This nationwide study assessed clinical features of osteoporosis in Turkish adults with diabetes. Osteoporosis prevalence was 9.36% in type 1 diabetes and 19.13% in type 2 diabetes, with higher rates in women and older individuals. Although overall fracture prevalence was low, fractures were markedly more frequent in patients with osteoporosis. Despite the high burden, most patients did not receive osteoporosis therapy, and age, female sex, and vascular complications were independently associated with osteoporosis. Fragility fractures related to diabetes are increasing worldwide with rising life expectancy. We aimed to investigate the prevalence of osteoporosis and its associated factors in a large nationwide cohort of adults with type 1 (T1DM) and type 2 diabetes (T2DM) in Türkiye. Using Turkish Ministry of Health electronic health records (2015-2021), adults with T1DM and T2DM were identified and classified according to the presence or absence of osteoporosis. Demographics, comorbidities, diabetes-related complications, fracture diagnoses, and laboratory parameters were analyzed. Factors independently associated with osteoporosis were evaluated using multivariable logistic regression. The cohort included 76,742 individuals with T1DM (mean age 44.3 ± 19.1 years; 45.8% women) and 7,006,910 with T2DM (mean age 59.1 ± 13.4 years; 60.2% women). Overall osteoporosis prevalence was 19.03% and was 9.3% in T1DM and 19.1% in T2DM. Osteoporosis was more frequent in women than men (T1DM: 14.17% vs 5.29% p < 0.001; T2DM: 27.76% vs 6.04% p < 0.001) and increased with age in both diabetes types. Fractures occurred in 0.22% of patients with T1DM and 0.21% of those with T2DM. In T1DM, fracture frequency was approximately sixfold higher in patients with osteoporosis than in those without osteoporosis (RR ≈ 6.92; 95% CI 5.09-9.39; p < 0.001), whereas in T2DM osteoporosis was associated with an approximately fourfold higher fracture frequency (RR ≈ 3.98). Macrovascular and microvascular complications were more frequent among osteoporosis patients with T1DM than those with T2DM. Only 13.4% of patients with osteoporosis received pharmacological osteoporosis therapy. In multivariable analysis, older age (OR 1.06), female sex (OR 6.58), cardiovascular disease (OR 1.58), and microvascular complications (OR 1.38) were independently associated with osteoporosis. In this nationwide Turkish cohort, osteoporosis affected 9.36% of adults with T1DM and 19.13% of those with T2DM. Among patients with osteoporosis, vascular complications were more prevalent in T1DM than in T2DM.Despite the substantial disease burden and the markedly higher fracture frequency in individuals with osteoporosis, most patients remained untreated.
Osteoporotic fractures are associated with morbidity, mortality and high healthcare costs. Fracture Liaison Services (FLS) prevent subsequent osteoporotic fractures but are traditionally limited to include major osteoporotic fractures (MOF). When the FLS at Skaraborg Hospital in Skövde, Sweden included both MOF and non-MOF, treatment indication was present for 51% (Number Needed to Screen (NNS) 1.41) and 71% (NNS 1.95), respectively. High treatment indication rates and low NNS were observed both in patients with MOF and non-MOF, suggesting that all fracture patients should be included in FLSs. Fracture Liaison Services (FLS) are coordinator-based, multidisciplinary programmes that provide systematic secondary prevention of fragility fractures. Many FLS programmes have been limited to major osteoporotic fractures (MOF, i.e. vertebrae, hip, proximal humerus, wrist and pelvis), but it is unclear whether patients with other types of fractures have similar risk profiles, as defined by low bone mineral density (BMD) and present clinical risk factors (CRF). To compare key characteristics related to fracture risk (e.g. FRAX and BMD) and eligibility for osteoporosis treatment between patients with a recent non-MOF and those with recent MOF after inclusion in an FLS at Skaraborg Hospital in Skövde, Sweden. Patients 50 years and older with a BMD measurement between December 2023 and May 2024, with a recent fracture were included (N = 705). Data on age, sex, CRFs, FRAX score, BMD, trabecular bone score, vertebral fracture assessment (VFA), and physician-issued assessment of osteoporosis treatment indication from the FLS evaluation were collected. Differences were analyzed using t-tests, chi-square tests, and expressed as standardized mean differences. The odds ratio (OR) for osteoporosis treatment indication (yes/no) was calculated using logistic regression for non-MOF vs. MOF, with adjustment for incremental number of confounders. There were high rates of osteoporosis treatment indication in both non-MOF (51%) and MOF (71%) patients, and low numbers needed to screen (NNS) to identify one patient with osteoporosis treatment indication in both the non-MOF (1.95) and MOF groups (1.41). When comparing non-MOF and MOF within the subgroup of patients with osteoporosis treatment indication, BMD and risk profiles were similar. The proportions of patients with osteoporosis treatment indications were high regardless of fracture site category, indicating that patients with both recent non-MOF and MOF should be included in FLS programmes.
This study aimed to describe the level of knowledge about osteoporosis prevention among health science students and to identify influencing factors. Results show a low level of knowledge regarding osteoporosis 13.27 ± 3.67 out of 32. Also influencing factors were such as gender (p = 0.007), age (p = 0.003), living environment (p = 0.009) and educational level (p = 0.017). The Purpose of this study was to describe the level of knowledge about osteoporosis prevention among health science students and to identify influencing factors. A descriptive correlational study was conducted among 524 health science students enrolled at the Higher School of Health Sciences and Techniques of Sousse (HSHSTS) and the Higher Institute of Nursing Sciences of Sousse (HINSS), Tunisia. Data were collected using a validated, self-administered questionnaire based on the revised Osteoporosis Knowledge Test (OKT). The OKT included two subscales assessing knowledge of osteoporosis prevention through physical activity and nutrition. Each correct response was awarded one point, while incorrect or "unknown" answers received zero points. The questionnaire also gathered sociodemographic information, including gender, age, living environment, and educational level. The participants had a mean age of 20.5 ± 1.4 years. Overall, 71.8% of students demonstrated a low level of knowledge regarding osteoporosis. The mean total knowledge score was 13.27 ± 3.67 out of 32. Female students scored significantly higher on the overall OKT compared to males (p = 0.007). Physical activity subscale scores were significantly associated with gender (p = 0.005), age (p = 0.003), living environment (p = 0.009), and education level (p = 0.010). Similarly, nutrition-related knowledge showed significant associations with gender (p < 0.001), age (p = 0.001), living environment (p = 0.033), and education level (p = 0.002). Key limitations include the cross-sectional design, possible participation bias from differing response rates between institutions, and a markedly imbalanced sex ratio, which may limit generalizability. These findings highlight the need for targeted educational interventions and early integration of osteoporosis content into university curricula to improve knowledge.
Distal radius fractures may indicate underlying osteoporosis. In 856 surgical patients ≥ 50 years, DXA testing rose from 19.0 to 85.7%; 64.5% had osteoporosis and 36.3% had fracture risk. Many were previously untreated. Routine DXA screening for all DRF patients ≥ 50, including men, may enable early treatment and secondary fracture prevention. The objective was to investigate the dual-energy X-ray absorptiometry (DXA) examination rate, osteoporosis diagnosis rate, and osteoporosis severity in distal radius fracture (DRF) at a trauma flagship hospital. We retrospectively examined 856 DRF patients aged 50 years or older (723 women, 133 men; mean 71.8 years) who underwent surgery between 2007 and 2025. We evaluated the presence of DXA testing, osteoporosis diagnosis (T-score ≤ -2.5SD), and osteoporosis with high fracture risk, including (1) L-spine T-score < -3.3SD, (2) T-score ≤ -2.5SD with at least one fragility fracture, (3) two or more vertebral fractures, or (4) semiquantitative grade 3 vertebral fracture. Subgroup comparisons were according to sex, age, and mechanism of injury (low vs. high energy). The chi-square test and Cochran-Armitage test were used for statistical analysis. DXA implementation rate was 31.0% and increased significantly from 19.0% in 2007 to 85.7% in 2025. This rate was significantly higher in women (34.2%) than men (13.5%). Of those tested, 64.5% were diagnosed with osteoporosis (women 65.2%, men 55.6%). Osteoporosis was observed in over half of patients even in 50 s (57.1%) and with high-energy injuries (56.5%). Among osteoporosis patients, 81.9% had not received prior treatment for osteoporosis, and 90% of untreated cases subsequently initiated treatment. Fracture risk was estimated in 36.3% of osteoporosis cases. These results revealed a high prevalence of latent osteoporosis, regardless of age, sex, or injury mechanism. DXA testing should be recommended to prevent secondary fragility fractures for all DRF patients aged 50 and older, including males.
Evaluation of the effectiveness of bone mineral density (BMD) testing within national health screening programs should consider country-specific contexts when applied to asymptomatic populations. BMD testing at age 66 in women was associated with increased osteoporosis-related medical visit and a reduction of subsequent fracture incidence. These findings suggest potential benefits of population-based screening with BMD testing. Early detection of osteoporosis through bone mineral density (BMD) testing may help prevent future fractures. This study aimed to investigate the impact of incorporating BMD testing in South Korea's national health screening program on outpatient visits with an osteoporosis diagnosis and fractures. We used data from the Korean National Health Insurance Service-Senior Cohort (2002-2019) and included only women aged 66 years, as specified by national screening policy, without prior osteoporosis who underwent national health screening between 2004 and 2009. Screening periods were categorized by the inclusion of BMD testing. Outcomes included osteoporosis-related medical visits within two years and incident osteoporotic fractures. Multivariable logistic regression and Cox proportional hazards regression were used to examine osteoporosis detection and fracture risk, respectively. Among the 24,895 women screened, 24.7% had osteoporosis-related medical visits within two years, and 21.5% experienced fractures during follow-up. Compared to the period without BMD testing, the inclusion of BMD testing was associated with a 52% increase in osteoporosis-related medical visits (odds ratio: 1.52, 95% confidence interval [CI]: 1.42-1.62), whereas the risk of subsequent fractures was reduced by 9% (hazard ratio: 0.91, 95% CI: 0.86-0.96). These associations were more pronounced among those with low body mass index and significant during the 5-10 years of follow-up for hip and vertebral fractures. Nationwide implementation of BMD testing increased the medical visits for osteoporosis and was associated with a reduction in subsequent fractures. To further enhance the effectiveness of the screening program, improved post-screening management is needed.
Evidence supporting osteoporosis screening in older men remains limited. In a large real-world cohort of 29,906 men aged ≥ 70 undergoing DXA screening, osteoporosis was identified in 16.5% and osteopenia in 51.3%, with prevalence increasing with age. These findings indicate that a substantial proportion of older men have low bone mass and are therefore at increased risk of fracture. Evidence supporting routine osteoporosis screening in older men remains limited. We aimed to evaluate the prevalence and skeletal distribution of low bone mineral density (BMD) in elderly men within a large healthcare system where an age-based DXA screening recommendation has been implemented. We conducted a retrospective cohort study of DXA examinations performed between 2014 and 2024 at Assuta Medical Centers within Maccabi Health Services (MHS). MHS implemented a computerized clinical recommendation within the electronic medical record supporting DXA screening in men aged ≥ 70 years approximately a decade ago. To approximate primary age-based screening conditions, individuals with prior DXA examinations before age 70, oncologic disease, prior fracture, chemotherapy or radiotherapy exposure, and other causes of secondary osteoporosis were excluded. Additional exclusions for inflammatory disease, chronic glucocorticoid therapy, and endocrine disorders were applied using structured diagnostic fields and referral free-text data. Participants were required to have at least two valid skeletal site-groups available for analysis. Among a total of 29,906 eligible individuals who underwent DXA, osteoporosis prevalence was 15.0% at the femoral neck, 6.1% at the total hip, and 3.8% at the lumbar spine. Using the lowest T-score definition, overall osteoporosis prevalence was 16.5% and 51.3% of participants demonstrated osteopenia. Femoral neck osteoporosis increased from 12.4% in men aged 70-74 years to 26.1% in men aged ≥ 80 years. In a large real-world cohort approximating systematic screening conditions, nearly one in six older men met diagnostic criteria for osteoporosis. These data help address the current evidence gap regarding osteoporosis screening in men.
The efficacy of OsteoStrong® (OS) on bone strength is limited, and how it compares to dynamic multicomponent exercise (DME) is unknown. In this randomized controlled trial, the effect of OS on bone material strength index (BMSi) in older women was non-inferior to that of DME. No significant interaction between treatment and time was observed in any measured outcomes, indicating no meaningful difference between the intervention groups. Although the OsteoStrong® intervention met the pre-specified non-inferiority margin compared to the DME group, the lack of efficacy of the DME intervention on BMSi limits the interpretation of this finding. The aim of this study was to investigate whether the effect of using OS was non-inferior to DME for the primary outcome of BMSi in older women. Women aged 65-79 years with osteopenia or osteoporosis were randomized to 9 months of once-weekly OS (20 min) or twice-weekly DME (60 min/session). A total of 194 women (OS, 97; DME, 97), median age 70 years, participated in the trial. The primary outcome was BMSi measured with impact microindentation at the tibia. A pre-specified non-inferiority margin of BMSi -5.2 was applied to determine whether the intervention's efficacy was not clinically worse than the comparator within an acceptable threshold. The secondary outcomes were bone mineral density (BMD) and bone markers (S-CTX, S-P1NP, S-BALP, and S-sclerostin). At the 9-month follow-up, there were no significant differences between the groups in any of the outcomes. The mean between‑group difference in BMSi was 1.16, with a 95% confidence interval ranging from - 1.51 to 3.82. Since the lower limit of the confidence interval (- 1.51) did not cross the predefined non‑inferiority margin of - 5.2, non‑inferiority was established. There was a significant increase in BMSi by 2.9% in the OS group (from 73.9 ± 9.5 to 76 ± 9.4, p = 0.026), and lumbar spine BMD by 0.8% in the DME group (from 0.866 g/cm2 ± 0.13 to 0.872 g/cm2 ± 0.13, p = 0.016). Changes in femoral neck BMD were not significant. There were no significant within- or between-group differences in any of the bone markers at 3 and 9 months. Based on these findings, the effect of OsteoStrong® on BMSi in older women was non-inferior to that of dynamic multicomponent exercise. No significant interaction between treatment and time was observed in any measured outcomes, indicating no meaningful difference between the intervention groups. Although the OsteoStrong® intervention met the pre-specified non-inferiority margin compared to the DME group, the lack of efficacy of the DME intervention on BMSi limits the interpretation of this finding.
This survey collected global perspectives on the burden and management of hypophosphataemic osteomalacia in adults through the International Osteoporosis Foundation (IOF). The IOF network represents a valuable international resource for understanding the burden and management of rare bone disorders. To investigate the international burden and management of hypophosphataemic osteomalacia (HO) in adult patients. A survey was developed consisting of seven questions about respondents and their experiences of managing HO, with a second section inviting additional non-identifying information on up to five patients. The survey was disseminated to the International Osteoporosis Foundation (IOF) network. Forty clinicians from 24 countries responded, with most based in academic centres. Respondents reported managing over 1000 adult patients with HO, primarily diagnosed with X-linked hypophosphataemia (XLH; 35%), tumour-induced osteomalacia (TIO; 24%), and fibrous dysplasia/McCune-Albright syndrome (FD/MAS; 16%). Management varied by diagnosis, reflecting differences in the underlying pathophysiology and clinical manifestations of the disorders. Respondents provided additional information on 19 patients with XLH, 28 with TIO, and 9 with other HO disorders. Common symptoms across XLH and TIO included bone pain (XLH, 67%; TIO, 88%), muscle pain (XLH, 61%; TIO, 76%), and muscle weakness (XLH, 61%; TIO, 88%). Many patients with XLH had discontinued phosphate and vitamin D therapies, with a subset initiating burosumab treatment. In contrast, phosphate and vitamin D were commonly used in TIO, with many patients being considered for tumour resection and limited burosumab use. Pain medication use, including opiates, was relatively high across all patients. Adults with HO experience a significant burden of musculoskeletal symptoms. Future efforts should focus on global education of healthcare professionals. The IOF network represents a valuable international resource for understanding the burden and management of rare bone disorders.
Brief rationale: To evaluate the utility of forearm-DXA in differentiating postmenopausal osteoporosis and to explore its relationship with clinical features of PHPT. Forearm-DXA was useful for differential diagnosis and independently associated with calcium in PHPT. Significance of the paper: This is the first study demonstrating these findings. To evaluate the utility of forearm dual-energy X-ray absorptiometry (DXA) measurement in differentiating primary postmenopausal osteoporosis from primary hyperparathyroidism (PHPT) related osteoporosis and to examine its association with clinical features of PHPT. This retrospective study included 246 women with PHPT (153 postmenopausal and 93 premenopausal) and 100 postmenopausal controls with osteopenia/osteoporosis. DXA measurements of the lumbar spine, hip, and one-third distal radius, together with clinical and biochemical data, were compared between postmenopausal patients with PHPT and controls, as well as between postmenopausal and premenopausal PHPT groups. Associations between DXA measurements and clinical findings were also analyzed in PHPT. Postmenopausal PHPT and controls were matched for age and body-mass index (BMI), osteoporosis was more frequent in PHPT (p = 0.001), with the distal radius most affected (p < 0.001). Multivariate regression confirmed an independent association between distal radius T-scores and PHPT [OR 1.88, 95% CI: 1.44-2.47]. In postmenopausal patients with osteoporosis by lumbar spine or hip DXA, ROC analysis showed that distal radius scores had excellent discriminatory value (AUC > 0.80) for differentiating PHPT from primary postmenopausal osteoporosis; optimal cutoffs were T-score < -2.4 (80.0% sensitivity, 63.6% specificity) and Z-score < -1.0 (81.5% sensitivity, 63.6% specificity). In premenopausal PHPT, calcium was independently associated with the distal radius T-score [(B = -0.594 (95% CI: -1.027 to -0.160)]. This is the first study to show the utility of forearm DXA in differentiating primary postmenopausal osteoporosis from PHPT-related osteoporosis as well as its independent association with calcium in PHPT. Although the diagnosis of PHPT is primarily biochemical, a predominant reduction in distal radius BMD should prompt evaluation for a parathyroid disorder. Moreover, our data may provide clues to help distinguish whether osteoporosis-identified as a surgical indication in PHPT-observed in postmenopausal individuals with PHPT is primarily attributable to PHPT or to menopause.
In our real-world study of women with postmenopausal osteoporosis (PMO), general practitioners (GPs) adhered to French guidelines on stopping, changing, or continuing oral bisphosphonates in 60% of cases and adhered to guidelines on initiating oral BPs in only 39%. These findings highlight the need to educate GPs on PMO treatment recommendations. French guidelines for postmenopausal osteoporosis (PMO) recommend dual energy X-ray absorptiometry (DXA) assessment of bone mineral density (BMD) to guide treatment decisions. However, data reporting implementation of these guidelines in general practice is lacking. Our study assessed general practitioners' (GPs') use of DXA results to guide decisions regarding first-line oral bisphosphonate (oBP) treatment in women with PMO. In this multicenter cohort study, participating GPs enrolled women with PMO who had been receiving the first-line bisphosphonates for 2-5 years, had a reference (baseline) DXA in the 2 years pre-enrolment or ≤ 2 years prior to BP initiation, and agreed to a follow-up DXA. GPs prescribed a follow-up DXA to guide their decision to stop, continue, or change BPs. We checked the GPs' decision for concordance with national treatment guidelines. From January 2018 to November 2019, 23 GPs enrolled 99 women meeting the inclusion criteria. Based on follow-up DXA, the decision to stop, change, or continue oBPs aligned with guidelines in 60% of cases. Agreement was higher in women receiving oBPs for < 3 vs ≥ 3 years (70.2% vs 54.3%). Based on baseline DXA, the decision to initiate treatment was aligned in only 39% of cases, with the follow-up treatment decision aligned with guidelines in 72% of these cases. The consistency of treatment decision between GPs and the scientific committee was weak (kappa coefficient of 0.295). Our study suggests insufficient awareness of national recommendations for PMO treatment in French general practice, highlighting the need for stronger GP education.
Osteoporosis causes bone fragility and fractures, yet most patients receive no treatment. This German registry study of nearly 1500 elderly pelvic fracture patients found that two-thirds were untreated before fracture. Paradoxically, treated patients sustained more severe, displaced fractures requiring surgery more often, possibly reflecting advanced disease severity or altered bone properties from medication. Fragility fractures of the pelvis (FFP) are related to low-energy trauma and osteoporosis. Currently, data on secondary pharmacological fracture prevention and their effect on fracture morphology is rare. We aimed to determine the proportion of patients receiving specific osteoporosis medication (SOM), vitamin D supplementation only (VitD), or no treatment (NOT) before and after a FFP. Secondarily, we evaluated possible differences in fracture morphology and treatment in the study population. This retrospective cohort study analyzed data from the German Pelvic Fracture Registry (2018-2024) of patients ≥ 60 years with an FFP. Patients were grouped hierarchically in the following groups: SOM, VitD, or NOT. Demographics, fracture morphology, treatment, and postfracture group changes regarding osteoporosis treatment were compared between groups. Of 1493 patients, mean age 82.34 ± 8.06 years, predominantly female (83.5%), 98 (6.6%) had a SOM, 386 (25.9%) VitD, and 1009 (67.6%) NOT before FFP. The SOM group was significantly older, predominantly female (p < 0.05), and demonstrated higher prefracture functional independence (71.4% SOM vs. 58.5% VitD vs. 66.4% NOT; p = 0.018). FFP Type IV fractures occurred more frequently in the SOM group (33.7% SOM vs. 23.3% VitD, 19.8% NOT; p = 0.006) and were more frequently operatively treated (45.9% SOM vs. 30.4% VitD, 29.2% NOT; p = 0.006). Following a FFP, in 527 patients (35.9%), the treatment regime was escalated; in 463 patients (31.0%), no change occurred. Despite established treatment guidelines, two-thirds of patients who sustained an FFP received neither SOM nor VitD in Germany. Patients with prefracture SOM treatment sustained more unstable fractures requiring surgical intervention, possibly reflecting advanced disease severity or altered bone biomechanics. Secondary fracture prevention remains suboptimal, with one-third of patients not receiving treatment postfracture.
We assessed the association of TBS with radiographic severity of Colles-type DRFs in female patients aged ≥ 50 years. The results indicated a significantly higher incidence of intra-articular DRFs and DUFs in low-TBS group, independent of displacement. Deteriorated bone microarchitecture may be associated with the severity of low-energy osteoporotic DRFs. This study investigated the effect of the trabecular bone score (TBS), which reflects bone microarchitecture, on the radiographic severity of Colles-type distal radius fractures (DRFs). 104 patients aged ≥ 50 years with Colles-type DRFs underwent TBS measurements using lumbar spine dual-energy X-ray absorptiometry (DXA) data. Among them, 83 were included after excluding 21 patients with high-energy injuries. Low-TBS was defined as 1.230 or less, on the basis of Japanese reference data. Radiographic fracture severity [presence or absence of intra-articular fractures according to the AO classification and complications of distal ulna fractures (DUFs)] and fracture-displacement parameters (radial inclination, ulnar variance, and palmar tilt) were compared between the low-TBS and non-low-TBS groups. Factors affecting fracture severity were evaluated using the Firth logistic regression model. The mean TBS was 1.299 ± 0.084, with 16/83 (19.3%) and 67/83 (80.7%) patients in the low- and non-low-TBS groups, respectively. The incidence of intra-articular fractures (AO type C) was significantly higher in the low-TBS group (93.8%) than non-low-TBS group (35.8%). The incidence of DUFs was significantly higher in the low-TBS group (87.5%) than non-low-TBS group (49.3%). The prevalence of multi-fragmentary fractures (AO type C3) in the low-TBS group (53.3%) was significantly higher than non-low-TBS group (20.8%). No significant differences were observed in the fracture-displacement parameters. Multivariate analysis confirmed that a low TBS was an independent predictor of intra-articular fractures. These findings suggest that deterioration of bone microarchitecture may increase the severity of low-energy osteoporotic DRFs, independent of fracture displacement.
This updated Moroccan guideline provides 17 expert recommendations for managing postmenopausal osteoporosis. Developed through a national consensus process, it aligns with international standards and includes a practical algorithm to support clinical decisions. It aims to improve diagnosis, fracture risk assessment, and treatment outcomes for women in routine care. These new recommendations update those published in 2007, in accordance with the most recent international guidelines. The initial framework and key thematic areas were defined by a national steering committee. The recommendations were subsequently elaborated, discussed, and validated by a multidisciplinary panel of experts. An independent reading group was also consulted to review and approve the final document. A structured consensus process using the Delphi method (four iterative rounds) was conducted to formulate 17 recommendations; they incorporate recent advances in the diagnosis, fracture risk stratification, and therapeutic management of osteoporosis. Major updates include the integration of fracture risk assessment tools, the revision of intervention thresholds, clarification of the respective roles of antiresorptive and anabolic therapies, and the updating of prevention and follow-up strategies. A practical algorithm is proposed to guide the management of postmenopausal osteoporosis in routine clinical practice.
Malignant transformation in patients with monoclonal gammopathy of undetermined significance treated with teriparatide was evaluated. Among 29 patients, only two progressed to hematologic malignancy (one multiple myeloma, one Waldenström's macroglobulinemia). These findings are reassuring and suggest that TPT may remain an option for selected patients with severe osteoporosis and MGUS. Osteoporosis is a highly prevalent bone disease with limited therapeutic options, particularly in multimorbid patients. Monoclonal gammopathy of undetermined significance (MGUS), a frequent finding in osteoporosis and a recognized fracture risk factor, often leads to contraindication of teriparatide (TPT), further restricting treatment choices. This study aimed to assess hematologic malignant transformation in osteoporotic patients with MGUS treated with TPT. A retrospective bicenter observational study was conducted at Lille and Angers University Hospitals (2016-2022). Patients with osteoporosis and confirmed MGUS at TPT initiation were included. Demographic, hematologic, bone, and treatment parameters were collected. In parallel, hematologic malignancies reported with TPT were reviewed from the French national pharmacovigilance database (PVDB) over the same period. Twenty-nine patients (69% women; mean age 72.6 ± 12.6 years) were included. Most had major comorbidities (89.7% with Charlson Comorbidity Index ≥ 3). MGUS was IgG-type in 55.2% and IgM-type in 41.4%. The mean follow-up from TPT initiation was 60.2 ± 30.7 months (median 54.0; 95% CI 49.0-71.4). Two patients developed hematologic malignancy: one multiple myeloma (MM) 7 years after TPT and one Waldenström's macroglobulinemia 21 months after initiation, both with intermediate-risk MGUS. TPT was well tolerated with premature discontinuation in 17.2% of cases. Of the two hematologic malignancies identified in the PVDB, only one (MM) occurred in a patient with pre-existing MGUS. Malignant progression was rare, providing reassuring evidence regarding hematologic safety. TPT may be considered in selected patients with severe osteoporosis and MGUS, provided careful hematologic monitoring.
Metabolic dysfunction-associated steatotic liver disease (MASLD) and osteoporosis are prevalent chronic metabolic disorders. Although a pathophysiological plausibility for their association exists, clinical evidence demonstrates substantial controversy and heterogeneity. First, review and critically evaluate the controversial evidence regarding their association; second, analyze the sources of research heterogeneity, elucidate the regulatory roles of key effect modifiers; and third, integrate shared pathophysiological mechanisms to provide insights for future research and clinical practice. We conducted a literature search in PubMed, Embase, Cochrane Library, Scopus, and Web of Science up to September 16, 2025, using relevant keywords and terms. Current studies have reported varying associations between MASLD and bone mineral density, ranging from negative to null to positive. The relationship between MASLD and bone metabolism exhibits highly complex, conditional, and context-dependent characteristics. The strength and direction of this association may be significantly influenced by a range of effect modifiers, including gender, age, ethnicity, visceral fat distribution, the severity of MASLD, and the sites of skeletal measurement. Factors such as chronic inflammatory responses, insulin resistance, and adipokine dysregulation may be involved in modulating this association. The association between MASLD and osteoporosis is highly complex, conditional, and context-dependent, as its direction and magnitude are significantly modulated by multiple effect modifiers. Future research requires large-scale, long-term, multicenter prospective cohort studies to thoroughly investigate their causal relationship and underlying mechanisms.
In two large, ethnically different prospective cohorts from the UK and Hong Kong, osteoporosis was associated with a higher risk of age-related cataracts, particularly in women. Proteomic mediation analysis identified five circulating proteins (MEPE, GDF15, TCN2, CDCP1, SIGLEC1) that may link osteoporosis to cataract development, warranting future mechanistic investigation. Osteoporosis and cataracts are frequently comorbid age-related conditions. This study aims to investigate the association between osteoporosis and the risk of age-related cataracts in cohorts from the United Kingdom (UK) and Hong Kong. Prospective cohort studies were conducted in participants aged ≥ 40 years without cataracts at baseline, using data from the UK Biobank (UKB; n = 337,952) and the Hong Kong Osteoporosis Study (HKOS; n = 4,935), with a median follow-up of 13.5 and 18.5 years, respectively. Incident age-related cataracts were identified using International Classification of Diseases (ICD) codes in each cohort, and the associations of bone mineral density (BMD) and osteoporosis with the risk of age-related cataract were analyzed using Cox proportional hazard models, adjusted for demographics, comorbidities, medications, and blood biomarker levels. We also conducted a mediation analysis to explore potential proteins mediating the relationship. In UKB, osteoporosis was associated with increased cataract risk (HR, 1.16; 95% CI, 1.08-1.25). In HKOS, participants with BMD T-scores between - 2.5 and - 1 (HR, 1.24; 95% CI, 1.05-1.45) and ≤  - 2.5 (HR, 1.34; 95% CI, 1.09-1.66) had higher cataract risk compared to those with T-scores ≥  - 1. Subgroup analyses suggested the relationship was female-specific in both cohorts. Mediation analysis identified five proteins that may mediate this relationship. Our findings suggest a female-specific association between osteoporosis and incident age-related cataracts. Integrated care is crucial for patients with these conditions. Timely ophthalmic evaluation and intervention may benefit patients with low BMD.
Osteoporotic spine fractures deeply affect patients' lives, yet little is known about patients' lived experiences. This qualitative study found that patients face delayed diagnosis, inconsistent care, and emotional distress, while professionals call for clearer communication and coordination. Results highlight the urgent need for more consistent, patient-centered osteoporosis care. Osteoporotic vertebral compression fractures (OVCFs) are common and often debilitating, yet patient perspectives remain underexplored. This study aimed to investigate the lived experiences of patients with OVCF and the perspectives of healthcare professionals involved in their care. A qualitative research design was used, involving 25 semi-structured interviews with postmenopausal women with a symptomatic OVCF (n = 15) and healthcare providers (n = 10) across six Dutch hospitals. Thematic analysis was performed using ATLAS.ti. After initial familiarization, data were organized into categories and subcategories. Coding was iterative, and 25% of transcripts were independently reviewed by a second author. Key themes among patients included delayed recognition of fractures, severe early pain with mixed responses to pain management, and a lasting impact on physical function, emotional well-being, and independence. Kinesiophobia and perceived loss of autonomy were prominent. Despite this, many patients demonstrated resilience and adapted pragmatically to limitations. Healthcare professionals reported heterogeneity in care protocols, particularly regarding bracing and physical therapy, and emphasized the need for personalized, multidisciplinary care. Both patients and providers identified gaps in communication and inconsistencies throughout the entire patient-journey. This study underscores the profound impact of OVCF on patients' daily lives and highlights the need for earlier recognition, clearer communication, and more consistent care strategies. Embedding psychological support and improving coordination across disciplines may enhance recovery. These findings point to the need for more standardized guidance on pain management, diagnostic pathways, and patient communication and may inform the development of uniform treatment protocols and patient information tools within osteoporosis care.
TSH suppression was associated with an attenuated early skeletal response to zoledronic acid in postoperative DTC patients with osteoporosis. This prospective study aimed to evaluate the impact of TSH suppression therapy on the early skeletal efficacy of zoledronic acid in patients with differentiated thyroid cancer (DTC), and to explore whether this response differs across subgroups. Patients were divided into two groups: the osteoporosis with TSH suppression group (TSH + OP, n = 42) and the osteoporosis without TSH suppression group (TSH - OP, n = 67). Both groups received a single infusion of zoledronic acid (5 mg) along with daily calcium and calcitriol supplementation. Primary analyses compared changes in bone mineral density (BMD) and bone turnover markers(BTMs) at 6 and 9 months post-treatment. After propensity score matching (PSM), 36 patients from each group were included in the primary analyses. Exploratory subgroup analyses were conducted according to age and sex. After PSM, the TSH + OP group showed significantly less BMD improvement compared to the TSH - OP group. At 9 months, the intergroup differences in BMD change were -7.08 mg/cm2 (lumbar, P = 0.02), -12.03 mg/cm2 (left hip, P < 0.001) and -6.12 mg/cm2 (femoral neck, P < 0.001). BTMs (PINP and β-CTX) remained higher in the TSH + OP group at all time points (all P < 0.01). Subgroup analyses suggested that these differences were primarily observed in postmenopausal patients. TSH suppression therapy was associated with an attenuated early skeletal response to zoledronic acid in postoperative DTC patients with osteoporosis, with this attenuation being more pronounced at the hip and femoral neck. Exploratory subgroup analyses suggested that this attenuation was primarily observed in postmenopausal women. In patients undergoing TSH suppression, serum PINP and β-CTX are useful monitoring biomarkers.
We examined type 2 diabetic patients by diffusion tensor imaging, an advanced magnetic resonance technique, and found significant differences than healthy subjects that correlated with markers of bone turnover. This could help in assessment of bone quality in diabetics where bone density often appears normal despite high fracture risk. Type 2 diabetes (T2DM) induced bone fragility is mainly due to alteration of bone quality rather than a decline in bone mineral density. The aim of the present study was to assess the ability of diffusion tensor imaging (DTI) to assess bone quality in T2DM. A total of 68 patients with T2DM were enrolled and stratified into two groups: those with microvascular complications (n = 38) and those without (n = 30). Additionally, 30 age- and sex-matched healthy controls were included. All participants underwent DTI of the lumbosacral spines and both hips, dual-energy X-ray absorptiometry (DEXA) scanning, and assessment of bone turnover biomarkers, including C-terminal telopeptide of type I collagen (CTX) and procollagen type I N-terminal propeptide (P1NP). DTI parameters-fractional anisotropy (FA) and apparent diffusion coefficient (ADC)-differed between patients and controls. FA values for the spine and hips were lower, while ADC values for the hips were higher in both diabetic patient groups compared to control subjects. ADC values for the spine were higher in diabetic patients with complications than in controls. A significant positive correlation was observed between FA and CTX levels in patients with complications. No significant differences were found in DEXA scan results between patients and controls. FA and ADC values for the hips showed the highest area under the curve (AUC) values (0.868 and 0.818, respectively), followed by FA and ADC for the spine (0.779 and 0.721), according to ROC curve analysis. The optimal cutoffs yielding the best sensitivity and specificity were observed for FA over ADC. DTI can provide information about the microstructural changes associated with the development of a low bone turnover state in type 2 diabetes mellitus, where bone mineral density typically remains within the normal range.
This is the first study to investigate bone microarchitecture in patients with syndrome of inappropriate secretion of thyrotropin (SITSH). Patients with SITSH had impaired bone microarchitecture compared with healthy controls, and the bone loss was associated with the degree of thyrotoxicosis. This study aims to evaluate bone microarchitecture through high-resolution peripheral quantitative computed tomography (HR-pQCT) in patients with syndrome of inappropriate secretion of thyrotropin (SITSH). This cross-sectional study enrolled 32 patients with SITSH. All patients underwent HR-pQCT at distal radius and tibia to quantify bone geometry, volumetric bone mineral density (vBMD) and bone microarchitecture. Of the patients with SITSH, 18 were surgically confirmed to have thyrotropin-secreting pituitary adenoma (TSHoma). An additional 3 patients were clinically diagnosed with TSHoma but did not undergo surgery. The remaining patients were clinically considered to have thyroid hormone resistance, despite the absence of pathogenic variants on genetic testing. Each patient with SITSH was matched by age and gender with one patient with primary hyperthyroidism and one healthy control to analyze the effect of thyroid function on bone microarchitecture. All patients with SITSH in this study presented with elevated thyroid hormone levels and concomitant clinical symptoms of hypermetabolism. Compared with age- and gender-matched healthy controls, patients with SITSH exhibited reduced vBMD, decreased trabecular number, increased trabecular separation, and thinner cortical thickness measured by HR-pQCT. At the non-weight-bearing distal radius, their bone microstructural deficits, including low bone volume, sparse trabeculae, and thin cortex, were comparable to those seen in primary hyperthyroidism. However, at the weight-bearing distal tibia, both trabecular and cortical microarchitecture were more severely compromised in SITSH than in primary hyperthyroidism. In the subgroup analysis of TSHoma, 18 patients were diagnosed as TSHoma after surgery, and they had lower vBMD and decreased cortical thickness compared with healthy controls. While radial microarchitectural impairment in TSHoma was similar to that in primary hyperthyroidism, tibial damage was markedly more severe. Moreover, patients with higher levels of thyroid hormones showed compromised bone microarchitecture. Compared with healthy controls, patients with SITSH exhibited impairment in bone microarchitecture. The degree of impairment at the non-weight-bearing distal radius was comparable to that in primary hyperthyroidism, but microarchitectural deterioration was more pronounced in SITSH at the weight-bearing distal tibia.