helps ensure that the most appropriate initial treatment and treatment sequence is selected for individual patients. Goal-directed treatment decisions require assessment of clinical fracture history, vertebral fracture identification (using vertebral imaging as appropriate), measurement of bone mineral density (BMD), and consideration of other major clinical risk factors. Treatment targets should be tailored to each patient's individual risk profile and based on the specific indication for beginning treatment, including recency, site, number and severity of prior fractures, and BMD levels at the total hip, femoral neck, and lumbar spine. Instead of first-line bisphosphonate treatment for all patients, selection of initial treatment should focus on reducing fracture risk rapidly for patients at very high and imminent risk, such as in those with recent fractures. Initial treatment selection should also consider the probability that a BMD treatment target can be attained within a reasonable period of time and the differential magnitude of fracture risk reduction and BMD impact with osteoanabolic versus antiresorptive therapy. This position statement of the ASBMR/BHOF Task Force on Goal-Directed Osteoporosis Treatment provides an overall summary of the major clinical recommendations about treatment targets and strategies to achieve those targets based on the best evidence available, derived primarily from studies in older postmenopausal women of European ancestry. Lay Summary: Goal-directed treatment can help healthcare providers recommend the best treatments for individual patients to prevent fractures. The goal-directed strategy considers the site, number, and recency of prior fractures. This may require imaging for spine fractures, which may not have caused pain. Treatment decisions also require bone mineral density (BMD) measurement and consideration of other major risk factors. In contrast to the standard approach, same first treatment for all, treatment selection is tailored to an individual's risk. In patients with recent fractures of the spine, hip, or pelvis, fracture risk is very high and treatment should rapidly reduce that risk. For others, the target is a specific BMD level and should consider the likelihood that the treatment target can be attained within a reasonable period of time, which differs for osteoporosis medications. After initial therapy, BMD should be assessed to determine if the target has been achieved. If so, strategies should focus on maintaining BMD. If the target is not yet achieved, treatment should be intensified, or continued if it is already the most potent option. This position statement represents a consensus of expert recommendations about treatment targets and strategies to achieve those targets based on the best available evidence. [ABSTRACT FROM AUTHOR]

Background X-linked hypophosphatemia (XLHR) is the most common genetic form of hypophosphatemic rickets (HR), which is caused by phosphate regulating endopeptidase homolog X-linked (PHEX) gene mutation. At present, the genotype–phenotype relationship of XLHR and the pathogenic role of PHEX are not fully understood. Methods In this study, we summarized clinical features in a new cohort of 49 HR patients and detected 16 novel PHEX and 5 novel non-PHEX variants. Subsequently, we studied the pathogenesis of new variants by protein expression, glycosylation analysis, subcellular localization, and endopeptidase activity. Results The results showed that missense variants (Q189H and X750R) slightly reduced protein expression without obviously altering protein length and localization, whereas truncating variants significantly impaired the synthesis of PHEX and produced a shorter immature protein in cells. Interestingly, no evident correlation was observed between mutation types and clinical phenotypes. However, when we analyzed the relationship between PHEX activity and serum phosphorus level, we found that patients with low PHEX activity tended to have severe hypophosphatemia and high rickets severity score. Following this observation, we established 2 new knock-in XLHR mouse models with 2 novel Phex variants (c.T1349C and c.C426G, respectively) using CRISPR/Cas9 technology. Both mouse models demonstrated clinical manifestations of XLHR seen in patients, and PhexC426G mice showed more severe phenotype than PhexT1349C mice, which further confirmed the rationality of genotype–PHEX enzymatic activity correlation analysis. Conclusion Therefore, our findings demonstrated that novel PHEX variants could disrupt protein function via affecting protein synthesis, post-translational modification, cellular trafficking, and catalytic activity. Our study facilitates a better understanding of XLHR pathogenic mechanism and PHEX activity-phenotype correlation, which is of crucial importance for future diagnosis and treatment of XLHR. [ABSTRACT FROM AUTHOR]