Orthopedic Research and Reviews最新文献

{"title":"Ultrasound-Guided Perineural Corticosteroid Injection for Lacertus Fibrosus Syndrome: A Retrospective Cohort Study.","authors":"Cristóbal Greene, Guillermo Droppelmann, Nicolás García, Carlos Jorquera, Julio Rosales","doi":"10.2147/ORR.S492591","DOIUrl":"https://doi.org/10.2147/ORR.S492591","url":null,"abstract":"<p><strong>Background: </strong>The lacertus fibrosus serves as a site of entrapment for the proximal median nerve. Traditionally, surgical intervention has been the preferred method for resolution. This study demonstrates that perineural corticosteroid injection of the proximal median nerve entrapment under ultrasound guidance can improve nerve compression, strength, and pain in patients with lacertus fibrosus syndrome (LFS).</p><p><strong>Methods: </strong>A retrospective quasi-experimental cohort study without a control group following the STROBE guidelines was conducted from July 2020 to May 2023. The patient selection was carried out considering Elisabet Hagert's diagnostic criteria. Ultrasound-guided proximal perineural corticosteroid injections were administered in the region of the lacertus fibrosus. Contingency tables were constructed to compare pre-and post-intervention data. The McNemar test was performed to evaluate the differences. Odds ratios (with 95% CI) were calculated to estimate the likelihood of improvement. A level of less than 0.05 was considered statistically significant. All analyses were performed using the R program.</p><p><strong>Results: </strong>Twenty-four patients with LFS (61% female, median age: 36 years), were analyzed. Significant improvements were observed in muscle strength perception for the flexor carpi radialis [OR: 33.0, 95% CI: 24.95-41.0; p < 0.001], index flexor digitorum profundus [OR: 37.0, 95% CI: 29.0-45.0; p < 0.001], and flexor pollicis longus [OR: 39.0, 95% CI: 31.0-45.0; p < 0.001]. The scratch test positivity significantly decreased [OR: 4.56, 95% CI: 1.94-15.67; p < 0.001], and pain levels were notably reduced [OR: 2.33, 95% CI: 0.97-5.63; p < 0.001].</p><p><strong>Conclusion: </strong>Perineural corticosteroid injection under ultrasound guidance proved to be a minimally invasive approach for managing LFS. The intervention significantly improves muscle strength perception and reduces nerve compression and pain. These findings underscore the potential of this technique as a viable option for patients who have exhausted other therapeutic approaches before considering surgery.</p><p><strong>Level of evidence: </strong>III cohort, treatment study.</p>","PeriodicalId":19608,"journal":{"name":"Orthopedic Research and Reviews","volume":"17 ","pages":"229-240"},"PeriodicalIF":1.7,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12169028/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310264","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":"Mitochondrial Function, Gut Microbiota, and Gout Risk Among Individuals of European Descent: A Mendelian Randomization Study of a Mediated Relationship.","authors":"Jianing Li, Xinyu Yin, Zhu Wen, Jiahao Liang, Shulin Yang, Yanan Ju, Lu Liu, Ying Tong, Hongbo Cai","doi":"10.2147/ORR.S513204","DOIUrl":"https://doi.org/10.2147/ORR.S513204","url":null,"abstract":"<p><strong>Purpose: </strong>Gout, a common form of arthritis, is characterised by recurrent episodes of severe inflammation owing to the accumulation of monosodium urate crystals in the joints and tissues, resulting from elevated serum uric acid levels. While the roles of gut microbiota and mitochondria in gout have been studied, their causal interactions remain unclear. The purpose of this study is to investigate the interplay between gut microbiota and mitochondrial biological function in the pathogenesis of gout.</p><p><strong>Methods: </strong>This study utilized Mendelian randomization to explore causal links between mitochondrial biological function, gut microbiota, and gout, by leveraging data from genome-wide association studies. Bidirectional causal effects of mitochondrial biological functions on gout and serum uric acid levels were analysed; moreover, the causal effects of gut microbiota on gout and uric acid levels were evaluated through mediation analysis of the gut microbiota in the pathway linking mitochondrial biological function with gout.</p><p><strong>Results: </strong>A causal relationship was found between mitochondrial biological function and gout mediated by gut microbiota. The NAD-dependent protein deacylase sirtuin-5 mediated 18.24% of the total effect on the adverse effects of gout by reducing creatinine degradation I. Calcium uptake protein 3 had a substantial impact on mitigating the negative effects of serum uric acid by decreasing the abundance of the order Burkholderiales and class Betaproteobacteria, which accounted for 16.52% and 15.83%, respectively, of the overall effect.</p><p><strong>Conclusion: </strong>This analysis elucidated the complex relationships between mitochondrial biological function, gut microbiota, and gout, providing novel perspectives for gout prevention and treatment. Further investigations will enhance our understanding of the interactions between these biological processes and guide future intervention strategies.</p>","PeriodicalId":19608,"journal":{"name":"Orthopedic Research and Reviews","volume":"17 ","pages":"241-255"},"PeriodicalIF":1.7,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12168985/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310263","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":"Treatment Strategies for Distal Clavicle Fractures: A Narrative Review.","authors":"Lei Yue, Changsheng Huang, Jianming Zhang, Ziqi Wang, Shijun Wang, Haolin Sun","doi":"10.2147/ORR.S507343","DOIUrl":"10.2147/ORR.S507343","url":null,"abstract":"<p><p>Distal clavicle fractures, accounting for a significant portion of clavicle fractures, present a treatment challenge due to their high non-union rate and the controversy surrounding operative versus non-operative management strategies. This review synthesizes recent studies and clinical evidence to compare the effectiveness of operative and non-operative approaches for distal clavicle fractures. It discusses the anatomical and classification aspects of these fractures, the indications for surgery, and the rationale behind different treatment options. Surgical fixation, predominantly through locking plates or hook plates, generally provides high union rates and stable outcomes; however, complications such as hardware irritation, subacromial impingement, and implant removal rates are significant concerns. Recent surgical advancements, including ligament repair, distal augmentation, and arthroscopic techniques, have shown promise in improving outcomes. Conversely, conservative treatment is recommended for certain fracture types, with emerging evidence suggesting it provides comparable functional outcomes to those of surgical methods. Despite a high non-union rate, non-operative treatment can be effective in restoring functions. However, challenges such as symptomatic nonunion and osteoarthritis are noted. The choice between surgical and conservative treatments depends on multiple factors, including fracture type, patient age, activity level, and overall health status. This review highlights the need for a personalized approach in managing distal clavicle fractures, considering the evolving evidence and advancements in treatment strategies.</p>","PeriodicalId":19608,"journal":{"name":"Orthopedic Research and Reviews","volume":"17 ","pages":"221-227"},"PeriodicalIF":1.7,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12101621/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143079","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":"Contiguous Two-Level Anterior Cervical Discectomy and Fusion Using Zero-P VA System: A Retrospective Study.","authors":"Qiang Zhang, Zhe Chen, Yazhou Lin, Peng Cao, Xingkai Zhang, Wenjian Wu, Yu Liang","doi":"10.2147/ORR.S517491","DOIUrl":"10.2147/ORR.S517491","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this study was to explore short-term radiological findings after contiguous two-level ACDF with Zero-P VA devices.</p><p><strong>Methods: </strong>Patients who underwent contiguous two-level anterior cervical discectomy and fusion (ACDF) from C3 to C7 with a Zero-P VA system were followed. Cervical anteroposterior and lateral X-rays and functional outcomes were assessed 3 months after surgery.</p><p><strong>Results: </strong>Overall, 34.9% of patients had prosthesis subsidence and 74.6% screw loosening. Up to 46.8% of the patients with screw loosening also experienced prosthesis subsidence compared with 0 patients without screw loosening (<i>p</i>=0.0005). The screw-loosening rate was 91.7% in patients with poor positioning of the screw/cage and 70.6% in patients without poor positioning of the screw/cage, but no statistical difference was found between the groups (<i>p</i>=0.267). The subsidence rate was 50% in patients with poor positioning of the screw/cage and 31.4% in patients without poor positioning of the screw/cage, but no statistical difference was found between the groups (<i>p</i>=0.314). VAS scores of patients with prosthesis subsidence were much higher than those without (<i>p</i>=0.031), but this difference was not found for patients with or without screw loosening (<i>p</i>=0.116). The NDI scale was much higher in patients regradless of screw loosening or subsidence.</p><p><strong>Conclusion: </strong>Screw loosening and prosthesis subsidence happen frequently after contiguous two-level ACDF with Zero-P VA. Screw loosening seems to be the only risk factor for prosthesis subsidence.</p>","PeriodicalId":19608,"journal":{"name":"Orthopedic Research and Reviews","volume":"17 ","pages":"213-220"},"PeriodicalIF":1.7,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12091234/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144111654","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":"Ulnar-Sided Wrist Pain: Systematic Clinical Approach and Principles of Treatment.","authors":"Oryza Satria, Dina Aprilya, Seti Aji Hadinoto","doi":"10.2147/ORR.S506374","DOIUrl":"https://doi.org/10.2147/ORR.S506374","url":null,"abstract":"<p><strong>Abstract: </strong>The source of ulnar-sided wrist pain is difficult to determine because the history and physical examination findings of various illnesses frequently coincide, and are multifactorial. Pain on the ulnar side of the wrist can be identified on the basis of the tissue from which it arises. Knowledge of the anatomy of the ulnar side of the wrist is required for correct diagnosis, as in numerous diagnostic tests. Given the complex nature of disease diagnosis, various methods have been proposed. This article discusses systematic methods for obtaining a patient's medical history, physical examination, and treatment principles to assist surgeons in determining the source of common ulnar-sided wrist pain.</p><p><strong>Level of evidence: </strong>D.</p>","PeriodicalId":19608,"journal":{"name":"Orthopedic Research and Reviews","volume":"17 ","pages":"199-212"},"PeriodicalIF":1.7,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12075400/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078816","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":"The Role of Robot-Assisted Technique in Treating Adult Degenerative Scoliosis with Circumferential Minimal Invasive Correction Surgery - A Retrospective Analysis of 51 Consecutive Cases.","authors":"Qiang Zhang, Zhe Chen, Yazhou Lin, Xingkai Zhang, Wenjian Wu, Yu Liang","doi":"10.2147/ORR.S514237","DOIUrl":"https://doi.org/10.2147/ORR.S514237","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective chart review.</p><p><strong>Objective: </strong>This study aims to investigate the application of robots in treating adult degenerative scoliosis (ADS) with circumferential minimal invasive surgery (cMIS).</p><p><strong>Background: </strong>The cMIS is useful but faces a lot of challenges in correcting ADS. One of the most important challenges is the difficulty in screw placement. Robot-assisted technique demonstrates lots of advantages but the data about its application in treating ADS is limited in literatures.</p><p><strong>Methods: </strong>A total of 51 cases diagnosed with ADS were retrospectively analyzed. All patients underwent cMIS technique with staged surgeries (OLIF and PPS fixation). Group A enrolled 21 patients and performed robot-assisted technique. Group B enrolled 30 patients and performed fluoroscopy guided technique. Clinical outcomes like the operation time, radiation exposure, pressure curve and post-operation VAS score were recorded. 3D-CT scan was also performed to evaluate the accuracy of the screws.</p><p><strong>Results: </strong>The average preparation time were much higher in group A (23.4 ± 2.8 vs 3.1 ± 1.0 min, p < 0.0001). But the total operation time was similar (62.7 ± 12.5 vs 55.7 ± 20.6 min, p = 0.174). The average fluoroscopic scan number were 9.4 ± 1.7 in group A, much lower than that of group A (27.7 ±5.9, p < 0.001). No statistical difference was found with the VAS scale between the groups (p = 0.631). No matter considers only screws of grade A as perfect screws (81.5% vs 73.8%) or considers both grade A and B as acceptable screws (93.8% vs 87.7%), group A demonstrated significant higher screw accuracy (p = 0.038, p = 0.018, respectively). Also, the robots demonstrated significant less facet joint violence (p < 0.0001), larger inward tilt angle (p < 0.0001), and longer screw length (p = 0.0008).</p><p><strong>Conclusion: </strong>The robot-assisted technique demonstrated significant advantages like higher pedicle screw accuracy, better trajectory, less radiation exposure, but similar operation time compared with fluoroscopy guided technique in treating ADS with CMIS.</p>","PeriodicalId":19608,"journal":{"name":"Orthopedic Research and Reviews","volume":"17 ","pages":"189-198"},"PeriodicalIF":1.7,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067674/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144008023","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":"A Review on Bone Tumor Management: Cutting-Edge Strategies in Bone Grafting, Bone Graft Substitute, and Growth Factors for Defect Reconstruction.","authors":"Siwat Sakdejayont, Thanapon Chobpenthai, Ploy Suksirivecharuk, I-Fan Ninatkiattikul, Thanate Poosiripinyo","doi":"10.2147/ORR.S521832","DOIUrl":"https://doi.org/10.2147/ORR.S521832","url":null,"abstract":"<p><p>Bone tumors present complex challenges in orthopaedic oncology, requiring precise management strategies to restore skeletal integrity and function with minimal morbidity. Traditional autologous bone grafting has been the gold standard due to its osteogenic, osteoconductive, and osteoinductive properties. However, limitations such as donor site morbidity and graft availability have prompted the development of alternative approaches.This review evaluates contemporary approaches in bone tumor management, focusing on advancements in bone grafting techniques, bone graft substitutes (eg, ceramics, polymers, bioactive materials), and growth factor-based therapies. The efficacy and safety of these substitutes are compared with autografts, examining their potential benefits and drawbacks.Recent innovations in bone graft substitutes show promise in overcoming autograft limitations. Ceramic, polymer, and bioactive materials offer diverse properties that may enhance bone regeneration. Growth factor-based therapies, including bone morphogenetic proteins (BMPs) and vascular endothelial growth factor (VEGF), have revolutionized bone healing by stimulating osteogenesis and angiogenesis.</p>","PeriodicalId":19608,"journal":{"name":"Orthopedic Research and Reviews","volume":"17 ","pages":"175-188"},"PeriodicalIF":1.7,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067467/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144046699","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":"Personal and Psychological Perceptions of Return to Activities After Anterior Ligament Reconstruction Among Patients with an Anterior Cruciate Ligament Tear in Jazan Province.","authors":"Zenat Khired, Hussam Darraj, Basem Zogel, Salman Mohammed Qahl, Nawaf Bakri, Khalid Ahmed Muafa Jnr, Mohammed H Alhazmi, Mohammed A Zalah, Almutasim Billa Moafa, Yahya Mahnashi","doi":"10.2147/ORR.S506370","DOIUrl":"https://doi.org/10.2147/ORR.S506370","url":null,"abstract":"<p><strong>Background: </strong>The knee joint is primarily stabilized by the Anterior Cruciate Ligament (ACL). ACL tear, a common injury resulting from sudden shock or intense forceful knee movement, is characterized by an ACL sprain or stretch. In Saudi Arabia, the incidence of ACL damage is estimated at 31.4%. Injuries can be contact-based (direct collision) or non-contact (imbalanced or flawed movement).</p><p><strong>Methodology: </strong>This cross-sectional observational study was conducted in the Jazan region of Saudi Arabia between December 2022 and May 2023 to assess personal and psychological perceptions of returning to activities after ACL reconstruction. The study included 113 patients; data was collected via self-administered questionnaire, and data analysis was performed using SPSS 23rd version. This study provides valuable insights into the factors affecting the return to activities after ACL tears.</p><p><strong>Results: </strong>The study found that most patients were male. Football is the most common physical activity associated with knee injury. Postoperative complication rates were low. Sex, site of injury, and reoperation were significantly associated with the perceived importance of the exercise score. Muscle strengthening postoperatively and age were significantly associated with knee injury and osteoarthritis outcome scores. Site of injury and ACL- quality of life score of \"social and emotional\" segment were significant factors associated with ACL - quality of life score of \"entertaining and physical activity\" segment. This study provides valuable insights into the factors affecting the return to ACL tear activity in the Jazan region.</p><p><strong>Conclusion: </strong>This study highlights the importance of patient education and support for safe exercise and emotional well-being after ACL. We found correlations between injury location and exercise perception, thus emphasizing the need for a safe environment. Postoperative strengthening and age- and sex-specific strategies are also important, and emotional support is critical for rehabilitation success. Further research on patients' beliefs, motivations, and provider communication is needed.</p>","PeriodicalId":19608,"journal":{"name":"Orthopedic Research and Reviews","volume":"17 ","pages":"159-173"},"PeriodicalIF":1.7,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039846/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144036538","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":"Exploring the Causal Relationship Between Osteoporosis and Rheumatoid Arthritis: A Bidirectional Mendelian Randomization Study.","authors":"Jie Li, Li Bao, Can Dai, Miao He","doi":"10.2147/ORR.S508155","DOIUrl":"https://doi.org/10.2147/ORR.S508155","url":null,"abstract":"<p><strong>Objective: </strong>Osteoporosis and rheumatoid arthritis (RA) are commonly associated, but whether there is a causal genetic relationship between them remains unclear. This study used a two-sample Mendelian randomization (MR) approach to investigate this causal relationship.</p><p><strong>Methods: </strong>Genetic instruments for osteoporosis and RA were obtained from published genome-wide association studies (GWAS). We selected SNPs with genome-wide significance (p < 5×10-8) and independent variation (r2 < 0.001). Causality was assessed using the inverse variance weighted (IVW) method, and heterogeneity, pleiotropy, and robustness were tested using Cochran's Q test, MR-Egger intercept, and leave-one-out sensitivity analysis.</p><p><strong>Results: </strong>The MR analysis revealed a causal effect of decreased bone mineral density (BMD) on RA risk (TB-BMD: OR = 1.094, 95% CI = 1.023-1.170, P = 0.009; FA-BMD: OR = 1.159, 95% CI = 1.019-1.320, P = 0.025; LS-BMD: OR: 1.175, 95% CI = 1.070-1.291, P = 0.001). Osteoporosis at different sites and age groups significantly influenced RA, while RA did not significantly affect osteoporosis. Sensitivity analyses confirmed the robustness of the results.</p><p><strong>Conclusion: </strong>Our study suggests a potential causal relationship between osteoporosis and RA, suggesting that osteoporosis may predispose individuals to RA. Further research is needed to understand the mechanisms and to confirm these findings across diverse populations.</p>","PeriodicalId":19608,"journal":{"name":"Orthopedic Research and Reviews","volume":"17 ","pages":"147-157"},"PeriodicalIF":1.7,"publicationDate":"2025-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12005204/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143997868","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":"The Role of Antidiabetic Drugs in Bone Health: Assessing the Risk of Osteoporosis Subtypes and Fractures Using Mendelian Randomization.","authors":"Gaorong Deng, Liping Wu, Shui Xiong, Junxin Zhou, Zongfang Li","doi":"10.2147/ORR.S508278","DOIUrl":"https://doi.org/10.2147/ORR.S508278","url":null,"abstract":"<p><strong>Introduction: </strong>Osteoporosis leads to decreased bone density and an increased risk of fractures, with diabetic patients being particularly vulnerable. This study aims to evaluate the effects of five common antidiabetic drugs-Metformin, GLP-1 receptor agonists, SGLT2 inhibitors, Insulin, and Gliclazide-on the risk of osteoporosis subtypes and fractures, using Mendelian Randomization (MR) to ensure result accuracy.</p><p><strong>Methods: </strong>Data from multiple Genome-Wide Association Studies (GWAS) databases were employed to assess the relationships between the use of these antidiabetic drugs and osteoporosis risk. The analysis utilized Mendelian Randomization techniques to minimize confounding and reverse causation, ensuring robust results.</p><p><strong>Results: </strong>The findings reveal that: Metformin is significantly negatively associated with osteoporosis (OR [95% CI]: 0.00936 [0.0011-0.0806], p = 2.11×10⁻⁵), indicating a potential bone-protective effect by reducing bone resorption and enhancing osteoblast activity through the activation of the AMPK pathway. GLP-1 receptor agonists are significantly positively associated with osteoporosis with pathological fractures (OR [95% CI]: 1.1247 [1.0043-1.2594], p = 0.0420), suggesting a potential increase in fracture risk. SGLT2 inhibitors show a weak negative association with osteoporosis (OR [95% CI]: 0.8987 [0.8092-0.9980], p = 0.0429), though the effect is minor and unstable. Gliclazide significantly increases the risk of pathological fractures (OR [95% CI]: 1.03E+08 [1.28E+02-8.32E+12], p = 0.0395), indicating a need for caution in its use among patients at high fracture risk.</p><p><strong>Discussion: </strong>The results highlight the potential bone-protective role of Metformin, which may be suitable for patients at high fracture risk. On the other hand, the use of GLP-1 receptor agonists and Gliclazide should be carefully considered, especially in individuals with osteoporosis or at high risk of fractures. These findings emphasize the importance of personalized medication management in diabetic patients to optimize bone health.</p>","PeriodicalId":19608,"journal":{"name":"Orthopedic Research and Reviews","volume":"17 ","pages":"129-145"},"PeriodicalIF":1.7,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11980942/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144008011","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}