Archives of Osteoporosis最新文献

{"title":"Actionable osteoporosis alerts in musculoskeletal radiology reports improve secondary fracture prevention after orthopaedic fragility fractures","authors":"Farid Pakizeh, Keyvan Mansouri","doi":"10.1007/s11657-026-01770-1","DOIUrl":"10.1007/s11657-026-01770-1","url":null,"abstract":"<div><h3>\u0000 <i>Summary</i>\u0000 </h3><p>A standardized osteoporosis alert in fracture radiology reports boosted osteoporosis care from 17 to 57% in 500 patients. This low-cost, scalable intervention bridges a critical communication gap between radiologists and clinicians, substantially improving secondary fracture prevention after fragility fractures.</p><h3>Background\u0000</h3><p>Fragility fractures in adults aged 50 years or older are sentinel events for osteoporosis, but post-fracture evaluation and treatment remain inconsistent. Radiology reports are a scalable point of clinical communication, yet conventional fracture reports often describe morphology without explicitly recommending secondary fracture prevention.</p><h3>Purpose\u0000</h3><p>To evaluate whether an actionable osteoporosis alert embedded in musculoskeletal radiology reports improves downstream osteoporosis care after low-energy orthopaedic fractures.</p><h3>Methods\u0000</h3><p>This multicenter interrupted time-series study included 500 adults aged 50 years or older with low-energy fractures treated across three centers: one academic trauma center, one academic general hospital, and one public community hospital. The pre-alert period included 250 patients from January to December 2024; the post-alert period included 250 patients from January to December 2025. The primary cohort included hip/proximal femur, clinical vertebral compression, distal radius/forearm, and proximal humerus fractures. Pelvic/sacral insufficiency fractures were retained only as an expanded secondary cohort. Low-energy fracture status was adjudicated from emergency, orthopaedic, and radiology documentation and defined as a fall from standing height or less without malignancy, periprosthetic fracture, atypical femoral fracture, or high-energy trauma. The intervention was a standardized report impression sentence recommending osteoporosis evaluation and secondary fracture prevention. The primary outcome was osteoporosis care initiation within 90 days, defined as DXA order, specialist/FLS referral, fracture-risk assessment, or anti-osteoporosis medication initiation.</p><h3>Results\u0000</h3><p>In the expanded 500-patient cohort, actionable report wording increased from 6.8 to 82.4%. Overall radiologist adherence in the post-alert period was 206/250 reports (82.4%), varying by center from 71.7 to 88.4% and by fracture site from 66.7 to 91.4%. Osteoporosis care initiation increased from 16.8% before implementation to 56.8% after implementation. Segmented regression of 24 monthly observations demonstrated an immediate post-intervention level increase of 40.0 percentage points (95% CI, 33.0 to 47.0; <i>p</i> < 0.001), with no significant pre-intervention trend, no significant seasonality, and no evidence of positive autocorrelation (Durbin-Watson, 2.85). In multivariable analysis, the post-alert period remained associated with care initiation after adjustment for age, sex, fracture si","PeriodicalId":8283,"journal":{"name":"Archives of Osteoporosis","volume":"21 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148856874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High fracture risk in postmenopausal women established by FRAX, Garvan, and POL-RISK algorithms","authors":"Rafał Hebel,&nbsp;Wojciech Pluskiewicz,&nbsp;Piotr Adamczyk,&nbsp;Bogna Drozdzowska,&nbsp;Hanna Hüpsch","doi":"10.1007/s11657-026-01768-9","DOIUrl":"10.1007/s11657-026-01768-9","url":null,"abstract":"<div><h3>\u0000 <i>Summary</i>\u0000 </h3><p>The study presents osteoporotic fracture risk in postmenopausal women established by FRAX, Garvan and POL-RISK algorithms for next 10 years. In studied group, a relatively high level of fracture risk was shown. These findings emphasize the importance of increasing treatment to reduce the expected rise in fracture rate in the future.</p><h3>Purpose</h3><p>The aim of the study was to assess the 10-year osteoporotic fracture risk of postmenopausal women using the FRAX, Garvan, and POL-RISK algorithms and to compare those tools in terms of identification of high-risk subjects.</p><h3>Methods</h3><p>The study group consisted of 508 consecutive postmenopausal women recruited in three osteoporotic outpatient clinics. Mean age was 69.8 ± 7.5 years. Data on clinical risk factors were collected. Bone status was assessed at the hip using a Lunar Prodigy device. Fracture risk was established by FRAX, Garvan, and POL-RISK algorithms for the next 10 years.</p><h3>Results</h3><p>Mean risk for major fractures for FRAX was 8.85 ± 5.43% and for any fractures for Garvan and POL-RISK 29.71 ± 20.53% and 28.1 ± 14.85%, respectively. Mean risk for hip fractures for FRAX was 3.23 ± 3.72% and 13.33 ± 18.30% for Garvan. For FRAX in 185 women (36.4%), hip fracture risk was high (≥ 3%) and in 119 (23.4%) very high ≥ 4.5% and high risk for major fracture was in 159 (31.3%) women (≥ 10%) and very high (≥ 15%) in 64 (12.6%) women. For therapeutic thresholds, high risk for FRAX major fracture, POL-RISK, and Garvan was noted in 316 (62.2%), 374 (73.5%) and 298 (58.5%) women, respectively. The results correlated for any (major) significantly between algorithms FRAX-Garvan<i> r</i> = 0.66, <i>p</i> &lt; 0.001, FRAX-POL-RISK <i>r</i> = 0.60, <i>p</i> &lt; 0.001, and Garvan-POL-RISK <i>r</i> = 0.93, <i>p</i> &lt; 0.001. A stronger relationship was observed between Garvan and POL-RISK than between either of them and FRAX. FRAX hip risk correlated with Garvan hip risk <i>r</i> = 0.57, <i>p</i> &lt; 0.001.</p><h3>Conclusion</h3><p>In studied group, a relatively high level of fracture risk, especially for hip, was shown. Considering these findings, it is advisable to expand the population of postmenopausal women eligible for effective anti-osteoporotic therapy.</p></div>","PeriodicalId":8283,"journal":{"name":"Archives of Osteoporosis","volume":"21 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148838189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hip anteroposterior radiographic indices for effective osteoporosis screening in female patients undergoing total hip arthroplasty","authors":"Ryo Higuchi,&nbsp;Keisuke Uemura,&nbsp;Tomoki Asano,&nbsp;Sotaro Kono,&nbsp;Hirokazu Mae,&nbsp;Tetsuro Tani,&nbsp;Kazuma Takashima,&nbsp;Ryota Nakaya,&nbsp;Yasunori Okamoto,&nbsp;Katsuya Nakata,&nbsp;Seiji Okada,&nbsp;Hidetoshi Hamada","doi":"10.1007/s11657-026-01760-3","DOIUrl":"10.1007/s11657-026-01760-3","url":null,"abstract":"<div><h3>\u0000 <i>Summary</i>\u0000 </h3><p>Osteoporosis in patients awaiting total hip arthroplasty remains undiagnosed. Although hip radiographic indices have been proposed for screening, they have not been compared. We compared the diagnostic accuracy of eight indices for osteoporosis. The canal–bone ratio measured 7 cm below the lesser trochanter may be a useful screening tool.</p><h3>Purpose</h3><p>Osteoporosis increases the risk of perioperative and postoperative fractures in patients undergoing total hip arthroplasty (THA). However, osteoporosis remains undiagnosed and untreated preoperatively. Several indices measured on hip anteroposterior radiographs have been proposed to screen for osteoporosis. Nevertheless, few studies have compared these indices, necessitating investigations to identify a practical and effective radiographic index.</p><h3>Methods</h3><p>Osteoporosis prevalence was assessed in 317 female patients who underwent dual-energy X-ray absorptiometry before primary THA. The screening performance of eight radiographic indices was evaluated using anteroposterior hip radiographs for patients without previous diagnosis or treatment of osteoporosis: canal flare index (CFI), morphological cortical index (MCI), canal–bone ratio (CBR) at 2, 7, and 10 cm below the lesser trochanter and canal–bone area ratio (CBAR) measured at 2–7, 2–10, and 7–10 cm segments. Receiver operating characteristic analyses were performed, and the areas under the curve (AUCs) were calculated and compared among indices.</p><h3>Results</h3><p>Osteoporosis was identified in 129 patients (40.7%), of whom only 48 (37.2%) received treatment. The highest AUC values were observed for CBAR2–7 (0.801), CBAR7–10 (0.798), and CBR7 (0.798), followed by CBAR2–10 (0.785), CBR10 (0.766), CBR2 (0.740), CFI (0.696), and MCI (0.654). CBAR and CBR7 exhibited higher screening accuracy than other indices.</p><h3>Conclusion</h3><p>The osteoporosis prevalence and treatment rates were 40.7% and 37.2%, respectively. Among the radiographic indices, CBR7 and CBARs demonstrated favorable screening performance, with CBR7 offering comparable accuracy and greater simplicity. CBR7 may serve as a practical and efficient screening tool for osteoporosis.</p></div>","PeriodicalId":8283,"journal":{"name":"Archives of Osteoporosis","volume":"21 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s11657-026-01760-3.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148838358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Revisional Roux-en-Y gastric bypass after sleeve gastrectomy impacts bone health in postmenopausal women","authors":"Léa Karam,&nbsp;Cécile Philippoteaux,&nbsp;Nassima Ramdane,&nbsp;Hélène Verkindt,&nbsp;Julien Paccou","doi":"10.1007/s11657-026-01772-z","DOIUrl":"10.1007/s11657-026-01772-z","url":null,"abstract":"<div><h3>\u0000 <i>Summary</i>\u0000 </h3><p>Revisional Roux-en-Y gastric bypass after sleeve gastrectomy may worsen bone loss compared to primary surgery. This study found significantly lower hip and femoral neck bone density despite similar body composition. These results emphasize the need for careful bone monitoring in patients undergoing revisional bariatric procedures.</p><h3>Background</h3><p>Bariatric surgery effectively treats severe obesity but adversely affects bone health, particularly after malabsorptive procedures such as Roux-en-Y gastric bypass (RYGB). While skeletal consequences of primary RYGB are well-documented, data on revisional RYGB following sleeve gastrectomy (SG) are scarce. This study aimed to assess the impact of revisional RYGB on bone mineral density (BMD), body composition, and related biochemical parameters.</p><h3>Methods</h3><p>In this single-center, cross-sectional study, postmenopausal women who underwent primary or revisional RYGB were evaluated using dual-energy X-ray absorptiometry (DXA). Two groups were defined: primary RYGB (<i>n</i> = 97) and revisional RYGB after SG (<i>n</i> = 23). Demographics, comorbidities, osteoporosis risk factors, BMD at lumbar spine, femoral neck, and total hip, and body composition were collected. BMD and body composition were analyzed both unadjusted and adjusted for age, BMI, and time since surgery.</p><h3>Results</h3><p>Baseline characteristics, BMI, comorbidities, and osteoporotic risk factors were similar between groups. Unadjusted femoral neck BMD and T-scores were significantly lower in the revisional RYGB group (BMD: 0.693 ± 0.098 vs. 0.761 ± 0.114 g/cm², <i>p</i> = 0.011; T-score: −1.4 ± 0.8 vs. −0.9 ± 0.9, <i>p</i> = 0.016), whereas lumbar spine and total hip BMD were comparable. After adjustment, the adjusted mean (95% CI) of total hip BMD (0.834 (0.786 to 0.882) vs. 0.899 (0.877 to 0.921) g/cm², <i>p</i> = 0.017) and that of femoral neck BMD (0.682 (0.636 to 0.729) vs. 0.763 (0.742 to 0.785) g/cm², <i>p</i> = 0.003) remained significantly lower in the revisional group. Body composition did not differ between groups.</p><h3>Conclusions</h3><p>Revisional RYGB after SG is associated with lower BMD at femoral sites compared with primary RYGB, even after adjusting for age, BMI, and time since surgery, while body composition is similar. These findings highlight the need for targeted bone health monitoring and management in patients undergoing revisional bariatric procedures.</p></div>","PeriodicalId":8283,"journal":{"name":"Archives of Osteoporosis","volume":"21 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148824382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fragility fractures and risk factors in a peritoneal dialysis setting","authors":"Mariana Diz-Lopes,&nbsp;Bernardo Fernandes,&nbsp;Teresa Martins-Rocha,&nbsp;Lúcia Costa,&nbsp;Ana Beco,&nbsp;Ana Oliveira,&nbsp;Ricardo Neto,&nbsp;João Frazão","doi":"10.1007/s11657-026-01771-0","DOIUrl":"10.1007/s11657-026-01771-0","url":null,"abstract":"<div><h3>\u0000 <i>Summary</i>\u0000 </h3><p>Peritoneal dialysis patients have poorly characterized fracture risk. In this retrospective cohort of 325 patients, fragility fractures were frequent, mainly asymptomatic vertebral fractures. Fracture risk is independently associated with prior fractures and vascular calcification but FRAX® underestimates fracture risk, underscoring the need for improved assessment strategies tailored to peritoneal dialysis patients.</p><h3>Purpose</h3><p>Data on fracture incidence, risk factors, and fracture risk assessment tools in patients treated with peritoneal dialysis (PD) remain limited. We aimed to evaluate the prevalence, incidence, and determinants of fragility fractures in PD patients and to assess the performance of the Fracture Risk Assessment Tool (FRAX®).</p><h3>Methods</h3><p>Retrospective single-center cohort study including adult patients receiving PD for ≥ 12 months. Fragility fractures occurring during PD follow-up were identified through clinical records and review of spine radiographs. Vascular calcification was assessed using the Adragão vascular calcification score (VCS). FRAX® probabilities for fracture risk were calculated without bone mineral density. Logistic regression was used to identify independent predictors of fractures, and receiver operating characteristic (ROC) curves evaluated FRAX® performance.</p><h3>Results</h3><p>Among 325 patients receiving PD (mean age 53 ± 8 years, 57% male), 32 (9.8%) fragility fractures were identified, and most were asymptomatic vertebral fractures (<i>n</i> = 23, 7.1%). In multivariable analysis, previous fracture history (OR 4.85, 95% CI 1.22–19.27) and higher VCS (OR 2.10, 95% CI 1.10–4.03) were independently associated with fracture occurrence. FRAX® showed modest discriminatory ability for any fragility fracture (AUC 0.69) and very low sensitivity at standard intervention thresholds, even when CKD was classified as secondary osteoporosis.</p><h3>Conclusion</h3><p>Patients treated with PD experience a high burden of fragility fractures, largely driven by unrecognized vertebral fractures. Fracture risk is independently associated with prior fractures and vascular calcification. FRAX® underestimates fracture risk in this population, underscoring the need for improved fracture risk assessment strategies tailored to PD patients.</p></div>","PeriodicalId":8283,"journal":{"name":"Archives of Osteoporosis","volume":"21 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148837411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex-specific trends in hip fracture incidence and disparities in DXA utilization in Brazil: a nationwide ecological analysis","authors":"Isabela Januário,&nbsp;Ben-Hur Albergaria,&nbsp;Bruno Casaes Teixeira,&nbsp;Marise Lazaretti-Castro","doi":"10.1007/s11657-026-01734-5","DOIUrl":"10.1007/s11657-026-01734-5","url":null,"abstract":"<div><h3>Summary</h3><p>This study analyzed sex-specific trends in hip fracture incidence, DXA utilization, and device distribution in Brazil from 2008 to 2022. Hip fracture incidence increased over time, whereas DXA use, particularly among men, remained markedly lower, with substantial disparities in device availability between the public and private sectors.</p><h3>Purpose</h3><p>We aimed to evaluate temporal trends in hip fracture incidence and DXA exam utilization in Brazil, stratified by sex, and to assess DXA device distribution across public and private healthcare sectors.</p><h3>Methods</h3><p>This was a retrospective analysis of Brazilian public healthcare databases from January 1, 2008, to December 31, 2022, examining hip fracture hospitalizations, DXA exam utilization, and DXA device availability.</p><h3>Results</h3><p>From 2008 to 2022, 583,205 hip fractures occurred in individuals ≥ 50 years living in Brazil. In 2022, incidence rates were 155/100,000 in women and 94/100,000 in men; median ages were 80 and 74 years, respectively. Hip fracture incidence increased by 25.8%, with a more pronounced rise after 2015. DXA rates in 2022 were 2177/100,000 in women and 182/100,000 in men ≥ 50; in guideline-recommended groups, 2840/100,000 in women ≥ 65 and 385/100,000 in men ≥ 70. The hip fracture ratio between men and women was ~ 2:3, whereas the DXA exam ratio was 1:10. DXA device availability was 12.2 per million inhabitants overall, with 6.2 in the public sector versus 27 in the private sector.</p><h3>Conclusions</h3><p>Hip fracture incidence in Brazil increased over the study period, particularly after 2015, without a proportional expansion in DXA utilization. This mismatch is more pronounced in men, who experience a substantial fracture burden but remain markedly underscreened. These findings highlight structural inequities in access to osteoporosis diagnosis and suggest persistent underdiagnosis, particularly in the public healthcare system.</p></div>","PeriodicalId":8283,"journal":{"name":"Archives of Osteoporosis","volume":"21 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s11657-026-01734-5.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148824421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hip fracture seasonality in a mild climate: the joint association of daylight duration and temperature","authors":"Akeem A. Williams,&nbsp;Lauren Claravall,&nbsp;Madison T. Alexander,&nbsp;Adriana A. Solis,&nbsp;Molly A. Hulbert,&nbsp;Leon Z. Liu,&nbsp;Alexandra K. Schwartz,&nbsp;William T. Kent,&nbsp;Paul J. Girard,&nbsp;Jan M. Hughes-Austin","doi":"10.1007/s11657-026-01762-1","DOIUrl":"10.1007/s11657-026-01762-1","url":null,"abstract":"<div><h3>Purpose</h3><p>To evaluate the seasonality of hip fractures and determine whether daylight duration and temperature are associated with monthly fracture volume; and likelihood of a hip fracture occurring during high-volume months in Southern California, a region with mild seasonal climate variation.</p><h3>Methods</h3><p>We conducted a serial cross-sectional study of adults aged ≥ 50 years who underwent operative treatment for hip fracture at a single academic health system between 2017 and 2022. Patients were identified using ICD-10 codes and operative CPT codes. Monthly hip fracture counts were analyzed for seasonality using year-adjusted cosinor analysis and categorized into volume tertiles: high (≥ 9 fractures/month; top tertile) and lower (&lt; 9 fractures/month; lower two tertiles: low &lt; 6, middle 6–8). We used multivariable logistic regression to evaluate the interaction of daylight duration (short: ≤ 10.7 h, medium: 11–13 h, and long: &gt; 13 h) and temperature (cooler &lt; 65°F, warmer ≥ 65°F) on the odds of a hip fracture occurring during a high-volume month, adjusting for age, sex, and American Society of Anesthesiologists (ASA) Classification.</p><h3>Results</h3><p>Among 499 patients, average age was 77.2 ± 11.8 years and 62.7% were women. Monthly hip fracture counts demonstrated significant seasonality (<i>p</i> = 0.02), peaking in January with a trough in July. There was a significant interaction between daylight and temperature on the odds of a hip fracture occurring during a high-volume month, independent of age, sex, and ASA classification (p_interaction = 0.02). At cooler temperatures, shorter daylight duration was associated with higher odds of a hip fracture occurring during a high-volume month (OR = 2.6, 95% CI: 1.48–4.58). At warmer temperatures, both shorter (OR = 0.17, 95% CI: 0.06–0.50) and longer (OR = 0.52, 95% CI: 0.29–0.92) daylight durations were associated with lower odds compared to medium daylight duration.</p><h3>Conclusion</h3><p>Hip fractures followed a seasonal pattern, despite Southern California’s mild climate, with peak hip fracture volume during winter months. The association between daylight duration and hip fracture occurrence varied by temperature, suggesting seasonal influences beyond weather-related fall hazards.</p></div>","PeriodicalId":8283,"journal":{"name":"Archives of Osteoporosis","volume":"21 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148824441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medication-related osteonecrosis of the jaw in osteoporotic patients receiving antiresorptive therapy: prevalence and associated risk factors","authors":"Fatma Kumbara,&nbsp;Filiz Eser","doi":"10.1007/s11657-026-01769-8","DOIUrl":"10.1007/s11657-026-01769-8","url":null,"abstract":"<div><h3>\u0000 <i>Summary</i>\u0000 </h3><p>Medication-related osteonecrosis of the jaw (MRONJ) is an uncommon complication of antiresorptive therapy in osteoporosis. In this real-world cohort, longer treatment duration and tooth extraction were associated with MRONJ. These findings may improve risk assessment and support preventive dental management in high-risk patients.</p><h3>Objective</h3><p>Medication-related osteonecrosis of the jaw (MRONJ) is an uncommon but clinically important complication of antiresorptive therapy in osteoporosis. This study investigated the prevalence of MRONJ and factors associated with its development in osteoporotic patients receiving antiresorptive treatment.</p><h3>Methods</h3><p>This retrospective cohort study included patients with osteoporosis treated with antiresorptive agents between January 2020 and December 2025. Of 2153 screened records, 1131 met the inclusion criteria. Demographic, clinical, treatment-related, and oral-dental characteristics were collected. MRONJ was diagnosed and staged according to the 2022 American Association of Oral and Maxillofacial Surgeons (AAOMS) criteria. Factors associated with MRONJ were evaluated using univariate and multivariate logistic regression analyses.</p><h3>Results</h3><p>MRONJ was diagnosed in 26 of 1131 patients (2.3%). Patients with MRONJ had a significantly longer cumulative duration of antiresorptive therapy than those without MRONJ. Multivariable logistic regression analysis demonstrated that a longer cumulative duration of antiresorptive therapy (OR 1.03, 95% CI 1.01–1.06; <i>p</i> = 0.010) and a history of tooth extraction (OR 9.74, 95% CI 2.48–38.26; <i>p</i> = 0.001) were independently associated with MRONJ. Medication switching, drug holidays, diabetes mellitus, corticosteroid use, and immunosuppressive therapy were not independently associated with MRONJ. Among patients with MRONJ, 69.2% had stage 1 disease and 30.8% had stage 2 disease.</p><h3>Conclusion</h3><p>Longer antiresorptive treatment duration and tooth extraction were the main factors associated with MRONJ development. Careful dental assessment and multidisciplinary planning of invasive dental procedures may help reduce MRONJ risk in high-risk patients.</p></div>","PeriodicalId":8283,"journal":{"name":"Archives of Osteoporosis","volume":"21 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148824418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nails in osteoporosis and bone metabolism: a narrative review of current evidence and future directions","authors":"Jiani Fan,&nbsp;Jiabao Cai,&nbsp;Shengguang Chen","doi":"10.1007/s11657-026-01765-y","DOIUrl":"10.1007/s11657-026-01765-y","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;p&gt;Osteoporosis is a widespread public health problem, yet Dual-Energy X-ray Absorptiometry (DXA)—the current diagnostic gold standard—has significant limitations, including high cost, radiation exposure, and inability to assess bone organic phase changes. As an easily accessible epidermal derivative, nails share high molecular homology with bone tissue and offer unique advantages of non-invasive collection and stable composition reflecting medium- to long-term metabolic status. This narrative review aimed to systematically collate the pathophysiological associations between nails and bone metabolism and comprehensively analyze the clinical application evidence of nails in osteoporosis diagnosis, treatment monitoring, and prognostic assessment.&lt;/p&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;p&gt;A systematic literature search was conducted across PubMed, Web of Science, and Elsevier databases from inception to 2026. The search strategy combined Medical Subject Headings (MeSH) and free-text keywords: (nail OR fingernail OR toenail OR keratin) AND (osteoporosis OR bone metabolism OR bone mineral density OR fracture risk OR bone quality). Inclusion criteria were: (1) peer-reviewed original studies, systematic reviews, or meta-analyses; (2) studies exploring relationships between nail characteristics (composition, structure, or morphology) and bone health; and (3) human studies or animal model studies with direct clinical implications. Two reviewers independently screened titles and abstracts, extracted data, and resolved discrepancies through consensus. Ultimately, 32 studies were included.&lt;/p&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;Nails and bones share profound homology in structural protein metabolism (cysteine-disulfide bond pathways), mineral deposition (calcium and magnesium), and hormone regulation (estrogen and thyroid hormones). Clinically, nail plate thickness reduction and keratin structural abnormalities have been observed in osteoporosis patients. In grassroots screening, Laser-Induced Breakdown Spectroscopy (LIBS) achieved a classification accuracy of 85.9% atone-tenth the cost of DXA. For supplementary bone quality diagnosis, Raman spectroscopy combined with clinical data evaluating keratin disulfide bonds achieved an AUC of 74%, effectively identifying 75% of fracture patients missed by DXA. In treatment monitoring, nail composition changes preceded DXA-detected bone mineral density alterations, providing molecular evidence for early efficacy evaluation. For prognostic assessment, nail-related indicators predicted fracture risk over 3–20 years (OR 2.2 alone; OR 3.8 combined with clinical risk factors). The REMS fragility score also independently predicted fracture risk (OR = 9.23 when FS 37.2). A tiered integration model combining clinical risk assessment with nail-based screening was proposed to optimize clinical workflow.&lt;/p&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;p&gt;Nails demonstrate clear clinical value as a non-invasive tool for primary osteoporosis screening, supplementary b","PeriodicalId":8283,"journal":{"name":"Archives of Osteoporosis","volume":"21 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148824349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting femoral neck screw pullout strength using DXA and novel assessments of bone microarchitecture","authors":"Jarod Moyer,&nbsp;Richard Behlmer,&nbsp;Diane Krueger,&nbsp;Gretta Borchardt,&nbsp;Neil Binkley,&nbsp;Herman Feller,&nbsp;Sam Mosiman,&nbsp;Paul Whiting,&nbsp;Josh Roth","doi":"10.1007/s11657-026-01763-0","DOIUrl":"10.1007/s11657-026-01763-0","url":null,"abstract":"<div><h3>\u0000 <i>Summary</i>\u0000 </h3><p>This study determined how well DXA and other novel assessments of bone microarchitecture predicted screw pullout strength in the femoral neck. Hip-specific DXA performed as well as the novel approaches at predicting screw pullout. These findings support the use of DXA to evaluate bone quality and aid in surgical decision-making.</p><h3>Purpose</h3><p>The primary purpose of our study was to determine how well dual-energy x-ray absorptiometry (DXA), trabecular bone score (TBS Ortho), 3D-Shaper, and quantitative computed tomography (qCT) predicted screw pullout of cannulated screws placed in the femoral neck of cadaveric specimens. Our secondary objective was to determine how well insertional torque predicted screw pullout.</p><h3>Methods</h3><p>We conducted a biomechanical study using twenty proximal cadaveric femurs. Each femur underwent imaging with each respective modality to assess bone quality. Screws were placed in a standardized configuration, and insertional torque was measured using a digital torque screwdriver. Screws were then pulled out using a mechanical testing machine to determine peak pullout strength. The relationship between screw pullout force and each bone metric was assessed using Spearman correlation coefficients and univariate linear mixed-effects models.</p><h3>Results</h3><p>DXA bone mineral density (BMD) and 3D-Shaper volumetric BMD (vBMD) at the femoral neck had the highest correlation coefficients with screw pullout strength (<i>r</i> = 0.95, <i>p</i> &lt; 0.001). However, all of the imaging modalities were found to be strong predictors of screw pullout. Insertional torque was also a strong predictor of screw pullout strength (<i>r</i> = .86, <i>p</i> &lt; 0.001).</p><h3>Conclusion</h3><p>Our findings highlight the clinical utility of hip-specific DXA as a strong and accessible predictor of screw pullout strength, performing as well as newer imaging modalities such as TBS Ortho and 3D-Shaper. Insertional torque also demonstrated strong predictive value and may serve as a useful intraoperative tool when preoperative bone density data are not available.</p></div>","PeriodicalId":8283,"journal":{"name":"Archives of Osteoporosis","volume":"21 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s11657-026-01763-0.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148783397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}