Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA最新文献

{"title":"Chronic hyponatremia and skeletal vulnerability: bone loss, fragility fracture risk, and therapeutic uncertainties.","authors":"Lucas Maciel de Almeida Corrêa, Luiggi Kevin Virgino Brandão, Clara Belo Gamon Santiago, Alexandre de Assis Barbosa, Gabriel Rian Mazur, Gabriel Costa de Santana, Yan Roberth Delmiro Silva, Letícia Esteves Dante, Ivan Felipe Dutra Júnior","doi":"10.1007/s00198-026-08209-w","DOIUrl":"https://doi.org/10.1007/s00198-026-08209-w","url":null,"abstract":"<p><strong>Clinical relevance: </strong>Chronic hyponatremia is increasingly associated with skeletal vulnerability, including lower bone mineral density (BMD), greater fragility-fracture risk, and a broader phenotype of falls and frailty. Because hyponatremia is common in older and multimorbid adults, clinicians need a practical framework for interpreting its significance in osteoporosis care.</p><p><strong>Observations: </strong>Observational cohorts and meta-analyses consistently link chronic hyponatremia to lower BMD and higher fracture risk, while cellular, animal, biomarker, and selected clinical observations support biologic plausibility for a direct sodium-sensitive skeletal effect. Experimental data suggest that low extracellular sodium may stimulate osteoclastogenesis, impair osteoblast-lineage activity, alter mesenchymal stromal-cell fate, and interact with AVP-related signaling. Human evidence includes population studies, short-term remodeling-marker responses after sodium normalization, and rare clinical cases in which correction of chronic SIAD was followed by BMD recovery. However, residual confounding remains substantial, and available human data do not yet establish fracture protection, durable BMD gain, or uniform skeletal benefit across SIAD, hypervolemic hyponatremia, diuretic-associated hyponatremia, chronic kidney disease, malnutrition, or antiepileptic-drug exposure.</p><p><strong>Conclusions: </strong>Chronic hyponatremia should be regarded as a phenotype-sensitive skeletal risk signal and biologically plausible contributor to bone vulnerability, with the strongest causal arguments arising from chronic SIAD and experimental models, but it should not yet be treated as an evidence-based osteoporosis-treatment target in the absence of fracture or durable BMD endpoint data. In current practice, it should prompt fracture-risk contextualization, evaluation of falls, nutrition, muscle reserve, and secondary contributors to bone loss, while expectations regarding skeletal benefit from sodium correction remain cautious and evidence-based.</p>","PeriodicalId":520737,"journal":{"name":"Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149043206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systemic glucocorticoid use increases fracture risk similarly in individuals with and without type 2 diabetes: a Danish nationwide cohort study.","authors":"Zheer K Al-Mashhadi, Rikke Viggers, Jakob Starup-Linde, Bente L Langdahl, Veerle van Hulten, Joop P van den Bergh, Johanna Hm Driessen, Peter Vestergaard, Søren Gregersen","doi":"10.1007/s00198-026-08206-z","DOIUrl":"10.1007/s00198-026-08206-z","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Type 2 diabetes (T2D) and glucocorticoid treatment both increase risk of bone fractures. We found that glucocorticoid use increases fracture risk similarly regardless of T2D status. Findings were consistent over time and across subgroups. Care should be taken when prescribing glucocorticoids to individuals with T2D already at increased fracture risk.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Type 2 diabetes (T2D) is associated with increased risk of bone fractures, which may be caused by suppressed bone formation. Similarly, glucocorticoid (GC) treatment leads to suppressed bone formation, in addition to increased resorption. It is unknown whether GC treatment alters fracture risk equally in subjects with and subjects without T2D.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We performed a nationwide registry-based cohort study with a within-subject pre-treatment reference period to investigate whether T2D status modified the effects of systemic GCs on risk of first major osteoporotic fractures (MOFs)-defined as fractures of the hips, vertebrae, humerus, or forearm-within each observation period. Individuals with or without T2D receiving systemic GC treatment (≥ 1 redeemed prescription) between 2000 and 2018 were identified and followed during treatment. The reference period for GC treatment consisted of the 2-year period immediately prior to treatment in any given individual. For confounding control, we used standardized morbidity ratio (SMR) weighting. Each group (with/without T2D and during/before GC) was reweighted to resemble the T2D group in the GC treatment period. Incidence rate ratios (IRR) were estimated using a zero-inflated negative binomial model with predictors being T2D, GC treatment, and a product term between the two. A product term estimate &gt; 1 represents a larger effect of GC among the T2D group than in the non-T2D group.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We included 477,605 individuals (27,942 with T2D) with a total follow-up time of 1,358,739 person-years. A total of 21,581 MOFs were observed. Median follow-up time was 35 days (with a mean of 212 days) during GC treatment and 731 days in the pre-treatment period. After weighting, GC treatment was associated with an IRR of 1.70 [1.55-1.85], with no evidence of effect modification by T2D (product term IRR 1.01 [0.871.17]). These results were similar across subgroup and sensitivity analyses; when stratifying by sex (males vs. females) or age (&lt; 65 years, 6574 years, and ≥ 75 years), when counting recurring fractures during treatment, when allowing the effects of GC treatment to vary smoothly as a function of time-since-initiation, when accounting for differences in daily dosage with different durations of treatment, and under alternative modeling specifications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;We found that systemic GC use increases fracture risk to a similar degree in individuals with and individuals without T2D. While no potentiating effect was observed, individuals with T2D receiving GC t","PeriodicalId":520737,"journal":{"name":"Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148932463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of romosozumab on the peripheral and axial skeleton in postmenopausal women at high fracture risk: real-world evidence from DXA and HR-pQCT data.","authors":"M S A M Bevers, C E Wyers, B van Rietbergen, J P van den Bergh","doi":"10.1007/s00198-026-08148-6","DOIUrl":"https://doi.org/10.1007/s00198-026-08148-6","url":null,"abstract":"<p><p>Evidence on the effects of romosozumab mainly concerns axial aBMD. In 28 postmenopausal women, we found that spine and hip aBMD (DXA) significantly increased, while volumetric BMD, microarchitecture, and strength at the radius and tibia (HR-pQCT) remained unchanged or deteriorated. Most HR-pQCT changes did not differ from those in age-matched women on bisphosphonate treatment.</p><p><strong>Purpose: </strong>We assessed the effects of ROMO treatment on the axial skeleton using dual-energy X-ray absorptiometry (DXA) and on the peripheral skeleton using high-resolution peripheral quantitative CT (HR-pQCT) in real-world data of postmenopausal women at high fracture risk and compared HR-pQCT changes with those during bisphosphonate (BP) treatment.</p><p><strong>Methods: </strong>As part of regular care in our hospital, DXA (lumbar spine, hip) and HR-pQCT (distal radius, distal tibia) were performed before the start (T0) and after 12 months (T1) of ROMO treatment. HR-pQCT results were compared with those in 55 age-matched women receiving BP treatment after a recent fracture.</p><p><strong>Results: </strong>ROMO data were available of 28 women (72.4 ± 7.6 years, 67.9% treatment-naïve). At T0, areal bone mineral density (aBMD) T-scores were -2.3 ± 1.6 (lumbar spine), -2.1 ± 0.7 (total hip), and -2.7 ± 0.5 (femoral neck). At T1, aBMD was significantly higher than at T0 at the lumbar spine (+9.6% [IQR = 6.6,15.7], p < 0.001) and total hip (+4.4 ± 5.8%, p = 0.001) but not femoral neck. At the distal radius, a significant decrease was found in total (-2.4%, [-4.3,-0.1], p = 0.004) and trabecular (-1.7%, [-3.5,0.5], p = 0.013) volumetric BMD and in trabecular number, cortical thickness, and cortical area. Trabecular area and separation significantly increased. At the distal tibia, a significant change was found in trabecular number (decrease) and in trabecular thickness, separation, and heterogeneity (increase). Changes in radial and tibial stiffness and failure load were not significant. Most HR-pQCT changes did not significantly differ from those in the BP cohort.</p><p><strong>Conclusion: </strong>After 12 months of ROMO treatment, aBMD increased significantly at the lumbar spine and total hip, while volumetric BMD, microarchitecture, and strength at the peripheral skeleton did not change or deteriorated.</p>","PeriodicalId":520737,"journal":{"name":"Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148914634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical guidance on evaluation and management of bone fragility in patients with monoclonal gammopathy of undetermined significance (MGUS): an IOF position statement.","authors":"Cyrille B Confavreux, Beatrice Bouvard, Robert Blank, Peyman Hadji, Emmanuel Biver, Jean-Jacques Body, Maria Luisa Brandi, Claudia Campusano, Peter R Ebeling, Abdellah El Maghraoui, Gerold Holzer, David Kendler, Tobie de Villiers, René Rizzoli, A Joseph Foldes","doi":"10.1007/s00198-026-08178-0","DOIUrl":"https://doi.org/10.1007/s00198-026-08178-0","url":null,"abstract":"<p><p>Monoclonal gammopathy of undetermined significance (MGUS) is a frequent hematological condition that occurs in later life. MGUS is associated with increased fragility fractures that mix individual osteoporotic risk factors, MGUS-related comorbidities, and direct MGUS bone impact such as senescence of plasma cells. This International Osteoporosis Foundation (IOF) position statement aims at evaluating the potential relationship between MGUS and fracture risk, as well as methods for evaluating bone involvement in MGUS. Finally, we propose the first bone clinical guidance for patients with MGUS to improve their bone health.</p><p><strong>Background: </strong>Monoclonal gammopathy of undetermined significance is a prevalent hematological condition in adults, characterized by the presence of an abnormal monoclonal protein in the blood without concomitant symptoms or malignancy. MGUS is of considerable bone significance and contributes to fragility fractures in adults.</p><p><strong>Methods: </strong>In this review, data pertaining to bone fragility were collected, including epidemiological fracture data in patients with MGUS, bone mineral density (BMD), bone microarchitecture, bone turnover marker, and bone histomorphometry data.</p><p><strong>Results: </strong>Collectively, these findings suggest an elevated risk of fractures, especially in presence of osteoporotic risk factors or comorbidities, and a diminished BMD due to augmented bone resorption. Studies focusing on the treatment of this condition are limited.</p><p><strong>Conclusion: </strong>Based on this analysis, we present the International Osteoporosis Foundation (IOF) position statement for bone evaluation and management of these patients. We recommend a risk-adapted treatment strategy. A proposal of bone clinical guidance dedicated to patients with MGUS is presented, suggesting bisphosphonates as the preferred treatment option.</p>","PeriodicalId":520737,"journal":{"name":"Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148914644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multi-center validation of automated CT-based L1 vertebral Hounsfield unit.","authors":"Perry J Pickhardt, Glen M Blake, Matthew H Lee, Andrew D Rule, Ayis T Pyrros, Marcio A B C Rockenbach, Ross W Filice, Benjamin E Rush, Neil C Binkley, John W Garrett","doi":"10.1007/s00198-026-08212-1","DOIUrl":"https://doi.org/10.1007/s00198-026-08212-1","url":null,"abstract":"<p><p>This study assessed variation of automated CT-based L1 trabecular attenuation for opportunistic CT screening across multiple U.S.-based healthcare systems. L1 HU measurements demonstrated similar behavior among the five sites, including relative relationships according to age, sex, race, and CT scanner, and < 100 HU was generalizable for practical opportunistic CT screening and diagnosis.</p><p><strong>Purpose: </strong>To assess variability of automated population-based L1 trabecular attenuation (HU) measurement at abdominal CT among five US-based medical systems and consider a practical 100 HU threshold for opportunistic CT-based osteoporosis screening and diagnosis.</p><p><strong>Methods: </strong>Heterogeneous adult patient cohorts undergoing abdominal CT evaluation for any indication at five US medical systems were included for L1 vertebral body trabecular attenuation (L1 HU) assessment using a validated AI pipeline that places a fully automated ROI. Exclusion criteria included IV contrast, non-120 kVp setting, and non-physiologic outliers. All results were normalized to White patient ranges after age and sex matching. Thresholds of 100 HU and 120 HU were considered.</p><p><strong>Results: </strong>The final multi-center cohort included 123,001 adults (51.1% women, 79.6% White). For White women age 50+, 15% had L1 attenuation values ≤ 100 HU, and 30% ≤ 120 HU. For White men, the equivalent percentages were 12% and 26%; for Black women, 7% and 17%, and for Black men, 5% and 11%. For 20-49-year-olds, only about 1% were below the L1 100 HU threshold. L1 HU measurements showed similar distributions among the five medical systems and similar relative relationships according to age, sex, race, and CT scanner. After Bonferroni correction, none of the differences among different medical systems were significant.</p><p><strong>Conclusion: </strong>For opportunistic CT screening and diagnosis, automated assessment of L1 trabecular attenuation was generalizable in a multi-center setting. A 100 HU threshold maintains specificity with a prevalence that is age-, sex-, and race-dependent, ranging from 1% in adults under 50 to up to 15% in White women.</p>","PeriodicalId":520737,"journal":{"name":"Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2026-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148898879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Claims-based frailty index and risk of hospitalisation for hip fracture among adults aged 60-74 years in Tokyo, Japan.","authors":"Seigo Mitsutake, Takumi Hirata","doi":"10.1007/s00198-026-08216-x","DOIUrl":"https://doi.org/10.1007/s00198-026-08216-x","url":null,"abstract":"<p><p>Among 606,449 adults aged 60-74 years, the claims-based frailty index categories predicted hospitalisation for hip fractures: beneficiaries classified as pre-frail or frail were at higher risk (hazard ratios, 2.17 and 3.50, respectively). The CFI can help identify individuals who can benefit from targeted interventions to prevent hip fractures.</p><p><strong>Purpose: </strong>Although the claims-based frailty index (CFI) may aid early identification of older adults at high risk of hip fractures, little is known about the association between the CFI and the incidence of hip fractures. The aim of this study was to examine the association between the CFI and hospitalisation for hip fractures among adults aged 60-74 years in Tokyo, Japan.</p><p><strong>Methods: </strong>This retrospective cohort study used linked health checkup and medical claims data in Tokyo between April 2015 and March 2023. Beneficiaries of the National Health Insurance aged 60-74 years who underwent an annual health checkup between April 2017 and March 2018 were identified. Beneficiaries were followed up for hospitalisation for hip fractures through March 2023. Cox proportional hazards models, adjusted for Fracture Risk Assessment Tool (FRAX)-related variables, osteoporosis, and self-reported health status and habits, were used to examine the association between the CFI and hospitalisation for hip fractures. Harrell's C-statistics were compared between models with and without the CFI to assess the CFI's discriminative ability.</p><p><strong>Results: </strong>Among 606,449 beneficiaries, 553,747 (91.3%) were classified as robust, 47,348 (7.8%) as pre-frail, and 5,354 (0.9%) as frail. Compared with beneficiaries classified as robust, the risk of hospitalisation for hip fractures was higher in those classified as pre-frail (HR 2.17; 95% CI 1.87-2.51) and frail (HR 3.50; 95% CI 2.62-4.69). The CFI modestly improved discrimination beyond FRAX-related variates.</p><p><strong>Conclusions: </strong>The CFI can help identify individuals who may benefit from targeted interventions to prevent hip fractures.</p>","PeriodicalId":520737,"journal":{"name":"Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Body weight predicts denosumab pharmacodynamic duration: a real-world longitudinal cohort study.","authors":"Jinwen He, Haoze Song, Hao Liu, Huan Wang, Zhaoyu Wang, Churan Wang, Liyuan Tao, Chunli Song","doi":"10.1007/s00198-026-08210-3","DOIUrl":"https://doi.org/10.1007/s00198-026-08210-3","url":null,"abstract":"<p><p>Denosumab is administered as a fixed 60-mg subcutaneous injection every 6 months, regardless of body weight. In a retrospective cohort of 2123 patients with osteoporosis, the GAM-predicted duration of CTX reduction after each injection was about two months shorter at 80 kg than at 40 kg, but still exceeded the 6-month interval across the evaluated weight range. These findings support body-weight-aware CTX monitoring in heavier patients, not a change to the approved dosing interval.</p><p><strong>Purpose: </strong>Denosumab is administered as a fixed 60-mg subcutaneous injection every 6 months, but the duration of bone turnover reduction may vary with body weight. We investigated whether body weight affects the duration of bone turnover marker reduction and whether this association could inform body-weight-aware monitoring.</p><p><strong>Methods: </strong>We retrospectively analyzed data from 2123 adults with osteoporosis treated with denosumab between 2020 and 2025. Serial serum measurements of beta-isomerized C-terminal telopeptide of type I collagen (CTX) and total procollagen type I N-terminal propeptide (P1NP) were modeled using generalized additive models and random forests to estimate the time from injection until prespecified operational thresholds (CTX > 0.28 ng/mL; P1NP > 35 ng/mL) were crossed. Predicted threshold-crossing times were summarized by body weight.</p><p><strong>Results: </strong>The cohort contributed 4257 CTX and 4477 P1NP measurements. For CTX, the generalized additive model predicted threshold-crossing times that decreased from 262 days (8.7 months; 95% CI: 236-296) at 40 kg to 196 days (6.5 months; 95% CI: 180-238) at 80 kg, corresponding to a slope of - 1.60 days/kg (95% CI: - 2.03 to - 1.17). Random forest predictions were directionally consistent with those from the generalized additive model (Pearson r = 0.917 for CTX). For P1NP, the association followed an inverted U-shaped pattern, with the longest predicted interval at intermediate body weights; P1NP was therefore less informative for interval estimation. Sensitivity analyses using alternative thresholds, one observation per patient per dosing cycle, and adjustment for parathyroid hormone (PTH) all preserved the weight-stratified gradient.</p><p><strong>Conclusions: </strong>Body weight is an independent determinant of model-predicted denosumab pharmacodynamic duration. These findings, based on surrogate markers, support body-weight-aware CTX monitoring, particularly in heavier patients. They do not justify changing the approved 6-month dosing interval. Prospective studies incorporating fracture endpoints are needed before clinical implementation.</p>","PeriodicalId":520737,"journal":{"name":"Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recognition and reporting of vertebral fractures in thoracic and abdominal computed tomography images - have we learnt our lesson?","authors":"Dimai Hans Peter, Steiner Jakob, Igrec Jasminka, Stranger Nikolaus, Riedl Regina, Fuchsjäger Michael","doi":"10.1007/s00198-026-08204-1","DOIUrl":"https://doi.org/10.1007/s00198-026-08204-1","url":null,"abstract":"<p><p>The reporting rate of vertebral fractures (VFs) identified on routine thoracic and abdominal CT scans was evaluated. Only 14.7% of VFs were documented in the impression section of the radiology report. These findings indicate that the recognition and reporting of VFs on routine CT examinations have not improved over the past decade.</p><p><strong>Purpose: </strong>Vertebral fractures (VFs) are the most common osteoporotic fractures, yet they are substantially underreported on routine computed tomography (CT) scans. This study aimed to quantify the detection and reporting rates of VFs on thoracic and abdominal CT scans performed for non-musculoskeletal indications.</p><p><strong>Methods: </strong>Of 8500 CT scans performed at a large Austrian tertiary-care hospital in 2023, 1500 thoracic and abdominal CT scans were randomly selected. Two musculoskeletal radiologists independently assessed vertebral bodies of the thoracic and lumbar spine using Genant's semiquantitative method. Vertebral deformities were categorised as Grade 1 (20-25% height loss), Grade 2 (25-40%), or Grade 3 (>40%). For the purpose of this study, a VF was defined as Grade ≥ 2. Findings were compared with the original radiology reports to determine detection and reporting rates.</p><p><strong>Results: </strong>Consensus results were available for 1481 CT scans from 1364 individuals. Overall, 170 VFs (11.5%) were identified in 164 patients. Of these, 35.9% (n = 61) were lumbar, 52.4% (n = 89) were thoracic, and 11.8% (n = 20) involved both regions. Only 14.7% of all VFs were documented in the impression section of the corresponding radiology report, whereas 50.0% (85/170) were mentioned in the narrative interpretation section. Inter-reader agreement was excellent (κ = 0.94).</p><p><strong>Conclusion: </strong>Despite increasing awareness of osteoporosis, VFs remain underreported on routine thoracic and abdominal CT scans. Consequently, many patients may not receive appropriate osteoporosis evaluation and treatment, placing them at increased risk of subsequent fractures, disability, and increased mortality.</p>","PeriodicalId":520737,"journal":{"name":"Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Machine learning-based screening model for osteoporosis in Chinese postmenopausal women: a nationwide study with prospective fracture validation.","authors":"Qichao Sun, Xiangjun Yin, Wei Yu, Nan Zhao, Lin Chen, Shunyu Tang, Hua Lin, Lu Cui, Xiaolan Jin, Zhongjian Xie, Steven R Cummings, Zhixin Li, Linhong Wang, Lijia Cui, Weibo Xia","doi":"10.1007/s00198-026-08185-1","DOIUrl":"https://doi.org/10.1007/s00198-026-08185-1","url":null,"abstract":"<p><p>This study develops a machine learning model to predict osteoporosis in Chinese postmenopausal women. The model was trained using the largest nationwide cohort and externally validated. It showed AUCs of 0.744-0.798 and demonstrated prognostic value for 5-year fracture risk, supporting population-level screening where DXA resources are limited.</p><p><strong>Purpose: </strong>Osteoporosis is highly prevalent among Chinese postmenopausal women, yet underdiagnosis remains due to limited DXA availability. We aimed to develop and validate a machine learning-based model for osteoporosis prediction using easily obtainable variables.</p><p><strong>Methods: </strong>The model was trained using data from the largest nationwide cohort (China Osteoporosis Prevalence Study, n = 6,574) and externally validated in two independent cohorts: the China Vertebral and Osteoporosis Study (n = 1,758) and the Peking Vertebral Fracture Study baseline (n = 1,439). Five predictors selected via LASSO regression were used to train the prediction model. Model performance was evaluated by area under the curve (AUC) and calibration plot. To evaluate its ability to predict future fractures, the model was evaluated in a 5-year follow-up cohort (n = 795). A web-based calculator was developed for public use.</p><p><strong>Results: </strong>The model showed strong discrimination (AUC: 0.798 in the training cohort; 0.775 in the internal validation cohort; 0.750 and 0.744 in the external validation cohorts) and good calibration across all cohorts. A rule-out threshold (≥ 0.098) demonstrated high sensitivity (94.7%, 89.3%) and negative predictive value (91.3%, 92.7%) in two external cohorts. The model also demonstrated prognostic value for fracture risk stratification. In the 5-year follow-up, individuals classified as high risk had a significantly higher cumulative incidence of clinical fractures (HR 1.78; 95% CI, 1.06-2.99; P = 0.026), as well as higher rates of all fractures (15.9% vs. 9.5%; P = 0.015) and non-traumatic fractures (7.8% vs. 3.9%; P = 0.041).</p><p><strong>Conclusions: </strong>This model demonstrated good performance in predicting osteoporosis among Chinese postmenopausal women and may facilitate two-step screening strategies.</p>","PeriodicalId":520737,"journal":{"name":"Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148842310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preventing fragility fractures: AI-based opportunistic osteoporosis detection in routine CT ​.","authors":"Valentin Koch, Lorenz Lamm, Bianca Teodorescu, Karine Louis, Niklas Eisl, Jannik Kahmann, Patrick Schmidt, Pia Zimmermann, Christian Wiedemeyer, Lea-Elena Braunschneider","doi":"10.1007/s00198-026-08186-0","DOIUrl":"https://doi.org/10.1007/s00198-026-08186-0","url":null,"abstract":"<p><p>This study shows that an artificial intelligence tool can identify patterns of reduced bone mineral density in routine CT scans that would otherwise remain unreported. Compared to radiologists, the AI system flagged substantially more cases with potential signs of reduced bone mineral density, offering a scalable approach to support earlier identification of individuals who may benefit from further assessment.</p><p><strong>Purpose: </strong>Osteoporosis often goes unrecognized in routine computed tomography (CT) scans performed for unrelated indications, leading to diagnosis only after a fragility fracture occurs. We present an artificial intelligence (AI)-based tool for opportunistic bone mineral density (BMD) assessment on contrast-enhanced and native CT scans of the entire spine to enable detection of patterns suggestive of reduced BMD.</p><p><strong>Methods: </strong>We trained a neural network to classify BMD of individual vertebrae as normal, osteopenic, or osteoporotic, using labels derived from Dual-Energy X-ray Absorptiometry (DXA) T-scores as the reference standard. The training dataset included 1084 sagittal spine CT series from 526 patients across multiple US and German centers, encompassing cervical, thoracic, and lumbar regions. The model was evaluated on an independent holdout set of 270 patients. Additionally, in a retrospective analysis of 354 patients who later sustained fragility fractures, the AI model was applied to contrast or native CT scans acquired 12-24 months prior to the fracture event to assess how often the AI model would flag patterns suggestive of reduced BMD in patients who subsequently sustained fragility fractures.</p><p><strong>Results: </strong>On the independent holdout set, the algorithm achieved a specificity of 84% and a sensitivity of 67%. In the retrospective study, the AI model flagged patterns of reduced BMD in 184 of 354 patients (87 osteoporotic, 97 osteopenic), while radiologists had reported reduced BMD in only 41 cases.</p><p><strong>Conclusion: </strong>To the best of our knowledge, this AI model is the first to classify BMD across the entire spine on both contrast and native CT scans. It demonstrates robust real-world performance and offers a promising approach for scalable opportunistic BMD screening in routine CT imaging.</p>","PeriodicalId":520737,"journal":{"name":"Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148815478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}