Osteoporos Int [JOURNAL]
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200 papers
Effects of teriparatide on hip structure and bone microarchitecture in women with anorexia nervosa: a placebo-controlled randomized trial.
Amorim T, David NL, Moturi S … +4 more , Turnquist LR, Holmes TM, Bouxsein ML, Fazeli PK
Osteoporos Int · 2026 Mar · PMID 41591404 · Publisher ↗
UNLABELLED: Women with anorexia nervosa have low bone mineral density and increased fracture risk. We conducted a randomized, placebo-controlled trial investigating the effects of 6 months of teriparatide in anorexia ner...
UNLABELLED: Women with anorexia nervosa have low bone mineral density and increased fracture risk. We conducted a randomized, placebo-controlled trial investigating the effects of 6 months of teriparatide in anorexia nervosa. Teriparatide led to trends in improvements in bone structure. Longer-term studies are needed to evaluate the benefit of teriparatide in anorexia nervosa. PURPOSE: Women with anorexia nervosa have low BMD and increased fracture risk. Currently, there are no approved therapies for bone loss in anorexia nervosa. This study investigated the effects of teriparatide (TPT) on bone microarchitecture and structure in anorexia nervosa. METHODS: We conducted a randomized placebo-controlled study including women with anorexia nervosa and a T-score: ≤ - 2.5. Twenty-one women were randomized to (1) TPT (N = 10; 47.7 ± 8.6yrs) or (2) placebo (N = 11; 47.7 ± 7.7yrs) for 6 months. Primary outcomes included changes in trabecular and cortical bone microarchitecture (HR-pQCT) and hip structural analysis parameters (HSA program). Secondary outcomes included bone turnover markers (ELISA). RESULTS: After TPT treatment, no changes were observed in bone microarchitecture, but trends in HSA parameters in the intertrochanteric region (IT) of the proximal femur were noted. IT cortical thickness increased by 13% (p = 0.075 vs. baseline) after TPT (vs. a non-significant decrease in IT cortical thickness in placebo), and IT buckling ratio decreased 9% (vs baseline) in the TPT group (vs a 5% increase in placebo, p = 0.076). After TPT treatment, circulating levels of osteocalcin and osteopontin increased significantly in TPT (osteocalcin: 216.4%, p = 0.01 vs. baseline and osteopontin: 68.6%, p = 0.03 vs. baseline). No significant changes in osteocalcin or osteopontin levels were observed in the placebo group. CONCLUSION: Six months of TPT treatment in women with anorexia nervosa led to trends in improvements in bone structure. Long-term studies are needed to evaluate the potential benefit of TPT in anorexia nervosa.
Bisphosphonate treatment for secondary osteoporosis in children, youth, and young adults: a systematic review and meta-analysis.
Kim H, Yao X, Li O … +4 more , Cheng M, Ahn M, Ma J, Ward LM
Osteoporos Int · 2026 Apr · PMID 41591403 · Publisher ↗
Chronic illnesses and their treatments in childhood pose significant risks of bone fragility due to osteoporosis. Bisphosphonates (BP) are commonly used for treatment, yet evidence remains limited and heterogeneous. This...
Chronic illnesses and their treatments in childhood pose significant risks of bone fragility due to osteoporosis. Bisphosphonates (BP) are commonly used for treatment, yet evidence remains limited and heterogeneous. This systematic review aims to consolidate current empirical evidence on BP efficacy and safety in children, youth and young adults aged ≤ 21 years with secondary osteoporosis. Ovid MEDLINE and EMBASE, PubMed, Web of Science, Cumulative Index to Nursing and Allied Health, and Cochrane Central Register of Controlled Trials were searched by May 29th, 2025. This review followed the PRISMA guidelines the GRADE approach. This review was registered at PROSPERO (CRD42021242156). Seventeen studies were included (fifteen randomized controlled trials (RCTs), two quasi-RCTs) evaluating BP. Meta-analysis indicated that BP improved lumbar spine bone mineral density (BMD) z-score (mean difference (MD): 0.67; 95% confidence interval (CI): 0.37, 0.97) and lumbar spine bone mineral content (BMC) (MD: 2.90 g; 95% CI: 0.91, 4.90). There were no studies adequately powered to assess vertebral and non-vertebral fractures. Patient-reported outcomes showed no consistent results. Adverse events (AEs) were comparable between treatment and control groups (relative risk (RR): 1.08; 95% CI: 0.94, 1.23). When limited to short-term periods after the first infusion, AEs were more likely in the treatment group (RR: 2.24; 95% CI: 1.22, 4.11). BP treatment benefits pediatric secondary osteoporosis by improving lumbar spine BMD and BMC. However, small sample sizes and heterogeneity among the study methods continue to challenge the reliability of results, and larger RCTs are needed to assess fracture rates.
Incidence of first and subsequent fractures in multiple myeloma patients: a parallel cohort study using UK CPRD dataset.
Vijjhalwar R, Song K, Clemeno F … +9 more , Sanchez-Santos MT, Hawley S, Kishore B, Yong K, Bowcock S, Ramasamy K, Delmestri A, Pinedo-Villanueva R, Javaid MK
Osteoporos Int · 2026 Mar · PMID 41586834 · Publisher ↗
UNLABELLED: Based on a UK primary care dataset, patients with Multiple Myeloma (MM) experience a significantly higher index fracture rate from 1 year prior to MM diagnosis onwards and a higher subsequent vertebral fractu...
UNLABELLED: Based on a UK primary care dataset, patients with Multiple Myeloma (MM) experience a significantly higher index fracture rate from 1 year prior to MM diagnosis onwards and a higher subsequent vertebral fracture rate, compared to non-MM controls. There is potential for earlier MM diagnosis and reducing subsequent fracture risk. PURPOSE: Whilst multiple myeloma (MM) is known to increase fracture risk, the incidence of subsequent fractures is poorly described. Here, we describe the incidence of index and subsequent fractures in a real-world cohort of MM patients, compared to non-MM controls. METHODS: Using the UK Clinical Practice Research Datalink GOLD, we identified a MM cohort with age-, sex-, and GP-practice-matched controls from 1995 to 2017. The primary outcome was the incidence of fracture at major osteoporotic sites (i.e. hip, vertebral, wrist, or humerus) within 2 years before and after MM diagnosis. The cumulative incidence of subsequent fractures up to 2 years post-index fracture was estimated using Cox proportional hazards models. RESULTS: A total of 1972 patients (54.7% male, median age 70 years) with MM were matched to 6413 non-MM controls. The index fracture rate was significantly greater in the MM cohort compared to the non-MM cohort from 1 year prior to MM diagnosis onwards. Post-index fracture, the overall 2-year subsequent major fracture rate was 14.7% (95% CI:11.4-20.5) and 14.6% (95% CI:10.8-19.2) in the MM and non-MM cohorts, respectively. Within 2 years post-index fracture, the risk of subsequent vertebral fracture was significantly greater in MM patients (aHR: 8.16 (95% CI: 1.84-36.1), p = 0.006). CONCLUSIONS: MM patients are at higher risk of having an index fracture from 1 year pre-diagnosis and a subsequent vertebral fracture in the 2 years post-index fracture, compared to non-MM controls. These findings highlight the potential for earlier MM diagnosis in adults presenting with a major fracture, and the need to reduce subsequent fracture risk.
Paternal age is associated with offspring bone health-but not soft tissue composition or fracture: the Vitamin D in Pregnancy Study.
Percival MA, Anderson KB, Pasco JA … +4 more , Sim M, Hosking SM, Wark JD, Hyde NK
Osteoporos Int · 2026 Mar · PMID 41586833 · Full text
UNLABELLED: Emerging evidence suggests that paternal health may be associated with offspring later life heath. In this study, advanced paternal age at childbirth was associated with poorer offspring bone mineral density...
UNLABELLED: Emerging evidence suggests that paternal health may be associated with offspring later life heath. In this study, advanced paternal age at childbirth was associated with poorer offspring bone mineral density and content at age 11 years. These findings suggest that paternal age may impact childhood musculoskeletal development, warranting further investigation. INTRODUCTION: Maternal health during pregnancy is known to impact offspring's later life health. However, emerging evidence suggests that paternal factors may also be important. Advanced paternal age is associated with poorer offspring outcomes, yet few studies assess musculoskeletal outcomes. This study investigated the association between paternal age at childbirth and musculoskeletal outcomes of offspring at ages 11 and 16 years. METHODS: Data were from 402 mother-child pairs in the Vitamin D in Pregnancy study in southeastern Australia. Paternal date of birth was available for 173 fathers. Offspring lean, fat, and bone mass (spine and total body less head) were measured using dual-energy X-ray absorptiometry at age 11 years, and radiologically confirmed fractures were ascertained from birth (2002-2004) until July 19, 2019. Multivariable linear regression models were used to assess associations between paternal age and offspring bone and soft tissue composition outcomes, while multivariable Cox proportional hazards models were used to evaluate associations with offspring fracture occurrence. RESULTS: In total, 89 father-child pairs had data for bone and soft tissue composition analysis and 173 for fracture outcomes. In adjusted models, paternal age was associated with lower offspring total body less head bone mineral density (β - 0.002 g/cm; standard error (SE) 0.001; p = 0.046), bone mineral content (β - 5.830 g; SE 2.692; p = 0.033), and spine bone mineral content (β - 0.213 g; SE 0.0921; p = 0.023) but not spine bone mineral density or soft tissue composition. Paternal age was not associated with fracture occurrence at 16 years of age (HR 0.98; 95% CI 0.93-1.04; p = 0.51). CONCLUSION: Advanced paternal age may affect offspring musculoskeletal outcomes in childhood. This warrants further investigation in larger cohorts.
Prevalence and relative risk of fractures and osteoporosis in patients with ankylosing spondylitis: a systematic review and meta-analysis.
Liu Y, Ma X, Dai T … +4 more , Zhang J, Liu Y, Ren W, Bian J
Osteoporos Int · 2026 Apr · PMID 41575558 · Publisher ↗
Patients with ankylosing spondylitis are at greater risk of fractures and osteoporosis. This meta-analysis reveals their fracture and osteoporosis prevalence exceeds 13%. Two clinical indices, BASDAI and mSASSS, signific...
Patients with ankylosing spondylitis are at greater risk of fractures and osteoporosis. This meta-analysis reveals their fracture and osteoporosis prevalence exceeds 13%. Two clinical indices, BASDAI and mSASSS, significantly correlate with fracture risk. These findings support early screening and targeted management to prevent skeletal complications and improve patient outcomes. Patients with Ankylosing Spondylitis (AS) face an elevated risk of fractures and osteoporosis, which negatively impact quality of life and increase healthcare costs. This study systematically evaluates the prevalence of these conditions in AS patients and analyzes the associated risk factors. As of October 10, 2024, we conducted a systematic search of PubMed, Embase, the Cochrane Library, and Web of Science for epidemiological studies on the risk factors or prevalence of fractures and osteoporosis in AS. Effect sizes were pooled using fixed- or random-effects models, with subgroup and sensitivity analyses. Publication bias was evaluated using funnel plots and Begg's or Egger's test. A total of 28 studies were included in the final analysis. The overall fracture prevalence in AS patients was 13% (95% CI: 9%-17%), vertebral fracture prevalence was 14% (95% CI: 9%-19%), and osteoporosis prevalence was 14% (95% CI: 10%-19%). AS was significantly associated with vertebral fractures (OR = 2.26; 95% CI: 1.70-3.00) and non-vertebral fractures (OR = 1.24; 95% CI: 1.02-1.50). Among AS assessment indices, BASDAI (OR = 1.05; 95% CI: 1.02-1.08) and mSASSS (OR = 1.04; 95% CI: 1.01-1.06) were significantly associated with fracture risk, while BASFI and BASRI were not. AS significantly increases the risk of fractures and osteoporosis in patients. The BASDAI and mSASSS scoring systems can help predict fracture risk, enabling enhanced early identification and monitoring of complications in AS patients. This approach may ultimately improve long-term health outcomes and quality of life for affected individuals.
Hypercalcemia after denosumab discontinuation in patients with osteoporosis: a systematic review and case report.
Menéndez JQ, García Tellado Á, Pardo Lleidas J … +1 more , Hernández Hernández JL
Osteoporos Int · 2026 Mar · PMID 41571922 · Full text
UNLABELLED: Discontinuation of denosumab may result in rebound bone resorption, fractures, and rarely hypercalcemia, a very uncommon manifestation. Our systematic review and case report highlight that although rare, calc...
UNLABELLED: Discontinuation of denosumab may result in rebound bone resorption, fractures, and rarely hypercalcemia, a very uncommon manifestation. Our systematic review and case report highlight that although rare, calcium disturbances occur after treatment withdrawal. These findings emphasize the importance of sequential antiresorptive therapy and close monitoring in osteoporosis patients. BACKGROUND: Denosumab discontinuation has been associated with rebound bone resorption, rapid bone loss, and vertebral fractures. Hypercalcemia remains exceptional in postmenopausal osteoporosis. METHODS: We conducted a PRISMA-based systematic review up to April 2025, including case reports and series describing hypercalcemia after denosumab withdrawal in osteoporosis. We report one additional case. RESULTS: Three studies (encompassing four women, aged 64-86 years) met the inclusion criteria. All had received denosumab 60 mg every 6 months for 3-10 years, without prior bisphosphonate exposure. Hypercalcemia (range, 11.3-13.0 mg/dL), developed 3-11 months after discontinuation, was mild to moderate, and asymptomatic. Bone turnover markers were markedly elevated, with low or suppressed intact parathyroid hormone levels. Two patients sustained multiple vertebral fractures. Management consisted of reinitiation of bisphosphonates or denosumab. CONCLUSIONS: Hypercalcemia after denosumab withdrawal in osteoporosis is rare, typically mild, and reflects rebound osteoclast activation. Sequential antiresorptive therapy is strongly recommended following denosumab discontinuation.
Profiling bone status indices reveals evidence of a low-turnover bone phenotype in type 2 diabetes: findings from the DiaFALL cohort.
Rasmussen NH, Kvist AV, Bech AA … +5 more , Lykkeboe S, Starup-Linde J, Handberg A, van den Bergh JP, Vestergaard P
Osteoporos Int · 2026 Mar · PMID 41563408 · Full text
UNLABELLED: People with type 2 diabetes have increased fracture risk despite preserved bone density. In this matched cross-sectional study, suppressed Bone Status Indices and exploratory sex-related hormonal associations...
UNLABELLED: People with type 2 diabetes have increased fracture risk despite preserved bone density. In this matched cross-sectional study, suppressed Bone Status Indices and exploratory sex-related hormonal associations were observed in T2D, indicating altered bone remodeling that is not captured by aBMD alone. These findings support the need for fracture risk assessment approaches that incorporate biochemical markers and potential sex-related differences. INTRODUCTION/AIM: People with type 2 diabetes (T2D) experience increased fracture risk despite preserved or higher areal bone mineral density (aBMD). We evaluated Bone Status Indices (BSIs) and their relationships with aBMD in T2D, with exploratory evaluation of sex-related hormonal influences. METHODS: In this matched cross-sectional study from the DiaFALL cohort, 105 adults with T2D were compared 1:1 with age- and sex-matched controls. aBMD was assessed at lumbar spine, femoral neck, arms, and legs using DXA. BSIs included intact PINP (i-PINP), β-CTX-I, osteocalcin (OCN), sclerostin, TRACP5b, IGF-1, OPN, PTH, and vitamin-D metabolites. Group differences and associations with aBMD were evaluated using multivariable regression and Spearman correlations, with exploratory sex-stratified analyses. RESULTS: Femoral-neck aBMD was higher in people with T2D (men: + 0.070 g/cm, 95%CI + 0.026 to + 0.114, p = 0.002; women: + 0.089, 95%CI + 0.039 to + 0.139, p = 0.001) and lumbar-spine aBMD was higher in women (+ 0.137 g/cm, 95%CI + 0.072 to + 0.202, p < 0.001). In contrast, multiple BSIs were suppressed in T2D, including i-PINP (men: Δ-12.8 µg/L, 95%CI -19.4 to -6.2, p = 0.002; women: Δ-13.6 µg/L, 95%CI -25.9 to -1.3, p = 0.002), osteocalcin (men: Δ-6.36 µg/L, 95%CI -9.15 to -3.57, p < 0.001; women: Δ-6.66 µg/L, 95%CI -11.0 to -2.20, p < 0.001), and β-CTX-I (men: Δ-40.5 ng/L, 95%CI -62 to -18, p = 0.012; women: Δ-110 ng/L, 95%CI -180 to -44, p = 0.014). Sclerostin was higher in men with T2D (Δ + 24.6 pmol/L, 95%CI + 1.5 to + 47.7, p = 0.019) and correlated positively with lumbar-spine aBMD (r = 0.411; p = 0.007). Furthermore, 1,25(OH)₂D (men p = 0.013; women p = 0.001) and magnesium (p = 0.002 both sexes) were lower in T2D despite similar PTH. No significant T2D-sex interactions were observed for any BSI (all p > 0.05). CONCLUSION: T2D was characterized by higher aBMD together with broadly suppressed BSIs, consistent with a low-turnover skeletal phenotype not captured by DXA alone. Osteocalcin og sclerostin appeared most informative. These findings support longitudinal studies to determine whether BSIs can enhance identification of skeletal fragility in T2D.
Clinical and economic impact of deep learning-enhanced opportunistic osteoporosis screening using chest radiographs with and without the osteoporosis self-assessment tool for Asians (OSTA).
Chandran M, Reginster JY, Kim MY … +1 more , Hiligsmann M
Osteoporos Int · 2026 Mar · PMID 41563407 · Full text
UNLABELLED: Opportunistic analysis of chest radiographs with deep learning detects osteoporosis cost-effectively in women aged ≥ 50 years in Singapore. Adding OSTA marginally improves efficiency, but DL "deep learning" s...
UNLABELLED: Opportunistic analysis of chest radiographs with deep learning detects osteoporosis cost-effectively in women aged ≥ 50 years in Singapore. Adding OSTA marginally improves efficiency, but DL "deep learning" screening alone already reduces fractures and increases quality-adjusted life-years (QALYs) at acceptable cost. PURPOSE: Osteoporosis is underdiagnosed in older women due to limited access to dual-energy X-ray absorptiometry (DXA). Chest radiographs are commonly performed, and deep learning (DL) algorithms can opportunistically detect osteoporosis features. This study evaluated the clinical and economic impact of DL-enhanced opportunistic screening, alone or with the Osteoporosis Self-Assessment Tool for Asians (OSTA), in Singaporean women aged ≥ 50 years. METHODS: A lifetime microsimulation-based Markov model from the healthcare system perspective compared three strategies: DL screening alone, DL screening combined with OSTA, and no screening. Model inputs included screening performance, DXA referral rates, treatment uptake and adherence, and local fracture incidence and cost data. The base case assumed 5 years of alendronate therapy for treated women. Outcomes included fractures prevented, quality-adjusted life years (QALYs) gained, and incremental cost-effectiveness ratios (ICERs). RESULTS: Compared with no screening, DL screening alone reduced fractures and increased QALYs, with an ICER of S$46,412 per QALY at 17% osteoporosis prevalence, below a willingness to pay threshold of S$85,000. Adding OSTA improved efficiency, decreasing the ICER by ~ 6% while slightly improving clinical benefits. Across a prevalence range of 9.3%-37%, ICERs ranged from S$71,162 to S$24,749. When scaled to 10,000 women, the combined strategy could prevent 17 fractures, yield 7 additional life-years, and generate 16 QALYs. CONCLUSION: DL-enhanced chest radiographs offer a cost-effective approach for opportunistic osteoporosis screening in Singaporean women aged ≥ 50 years. Combining with OSTA slightly improves efficiency, but DL screening alone is already cost-effective and provides a scalable preventive strategy in real-world healthcare.
Effect of protein supplementation on hip bone mineral density, cortical thickness, and bone strength in older adult participants during a caloric restriction and aerobic exercise weight loss intervention: a randomized controlled trial.
Weaver AA, Greene KA, Leng X … +9 more , Lenchik L, Lyles MF, Nicklas BJ, Baker AM, Helgason B, Stapleton J, Devane K, Shapses SA, Houston DK
Osteoporos Int · 2026 Feb · PMID 41553490 · Full text
UNLABELLED: Weight loss in older age can cause bone loss. In older adults with overweight/obesity in a weight loss trial, 6-month hip bone strength increased with higher protein intake versus controls consuming the Recom...
UNLABELLED: Weight loss in older age can cause bone loss. In older adults with overweight/obesity in a weight loss trial, 6-month hip bone strength increased with higher protein intake versus controls consuming the Recommended Dietary Allowance. However, greater weight loss was associated with greater 18-month hip bone mineral density loss. PURPOSE: Weight loss (WL) to treat obesity in older age can exacerbate bone loss. METHODS: This trial assessed the effects of higher protein intake on hip bone outcomes in 187 older adults with overweight/obesity participating in 6 months of active WL (caloric restriction + aerobic exercise) followed by a 12-month maintenance phase. Participants were randomized to either the Recommended Dietary Allowance for protein intake of 0.8 g protein/kg body weight/day (RecProt) or higher protein intake of 1.2 g protein/kg/day for the 6-month WL period only (6-mo HiProt) or the full 18-month period (18-mo HiProt). CT scans at baseline, 6 months, and 18 months were analyzed for hip volumetric bone mineral density (vBMD) and cortical thickness; bone strength was assessed via finite element modeling of a sideways fall. Areal (a)BMD was measured with hip dual-energy X-ray absorptiometry. Analyses examined 6-month and 18-month bone changes using analysis of covariance, and Spearman's correlations of WL vs. bone changes. RESULTS: Greater WL was associated with greater gains in hip bone strength (p = 0.007) at 6 months, but greater trabecular vBMD loss at 18 months (p = 0.011) and aBMD loss at 6 and 18 months (p < 0.001). Hip bone strength increased 3.8 ± 1.7% over 6 months in the 18-mo HiProt group vs. 0.5 ± 1.6% in the RecProt group (p = 0.02) despite similar 6-month WL across groups (-8.0 ± 5.0%); however, there were no differences between the other groups. Eighteen-month group differences were non-significant. CONCLUSION: Higher protein intake had a beneficial effect on hip bone strength in older adults with overweight/obesity undergoing a WL intervention over the short-term.
Comment on: The association of bone density and hip fracture risk among Asian women.
Geng S, Chen R, Liu A
Osteoporos Int · 2026 Mar · PMID 41533086 · Publisher ↗
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Significant limitations and a future roadmap for the Li nomogram in tumor-induced osteomalacia.
Qi L, Gu Q, Chen B … +2 more , Yang D, Li D
Osteoporos Int · 2026 Mar · PMID 41533085 · Publisher ↗
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Conservative treatments for non-surgically managed osteoporotic vertebral compression fractures: a network meta-analysis of long-term pain and quality of life.
Chao WC, Chen YH, Shih JC … +2 more , Cheng B, Hu MH
Osteoporos Int · 2026 Mar · PMID 41528445 · Full text
UNLABELLED: The aim of this systematic review and network meta-analysis was to evaluate and rank the long-term effectiveness of conservative interventions for osteoporotic vertebral compression fractures (OVCFs). Teripar...
UNLABELLED: The aim of this systematic review and network meta-analysis was to evaluate and rank the long-term effectiveness of conservative interventions for osteoporotic vertebral compression fractures (OVCFs). Teriparatide demonstrated the greatest efficacy for both pain relief and quality of life improvement, significantly outperforming other non-surgical options. These results highlight the superior benefit of specific pharmacological therapies over other conservative strategies for long-term patient outcomes. PURPOSE: Osteoporotic vertebral compression fractures (OVCFs) are a major cause of pain, disability, and poor quality of life (QoL) in the elderly population. Although non-surgical interventions are widely used, long-term comparative evidence remains limited. This study aimed to conduct a systematic review and network meta-analysis (NMA) to evaluate and rank the long-term (≥ 6 months) effectiveness of conservative interventions for OVCFs in terms of pain relief and QoL improvement. METHODS: Following PRISMA-NMA guidelines, five databases were searched for randomized controlled trials involving adults (≥ 50 years) with radiographically confirmed OVCFs. Interventions included pharmacologic therapies (e.g., teriparatide, denosumab), exercise, manual therapy, and combination strategies. Outcomes were standardized across studies and analyzed using a frequentist random-effects model. RESULTS: Twelve full articles (n = 1512) met the inclusion criteria. Teriparatide demonstrated the greatest effect on pain reduction (SMD: - 1.75; 95% CI: - 3.10 to - 0.39) and QoL improvement (SMD: + 3.90; 95% CI: 2.33 to 5.47). Denosumab showed moderate QoL benefit (SMD: + 3.47), while other interventions yielded smaller or non-significant effects. CONCLUSION: Teriparatide is the most effective non-surgical intervention for long-term pain and QoL outcomes in OVCF patients. These findings support a personalized approach to conservative care and underscore the need for high-quality trials with standardized protocols and functional endpoints.
Letter to the editor.
Graumam RQ, Silva LVA, Pinheiro MMC … +2 more , Szejnfeld VL, Castro CHM
Osteoporos Int · 2026 Feb · PMID 41528444 · Publisher ↗
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Non-metastatic breast cancer patients discontinuing aromatase inhibitor on denosumab: what next?
Marcucci G, Biver E, Body JJ … +12 more , Campusano C, Cannata-Andía J, Confavreux C, de Villiers TJ, Ebeling PR, Hadji P, Kendler D, El Maghraoui A, Napoli N, Veronesi P, Rizzoli R, Brandi ML
Osteoporos Int · 2026 Feb · PMID 41524787 · Publisher ↗
Aromatase inhibitors (AIs) are one of the adjuvant endocrine therapies of choice, for estrogen receptor-positive breast cancer in postmenopausal women and premenopausal women with ovarian suppression. However, treatment...
Aromatase inhibitors (AIs) are one of the adjuvant endocrine therapies of choice, for estrogen receptor-positive breast cancer in postmenopausal women and premenopausal women with ovarian suppression. However, treatment with AIs leads to accelerated bone loss, and an increased fracture risk. Denosumab or bisphosphonates are recommended to prevent bone loss and reduce fracture risk during AIs treatment. However, specific attention must be paid to the "rebound phenomenon" after denosumab discontinuation. This review focuses on the therapeutic benefits of denosumab for its antiresorptive and antifracture effect in women with early breast cancer treated with AIs, risks related to denosumab discontinuation after treatment with AIs, prevention, and potential interventions for its associated fracture risk. A narrative review of available literature was carried out by International Osteoporosis Foundation Committee of Scientific Advisors Working Group on Cancer-Induced Bone Disease. Papers were retrieved by means of a PubMed enquiry (from 2006 to August 2025). A total of 126 papers closely related to our topic were included. After denosumab withdrawal in women with breast cancer treated with AIs, bone turnover increases, and there is a risk of spontaneous rebound-associated vertebral fractures, even in the absence of other risk factors for bone fragility. Therefore, expert consensus suggests initiating bisphosphonate treatment after denosumab discontinuation, even though there is no an optimal bisphosphonate regimen. There are numerous open research questions which future prospective studies will have to answer in order to personalize the most appropriate antiresorptive therapy for each patient.
Post-fracture care and predictors of anti-osteoporotic treatment in Switzerland: a nationwide health claims analysis.
Everts-Graber J, Schmid G, Häuselmann H … +8 more , Huber C, Streit S, Ravensbergen W, Reichenbach S, Maurer B, Lehmann T, Pinedo-Villanueva R, Graber SM
Osteoporos Int · 2026 Mar · PMID 41524786 · Publisher ↗
UNLABELLED: This retrospective study using Swiss health insurance claims data found that 88% of hip and 77% of vertebral fracture patients did not receive osteoporosis treatment within 6 months post-fracture. PURPOSE: Th...
UNLABELLED: This retrospective study using Swiss health insurance claims data found that 88% of hip and 77% of vertebral fracture patients did not receive osteoporosis treatment within 6 months post-fracture. PURPOSE: The treatment gap in osteoporosis in Switzerland has previously been estimated at 83% based on T-scores and/or FRAX thresholds. However, real-world data on treatment rates following fractures remain limited. This study analysed treatment rates and their predictors in hospitalised patients aged ≥ 50 years with recent vertebral, hip or other fractures and the associated direct economic burden. METHODS: This retrospective cohort study utilised claims data from the largest Swiss health insurance provider. The incidence of vertebral, hip and other fractures was assessed by age and sex, and treatment rates and predictors of anti-osteoporotic therapies at 12 months post-fracture were analysed. Additionally, hospitalisation duration, associated costs and care trajectories (nursing home placement, rehabilitation, home care services) were described for each fracture site, as well as mortality within 12 and 24 months post-fracture. RESULTS: From 2021 to 2023, there were 2458 vertebral, 6229 hip and 11,314 non-hip, non-vertebral fractures (59%, 70% and 74% in women, respectively). Inpatient rehabilitation was required in 8-11% of cases, and 18-21% of patients newly transitioned to nursing home placement within 3 months post-fracture. DXA scans were performed within 12 months in 10% of hip and 21% of vertebral fracture patients and represented the strongest predictor of treatment initiation (odds ratio 10.2, 9.1-11.5), with female sex, older age and greater comorbidity showing weaker effects. Treatment rates within 6 months post-fracture were 11.7% for hip fractures (including 5.0% denosumab, 2.6% zoledronate, 2.1% alendronate), 23% for vertebral fractures (including 9.4% denosumab, 4.7% zoledronate, 3.6% ibandronate, 2.7% anabolic agents) and 12.5% for other fractures, with 8%, 13% and 11% of patients, respectively, already receiving osteoporosis therapy prior to the fracture. CONCLUSION: Osteoporosis treatment rates after hip and vertebral fractures were low, with 88% and 77% of patients, respectively, not receiving treatment within 6 months. DXA scans, specialist consultations and comorbidity burden were the strongest predictors of post-fracture treatment, highlighting key patient- and system-level factors that could guide interventions to close the treatment gap.
T-score, stature, and fracture risk interpretation in Asian women.
Huang CC
Osteoporos Int · 2026 Feb · PMID 41524785 · Publisher ↗
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Muscle mass, not fat mass, predicts vertebral fracture risk: Vietnam osteoporosis study.
Nguyen HT, Nguyen BT, Nguyen QT … +7 more , Tran AV, Thai NHT, Phan QXT, Mai LD, Tran TS, Nguyen TV, Ho-Pham LT
Osteoporos Int · 2026 Feb · PMID 41507595 · Publisher ↗
UNLABELLED: The association between body weight and vertebral fracture is established, but whether muscle mass or fat mass drives this relationship remains unclear. In Vietnamese adults, our study demonstrates that muscl...
UNLABELLED: The association between body weight and vertebral fracture is established, but whether muscle mass or fat mass drives this relationship remains unclear. In Vietnamese adults, our study demonstrates that muscle mass, rather than fat mass, predicts vertebral fracture risk. Both low and excessive muscle mass significantly increase this risk, indicating a U-shaped relationship. PURPOSE: The purpose is to examine the relationship between various body composition measures and vertebral fracture in a Vietnamese population. METHODS: This cross-sectional study included 1,372 Vietnamese adults aged ≥ 50 years from the Vietnam Osteoporosis Study. Body composition was measured using dual-energy X-ray absorptiometry to derive lean body mass index (LBMI), appendicular skeletal muscle mass index (ASMI), body fat mass index (BFMI), and percentage-based indices. Vertebral fractures were identified via thoracolumbar radiographs using Genant's semiquantitative method. Adjusted logistic regression models and restricted cubic splines were used to assess associations and explore nonlinear relationships. RESULTS: Vertebral fractures were diagnosed in 173 participants (12.6%). Compared with those without fractures, affected participants were older (63.4 ± 9.6 vs 58.8 ± 7.3 years; p < 0.001) and more often male (38.7% vs 29.4%; p = 0.017). Both LBMI and ASMI showed U-shaped associations with fracture risk, with higher odds at the extremes; for ASMI, the lowest and highest quartiles had increased odds of fracture (OR 1.72; 95% CI 1.02-2.95 and OR 2.59; 95% CI 1.36-5.02, respectively). In contrast, BFMI was not significantly associated with fracture risk (p = 0.365). Higher trunk lean percentage was consistently related to fracture (ORs 1.82-2.54 across non-reference quartiles), whereas total body and leg lean percentages were associated with increased risk only in the highest quartile (OR 2.18; 95% CI 1.07-4.45 and OR 2.06; 95% CI 1.03-4.12). CONCLUSIONS: In Vietnamese adults, extremes of muscle mass (low and high), rather than fat mass, are associated with higher vertebral fracture risk. This emphasizes incorporating muscle mass evaluation into fracture risk assessment beyond reliance on BMI alone.
Impact of probiotic, prebiotic, and synbiotic supplementation on the gut microbiome in older adults with sarcopenia, obesity, and sarcopenic obesity.
Gandham A, Prokopidis K, Glavas C … +2 more , Scott D, Lorentzon M
Osteoporos Int · 2026 Feb · PMID 41507594 · Full text
Gut microbiome plays an important role in several metabolic, immune, and inflammatory pathways; however, there is limited evidence for its role in body composition and musculoskeletal health. Sarcopenia, defined as a los...
Gut microbiome plays an important role in several metabolic, immune, and inflammatory pathways; however, there is limited evidence for its role in body composition and musculoskeletal health. Sarcopenia, defined as a loss of skeletal muscle mass and function, and obesity, can co-exist in a condition known as sarcopenic obesity. This condition is highly prevalent among older adults, hence increasing the risk of negative health implications such as metabolic dysfunction, chronic inflammation, reduced physical performance, and poor quality of life. These age-related conditions are closely associated with alterations to the gut microbiome, including microbial profiles and a reduction in beneficial metabolites such as short-chain fatty acids (SCFAs). Probiotic, prebiotic, and synbiotic interventions are therefore emerging as promising strategies to improve the gut microbiome by enhancing microbial diversity and restoring microbial communities. This review utilizes current evidence on the impact of these interventions on gut microbiota composition, inflammatory and metabolic biomarkers, body composition, and functional outcomes in older adults with sarcopenia, obesity, and sarcopenic obesity. Probiotics, containing live beneficial microorganisms, have shown potential in enhancing SCFA production, reducing inflammation, and improving insulin sensitivity. Prebiotics are non-digestible fibers that selectively activate the growth of beneficial gut bacteria, further supporting gut health by proliferating the growth of SCFA-producing bacteria. Synbiotics, a combination of probiotics and prebiotics, provide a synergistic approach to gut health, accounting for the microbial composition and functional capability. Recent studies have demonstrated that probiotics, prebiotics, and synbiotics may reduce inflammation and improve muscle mass and strength among older adults with sarcopenia, obesity, and sarcopenic obesity. These interventions have the potential in mitigating obesity-related metabolic dysfunction and inflammation, particularly in individuals with sarcopenic obesity. Although, preclinical studies in mice exhibit beneficial effects, clinical studies in older adults remain limited, with heterogeneity of study design, intervention types, and outcome measures. This review highlights the need for robust, well-designed clinical trials to understand the mechanistic and molecular pathways through which probiotic, prebiotic, and synbiotic supplementation may modulate the gut microbiome and improve musculoskeletal health among older adults. These interventions may provide innovative, non-invasive therapeutic strategies for managing sarcopenia, obesity, and sarcopenic obesity, ultimately contributing to healthier aging and improved quality of life of older adults. This review also underscores the potential of microbiome-targeted interventions for aging populations, highlighting the need for further research.
Association between SGLT2 inhibitor use and the risk of vertebral augmentation after initial osteoporotic vertebral fracture in patients with type 2 diabetes.
Chang Y, Chi KY, Chen CM … +1 more , Lin HM
Osteoporos Int · 2026 Feb · PMID 41504956 · Publisher ↗
PURPOSE: Sodium-glucose cotransporter-2 (SGLT2) inhibitors are widely used in patients with type 2 diabetes mellitus (T2DM), but their influence on post-fracture outcomes remains unclear. This study aimed to evaluate the...
PURPOSE: Sodium-glucose cotransporter-2 (SGLT2) inhibitors are widely used in patients with type 2 diabetes mellitus (T2DM), but their influence on post-fracture outcomes remains unclear. This study aimed to evaluate the association between SGLT2 inhibitor use and the risk of vertebral augmentation after an initial osteoporotic vertebral compression fracture (VCF) in patients with T2DM and osteoporosis. METHODS: This retrospective cohort study used data from the TriNetX Global Collaborative Network. Adults with T2DM, osteoporosis, and a first documented VCF were identified. Patients who received SGLT2 inhibitors within 6 months prior to the fracture were compared with non-users. Individuals with prior vertebral augmentation, vertebral malignancy, or inflammatory spondylopathies were excluded. Propensity score matching (1:1) was performed based on demographics, comorbidities, and concurrent medications. The primary outcome was vertebral augmentation within 6 months following the index fracture. RESULTS: After matching, 1757 patients were included in each cohort with well-balanced baseline characteristics. Within 6 months after the initial VCF, vertebral augmentation was performed in 12.5% of SGLT2 inhibitor users and 9.3% of non-users. SGLT2 inhibitor use was associated with a higher likelihood of vertebral augmentation (odds ratio 1.40; 95% confidence interval 1.13-1.73; p = 0.002). CONCLUSION: In patients with T2DM and osteoporosis, SGLT2 inhibitor use was associated with an increased likelihood of vertebral augmentation following an initial osteoporotic vertebral fracture, suggesting potential differences in post-fracture clinical course or management intensity.
Controlling Nutritional Status (CONUT) score as a key predictor of disability following conservative treatment of osteoporotic vertebral fractures.
Yamaura T, Maruo K, Kusukawa T … +8 more , Toi M, Hatano M, Nagao K, Horinouchi Y, Oishi H, Arizumi F, Kishima K, Tachibana T
Osteoporos Int · 2026 Feb · PMID 41491419 · Publisher ↗
UNLABELLED: This study investigated risk factors for disability in elderly patients with osteoporotic vertebral fractures treated conservatively. Of 173 patients, 27.7% remained disabled at 12 months. Higher CONUT scores...
UNLABELLED: This study investigated risk factors for disability in elderly patients with osteoporotic vertebral fractures treated conservatively. Of 173 patients, 27.7% remained disabled at 12 months. Higher CONUT scores, lower lumbar indentation value, and hospitalization were associated with disability, suggesting that nutritional and functional assessments may improve long-term outcomes. PURPOSE: Although conservative treatment is the standard for osteoporotic vertebral fractures (OVFs), some patients develop persistent disability. This study aimed to investigate the clinical course and risk factors for disability in OVFs. METHODS: This nested case-control study analyzed data from a multicenter prospective cohort of patients with OVFs treated conservatively. Patients aged > 60 years with MRI-confirmed OVFs were included. At 12 months, patients with an Oswestry Disability Index (ODI) > 40% were classified as the disability group and those with an ODI ≤ 40% as the non-disability group. To control for age-related factors, groups were matched 1:1 by age. Clinical, radiological, and nutritional factors, including the Controlling Nutritional Status (CONUT) score, were compared. Multivariate conditional logistic regression analysis identified independent predictors for disability. RESULTS: Of 190 patients initially enrolled, 17 were excluded, leaving 173 for analysis. Among these, 27.7% had disabilities at 12 months. After age matching, 44 patients per group (total 88) were analyzed. The disability group showed worsening ODI from 3 to 12 months, whereas the non-disability group improved. Compared with the non-disability group, the disability group had lower lumbar indentation value (LIV), higher CONUT scores, and more frequent hospitalizations. Multivariate analysis identified the CONUT score as an independent risk factor for disability (OR = 1.4, 95% CI 1.1-1.9, p = 0.04). CONCLUSION: Baseline hospitalization, lower LIV, and higher CONUT scores were associated with disability. Malnutrition was an independent risk factor for disability after OVF. Comprehensive interventions, including rehabilitation and nutritional support, together with bracing and osteoporosis treatment, are essential to prevent long-term impairment of activities of daily living.
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