Vertebral Hounsfield units (HU) measured on routine computed tomography (CT) have emerged as an accessible surrogate for bone mineral density (BMD), yet reported diagnostic thresholds vary widely. This meta-analysis aime...Vertebral Hounsfield units (HU) measured on routine computed tomography (CT) have emerged as an accessible surrogate for bone mineral density (BMD), yet reported diagnostic thresholds vary widely. This meta-analysis aimed to define and test unified HU cut-offs for identifying osteopenia and osteoporosis. PubMed, EMBASE, MEDLINE, and Cochrane Library were searched to September 2025 for studies reporting vertebral HU referenced to dual-energy X-ray absorptiometry or quantitative CT. Continuous data were synthesised as standardised mean differences (SMD) and diagnostic accuracy using bivariate random-effects models. Reported thresholds were pooled to generate balanced, sensitivity-, and specificity-optimised cut-offs, tested through reconstructed 2 × 2 analyses. Twenty studies including 5016 patients met inclusion criteria. HU values were significantly lower in osteopenia and osteoporosis, with pooled SMD -2.78 for low BMD versus normal and -1.57 for osteoporosis versus non-osteoporotic bone (p < 0.001). Overall diagnostic performance was excellent (AUC 0.865; sensitivity 0.80; specificity 0.83). Pooled thresholds for osteopenia were 138.9 HU (balanced), 166.7 HU (high), and 111.2 HU (low); and for osteoporosis, 104.6 HU (balanced), 122.3 HU (high), and 86.8 HU (low). Decreasing HU was associated with stepwise increases in relative risk for low BMD. Vertebral HU strongly discriminate normal from low BMD, providing clinically applicable pooled thresholds for opportunistic CT-based screening and perioperative risk assessment. HU assessment could facilitate early detection and management of osteopenia and osteoporosis, particularly in surgical candidates.
UNLABELLED: We studied the use of rheumatoid arthritis (RA) as an input to FRAX® and trabecular bone score (TBS) to modify FRAX-based probability in individuals with diabetes. Our results help to inform the use of FRAX a...UNLABELLED: We studied the use of rheumatoid arthritis (RA) as an input to FRAX® and trabecular bone score (TBS) to modify FRAX-based probability in individuals with diabetes. Our results help to inform the use of FRAX and FRAXplus in patients with diabetes. BACKGROUND: Diabetes confers increased risk for fracture independently from FRAX-estimated fracture probability. PURPOSE: To compare the relative performance of the rheumatoid arthritis (RA) input and trabecular bone score (TBS) adjustment, alone or in combination, to capture FRAX-independent risk associated with diabetes. METHODS: We analyzed data on 54,609 individuals from the Manitoba Bone Density Program aged ≥ 40 years with FRAX-based probability and TBS measurements (mean age 63.8 years, 89.9% female) including 5274 (9.7%) with diabetes. Incident major osteoporotic fracture (MOF, 5723, 10.5%) and hip fractures (1715, 3.1%) were ascertained during mean 9.6 years observation from population-based healthcare data. The effect of diabetes on fracture outcomes was modeled without (Cox regression) and with competing mortality (Fine-Gray regression), adjusted for FRAX-based probability before and after RA input and TBS adjustment. RESULTS: For MOF prediction in those with diabetes duration less than 5 years, no FRAX adjustment was required. For those with duration 5-10 years, FRAX adjusted with TBS was slightly better than the unadjusted FRAX output. For those with diabetes duration greater than 10 years, the larger effect from RA was beneficial, with or without TBS. In contrast, hip fracture risk was consistently greater regardless of diabetes duration and required the use of TBS, with or without RA. CONCLUSION: Diabetes was associated with incident MOF and hip fracture independent of baseline fracture probability, but this risk was partially offset by excess mortality. TBS adjustment and RA input showed complementary benefits for improving fracture prediction that differed according to diabetes duration and fracture outcome.
UNLABELLED: This study explores the association between frailty trajectories and osteoporosis and hip fractures. Using data from two prospective longitudinal studies-the Health and Retirement Study (HRS) and the English...UNLABELLED: This study explores the association between frailty trajectories and osteoporosis and hip fractures. Using data from two prospective longitudinal studies-the Health and Retirement Study (HRS) and the English Longitudinal Study of Ageing (ELSA), it finds that frailty status is significantly associated with both osteoporosis and hip fracture. BACKGROUND: Frailty is associated with a variety of chronic diseases, yet there is a lack of research on the association of frailty trajectories with osteoporosis and hip fracture. METHODS: This study used data from two prospective longitudinal cohorts: the Health and Retirement Study (HRS) and the English Longitudinal Study of Ageing (ELSA), with biennial follow-up from 2014 to 2018. A frailty index (FI) was used to measure frailty status, and group-based trajectory modeling was applied to identify four distinct frailty trajectories. Osteoporosis and hip fracture were defined based on self-reported physician diagnosis. Logistic regression models were used to examine associations between frailty trajectories and the two outcomes, with odds ratios (ORs) and 95% confidence intervals (CIs) reported. RESULTS: A total of 10,207 participants were included (6816 from HRS and 3391 from ELSA). Four groups of frailty trajectories were identified: the "stable robust trajectory" (n = 4949, 48.3%), the "pre-frailty trajectory" (n = 2717, 26.6%), the "moderate frailty trajectory" (n = 1937, 19.0%), and "severe frailty trajectory" (n = 624, 6.1%). Compared to the stable robust trajectory group, the association with osteoporosis was stronger in the multivariate-adjusted pre-frailty trajectory group (OR 1.91, 95% CI 1.69-2.15), the moderate frailty trajectory group (OR 3.02, 95% CI 2.6-3.52), and severe frailty trajectory group (OR 5.39, 95% CI 4.1-7.07), and in the moderate frailty trajectory (OR 2.55, 95% CI 1.68-3.87), and stronger association with hip fracture in the severe frailty trajectory group (OR 6.03, 95% CI 3.2-11.36). CONCLUSION: These results suggest that frailty status is closely associated with the risk of osteoporosis and hip fracture, with poorer frailty status correlating with a higher risk of osteoporosis and hip fracture.
UNLABELLED: Using Danish registries, we identified 57,887 patients with hip fracture aged ≥ 65 without recent anti-osteoporosis medication (AOM) and examined whether mental disorders affect AOM initiation after hip fract...UNLABELLED: Using Danish registries, we identified 57,887 patients with hip fracture aged ≥ 65 without recent anti-osteoporosis medication (AOM) and examined whether mental disorders affect AOM initiation after hip fracture. One-year initiation ranged from 6.5 to 17.0% among patients with mental disorders compared to 21% in patients without mental disorder. Initiation remains suboptimal, highlighting required targeted interventions. PURPOSE: To evaluate the impact of mental disorders on the initiation of anti-osteoporosis medication (AOM) following hip fracture. METHODS: Using Danish medical registries, we identified patients aged ≥ 65, with no recent AOM use and a first-time hip fracture between 2010 and 2020 (n = 57,887). Mental disorders were categorized using a 10-year history of hospital contacts into no mental disorder, organic mental disorders, substance use, schizophrenic, mood, and anxiety disorders. The outcome was initiation of AOM defined by pharmacy dispensations and hospital treatment codes. Among patients without AOM use in the year prior to hip fracture, 1-year cumulative incidence functions (CIF) with 95% confidence intervals of initiation of AOM with death as a competing risk were calculated. Analyses were conducted overall and stratified by sex, age, previous fractures, somatic comorbidity, mental comorbidity, living arrangement, and calendar year. RESULTS: The 1 year CIF of initiation of AOM after hip fracture was 20.8% (20.4-21.1) for patients with no mental disorder, 6.5% (6.0-7.1) for organic mental disorders, 17.0% (15.6-18.5) for substance use, 11.5% (9.5-13.8) for schizophrenic disorders, 14.8% (13.8-15.8) for mood, and 16.1% (14.4-17.9) for anxiety disorders. Higher initiation of AOM was seen in patients < 80 years, females, with previous fractures, in patients with less somatic comorbidity and no other mental comorbidities, cohabiting in their own home, and in more recent calendar years. CONCLUSION: AOM initiation following hip fracture remains suboptimal. Patients with mental disorders were less likely to initiate AOM after hip fracture, highlighting a persistent gap in secondary fracture prevention among vulnerable populations.
UNLABELLED: In a peritoneal dialysis longitudinal cohort, REMS and DXA showed similar bone density, but only DXA detected significant cortical bone loss. REMS tended to give lower bone mineral density values and did not...UNLABELLED: In a peritoneal dialysis longitudinal cohort, REMS and DXA showed similar bone density, but only DXA detected significant cortical bone loss. REMS tended to give lower bone mineral density values and did not correlate with DXA changes. REMS may complement DXA when DXA findings are difficult to interpret or when closer longitudinal monitoring is needed, but larger studies are needed to define its role. BACKGROUND: Dual X-ray absorptiometry (DXA) is the gold standard for bone mineral density (BMD) assessment in chronic kidney disease patients, but it can have limited accuracy and radiofrequency echographic multi-spectrometry (REMS) may overcome some of its limitations. We aimed to evaluate and compare longitudinal BMD changes assessed by DXA and REMS in peritoneal dialysis (PD) patients. METHODS: Prospective cohort study including 20 PD patients that underwent two separate DXA and REMS evaluations. Clinical, biochemical, and imaging data, including abdominal aorta calcification (AAC) scores and fracture history, were collected. Longitudinal BMD changes were analyzed using linear mixed-effects models. RESULTS: Over a median follow-up period of 19.8 months, DXA revealed significant BMD declines at the femoral neck (FN) (-3.2%, p = 0.039) while REMS showed non-significant numerical declines. REMS consistently yielded lower BMD values than DXA at both lumbar spine (LS) and FN. The trajectories of BMD over time were similar between DXA and REMS for LS (p = 0.806) and FN (p = 0.229), regardless of whether patients were receiving anti-osteoporosis treatment and of the presence of fractures. However, there was no correlation of the annualized changes in BMD at the FN and LS between the two methods (r = 0.001, p = 0.905, and r = 0.001, p = 0.928, respectively). CONCLUSION: DXA detected a significant decline in BMD at cortical sites, whereas REMS did not, and the correlation of the annualized changes between the two methods in assessing changes over time was poor. Given the small sample size, larger studies are needed to clarify the comparative and possible complementary roles of REMS and DXA in monitoring bone health in end-stage kidney disease.
UNLABELLED: Baseline serum PINP was significantly and independently associated with achieving a ≥ 8% increase in lumbar spine (LS) bone mineral density (BMD) after 12 months of twice-weekly teriparatide therapy. PURPOSE:...UNLABELLED: Baseline serum PINP was significantly and independently associated with achieving a ≥ 8% increase in lumbar spine (LS) bone mineral density (BMD) after 12 months of twice-weekly teriparatide therapy. PURPOSE: Early predictors of the BMD response to twice-weekly teriparatide remain poorly defined. This study aimed to identify clinical and biochemical determinants of early LS BMD improvement under this regimen. METHOD: In this retrospective multicenter cohort study, 242 osteoporosis patients at high fracture risk completed 12 months of twice-weekly teriparatide (28.2 μg). At baseline, 88.0% were female, mean age was 80.0 years, 83.5% had a history of osteoporotic fracture, and 72.3% were treatment-naïve. Multivariate regression was performed to identify independent predictors of LS BMD change, and receiver operating characteristic (ROC) analysis was used to determine the optimal cutoff value for predicting an LS BMD increase ≥ 8% at 12 months. RESULTS: The percent change (mean ± standard deviation) in LS BMD was 7.0 ± 8.6%, and 41.3% of patients achieved an LS BMD increase ≥ 8% at 12 months. In the multivariate model, baseline total procollagen type I N-terminal propeptide (PINP) was significantly and independently associated with percent LS BMD change (standardized coefficient = 2.73, p < 0.001). ROC analysis identified a baseline PINP cutoff of 53.1 μg/L for predicting ≥ 8% LS BMD increase (sensitivity 74.4%, specificity 60.5%, area under the curve = 0.67). CONCLUSION: Baseline serum PINP represents one of the clinically relevant independent predictors of early LS BMD response to twice-weekly teriparatide.
Nasomyont N, Tian C, Hornung L
… +3 more, Khoury J, Wong BL, Rutter MM
Osteoporos Int
· 2026 Mar · PMID 41912872
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UNLABELLED: We evaluated fracture and osteoporosis prevalence in a large cohort of children with DMD undergoing routine spine imaging. Osteoporosis is common and worsens with age and glucocorticoid use. Low total body bo...UNLABELLED: We evaluated fracture and osteoporosis prevalence in a large cohort of children with DMD undergoing routine spine imaging. Osteoporosis is common and worsens with age and glucocorticoid use. Low total body bone mineral density may herald clinically detectable osteoporosis. Our findings emphasize the need for better detection and prevention. INTRODUCTION: Osteoporosis is a major health concern in individuals with Duchenne muscular dystrophy (DMD) due to long-term glucocorticoid (GC) therapy, muscle weakness and restricted mobility. Osteoporosis results in long bone and vertebral fractures, which can lead to significant morbidity including premature loss of ambulation. We evaluated the age-related prevalence of osteoporosis and bone health indices in children and adolescents with DMD on daily GC therapy. METHODS: We conducted a retrospective review of patients with DMD seen at Cincinnati Children's Comprehensive Neuromuscular Center over 9 years. Bone health assessments included fracture history, routine annual spine radiographs and bone mineral density (BMD) by dual-energy X-ray absorptiometry. RESULTS: We included 408 patients with DMD (mean age 8.0 ± 3.5 years, range 3.0-19.3 years) who had received daily GC (mean age of GC start 6.4 ± 2.5 years, mean duration 2.7 ± 2.4 years). Osteoporosis prevalence increased progressively with age: 4.4%, 20.9%, and 58.3% at ages 5, 10 and 18 years, respectively. The prevalence of long bone and/or vertebral fractures was 16.5%, 37.4%, and 83.3%, respectively. Low total body BMD Z-scores preceded clinically detectable osteoporosis, while low lumbar spine values lagged behind. CONCLUSIONS: Osteoporosis, fractures, and low BMD were highly prevalent from a young age in children and adolescents with DMD and increased progressively with age and GC exposure. The prevalence of osteoporosis reflected the cumulative acquisition of vertebral fractures, consistent with long-term GC effect. These data highlight the urgent need to improve early detection and prevention of osteoporosis in individuals with DMD.
Osteoporos Int
· 2026 Mar · PMID 41894014
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Osteoporosis is a common musculoskeletal disorder. Patients with this condition have poor treatment adherence. Health education may improve treatment adherence, nutritional self-care, and disease knowledge. In this study...Osteoporosis is a common musculoskeletal disorder. Patients with this condition have poor treatment adherence. Health education may improve treatment adherence, nutritional self-care, and disease knowledge. In this study, a meta-analysis of randomized controlled trials was conducted to quantitatively evaluate the effects of health education on treatment adherence, dietary supplement use, and disease knowledge. This study was registered in PROSPERO (CRD420251089299). English literature from multiple databases was retrieved. Randomized controlled trials involving patients with osteoporosis were included. Two researchers independently extracted the data and evaluated the risk of bias via RoB2. Statistical analysis was conducted via R software. The effect size was measured as the RR or SMD. This study ultimately included 9 randomized controlled trials (10 articles). In terms of treatment adherence/antiresorptive drug use, health education tended to improve treatment adherence (RR [95% CI] = 1.14 [0.98, 1.33], I = 68.4%), among which remote education based on electronic devices was statistically significant (RR [95% CI] = 1.09 [1.00, 1.18], I = 12.1%); health education tended to improve the use of vitamin D supplements (RR [95% CI] = 1.16 [0.96, 1.41], I = 67.8%); health education tended to improve the use of calcium supplements (RR [95% CI] = 1.09 [0.92, 1.30], I = 52.2%); and health education tended to improve disease knowledge (SMD [95% CI] = 0.38 [- 0.08, 0.84], I = 87.2%). This study highlights that health education tends to improve the adherence to the usage rate of anti-osteoporosis drug treatment, the usage rate of vitamin D and calcium supplements, and disease knowledge.
Kokubu Y, Obi A, Kimura Y
… +14 more, Hattori A, Nemoto H, Matsuda Y, Oki Y, Amamiya R, Ogine K, Misawa M, Shimaoka T, Hirose K, Ando Y, Kurashige T, Marusugi K, Kaneyama S, Kawaguchi H
Osteoporos Int
· 2026 Mar · PMID 41882213
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UNLABELLED: Lower hip bone density showed the most consistent association with distal ulna involvement in surgically treated distal radius fractures, whereas local fracture severity showed minimal discriminatory value. H...UNLABELLED: Lower hip bone density showed the most consistent association with distal ulna involvement in surgically treated distal radius fractures, whereas local fracture severity showed minimal discriminatory value. Hip bone density was particularly associated with the ulnar metaphyseal subtype, characterizing conditional fracture-pattern variation within this selected population. PURPOSE: To characterize clinical and skeletal features across fracture subtypes within surgically treated low-energy distal radius fractures and to distinguish ulnar metaphyseal fracture from ulnar styloid fracture when ulna involvement occurs. METHODS: This retrospective cross-sectional study included adults aged ≥ 45 years with surgically treated low-energy distal radius fracture (2020-2024). Patients were categorized into three groups: isolated distal radius fracture without distal ulna fracture (DRF group); distal radius fracture with isolated ulnar styloid fracture (USF group); and distal radius fracture with ulnar metaphyseal fracture, with or without ulnar styloid fracture (UMF group). Candidate variables included sex, age, hip and spine bone mineral density expressed as a percentage of the young adult mean reference value (YAM), body mass index, and distal radius fracture severity according to the AO/OTA classification. Univariable and multivariable logistic regression analyses were conducted in two stages: (1) USF + UMF versus DRF and (2) UMF versus USF. RESULTS: Among 236 patients, DRF, USF, and UMF accounted for 85, 129, and 22 cases, respectively (64.0% with distal ulna involvement). Low hip-YAM (≤ 70%) showed the most consistent association with ulna involvement across both analytic stages, with a stronger association in the second stage differentiating UMF from USF. Other variables, including radius fracture severity, exhibited minimal or no association. CONCLUSIONS: In patients with surgically treated distal radius fracture, lower hip bone density was consistently associated with distal ulna involvement, particularly the metaphyseal subtype, characterizing conditional fracture-pattern variation within this selected surgical population.
Ing SW, McDermott M, Yeh E
… +5 more, Lane JM, Cheung J, Amet M, Binkley N, Cosman F
Osteoporos Int
· 2026 Mar · PMID 41876723
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UNLABELLED: This survey of 116 patients aged ≥ 50 years with ≥ 1 confirmed symptomatic vertebral fracture within 36 weeks prior to enrollment showed that pain related to fracture persisted after 24 weeks for a subset of...UNLABELLED: This survey of 116 patients aged ≥ 50 years with ≥ 1 confirmed symptomatic vertebral fracture within 36 weeks prior to enrollment showed that pain related to fracture persisted after 24 weeks for a subset of patients and affected activities of daily living. These data emphasize the importance of vertebral fracture prevention. PURPOSE: To describe pain persistence, severity, and effect on ADLs after symptomatic vertebral fracture. METHODS: This was an observational cross-sectional survey of patients recruited from 7 United States clinical sites aged ≥ 50 years with ≥ 1 symptomatic osteoporotic vertebral fracture diagnosed within the prior 36 weeks. Patients' experience of pain and its impact on ADLs during the past 7 days before the patient survey were evaluated. Data were collected through one-time patient surveys and retrospective medical chart review and analyzed descriptively. RESULTS: Of 116 patients enrolled, most were postmenopausal women (83%), White (92%), and aged ≥ 65 years (83%); 37% were recruited within 12 weeks, 40% within > 12-24 weeks, and 23% within > 24-36 weeks of the symptomatic osteoporotic vertebral fracture. Fractures were confirmed by x-ray (60%), magnetic resonance imaging (50%), and/or computed tomography scan (37%). Within 12 weeks of a vertebral fracture, pain was reported as constant/steady by 42% of patients. Pain frequency decreased over time, but even among patients with vertebral fracture > 24-36 weeks earlier, > 20% still reported constant/steady pain and > 80% reported at least intermittent pain. Pain severity scores of 7-10 were reported by 44% within 12 weeks, 30% within > 12-24 weeks, and 36% within > 24-36 weeks following the vertebral fracture. The most common movements increasing pain were standing up (55%), bending down (53%), and lifting (42%). ADLs most impacted were housework and walking. CONCLUSION: In this study, pain related to fracture persisted after 24 weeks and affected ADLs, emphasizing the importance of vertebral fracture prevention and pain management strategies.
Ferrari S, Seefried L, Páll D
… +9 more, Viapiana O, Rosa J, Supronik J, Nestorova Licheva R, Kiefer J, Jeszenői N, Horvát-Karajz K, Jókai E, Takács I
Osteoporos Int
· 2026 Mar · PMID 41876722
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UNLABELLED: Osteoporosis is a chronic condition requiring long-term management of fracture risk. Biosimilars provide the possibility of continuous use of well-established compounds. Proposed denosumab biosimilar RGB-14-P...UNLABELLED: Osteoporosis is a chronic condition requiring long-term management of fracture risk. Biosimilars provide the possibility of continuous use of well-established compounds. Proposed denosumab biosimilar RGB-14-P demonstrated equivalent efficacy and similar pharmacodynamics, immunogenicity, and safety to the reference denosumab. Transitioning from reference denosumab to RGB-14-P was associated with continued effectiveness and safety. PURPOSE: To establish the therapeutic equivalence of RGB-14-P and reference denosumab (RD) in postmenopausal women with osteoporosis through demonstrating equivalent efficacy and similar safety, pharmacodynamics (PD), and immunogenicity when transitioning from RD to RGB-14-P. METHODS: Patients (n = 188) who had received two 60-mg doses of RGB-14-P or RD (day 1 and week 26) in a randomised, blinded, controlled phase 3 study were re-randomised 1:1:1 at week 52 to continue RGB-14-P (n = 63) or RD (n = 63) or transition from RD to RGB-14-P (n = 62) and followed to week 78. RESULTS: Gains in lumbar spine, hip, and femoral neck bone mineral density (BMD) observed in the first 52 weeks of treatment were further improved up to week 78 in all three groups, including patients who transitioned from RD to RGB-14-P. Incidences of new fragility fractures were comparable. Changes from baseline in serum PD markers (serum C-telopeptide of type I collagen and procollagen type I N-terminal propeptide) were maintained. The transition did not induce a discernible immunological reaction, and there were no clinically meaningful between-group differences in safety. CONCLUSION: Treatment responses to RGB-14-P or RD seen during the first 52 weeks of treatment further improved to week 78; transitioning from RD to RGB-14-P had no discernible impact on efficacy, PD, immunogenicity, or safety. The totality of the evidence on the proposed biosimilar RGB-14-P available to date demonstrated structural and functional similarity as well as PK, PD, and therapeutic equivalence to reference denosumab, which suggests that RGB-14-P can be considered for long-term treatment, as well as a continuation of denosumab treatment.
Vandenput L, Johansson H, McCloskey EV
… +84 more, Liu E, Schini M, Åkesson KE, Anderson FA, Azagra R, Bager CL, Beaudart C, Bischoff-Ferrari HA, Biver E, Bruyère O, Cauley JA, Center JR, Chapurlat R, Christiansen C, Cooper C, Crandall CJ, Cummings SR, da Silva JAP, Dawson-Hughes B, Diez-Perez A, Dufour AB, Eisman JA, Elders PJM, Ferrari S, Fujita Y, Fujiwara S, Glüer CC, Goldshtein I, Goltzman D, Gudnason V, Hall J, Hans D, Hoff M, Hollick RJ, Huisman M, Iki M, Ish-Shalom S, Jones G, Karlsson MK, Khosla S, Kiel DP, Koh WP, Koromani F, Kotowicz MA, Kröger H, Kwok T, Lamy O, Langhammer A, Larijani B, Lippuner K, McGuigan FEA, Mellström D, Merlijn T, Nguyen TV, Nordström A, Nordström P, O'Neill TW, Obermayer-Pietsch B, Ohlsson C, Orwoll ES, Pasco JA, Rivadeneira F, Schott AM, Shiroma EJ, Siggeirsdottir K, Simonsick EM, Sornay-Rendu E, Sund R, Swart KMA, Szulc P, Tamaki J, Torgerson DJ, van Schoor NM, van Staa TP, Vila J, Wareham NJ, Wright NC, Yoshimura N, Zillikens MC, Zwart M, Harvey NC, Lorentzon M, Leslie WD, Kanis JA
Osteoporos Int
· 2026 Mar · PMID 41874643
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Li VKC, Cosgrove S, Collins K
… +15 more, Baden P, Blennerhassett R, Chan BA, Chan LH, Day D, Goodwin B, Kwok A, Packham D, Kyaw KT, Todaro C, Webber K, Williams J, Zengin A, Grech L, BHCS study team
Osteoporos Int
· 2026 Mar · PMID 41872365
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OBJECTIVE: Accelerated bone loss is a side effect of many anticancer treatments, posing significant health challenges for cancer survivors. The aim of this systematic review was to evaluate and synthesize recommendations...OBJECTIVE: Accelerated bone loss is a side effect of many anticancer treatments, posing significant health challenges for cancer survivors. The aim of this systematic review was to evaluate and synthesize recommendations for the management of bone health, specifically fracture and osteoporosis risk, in clinical guidelines for people with cancer. METHODS: Searches related to bone health clinical guidelines for cancer patients were conducted in four electronic databases (PubMed, EMBASE, CINAHL, and Scopus). Data extraction was performed independently by multiple authors. Quality appraisal was performed using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument. Guidelines were categorized into three key focus areas (pharmacological interventions, screening, and lifestyle modifications) and compared across cancer types. RESULTS: A total of sixty-five guidelines were included in the systematic review. Two-thirds of guidelines included recommendations related to lifestyle (most commonly vitamin D and calcium supplementation), 76% related to screening (mostly bone mineral density via DXA), and 89% related to pharmacological intervention (most commonly bisphosphonates and denosumab). Fifty-four percent included recommendations in all three domains. Using the AGREE II tool, 42 guidelines were rated moderate and 23 high with strong scoring in domains of Scope and Purpose, Clarity of Presentation and Editorial Independence. CONCLUSIONS: Findings highlight variations in guideline quality, with many lacking holistic, multidisciplinary recommendations for bone health management. Further development of guidelines supporting patients impacted by multiple risk factors, and the inclusion of management strategies to mitigate compounding effects of cancer-related bone loss and age-related bone degradation among cancer patients, is recommended.
Osteoporos Int
· 2026 Mar · PMID 41872364
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UNLABELLED: REMS estimates bone mineral density and fracture risk. This study found that its output is driven mainly by demographic factors (age and weight) rather than direct skeletal measurement. This affects interpret...UNLABELLED: REMS estimates bone mineral density and fracture risk. This study found that its output is driven mainly by demographic factors (age and weight) rather than direct skeletal measurement. This affects interpretation of outliers, discordance with DXA, and monitoring. Using REMS within FRAX, which already includes demographic variables, may introduce confounding effects. Algorithm transparency is essential to reassess REMS' clinical role. PURPOSE: Recent findings have questioned the dependency of radiofrequency echographic multi-spectrometry (REMS) outputs on demographic inputs. This study investigates the extent to which REMS-derived fragility score (FS) and REMS-derived bone mineral density (REMS-BMD) values are influenced by demographic inputs (e.g., age, weight, and height) through the analysis of clinical data and controlled experimental manipulation. METHODS: A clinical cohort (178 females, 31 males) underwent REMS scans of the lumbar spine (LS) and femoral neck (FN). Multiple linear regression was used to determine the variance in REMS-BMD and FS explained by demographics. Additionally, five healthy volunteers underwent multiple REMS scans where age and weight inputs were artificially varied to measure the direct impact on the REMS-BMD output, assuming stable underlying bone. RESULTS: In the clinical cohort, regression models based on demographic variables of input age and input weight (as well as input height for LS) explained the majority of the variance for REMS-BMD (R > 0.90), FN FS (R > 0.95), and LS FS (R > 0.80) in both males and females. In the experimental cohort, artificially increasing the input age caused a FN REMS-BMD decline of approximately 6.3% per decade, while an artificial 5-kg increase in weight input caused a FN REMS-BMD increase of approximately 4.3%. CONCLUSIONS: REMS-BMD and fragility scores are strongly influenced by demographic inputs, particularly age and weight. The REMS output therefore reflects an assessment of BMD and fracture risk strongly based on demographic parameters, rather than an ultrasound-based direct skeletal measurement. The results indicate the need for caution in individual patient assessment (particularly outliers), its application with FRAX calculations, and its use for longitudinal monitoring.
Su Y, Tian X, Wang Y
… +7 more, Zou Y, Hu M, Diji Z, Liu X, Li J, Jiang X, Fan M
Osteoporos Int
· 2026 Mar · PMID 41870607
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UNLABELLED: To investigate the correlation between a healthy sleep pattern and the incidence of falls and fractures in individuals with CVD. A healthy sleep pattern is significantly associated with a lower risk of falls...UNLABELLED: To investigate the correlation between a healthy sleep pattern and the incidence of falls and fractures in individuals with CVD. A healthy sleep pattern is significantly associated with a lower risk of falls and fractures in CVD patients. This study highlights the importance of sleep management in CVD care. PURPOSE: Epidemiological evidence on whether patients with cardiovascular disease (CVD) could benefit from combined healthy sleep behaviors is limited. We prospectively evaluated the association of multiple sleep behaviors with incident falls and fractures in individuals with CVD. METHODS: Sixty eight thousand nine hundred sixty-one UK Biobank participants with prevalent CVD were included. A healthy sleep score (0-4 points) combined four factors: optimal sleep duration (7-8 h/day), early chronotype, infrequent insomnia, and infrequent daytime sleepiness. Each factor meeting the healthy criteria scored 1 point. Cox regression yielded adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for incident falls and fractures. RESULTS: Over a median follow-up of 13.4 years, 5565 falls, 4080 fractures, and 833 hip fractures were documented. Among CVD patients, 8% lower risks of fall and fracture outcomes were associated with each additional healthy sleep factor. Adjusted HRs (95% CI) for patients with healthy sleep pattern (3-4 scores) compared with patients having poor sleep pattern (0-1 scores) were 0.79 (0.72 to 0.85) for fall, 0.78 (0.71 to 0.86) for all fracture, and 0.79 (0.64 to 0.98) for hip fracture. Individually, both sleep 7-8 h/day and early chronotype were statistically correlated with a reduction risk of fall, all fracture, with HRs ranging between 0.84 and 0.93. CONCLUSION: A healthy sleep pattern is associated with reduced risk of falls and fractures among CVD patients. Our finding should act as a timely reminder to incorporate sleep into CVD management to prevent subsequent injury.
Glavas C, Ryan JR, Breasail MÓ
… +4 more, Gandham A, Ebeling PR, Mesinovic J, Scott D
Osteoporos Int
· 2026 Mar · PMID 41870606
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It is unclear whether comorbid low bone mineral density (BMD) and sarcopenia, known as 'osteosarcopenia', synergistically increase fall and fracture risk. This review aims to determine whether osteosarcopenia confers a g...It is unclear whether comorbid low bone mineral density (BMD) and sarcopenia, known as 'osteosarcopenia', synergistically increase fall and fracture risk. This review aims to determine whether osteosarcopenia confers a greater risk for incident falls and fractures than low BMD or sarcopenia alone. Relevant databases were searched from inception to 2025 for prospective studies in populations aged ≥ 50 years comparing fall and fracture risk in osteosarcopenia to low BMD (T-Score < -1.0) or sarcopenia alone. Meta-analyses calculated risk ratios (RR) and measures of interaction on additive (relative excess risk due to interaction; RERI) and multiplicative (multiplicative interaction ratio; MR) scales. Seven records (n = 813) were included. Osteosarcopenia was associated with similar fracture risk as low BMD (RR 1.22; 95% CI 0.96, 1.56; k = 6, I = 0%), but higher risk than sarcopenia (RR 2.12; 95% CI 1.42, 3.15; k = 5; I = 0%). Falls risk did not differ for osteosarcopenia compared to low BMD (RR 1.15; 95% CI 0.44, 2.97; k = 3; I = 72.9%) or sarcopenia (RR 1.06; 95% CI 0.70, 1.59; k = 3; I = 1.1%). Synergy analyses showed pooled RERI of 0.35 (95% CI - 0.22, 0.91; k = 5) for fractures and - 0.16 (95% CI - 0.60, 0.28; k = 3) for falls, with MR estimates of 1.21 (95% CI 0.90 to 1.62) and 0.83 (95% CI, 0.64 to 1.09), respectively. Risk of incident fracture in osteosarcopenia is similar to that of low BMD, but higher than sarcopenia, and falls risk does not differ between conditions. The absence of significant additive or multiplicative interactions suggests there is insufficient evidence to support the promotion of osteosarcopenia as a distinct diagnostic entity.