Journal of Bone Metabolism最新文献

{"title":"Emerging Role of Myostatin Inhibitors in the Management of Glucagon-Like Peptide-1-Associated Sarcopenia and Metabolic Disorders.","authors":"Jongmin Baik, Yun-Sil Lee","doi":"10.11005/jbm.25.919","DOIUrl":"10.11005/jbm.25.919","url":null,"abstract":"<p><p>Glucagon-like peptide-1 (GLP-1) analogs, originally developed as antidiabetic agents, have emerged as groundbreaking drugs for treating obesity, following reports of their remarkable weight-reducing effects. With growing recognition of obesity as a disease in modern society and a sharp rise in its prevalence, pharmacological interventions are now being actively pursued. However, due to their mechanism of action, primarily appetite suppression, GLP-1 analogs have been associated with various adverse effects. Most notably, muscle loss - which may be related to reduced nutritional intake - has become an important issue in the long-term management of patients undergoing GLP-1 therapy. This has drawn attention to myostatin (MSTN) inhibitors for their ability to significantly increase muscle mass. These agents are now being explored not only as a strategy to offset the side effects of GLP-1 analogs, but also as direct therapeutics for a range of metabolic disorders, including obesity and diabetes. In this review, we discuss the emerging therapeutic potential of MSTN inhibitors and examine current clinical trials investigating their use alone or in combination with GLP-1 analogs in metabolic disorders.</p>","PeriodicalId":15070,"journal":{"name":"Journal of Bone Metabolism","volume":"32 4","pages":"263-275"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12719006/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145804239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bisphosphonate Use and Reduced All-Cause Mortality in Korean Women Older than 50 Years: A Nationwide Sample Cohort Study.","authors":"Soon Young Park, Jisoo Lee, Youjin Lee, Jung-Wee Park, Young-Kyun Lee","doi":"10.11005/jbm.25.933","DOIUrl":"10.11005/jbm.25.933","url":null,"abstract":"<p><strong>Background: </strong>The survival impact of bisphosphonates (BPs) remains uncertain, particularly in East Asian populations, where new-user analyses have been limited.</p><p><strong>Methods: </strong>This was a retrospective, new-user cohort study using the Korean National Health Insurance Service-National Sample Cohort (2002-2011). We identified new users of BPs (N=41,854), and a 1:1 age-matched control group (N=41,854) among women aged ≥ 50 years. Participants were followed for all-cause mortality for up to 10 years. Multivariable Cox proportional hazards models were used to calculate hazard ratios (HRs), adjusting for age and the Charlson Comorbidity Index.</p><p><strong>Results: </strong>A total of 83,708 women were included. Compared with the control group, the risk of all-cause mortality was lower in BP group. BP users showed adjusted HR of 0.47 (95% confidence interval, 0.44-0.49; P<0.001) compared to controls.</p><p><strong>Conclusions: </strong>In this large, nationwide Korean cohort, initiating BPs was associated with a reduced risk of all-cause mortality in women aged 50 and older. These findings suggest that BPs may have survival benefits beyond fracture prevention.</p>","PeriodicalId":15070,"journal":{"name":"Journal of Bone Metabolism","volume":"32 4","pages":"323-330"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12718989/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145804656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endocrine Regulation of Osteoporosis: Insights from the Brain-Bone Axis Theory.","authors":"Xin Chen, Jialing Wang, Tingting Deng, Qing Ni, Fanjie Liu","doi":"10.11005/jbm.25.887","DOIUrl":"10.11005/jbm.25.887","url":null,"abstract":"<p><p>Osteoporosis (OP) is a systemic skeletal disease characterized by reduced bone mass and increased risk of fractures, with limitations in traditional treatment methods. The \"brainbone axis\" theory has revealed a bidirectional regulatory network between the central nervous system and the skeletal system, providing new insights into the mechanisms and treatment of OP. This review summarizes the bidirectional regulatory mechanisms of the \"brain-bone axis\", including descending pathways (such as the regulation of bone metabolism by the sympathetic nervous system, parasympathetic nervous system, and hypothalamic nuclei) and ascending feedback (such as bone-derived factors influencing central nervous system function through the blood-brain barrier), and explores the synergistic roles of endocrine systems (such as the thyroid axis and gonadal axis) within this network. Additionally, the article summarizes multi-modal treatment strategies based on the \"brain-bone axis\" theory, offering new insights for the precise prevention and treatment of OP. Future research should further integrate basic and clinical studies to advance the paradigm shift of OP from a localized bone disorder to a systemic disease.</p>","PeriodicalId":15070,"journal":{"name":"Journal of Bone Metabolism","volume":"32 4","pages":"247-262"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12719010/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145804291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Bone Graft Type on Spinal Fusion Outcomes in Adolescent Idiopathic Scoliosis: Updated Meta-Analysis.","authors":"Eunseo Joung, Ki-Tae Park, Naye Kang, Suyeon Park, Nah Yon Kim, Young Hak Roh, Byung-Ho Yoon","doi":"10.11005/jbm.25.889","DOIUrl":"10.11005/jbm.25.889","url":null,"abstract":"<p><strong>Background: </strong>Posterior spinal fusion is performed for severe adolescent idiopathic scoliosis (AIS), with bone graft playing a critical role in achieving solid fusion. Iliac crest bone graft (ICBG) is the gold standard but has donor site morbidity, leading to increased use of non-ICBG. This study compared the effectiveness and safety of ICBG and non-ICBG bone grafts in AIS.</p><p><strong>Methods: </strong>This meta-analysis included 23 studies with 3,350 patients, categorized into ICBG and non-ICBG groups. The primary outcome was fusion rate; secondary outcomes were implant-related complication rate, infection rate, donor site pain, blood loss, and operation time. A proportion meta-analysis was conducted to estimate binary outcomes, and a weighted mean model was used to estimate continuous variables.</p><p><strong>Results: </strong>The fusion rate was 97% (95% confidence interval [CI], 93-99) in ICBG group and 97% (95% CI, 95-98) in non-ICBG group. Implant-related complications occurred in 5% (95% CI, 3-7) and 4% (95% CI, 2-6) of each group, while surgical site infections occurred in 3% (95% CI, 2-7) and 2% (95% CI, 1-3). Donor site pain was observed exclusively in ICBG group, with a prevalence of 49% (95% CI, 3-97). Estimated pooled blood loss was 1,461.10 mL (95% CI, 545.30-2,376.90) in ICBG group and 1,047.45 mL (95% CI, 666.92-1,427.99) in non-ICBG group. The estimated pooled operation time was 246.77 (95% CI, 221.74-271.80) and 232.37 (95% CI, 194.88-269.86) for each group.</p><p><strong>Conclusions: </strong>Considering both ICBG and non-ICBG demonstrated high fusion rates and low complication rates, non-ICBG grafts may serve as an effective and safe alternative to ICBG, minimizing morbidity, donor site pain, and blood loss.</p>","PeriodicalId":15070,"journal":{"name":"Journal of Bone Metabolism","volume":"32 4","pages":"331-343"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12719007/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145804253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges in Evaluation and Management in Tumor-Induced Osteomalacia: A Retrospective Institutional and Literature-Based Scoping Review in Korean Patients.","authors":"Seyoun Park, Sung Joon Cho, Jin Ah Park, Namki Hong, Yumie Rhee","doi":"10.11005/jbm.25.901","DOIUrl":"10.11005/jbm.25.901","url":null,"abstract":"<p><strong>Background: </strong>Tumor-induced osteomalacia (TIO) is a rare paraneoplastic syndrome characterized by hypophosphatemia and osteomalacia, resulting from excessive production of fibroblast growth factor 23 by mesenchymal tumors. Although various imaging techniques are used to localize the tumor, the rarity of the disease poses significant challenges in tumor detection.</p><p><strong>Methods: </strong>After retrospectively analyzing 25 TIO patients who visited the Severance bone and mineral clinic between 2004 and 2024, we added all reported TIO cases in Korea by searching PubMed, Embase, and Web of Science. Using the PRISMA method, an additional 14 reports comprising 22 patients were included.</p><p><strong>Results: </strong>Among the 47 patients, 25 (53.2%) were male, with a median age of 52 years. Tumors were most commonly located in the lower extremities (57.5%), with a median size of 1.9 cm. Surgical resection, including radiofrequency ablation, was performed in 45 patients; reoperation was required in 26.7% (12/45) due to residual tumors. After gallium scans were covered by insurance, 83.3% (25/30) of patients underwent gallium-based imaging for tumor localization with 77.3% of tumors successfully localized in initial scan. Of the five patients with negative initial scans, four (80%) showed positive findings on a second scan conducted 1 to 2 years later.</p><p><strong>Conclusions: </strong>Although gallium scans are the most commonly employed imaging modality for detecting tumors responsible for TIO, localization remains challenging due to the small tumor size, potential for widespread anatomical distribution, and prolonged diagnostic delay. Repeating gallium imaging can yield positive results in previously negative cases, and additional imaging modalities may be necessary to facilitate accurate localization.</p>","PeriodicalId":15070,"journal":{"name":"Journal of Bone Metabolism","volume":"32 4","pages":"315-322"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12719003/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145804697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Myostatin Function during In Vitro Myogenesis: Considerations for Knockout-Based Mechanistic Analysis.","authors":"Joonho Suh, Jongmin Baik, Yun-Sil Lee","doi":"10.11005/jbm.25.915","DOIUrl":"10.11005/jbm.25.915","url":null,"abstract":"<p><strong>Background: </strong>Myostatin (MSTN) is a well-known negative regulator of skeletal muscle growth, and its pharmacological blockade, such as with follistatin (FST), an endogenous MSTN inhibitor, is under active investigation as a treatment for muscle-wasting conditions. However, the dynamics of MSTN signaling during in vitro myogenesis and its modulation by culture conditions remain incompletely understood.</p><p><strong>Methods: </strong>Primary myoblasts were isolated from wild-type (WT), Mstn-/-, and FST transgenic (F66) mice to evaluate the effects of MSTN inhibition on myotube formation. Myoblasts were differentiated on Matrigel-coated surfaces in the presence of horse serum. Myotube maturation was evaluated by confocal microscopy and reverse transcription-polymerase chain reaction; protein synthesis was assessed using a puromycin incorporation assay; and MSTN concentrations in serum were quantified by enzyme-linked immunosorbent assay.</p><p><strong>Results: </strong>Mstn expression peaked at 24 hr of differentiation, coinciding with early myotube formation, and progressively declined as myotubes matured. Both Mstn-/- and F66 myotubes showed increased thickness and protein synthesis compared to WT controls, with more pronounced effects observed in F66 myotubes. Consistent with this, F66 myotubes also displayed higher expression of myogenic maturation markers. Notably, horse serum used in the culture medium contained detectable levels of MSTN, which may have partially restored MSTN signaling in Mstn-/- cultures and masked the full knockout phenotype.</p><p><strong>Conclusions: </strong>FST overexpression induces greater myotube hypertrophy and protein synthesis than Mstn deletion, likely due to its broader inhibition of both endogenous and serum-derived MSTN. These findings highlight the importance of serum composition in interpreting phenotypes from in vitro knockout models targeting secreted factors such as MSTN.</p>","PeriodicalId":15070,"journal":{"name":"Journal of Bone Metabolism","volume":"32 4","pages":"276-284"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12718992/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145804384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Latest Updates on Sarcopenia and Cachexia: Insights from the 17th Sarcopenia, Cachexia, and Wasting Disorders Conference.","authors":"Hyunwoo Park, Hyeon Su Kim, Bon-Sang Gu, Hyunbin Kim, Jun-Il Yoo","doi":"10.11005/jbm.25.867","DOIUrl":"10.11005/jbm.25.867","url":null,"abstract":"<p><p>The 17th Sarcopenia, Cachexia, and Wasting Disorders Conference, held from December 6 to 8, 2024, in Washington, DC, showcased groundbreaking advancements in understanding and managing muscle wasting conditions. Drawing on the lecture notes and presentations of internationally recognized experts who spoke at the meeting, this review highlights key insights and recent developments discussed during the conference. This review focuses on sarcopenia, cancer cachexia, and other wasting disorders linked to chronic diseases. Key discoveries included the identification of the Macroautophagy and YouTH Optimizer pathway in muscle regulation, the role of ectodysplasin A2 receptor-nuclear factor-κB-inducing kinase signaling in muscle atrophy, and the impact of mitochondrial dysfunction on systemic health. Advancements in diagnostic tools, including artificial intelligence-powered imaging and novel biomarkers, are transforming the detection and management of these conditions. Emerging therapeutic strategies, such as glucagon-like peptide 2-based treatments, selective androgen receptor modulators, and cytokine inhibitors, are reshaping the therapeutic landscape. The conference underscored the importance of precision medicine, integrating molecular insights with personalized care approaches, and emphasized multidisciplinary rehabilitation to optimize patient outcomes. The conference also highlighted promising clinical advancements, including the HIPGEN trial on placental-expanded stromal cells for muscle regeneration in hip fracture patients and the ponsegromab study targeting growth/differentiation factor-15 inhibition to mitigate cancer cachexia-associated muscle wasting. This review highlights the integration of basic science, innovative diagnostics, and clinical applications as a promising framework for addressing the complex challenges posed by muscle-wasting disorders. As the field progresses, these insights offer hope for improving the quality of life and survival of affected patients.</p>","PeriodicalId":15070,"journal":{"name":"Journal of Bone Metabolism","volume":"32 3","pages":"167-179"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12444086/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145075340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Awareness, Knowledge, and Health Beliefs Regarding Osteoporosis among Hypothyroid Patients in Turkey: An Observational Study.","authors":"Feyza Nur Yücel, Mustafa Hüseyin Temel, Muhammed Görgel, Yeliz Bahar-Özdemir, Emre Ata, Eylem Çağıltay","doi":"10.11005/jbm.25.855","DOIUrl":"10.11005/jbm.25.855","url":null,"abstract":"<p><strong>Background: </strong>Hypothyroidism is the most common thyroid dysfunction, and current evidence suggests that it increases the risk of osteoporosis in these patients. Assessing the level of osteoporosis awareness and understanding among hypothyroid patients is an important requirement for implementing preventive interventions to maintain bone health.</p><p><strong>Methods: </strong>Thyroid-stimulating hormone, thyroxine, and 25-hydroxy-vitamin D levels were recorded along with the patients' demographics. Osteoporosis awareness was assessed with the osteoporosis awareness scale (OAS), and knowledge level was assessed with the revised osteoporosis knowledge test (R-OKT). Health beliefs related to osteoporosis were evaluated using the osteoporosis health belief scale (OHBS).</p><p><strong>Results: </strong>The median (interquartile range) values for OAS and R-OKT of 348 patients were calculated as 66.0 (32.0) and 9.0 (5.0), respectively. Female patients had higher OAS scores (P<0.001), OHBS benefits of exercise (P=0.002), and calcium intake (P<0.001) subscores compared to males. The distribution of OAS, R-OKT, and OHBS total and susceptibility scores differed significantly across education categories (P<0.001). The linear regression model revealed significant predictors of OAS score variation, including gender (β=-0.27, P<0.001), education (β=0.09, P=0.045), and osteoporosis knowledge (β=0.49, P<0.001).</p><p><strong>Conclusions: </strong>Patients with hypothyroidism, particularly males and those with lower educational attainment, lack adequate knowledge and awareness regarding osteoporosis. To better comprehend and manage osteoporosis, targeted educational initiatives are required for this vulnerable group.</p>","PeriodicalId":15070,"journal":{"name":"Journal of Bone Metabolism","volume":"32 3","pages":"200-211"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12444079/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145075352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Low Muscle Mass, Weak Grip Strength, and Neutrophil-to-Lymphocyte Ratio in Old Ages.","authors":"Jungha Park, Hyeon Ju Kim, Mi Hee Kong, Ji Hyun Moon","doi":"10.11005/jbm.25.853","DOIUrl":"10.11005/jbm.25.853","url":null,"abstract":"<p><strong>Background: </strong>Sarcopenia is an age-related disease, and is assumed to be associated with systemic inflammation. We examined the relationship between the neutrophil-to-lymphocyte ratio (NLR), an easily accessible inflammatory marker, and sarcopenia in older adults.</p><p><strong>Methods: </strong>This retrospective cross-sectional study, medical records of patients visiting a tertiary hospital's health check-up center were analyzed. The study included older adults aged 60 and over, and who had their grip strength, skeletal muscle mass, and complete blood count with differential tests measured. In this study, sarcopenia was defined as the presence of both low muscle mass and weak grip strength according to the Asian Working Group for Sarcopenia 2019 criteria.</p><p><strong>Results: </strong>Of the 2,385 participants, 74 participants (3.10%) had sarcopenia. The non-sarcopenia group was younger than the sarcopenia group (mean age, 65.8±5.4 vs. 73.2±7.5). The average NLR of participants without sarcopenia was 1.75±0.97 and the average NLR of participants with sarcopenia was 2.08±1.11 (P=0.004). The number of participants with sarcopenia increased across higher NLR quintile (P for trend=0.016), as well as those with low skeletal muscle mass (P for trend<0.001) and weak grip strength (P for trend=0.009).</p><p><strong>Conclusions: </strong>Older adults with a high NLR may be considered for sarcopenia screening.</p>","PeriodicalId":15070,"journal":{"name":"Journal of Bone Metabolism","volume":"32 3","pages":"190-199"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12444080/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145075371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pitfalls in the Missed Diagnosis of Atypical Femoral Fracture Presenting as Prodromal Pain that Mimics Degenerative Disease: A Multicenter Study - Secondary Publication of the Japanese Version.","authors":"Tatsuji Fujiwara, Ikko Ohno, Nobumasa Matsumura, Keiichiro Oura, Yasutaka Nakahori, Takashi Nishii","doi":"10.11005/jbm.25.843","DOIUrl":"10.11005/jbm.25.843","url":null,"abstract":"<p><strong>Background: </strong>Prodromal symptoms might lead to an early diagnosis of atypical femoral fracture (AFF). However, incomplete AFF can progress to complete fractures because they are often misdiagnosed as degenerative diseases such as lumbar canal stenosis or knee and hip osteoarthritis. The purpose of this study was to examine how many AFFs are misdiagnosed as degenerative diseases and the characteristics of the site of prodromal symptoms in a multicenter study.</p><p><strong>Methods: </strong>We retrospectively analyzed the medical records of patients with AFFs at two institutions. In addition, a survey was sent to affiliated institutions to collect data on prodromal symptoms.</p><p><strong>Results: </strong>Analysis in two institutions revealed 46 AFFs in 35 patients. Seventeen fractures were associated with localized prodromal symptoms in the groin or lateral thigh (conventional type), and 12 fractures had prodromal symptoms not localized to the fracture site, such as widespread lateral thigh, knee, or lateral lower leg (modified type). Eleven fractures were misdiagnosed as degenerative diseases. The survey of 11 affiliated institutions revealed that prodromal pain was reported in 29 of 49 AFFs. Nineteen fractures were associated with modified prodromal pain, and 9 fractures were misdiagnosed as degenerative diseases.</p><p><strong>Conclusions: </strong>Twenty-one percent of AFFs were misdiagnosed with degenerative diseases. All of the misdiagnosed cases were associated with prodromal symptoms. We believe that the prodromal symptoms of AFF are diverse and very similar to those of degenerative diseases, which may have caused the misdiagnosis.</p>","PeriodicalId":15070,"journal":{"name":"Journal of Bone Metabolism","volume":"32 3","pages":"180-189"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12444082/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145075350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}