Osteoporos Int [JOURNAL]
Sun
200 papers
Comparative efficacy of different traditional Chinese exercises on bone mineral density in older adults: a systematic review and network meta-analysis.
Hou M, Jin S, Luo J … +1 more , Yang L
Osteoporos Int · 2026 Mar · PMID 41865157 · Publisher ↗
BACKGROUND: Osteoporosis is a major public health concern in the aging global population. Traditional Chinese Exercises (TCEs) are promising non-pharmacological interventions, but their comparative efficacy for improving...
BACKGROUND: Osteoporosis is a major public health concern in the aging global population. Traditional Chinese Exercises (TCEs) are promising non-pharmacological interventions, but their comparative efficacy for improving bonemineral density (BMD) at specific skeletal sites remains unclear. OBJECTIVE: This systematic review and network meta-analysis (NMA) aimed to compare and rank the effects of four common TCEs (Taiji, Baduanjin, Wuqinxi, Yijinjing) on BMD at various sites in older adults. METHODS: We systematically searched PubMed, Web of Science, Scopus, CNKI, WanFang, and WeiPu databases from inception to July 31, 2025, for randomized controlled trials (RCTs) investigating TCEs for BMD in older adults. Two reviewers independently performed study selection, data extraction, and risk-of-bias assessment using the Cochrane RoB 2 tool. A frequentist NMA was conducted using Stata 17 and R software to estimate pooled mean differences (MDs) with 95% confidence intervals (CIs). Treatments were ranked using the surface under the cumulative ranking curve (SUCRA). RESULTS: Thirty-one RCTs (n = 2,457 participants) were included. For lumbar spine BMD, Baduanjin (MD = 0.10, 95% CI0.06 to 0.14; SUCRA = 91.6%), Yijinjing (MD = 0.11, 95% CI 0.00 to 0.16; SUCRA = 71.3%), and Taiji (MD = 0.07, 95% CI0.04 to 0.09; SUCRA = 57.4%) were significantly more effective than control. For femoral neck BMD, Yijinjing (SUCRA = 71.6%), Taiji (SUCRA = 67.7%), and Baduanjin (SUCRA = 58.0%) were the most effective. Taiji consistently ranked as the best intervention for both the greater trochanter (SUCRA = 83.1%) and Ward's triangle (SUCRA = 83.5%). Wuqinxi generally showed non-significant effects compared to control across all sites. The overall risk of bias was a concern, but sensitivity analyses excluding high-risk studies reduced heterogeneity and strengthened the results. CONCLUSION: The efficacy of TCEs on BMD is site-specific. Baduanjin and Yijinjing appear most beneficial for the lumbar spine, while Taiji demonstrates broad efficacy across hip sites. These findings support the use of tailored TCE prescriptions based on an individual's fracture risk profile, offering valuable non-pharmacological strategies forcommunity-based osteoporosis management in older adults. PROSPERO registration number: CRD420251108373.
A new age of osteoanabolic therapy? A real-world, two-centre study comparing effects of romosozumab, teriparatide, and antiresorptive therapies for osteoporosis.
Richardson-Thornton I, Brennan SC, Liu L … +5 more , Streeter C, Hill J, Clifton-Bligh RJ, Girgis CM, Gild ML
Osteoporos Int · 2026 Apr · PMID 41860715 · Publisher ↗
UNLABELLED: Romosozumab demonstrates strong real-world effectiveness in improving bone density, with particularly pronounced gains at the lumbar spine. Treatment-naïve patients derive the greatest benefit. Lumbar spine i...
UNLABELLED: Romosozumab demonstrates strong real-world effectiveness in improving bone density, with particularly pronounced gains at the lumbar spine. Treatment-naïve patients derive the greatest benefit. Lumbar spine improvements surpass those achieved with teriparatide or anti-resorptive therapies, and longer prior exposure to anti-resorptives is associated with attenuated responses to romosozumab. INTRODUCTION: Osteoporosis is a progressive disease that leads to considerable morbidity. The osteoanabolic agent romosozumab has shown efficacy in clinical trials, enhancing bone mineral density (BMD) and reducing fracture risk. However, real-world evidence, particularly in patients receiving long-term anti-resorptive therapy, remains limited. This study aimed to characterise real-world outcomes of romosozumab use in an Australian cohort, identifying predictors of optimal response following standard anti-resorptive treatment. METHODS: This retrospective cohort study identified 53 patients treated with romosozumab from the electronic medical record (eMR) at tertiary hospitals between 2021 and 23 who had completed 12 months of therapy and where baseline and follow-up DXA scans were available for analysis. Comparative data for teriparatide and anti-resorptive treatment cohorts were obtained from prior eMR datasets (n = 54 and n = 60, respectively). RESULTS: Romosozumab treatment led to BMD increases at the lumbar spine (LS), total hip (TH), and femoral neck (FN), with a decrease at the wrist (p < 0.05). Mean BMD gains at LS were significantly higher with romosozumab than with teriparatide (11.3 ± 8.2% vs. 5.0 ± 8.6%, p < 0.001) and anti-resorptive treatment (11.3 ± 8.2% vs. 6.6 ± 6.1%, p < 0.001). Treatment-naïve patients achieved more pronounced gains at LS (14.0 ± 6.6%); TH (5.0 ± 1.7%) compared to those with prior anti-resorptive therapy (LS 10.7 ± 8.5%, p = 0.220; TH 1.9 ± 5.8%, p = 0.009). Duration of previous anti-resorptive treatment was inversely correlated with LS BMD gains on romosozumab (r = - 0.305, p = 0.026). Linear regression showed that more vertebral fractures, longer prior anti-resorptive use, and higher baseline LS BMD each attenuated the LS BMD response to romosozumab, with romosozumab outperforming teriparatide and anti-resorptives, while teriparatide showed no significant difference from standard anti-resorptives. CONCLUSION: Romosozumab provides real-world efficacy in BMD improvement, particularly at the LS, with significantly greater gains than those seen with teriparatide or standard therapies. Prior anti-resorptive use may attenuate romosozumab's anabolic effects, suggesting that treatment-naïve patients may benefit most from this therapy.
Impact of splenectomy on fracture risk via the bone-immune axis: A nationwide Korean cohort study.
Kang S, Choi NJ, Han K … +5 more , Park Y, Lee C, Jin S, Nam GE, Cho JW
Osteoporos Int · 2026 Mar · PMID 41857385 · Publisher ↗
UNLABELLED: Splenectomy compromises bone health by disrupting the immune-bone axis. In this nationwide cohort study, splenectomy was associated with increased risk of fractures, particularly hip fractures, with the stron...
UNLABELLED: Splenectomy compromises bone health by disrupting the immune-bone axis. In this nationwide cohort study, splenectomy was associated with increased risk of fractures, particularly hip fractures, with the strongest association observed after traumatic splenectomy. These findings support the need for bone quality monitoring and preventive strategies in post-splenectomy patients. BACKGROUND: Splenectomy may interfere with immune-mediated bone remodeling, potentially compromising bone quality and strength. However, large-scale, long-term evidence linking splenectomy to bone health remains limited. We aimed to investigate the association between splenectomy and fracture incidence using a nationwide cohort. METHODS: The analysis included 3,125,549 individuals who participated in national health screenings conducted by the Korean National Health Insurance Service, of which 769 had undergone splenectomy. The primary outcome was the incidence of new-onset fractures (hip, vertebral, or other fractures). Multivariable Cox proportional hazards models were used to assess fracture risk, adjusting for potential confounders. RESULTS: Over a median follow-up of 10.3 years, the splenectomy group exhibited a significantly increased risk for any fracture (hazard ratio [HR] 1.61, 95% confidence interval [CI] 1.33-1.95), hip fracture (HR 2.57, 95% CI 1.76-3.76), and other fractures (HR 1.36, 95% CI 1.05-1.76). Although splenectomy was not significantly associated with vertebral fracture risk in the overall population, analyses stratified by the indication of splenectomy revealed a pronounced increase in risk among individuals who underwent traumatic splenectomy, with a 3.27-fold higher risk of vertebral fracture (95% CI 1.06-10.15) and a 7.86-fold higher risk of hip fractures (95% CI 2.95-20.95). Subgroup analyses identified significantly higher vertebral fracture risks among males and current drinkers. CONCLUSION: Our findings indicate that splenectomy is associated with an increased risk of fractures, particularly hip fractures, with the association being most pronounced among individuals who underwent traumatic splenectomy. These findings highlight the necessity of individualized bone health monitoring and targeted preventive strategies for post-splenectomy patients.
The association between GLP-1 receptor agonists and fractures: a nationwide Danish nested case-control study.
Kvist AV, Andersen SS, Vestergaard P … +1 more , Viggers R
Osteoporos Int · 2026 Mar · PMID 41851446 · Publisher ↗
UNLABELLED: To examine whether GLP1-RA is associated with increased fracture risk, we compared 337,648 people with fractures to 675,296 people without fractures. Our adjusted analysis found that people with fractures ten...
UNLABELLED: To examine whether GLP1-RA is associated with increased fracture risk, we compared 337,648 people with fractures to 675,296 people without fractures. Our adjusted analysis found that people with fractures tended to use GLP1-RA less often than people without fractures. This suggests that GLP1-RA may reduce fracture risk. BACKGROUND: Glucagon-like peptide-1 (GLP-1) receptor agonists were introduced as a treatment for type 2 diabetes mellitus with weight loss as a beneficial side effect. Since then, the medications have been approved as weight-loss medication. However, rapid and substantial weight loss can lead to bone loss and increased fracture risk. METHODS: We identified persons aged 30-90 years with a fracture between 2017 and 2021 and matched them 1:2 with fracture-free controls by sex and year of birth. Conditional logistic regression models were used to estimate odds ratios (ORs) for any fracture and major osteoporotic fracture (MOF) associated with GLP-1 receptor agonist use. Analyses were adjusted for relevant risk factors. RESULTS: A total of 337,648 fracture cases and 675,296 fracture-free controls were included. In the unadjusted analyses, GLP-1 receptor agonist use did not differ between cases and controls (any fracture OR [confidence intervals (CI)], 1.00 [0.97-1.04]; MOF OR [CI], 0.96 [0.90-1.02]). In the adjusted analyses, GLP-1 receptor agonists were used less frequently in the group that sustained any fracture (OR [CI], 0.94 [0.90-0.97]) or MOF (OR [CI], 0.88 [0.83-0.94]) compared to the controls. CONCLUSION: GLP-1 receptor agonists may reduce fracture risk, suggesting a potential protective effect on bone health.
Association of physical activity with fracture: a prospective cohort study of 387,307 Chinese participants.
Yang Q, Zeng B, Zheng J … +3 more , Yu K, Dou L, Sun F
Osteoporos Int · 2026 Mar · PMID 41848860 · Publisher ↗
UNLABELLED: Analyzing data from over 387,000 Chinese adults, we found that moderate physical activity was associated with a lower risk of hip fracture. In contrast, high levels of activity driven by manual labor were ass...
UNLABELLED: Analyzing data from over 387,000 Chinese adults, we found that moderate physical activity was associated with a lower risk of hip fracture. In contrast, high levels of activity driven by manual labor were associated with increased overall fracture risk. These results highlight the need to differentiate between leisure and occupational exertion in health guidelines. BACKGROUND: Fractures are a major health burden in ageing populations, but evidence on the association between physical activity and fracture risk in Chinese adults is scarce. We aimed to investigate the relationship between physical activity and incident fracture in a large Chinese cohort. METHODS: In this prospective cohort study, we included 387,307 participants aged 40-79 years from the China Kadoorie Biobank. Physical activity was assessed via questionnaire and quantified primarily as total physical activity (TPA, metabolic equivalent of task-hours per day [MET-h/day]), with further disaggregation into occupational (OPA) and non-occupational (non-OPA) domains. Moderate-to-vigorous physical activity (MVPA) duration (min/week) was also analyzed. Incident fractures were ascertained through linkage to health insurance databases. Cox models were used to estimate hazard ratios (HRs) with 95% CIs. RESULTS: During a median follow-up of 10.1 years, 8964 fractures occurred. Higher levels of TPA were associated with an increased risk of fracture (quartile 3 [16.42-28.19 MET-h/day] HR 1.34, 95% CI 1.25-1.43; quartile 4 [> 28.19 MET-h/day] HR 1.47, 95% CI 1.37-1.58). This elevated risk was primarily driven by OPA. In contrast, non-OPA showed no significant association with fracture risk. A moderate level of TPA (quartile 2 [9.73-16.41 MET-h/day]) was associated with a lower risk of hip fracture (HR 0.82, 95% CI 0.71-0.94). When assessed by duration, MVPA of 300-449 min/week or ≥ 450 min/week was also associated with increased fracture risk. CONCLUSIONS: High levels of physical activity, particularly OPA, are associated with an increased risk of fracture in Chinese middle-aged and older adults, whereas non-OPA shows no such association. Moderate activity was associated with a lower risk of hip fracture. These findings highlight the importance of distinguishing between OPA and OPA in fracture prevention guidance.
Are birth characteristics related to bone quality measures in young adults? The HUNT study, Norway.
Holltrø HT, Nilsen TIL, Schei B … +7 more , Horn J, Holvik K, Daltveit AKN, Dennison EM, Harvey NC, Langhammer A, Hoff M
Osteoporos Int · 2026 Mar · PMID 41848859 · Publisher ↗
UNLABELLED: This population-based study investigated the association between birth characteristics and DXA-derived bone quality in 2,680 young adults (aged 20-54 years). Higher birth weight and length were positively ass...
UNLABELLED: This population-based study investigated the association between birth characteristics and DXA-derived bone quality in 2,680 young adults (aged 20-54 years). Higher birth weight and length were positively associated with bone strength measures, while associations with buckling ratio and hip axis length were weaker and less consistent. PURPOSE: To investigate the association between birth characteristics and bone quality indicators from dual-energy X-ray absorptiometry (DXA) in young adults. METHODS: This population-based study included 2,680 participants (60% women), aged 20-54 years, from the Trøndelag Health Study (HUNT3 and HUNT4), linked with birth data from the Medical Birth Registry of Norway. Birth characteristics included birth weight, birth length, and birth weight relative to gestational age and sex (categorized as small, appropriate, or large for gestational age). Linear regressions assessed associations with bone quality measures, including cross-sectional area, cross-sectional moment of inertia, buckling ratio, and hip axis length. Analyses were adjusted for sex, birth year, age at DXA scan, gestational length, and adult height (for buckling ratio and hip axis length). Additional analyses included bone mineral density (BMD) to assess direct effects. RESULTS: Higher birth weight and length were positively associated with cross-sectional area and cross-sectional moment of inertia. For each SD increase in birth weight and length, CSA increased by 4.33 and 4.29 mm, and CSMI by 0.74 and 0.45 mm, respectively. After BMD adjustment, these associations were attenuated for both birth weight (CSA: 1.90 mm; CSMI: 0.55 mm), and birth length (CSA: 2.13 mm; CSMI: 0.58 mm). Buckling ratio and hip axis length showed weaker and less consistent associations with birth characteristics, but the association of birth weight and small for gestational age with buckling ratio was somewhat strengthened after adjustment for BMD. CONCLUSION: Birth characteristics are associated with both bone strength and geometry in young adulthood. These associations are partly independent of BMD, highlighting the value of DXA-derived bone quality measures in assessing skeletal health.
IOF REGIONAL 2025 IOF REGIONAL 2025 9th Asia-Pacific Bone Health Conference: Posters Abstracts.
Osteoporos Int · 2026 Apr · PMID 41848858 · Publisher ↗
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Association of orthogeriatric co-management with the occurrence of secondary fragility fractures in patients with an initial hip fracture.
Rapp K, Schoene D, Roigk P … +8 more , Becker C, Konnopka C, König HH, Friess T, Schoeneberg C, Jaensch A, Rothenbacher D, Büchele G
Osteoporos Int · 2026 Mar · PMID 41844918 · Publisher ↗
UNLABELLED: This study examined the association between the availability of an orthogeriatric co-management and secondary fractures in 97,976 hip fracture patients. We found that the presence of orthogeriatric co-managem...
UNLABELLED: This study examined the association between the availability of an orthogeriatric co-management and secondary fractures in 97,976 hip fracture patients. We found that the presence of orthogeriatric co-management was associated with a small but sustainable reduction in secondary fragility fractures in patients with an initial hip fracture. PURPOSE: The risk of experiencing a subsequent fracture is particularly high immediately following an initial fragility fracture. Geriatricians are increasingly involved in the management of fragility fractures. However, there is currently no evidence indicating whether this orthogeriatric co-management (OGCM) can reduce the incidence of secondary fracture. This study aimed to analyse the association between OGCM and the occurrence of secondary fragility fractures in patients with an initial hip fracture. METHODS: Nationwide health insurance data from Germany were used to identify hip fracture patients aged ≥ 80 years. According to the presence of an OGCM, hospitals were categorised into those with OGCM and those without OGCM. Outcomes were secondary fragility fractures (i.e. humerus, forearm, hip, pelvis, spine) within different time periods after an initial hip fracture. Crude incidences and hazard rate ratios for a secondary fragility fracture were calculated. RESULTS: The dataset included 97,976 hip fracture patients aged 80 and older from 716 hospitals (71% with OGCM). Within 12 months after the initial fracture, 5487 (5.6%) patients experienced at least one secondary fragility fracture. Patients treated in hospitals with OGCM had a lower incidence of secondary fragility fractures than those treated in hospitals without OGCM. For instance, after 1, 3 and 6 months, there was an absolute risk reduction of 0.1, 0.3 and 0.4% and a relative risk reduction of 27, 14 and 8%. CONCLUSIONS: The presence of an OGCM was associated with a small reduction in secondary fragility fractures in patients with an initial hip fracture.
Research progress of drug-induced osteoporosis.
Tan W, He T, Li J
Osteoporos Int · 2026 Mar · PMID 41840224 · Publisher ↗
Drug-induced osteoporosis (DIO) is an important part of secondary osteoporosis. This article discusses the effects of common drugs on bone metabolism and the possible mechanisms leading to osteoporosis and discusses the...
Drug-induced osteoporosis (DIO) is an important part of secondary osteoporosis. This article discusses the effects of common drugs on bone metabolism and the possible mechanisms leading to osteoporosis and discusses the possible treatment strategies. Although anti-osteoporosis drugs can effectively improve bone mineral density and reduce the risk of fracture and prevent the occurrence of DIO, long-term use of anti-osteoporosis drugs may lead to skeletal adverse events such as atypical femur fracture. Therefore, for the prevention and treatment of DIO, the benefits and adverse reactions of drugs should be comprehensively considered to develop an individualized treatment plan for patients.
Comment on: 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 : Topic: Cortical bone gains in weight loss: Biological reality or Q. C. T. artifact?
Lu M, Zhou H, Li X … +2 more , Zhang F, He L
Osteoporos Int · 2026 Apr · PMID 41824060 · Publisher ↗
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Authors' reply to comment on: 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.
Stapleton J, Greene KA, Leng X … +9 more , Lenchik L, Lyles MF, Nicklas BJ, Baker AM, Helgason B, Devane K, Shapses SA, Houston DK, Weaver AA
Osteoporos Int · 2026 Apr · PMID 41824059 · Publisher ↗
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Predictive value of BMD for hip and other fractures: a meta-analysis to update FRAX.
Kanis JA, McCloskey EV, Johansson H … +81 more , Liu E, Åkesson KE, Anderson FA, Azagra-Ledesma 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, Mellström D, Merlijn T, Nordström A, Nordström P, O Neill TW, Obermayer-Pietsch B, Ohlsson C, Orwoll ES, Pasco JA, Rivadeneira F, Schei B, Schott AM, Shiroma EJ, Siggeirsdottir K, Simonsick EM, Sornay-Rendu E, Sund R, Swart K, 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
Osteoporos Int · 2026 Mar · PMID 41820630 · Publisher ↗
UNLABELLED: The relationship between bone mineral density (BMD) at the femoral neck and fracture risk was determined in a meta-analysis of primary data of 307205 men and women from 53 cohort studies. Low BMD was an impor...
UNLABELLED: The relationship between bone mineral density (BMD) at the femoral neck and fracture risk was determined in a meta-analysis of primary data of 307205 men and women from 53 cohort studies. Low BMD was an important predictor of fracture risk, particularly for hip fracture. INTRODUCTION: This study aimed to quantify the relationship between DXA-measured femoral neck BMD and fracture risk and examine the effect of age, sex, time since measurement, and initial BMD value on fracture risk, with a view to updating FRAX®. METHODS: We studied 307,205 men and women from within 53 predominately population-based cohorts followed up for an average of 8.7 years and a total of 2,683,185 person-years. The association of BMD and fracture risk was examined using a Poisson model in each cohort separately by sex. Results were expressed as a gradient of risk (GR, hazard ratio/standard deviation decrease in BMD). The different studies were then merged using weighted coefficients. RESULTS: Most hip fractures arose in men and women with low bone mass or osteoporosis at baseline (73% and 92%, respectively) as was also the case for MOF (65% and 85%, respectively). BMD at the femoral neck strongly predicted hip fractures both in men and women with a similar gradient of risk and absolute risk at any given T-score. At the age of 65 years, the GR was 2.73 (95% CI = 2.29-3.26) in men and 2.61 (95% CI = 2.34-2.92) in women. However, the magnitude of association was significantly dependent on age, with a higher gradient of risk at younger ages. For example, at age 50 years, the GR was 3.49 (95% CI 2.51-4.84) in men and decreased to 2.14 (1.96-2.34) at age 80 years. The change in GR with age was slightly less marked in women (3.23 [2.75-3.80] and 2.11 [1.99-2.44], respectively). The GR for major osteoporotic fracture (MOF) remained unchanged with age (p = 0.12 for women and p = 0.89 for men). A significant decrease in GR for hip fracture was observed with increasing duration of follow-up, but the magnitude of the effect was modest compared with the effect of age. For other fracture outcomes, including non-hip major osteoporotic fracture, the gradient of risk was lower than for hip fracture. CONCLUSIONS: Femoral neck BMD is a risk factor for fracture of substantial importance, particularly for future hip fracture. The lower magnitude of association at older age is consistent with other non-skeletal factors contributing to hip fracture risk with advancing age. Its validation on an international basis supports its use in case finding strategies. Its use should, however, take account of the variations in predictive value of BMD with age, sex, length of follow-up, and BMD.
Comparing home-based and institutional rehabilitation for community-dwelling hip fracture patients: a matched cohort study.
Haugen J, Hagen TP
Osteoporos Int · 2026 Mar · PMID 41820629 · Publisher ↗
UNLABELLED: Home-based rehabilitation after hip fracture costs less than institutional care, but is care quality comparable? Using Norwegian registry data, we found that patients rehabilitated at home had substantially l...
UNLABELLED: Home-based rehabilitation after hip fracture costs less than institutional care, but is care quality comparable? Using Norwegian registry data, we found that patients rehabilitated at home had substantially lower mortality and readmission rates. These findings suggest home-based rehabilitation may offer both economic and clinical advantages. BACKGROUND: While home-based rehabilitation following hip fracture typically costs less than institutional care, questions remain about care quality equivalence. OBJECTIVE: To compare care quality between home-based and institutional rehabilitation by examining 1-year mortality and 30-day readmission rates among hip fracture patients. METHODS: We identified 10,790 community-dwelling hip fracture patients aged 60+ from the Norwegian Patient Registry (2018-2019). Patients receiving institutional rehabilitation were matched with those receiving home-based care using propensity score matching. Logistic regression examined treatment effects on outcomes. RESULTS: After propensity score matching, home-based treatment was associated with lower mortality (OR = 0.44; 95% CI, 0.38-0.51) and lower readmission rates (OR = 0.56; 95% CI, 0.49-0.63) compared to treatment at institutions. CONCLUSION: Community-dwelling hip fracture patients receiving institutional rehabilitation had higher mortality and readmission rates than those treated at home, suggesting superior care quality with home-based treatment.
Letter comments on: a programmatic approach to osteoporosis treatment: insight from a 20-year longitudinal study.
Jayaswal RP, Kholiya K
Osteoporos Int · 2026 Apr · PMID 41817743 · Publisher ↗
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Secondary fracture risk after hip fracture in older patients: an updated sex-specific systematic review and meta analysis with GRADE and PAF assessment.
Ren J, Liu M, Wang B … +7 more , Bai C, Yang K, Ma X, Zhang L, Sai H, Zhu Y, Li X
Osteoporos Int · 2026 Mar · PMID 41817742 · Publisher ↗
BACKGROUND: The incidence and risk factors of secondary hip fractures is unknown. This study aims to evaluate the sex-specific incidence and risk factors of secondary hip fractures in elderly patients after hip fracture....
BACKGROUND: The incidence and risk factors of secondary hip fractures is unknown. This study aims to evaluate the sex-specific incidence and risk factors of secondary hip fractures in elderly patients after hip fracture. METHODS: We did a systematic search of PubMed, Web of Science, Cochrane Library, Embase, MEDLINE, CBM, CNKI, VIP, and Wanfang Database from January 1, 2000 to August 1, 2025, for cohort studies that assessed incidence and risk factors among patients with secondary hip fracture. Eligible studies were appraised using the Newcastle-Ottawa Scale. The primary outcomes were incidence rates for secondary hip fracture, reported separately for man and woman. The secondary outcomes were risk factors for secondary hip fractures. Effect sizes included odds ratio (OR) with 95% confidence intervals (CI). Sensitivity analyses and subgroup analyses were performed to explore sources of heterogeneity. We used the population attributable fraction (PAF) and the grading of recommendations, assessment, development and evaluation (GRADE) to assess contribution and evidence quality. RESULTS: 19 eligible studies were included. The pooled incidence of secondary hip fractures among older adults was 10.63% (95% CI, 9.9%-11.4%), higher in females (14.94%; 95% CI, 0.123-0.178) than in males (9.89%; 95% CI, 0.083-0.116). Significant risk factors were reduced gluteus medius/minimus (G.Med/MinM) and gluteus maximus muscle density, reduced bone mineral density at hip, femoral neck, and intertrochanteric regions, osteoporosis, cognitive impairment, and calcium/vitamin D deficiency. Among these, G.Med/MinM density lower (moderate quality evidence, PAF, 6.54%, 95% CI 0.038-0.093), and calcium/vitamin D deficiency (moderate quality evidence, PAF,1.12%, 95% CI 0.007-0.016) were important factors. CONCLUSION: Roughly one in ten older adults suffers a secondary hip fracture, with substantially higher rates in women. Muscle degeneration and inadequate calcium/vitamin D intake emerged as the most influential and potentially modifiable contributors. Targeted postoperative interventions addressing these factors may reduce recurrent fracture burden in aging populations. PROSPERO: CRD420251136318.
Romosozumab is effective in patients with variants in LRP5, LRP6, or WNT1.
von Brackel FN, Dehne N, Kornak U … +4 more , Barvencik F, Schinke T, Amling M, Oheim R
Osteoporos Int · 2026 Mar · PMID 41813941 · Publisher ↗
UNLABELLED: Romosozumab has proven efficacy in postmenopausal osteoporosis, but data in LRP5/6 or WNT1 variant carriers are scarce. In 33 patient-years of women carrying such variants, romosozumab improved BMD and bone f...
UNLABELLED: Romosozumab has proven efficacy in postmenopausal osteoporosis, but data in LRP5/6 or WNT1 variant carriers are scarce. In 33 patient-years of women carrying such variants, romosozumab improved BMD and bone formation more than antiresorptives or no treatment. These findings suggest romosozumab as a potential therapy for genetically defined bone loss. PURPOSE: The sclerostin inhibitor romosozumab is an osteoanabolic drug that enhances the canonical Wnt-β-catenin pathway. While its efficacy in postmenopausal osteoporosis is known, clinical data on the use of romosozumab in patients with variants in the LRP5, LRP6, or WNT1 gene affecting this pathway remain limited. METHOD: We present clinical routine data of 33 patient-years in 27 postmenopausal women with heterozygous deleterious or established risk alleles variants (ACMG class 2-5) in the LRP5/6 or WNT1 gene, using dual-energy X-ray absorptiometry (DXA), high-resolution peripheral quantitative computed tomography (HR-pQCT), and laboratory parameters. Among these, 12 were treated with vitamin D and calcium only (NoT), 11 with antiresorptive therapy (AR), and 10 with romosozumab (ROMO). RESULTS: Patients treated with romosozumab showed significantly greater gains in areal bone mineral density (aBMD) compared to others (lumbar spine-NoT = -0.12% ± 5.02%, AR = + 3.97% ± 4.71%, ROMO = + 15.74% ± 7.63%, p < 0.001 for ROMO vs. AR and vs. NoT). This was accompanied by an increase in trabecular bone density and mass in the tibia, as well as elevated bone formation markers such as bone alkaline phosphatase after 6 months (AR = -3.36 µg/L ± 8.044 µg/L vs. ROMO = + 3.08 µg/L ± 2.21 µg/L, p = 0.026). Our findings indicate that romosozumab is effective in patients with heterozygous variants in the LRP5/6 or WNT1 gene. Here, romosozumab was superior to established antiresorptive treatments. CONCLUSION: Thus, romosozumab might be a specific treatment for these patients. However, further studies are needed with larger patient cohorts and in particular with regard to biallelic loss-of-function variants in the LRP 5/6 or WNT1 gene.
Clinical implementation of AI for vertebral fracture detection in CT aligned with fracture liaison services: high prevalence of undiagnosed vertebral fractures.
Woisetschläger M, Baldimtsi E, Lindblom M … +3 more , Davidson T, Bjerner T, Spångeus A
Osteoporos Int · 2026 Mar · PMID 41805842 · Publisher ↗
UNLABELLED: We assessed feasibility and effectiveness of AI-based VF screening in CT, integrated with a local FLS. The system identified VFs in 14% of patients, half previously unrecognized or untreated. This suggests th...
UNLABELLED: We assessed feasibility and effectiveness of AI-based VF screening in CT, integrated with a local FLS. The system identified VFs in 14% of patients, half previously unrecognized or untreated. This suggests that 2-3 patients with VFs were identified daily at our hospital, highlighting the potential clinical impact of AI-assisted detection. PURPOSE: To evaluate the feasibility and efficacy of integrating an AI algorithm into the radiology workflow for opportunistic vertebral fracture (VF) screening in CT and align it to a local fracture liaison service (FLS). METHODS: The AI algorithm was integrated into the radiology workflow and applied to all non-skeletal CT scans covering thorax and/or abdomen from patients aged ≥ 50 years over a four-month period at our hospital (catchment area ~ 250,000). Detected VFs were verified by radiologists and subsequently referred to the FLS for further management. A system was established to enable both technical and clinical monitoring. RESULTS: The AI setup and workflow were considered feasible and robust, and AI showed a high performance. During the study period, 3971 unique patients (mean age 72 ± 11 years; 51% female) underwent 5147 CT scans. The AI algorithm identified VFs in 566 patients (14%, mean age 78 ± 10; 62% women), all of which were confirmed by radiologist. After clinical triage, 49% were considered in need of further osteoporosis evaluation/treatment, the remainder where either terminally ill/died shortly after CT or were considered correctly handled before. CONCLUSION: AI-based opportunistic screening for VF is feasible and effective in routine clinical practice. Integration of such tools into radiology workflows enhances the detection of at-risk patients and supports timely referral to FLS, potentially reducing the burden of untreated osteoporosis and future fracture risk. In our clinical setting, this meant 2-3 new identified patients every day. These findings support the broader implementation of AI in secondary fracture prevention strategies. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT07100756.
Molecular-level understanding of the aging bone and regeneration mechanisms using computational methods.
Stojceski F, Zaverdas H, Danani A … +7 more , Mengoni A, Ledda M, Labate GFD, Kalogeras A, Theofilatos K, Mavroudi S, Grasso G
Osteoporos Int · 2026 Mar · PMID 41805841 · Publisher ↗
Bone degeneration diseases, such as osteoporosis, are skeletal disorders characterized by diminished bone mass and increased susceptibility to fractures and represent a growing global health challenge, particularly in ag...
Bone degeneration diseases, such as osteoporosis, are skeletal disorders characterized by diminished bone mass and increased susceptibility to fractures and represent a growing global health challenge, particularly in aging populations. The development of effective therapeutic strategies necessitates a deep understanding of the complex biological processes underlying bone remodeling, regeneration, and homeostasis. To address these challenges, computational approaches have played a crucial role in advancing our understanding of bone biology and improving therapeutic strategies. This review explores these contributions across three main areas: (1) elucidating the structural organization and interactions within the bone matrix, particularly between collagen and hydroxyapatite; (2) investigating the regulatory roles of non-collagenous proteins, such as bone morphogenetic proteins, osteocalcin, osteopontin, and fibronectin, in bone mineralization; and (3) facilitating drug discovery and development for bone regeneration by targeting key pathways and molecules, including sclerostin, RANKL, and estrogen receptors. Molecular dynamics and docking have helped identify and optimize natural and synthetic therapeutic agents for these critical pathways. Additionally, we apply bioinformatics tools to analyze bone regeneration and degeneration pathways, emphasizing the need for more accurate computational techniques to reconstruct their interactome. As these techniques continue to evolve, integrating advancements in machine learning, molecular dynamics, and multi-scale modeling, their potential to bridge the gap between experimental research and clinical application is becoming increasingly apparent. A multidisciplinary approach that combines computational predictions with experimental validation and clinical data is poised to drive the development of personalized and effective osteoporosis therapies, ultimately reducing the global burden of this debilitating disease.
Bone mineral density in paediatric to young adult tennis players: a narrative review.
Nicol G, Sammut L
Osteoporos Int · 2026 Mar · PMID 41803487 · Publisher ↗
Tennis is a high-impact unilateral sport that may enhance bone mineral density (BMD) during growth, although evidence in young players has been limited. This review finds that tennis participation is associated with high...
Tennis is a high-impact unilateral sport that may enhance bone mineral density (BMD) during growth, although evidence in young players has been limited. This review finds that tennis participation is associated with higher site-specific BMD, with lean body mass (LBM) being the strongest predictor, while training-related associations remain inconsistent. Osteoporosis is defined by compromised bone strength due to reduced bone mass and deterioration of bone microarchitecture, leading to an increased risk of fragility fracture and associated morbidity and mortality. Peak bone mass (PBM) is largely accrued during childhood, adolescence, and young adulthood, making youth a critical period for optimizing bone health. High-impact sports such as tennis may promote osteogenic responses of bone, yet evidence in younger populations remains limited. This narrative review explores findings from 15 studies examining BMD in paediatric, adolescent, and young adult tennis players, identified through a systematic search of PubMed, Google Scholar, and Embase. Across studies, tennis players demonstrated significantly higher BMD compared to controls, particularly in the dominant upper limb, reflecting site-specific adaptations to unilateral loading. LBM was highlighted as the strongest predictor of BMD, while associations with training frequency and strength measures were mixed. Overall, tennis participation during growth appears to be associated with favourable site-specific skeletal adaptations. However, small sample sizes and heterogeneity in study design, participant maturity, and outcome reporting limit generalisability, underscoring the need for further research.
Comparison of traditional and new treatments for fibrous dysplasia: a systematic review and meta-analysis.
Levaillant L, Mabilleau G, Malagié A … +4 more , Donat S, Coutant R, Rodien P, Briet C
Osteoporos Int · 2026 Mar · PMID 41790192 · Publisher ↗
INTRODUCTION: Fibrous dysplasia, alone or associated with McCune-Albright syndrome, is a rare bone disorder that can cause pain, deformity, fractures, and thus affect quality of life. Various treatments have been tried,...
INTRODUCTION: Fibrous dysplasia, alone or associated with McCune-Albright syndrome, is a rare bone disorder that can cause pain, deformity, fractures, and thus affect quality of life. Various treatments have been tried, starting with bisphosphonate administration, and now targeted therapies are being developed. Due to the rarity of the disease, there are only a few randomised clinical trials, making it difficult to understand the efficacy of each treatment. The aim of this systematic review is to provide an overview of what has been done in the past and what has been published recently on new targeted therapies. METHODS: A systematic search was conducted in MEDLINE and Web of Science up to February 3, 2026 for all oral, subcutaneous or intravenous therapies in patients with fibrous dysplasia. Data extraction and analysis followed PRISMA guidelines. The review was registered on PROSPERO, no. 42024602268. RESULTS: Fifty-six studies were included, most focusing on nitrogen-containing bisphosphonates, followed by new targeted therapies, mainly denosumab, a monoclonal antibody targeting RANKL. Overall, almost three-quarters of the studies showed a reduction in lesion size or activity, with only a few studies quantifying this reduction by various means (X-rays, CT, MRI, or Na[18F]F PET-CT). Almost all showed a reduction in circulating bone markers (n = 45/47), with a weighted mean reduction of 31 ± 18% in alkaline phosphatase (n = 30). The new targeted therapies looked promising, in particular denosumab showing a 66 ± 15% weighted mean reduction in fibrous dysplasia lesion activity on Na[18F]F PET-CT, but some patients have experienced serious side effects, which need to be better understood in order to prevent them more effectively. CONCLUSION: Denosumab has shown promising results in recent years in terms of reducing the size and activity of fibrous dysplasia lesions and improving bone markers. Further research is needed to better prevent the serious side effects sometimes associated with this treatment.
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