Archives of Osteoporosis最新文献

{"title":"A novel variant in MAFB in a patient with hereditary multicentric carpo-tarsal osteolysis","authors":"Sarah Haroon,&nbsp;Joseph L.Shaker","doi":"10.1007/s11657-026-01739-0","DOIUrl":"10.1007/s11657-026-01739-0","url":null,"abstract":"<p>Multicentric carpo-tarsal osteolysis (MCTO) is a rare, progressive skeletal disorder that can be chall enging to diagnose due to its very low prevalence, with fewer than 60 genetically confirmed cases documented in the last decade. The disease has an autosomal dominant pattern of inheritance, although most cases arise sporadically. It occurs due to pathogenic variants in the <i>MAFB</i> gene that affect RANKL-mediated osteoclast differentiation, causing excessive bone remodeling. We present a patient with clinical skeletal features of MCTO who was found to have a novel missense variant in the <i>MAFB</i> gene, in a region where other pathogenic mutations have been described. Cases of MCTO have been frequently associated with renal dysfunction; however, significant renal disease was not notable in our patient or in affected relatives.</p><p>Lay summary</p><p>Rare skeletal disorders lend insights into the pathogenesis of bone disease, and study of their phenotype allows an appreciation of the spectrum of the disorder. One such disease is multicentric carpo-tarsal osteolysis (MCTO), which is a progressive skeletal disorder causing erosion and loss of bones of the hands and feet, and which has also been associated with kidney disease. It is inherited in an autosomal dominant manner, i.e., with a 50% chance of inheritance; however, cases mostly occur due to sporadic mutations. It has been found to occur due to pathogenic variants in the <i>MAFB</i> gene that is responsible for affecting signaling of RANKL, a protein that encourages osteoclasts to mature and cause bone loss. We present a patient with clinical features of MCTO and a strong family history of the disorder, who was found to have a novel variant in the <i>MAFB</i> gene.</p>","PeriodicalId":8283,"journal":{"name":"Archives of Osteoporosis","volume":"21 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148534799","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":"Ten-year re-validation of the fracture risk assessment tool (FRAX®) in Taiwan","authors":"Chia-Chun Li,&nbsp;I.‑Ting Liu,&nbsp;Fu‑Wen Liang,&nbsp;Yin-Fan Chang,&nbsp;Chin-Sung Chang,&nbsp;Zih-Jie Sun,&nbsp;Shau-Huai Fu,&nbsp;Chung-Yi Li,&nbsp;Li-Chieh Kuo,&nbsp;Chih-Hsing Wu","doi":"10.1007/s11657-026-01745-2","DOIUrl":"10.1007/s11657-026-01745-2","url":null,"abstract":"<div><h3>Summary</h3><p>The Taiwan-specific fracture risk assessment tool (FRAX) model is widely used to estimate 10-year fracture risk. However, FRAX with bone mineral density (BMD) may underestimate fracture risk, particularly in older adults.</p><h3>Purpose</h3><p>To evaluate the predictive performance and calibration of the Taiwan-specific FRAX calculator using complete 10-year real-world outcomes and to establish data-driven, population-specific screening thresholds.</p><h3>Methods</h3><p>A total of 1,976 participants aged ≥ 40 years were recruited from two population-based cohorts in Taiwan (2009–2010) and followed for 10 years via linkage with the National Health Insurance Research Database. Ten-year probabilities of major osteoporotic fracture (MOF) and hip fracture (HF) were estimated using Taiwan-specific FRAX calculators. Model calibration was evaluated using observed-to-expected (O/E) ratios. Statistically optimal thresholds were determined via receiver operating characteristic analysis maximizing the Youden index.</p><h3>Results</h3><p>During follow-up, 213 (10.8%) participants experienced MOF, and 93 (4.7%) experienced HF. FRAX without BMD demonstrated strong calibration for both MOF (O/E = 1.08; 95% CI: 0.94–1.24) and HF (O/E = 1.10; 95% CI: 0.89–1.34). Conversely, FRAX with BMD systematically underestimated risk, particularly among individuals aged ≥ 65 years (MOF O/E = 1.23; 95% CI: 1.06–1.42). Age, female sex, prior fracture, and low BMD were significant independent risk factors. Crucially, population-specific data-driven thresholds were identified via ROC analysis at 9.0% for MOF and 4.5% for HF using FRAX without BMD, and 8.5% for MOF and 4.0% for HF using FRAX with BMD, respectively.</p><h3>Conclusion</h3><p>FRAX<b>®</b> remains a useful and widely applied tool for fracture risk prediction in Taiwan. However, fracture risk may be underestimated, particularly in adults aged ≥ 65 years. Taiwan-specific, data-driven thresholds may improve risk stratification and support more targeted fracture prevention strategies.</p></div>","PeriodicalId":8283,"journal":{"name":"Archives of Osteoporosis","volume":"21 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13388683/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148534743","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":"Romosozumab in postmenopausal women with classical Osteogenesis imperfecta","authors":"Mikolaj Bartosik,&nbsp;Oskar Windels,&nbsp;Felix N. von Brackel,&nbsp;Michael Amling,&nbsp;Ralf Oheim","doi":"10.1007/s11657-026-01744-3","DOIUrl":"10.1007/s11657-026-01744-3","url":null,"abstract":"<div><h3>\u0000 <i>Summary </i>\u0000 </h3><p>This study explored whether Romosozumab, an anti-sclerostin antibody, can improve bone quality in women with Osteogenesis imperfecta. After 12 months, spinal areal bone mineral density increased, showing a beneficial treatment effect, although changes in hip bone density and bone structure were less pronounced than in women with severe osteoporosis.</p><h3>Purpose</h3><p>Osteogenesis imperfecta (OI) is the most common hereditary bone disorder, characterized by increased bone fragility and impaired bone quality, but pharmacological treatment is limited. Ongoing clinical trials investigate monoclonal anti-sclerostin antibodies for OI patients, offering new hope for reducing bone fragility by increasing bone mass.</p><h3>Methods</h3><p>Postmenopausal women with either OI (<i>n</i> = 5) or severe osteoporosis (OPO, <i>n</i> = 10) receiving Romosozumab monthly (210 mg s.c.) for 12 months were analyzed retrospectively. Clinical assessments were performed at baseline, after 6 months, and after 12 months. Bone mass and structure were evaluated at baseline and after 12 months of treatment. In addition, serum and urine markers of bone turnover were analyzed at each time point.</p><h3>Results</h3><p>The mean age of the participants was 53.6 ± 8.9 years for OI patients and 57.2 ± 5.8 years for OPO patients (<i>p</i> = 0.444). After 12 months of Romosozumab treatment, spinal aBMD and osteocalcin increased significantly in OI patients, indicating an anabolic response. HR-pQCT analysis revealed no statistically significant microstructural changes in patients with OI, although trends and moderate effect sizes suggested potential improvements. In patients with OPO, we observed a more pronounced response of bone turnover markers with greater aBMD gains at both the spine and femur, as well as significant improvements in bone microstructure, particularly at the tibia.</p><h3>Conclusions</h3><p>Romosozumab treatment in postmenopausal women with OI resulted in a significant increase in spinal aBMD, though the effect on hip aBMD and peripheral bone microstructure was limited in contrast to postmenopausal osteoporosis.</p></div>","PeriodicalId":8283,"journal":{"name":"Archives of Osteoporosis","volume":"21 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s11657-026-01744-3.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148466368","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":"Incidence of vertebral fracture in a cohort of Australian women: data from the Geelong Osteoporosis Study","authors":"Kara B. Anderson,&nbsp;Amelia G. Morse,&nbsp;Amanda L. Stuart,&nbsp;Julie A. Pasco,&nbsp;Mark A. Kotowicz,&nbsp;Kara L. Holloway-Kew","doi":"10.1007/s11657-026-01732-7","DOIUrl":"10.1007/s11657-026-01732-7","url":null,"abstract":"<div><h3>\u0000 <i>Summary</i>\u0000 </h3><p>This study reports the incidence rate of vertebral fractures (6.78 fractures per 1000 person-years) in a representative cohort of Australian women and identifies advanced age, prior low trauma fracture, a history of falls and an increase in bone turnover as potential key predictors.</p><h3>Purpose</h3><p>This study aimed to assess prevalence and incidence rates of objectively identified vertebral fracture in a representative cohort of Australian women and explore associated factors.</p><h3>Methods</h3><p>Serial lateral vertebral assessments (Lunar Prodigy) were performed in the Geelong Osteoporosis Study (median interval duration 6.86 years; interquartile range: 6.13–7.32). Prevalent and incident vertebral fractures were defined using Genant semi-quantitative approaches, with rates age-standardised to the 2006 Australian population in alignment with the period of data collection. Demographic, clinical and lifestyle factors were collected via a combination of in-person assessment and questionnaires, and logistic regression was used to investigate relationships between these factors and fracture outcomes.</p><h3>Results</h3><p>At baseline, 1013 women (ages 20–93 years) were measured and 23 individuals were identified with a prevalent vertebral fracture; 701 women were assessed at follow-up, 19 of whom experienced an incident vertebral fracture. The age-adjusted prevalence at baseline was 2.0% (1.3–2.8), and the age-adjusted incidence rate was 6.78 (4.19–9.37) fractures per 1000 person-years. Prior fracture (OR 6.70, 95% CI 2.55–17.64), lower lumbar spine bone mineral density (OR 0.01, 95% CI 0.00–0.13) and limited physical function (OR 3.80, 95% CI 1.47–9.83) were independently associated with prevalent fracture. In contrast, increased age (OR 1.12, 95% CI 1.06–1.17), prior fracture (OR 3.51, 95% CI 1.15–10.76), a history of falls (OR 3.55, 95% CI 1.29–9.79) and increased markers of bone formation (OR 1.02, 95% CI 1.00–1.04) were associated with incident fracture.</p><h3>Conclusions</h3><p>This study reports the incidence rate of vertebral fractures in a representative cohort of Australian women and identifies advanced age, prior low trauma fracture, a history of falls and increased bone turnover as potential key predictors.</p></div>","PeriodicalId":8283,"journal":{"name":"Archives of Osteoporosis","volume":"21 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s11657-026-01732-7.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148374289","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":"Provision of medication prescription in a fracture liaison service did not diminish during COVID","authors":"Joanna E. M. Sale,&nbsp;Alan Yang,&nbsp;Anum Ali,&nbsp;Ravi Jain,&nbsp;Jennifer Weldon,&nbsp;Larry Funnell,&nbsp;Lynn Meadows,&nbsp;Victoria Elliot-Gibson,&nbsp;Earl Bogoch","doi":"10.1007/s11657-026-01730-9","DOIUrl":"10.1007/s11657-026-01730-9","url":null,"abstract":"<div><h3>\u0000 <i>Summary</i>\u0000 </h3><p>We examined the association of COVID time periods and equity-related variables with pharmacotherapy in a large jurisdiction fracture liaison service (FLS). We did not observe a significant association between COVID time periods and medication prescription after adjusting for all covariates. This highlights another potential success of the FLS model.</p><h3>Purpose</h3><p>Our objective was to examine the impact of COVID on bone-active medication prescription in a fracture liaison service (FLS), after adjusting for fracture risk status and equity-related variables.</p><h3>Methods</h3><p>We conducted a logistic regression analysis with medication prescription (prescription by a bone health specialist or primary care provider) as the outcome. The model included covariates COVID time periods (T1: “pre-COVID” (<i>n</i> = 2796); T2: “during COVID” (<i>n</i> = 1575); T3: “COVID recovery” (<i>n</i> = 2208)), fracture risk status (high risk/not high risk) and equity-related variables (sex, age, marital status, living arrangement, education status, geographic location, and presence of comorbidities). Goodness of fit was assessed with the area under the receiver operating characteristic curve (AUC) and the Hosmer and Lemeshow test.</p><h3>Results</h3><p>Fracture risk status was the primary driver of treatment with high-risk patients 7.8 times more likely to receive a medication prescription compared to patients who were not high risk, after adjusting for all covariates (OR = 7.80 [95% CI 6.91, 8.79]). COVID time period was not statistically significant. Female patients, those married or in a common-law relationship, living alone, or residing in urban areas were more likely to be prescribed medication. The model had good prediction power and fit the data well (AUC: 0.77; Hosmer–Lemeshow test <i>p</i>-value: 0.83).</p><h3>Conclusion</h3><p>Among patients reached by the FLS, COVID time period was not significantly associated with medication prescription, although program reach decreased at T2 and T3. Fracture risk status, sex, marital status, living arrangement, and geographic location were significantly associated with medication prescription.</p></div>","PeriodicalId":8283,"journal":{"name":"Archives of Osteoporosis","volume":"21 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148359205","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":"The development and evolution of the Irish Hip Fracture Database: a quality care initiative 2013–2024","authors":"L. Brent,&nbsp;E. Ahern,&nbsp;T. Murphy,&nbsp;C. Hurson,&nbsp;T. Coughlan,&nbsp;P. Hickey,&nbsp;C. Lodola,&nbsp;M. E. Walsh,&nbsp;E. Byrne,&nbsp;F. Fitzpatrick","doi":"10.1007/s11657-026-01731-8","DOIUrl":"10.1007/s11657-026-01731-8","url":null,"abstract":"<div><h3>\u0000 <i>Summary</i>\u0000 </h3><p>Clinical audits are central to quality improvement in healthcare, yet practical real-world descriptions of how they are implemented, governed and sustained are limited. This paper describes the establishment, evolution and impact of the Irish Hip Fracture Database (IHFD) within the Irish healthcare system as an exemplar.</p><h3>Introduction</h3><p>Clinical audits compare clinical practice against defined standards to identify areas for improvement and showcase excellence. International literature provides limited insight into how they are governed and sustained. Using the IHFD, a mature national audit, this paper reviews its development, evolution and sustained momentum from 2013 to 2024.</p><h3>Methods\u0000</h3><p>Longitudinal data were captured via the Hospital Inpatient Enquiry (HIPE) system, encompassing all eligible Irish acute hospitals. Included cases were patients aged ≥ 60 years with hip fractures, as defined by IHFD. Three organisational surveys (2016, 2020, 2024) were undertaken to assess hospital resources, care pathways, governance structures and audit supports.</p><h3>Results</h3><p>In total, 41,304 cases were included in the analysis. National coverage exceeded 90% from 2017. Demographic characteristics remain consistent. Improvements in data quality, adherence to Irish Hip Fracture Standards were observed, including geriatrician assessment (11% in 2013 to 86% in 2024) and bone health assessment (65% in 2013 to 90% in 2024). Service reconfigurations and resourcing to support hip fracture care occurred over this period. Engagement with the audit remained robust despite major challenges including COVID-19, a national cyberattack and ongoing health system reform.</p><h3>Conclusion</h3><p>Sustained success of a national hip fracture clinical audit requires strong leadership, effective governance, clear clinical standards, accessible data and timely reporting. Continued relevance requires agility and alignment with evolving system needs.</p></div>","PeriodicalId":8283,"journal":{"name":"Archives of Osteoporosis","volume":"21 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s11657-026-01731-8.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148315225","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":"Bone mineral density testing rates and fracture risk across cancers with different mortality risks: a nationwide matched cohort study","authors":"Seung Hoon Kim,&nbsp;Eunjeong Choi,&nbsp;Yonghan Cha,&nbsp;Seoyeong Choi,&nbsp;Suk-Yong Jang","doi":"10.1007/s11657-026-01733-6","DOIUrl":"10.1007/s11657-026-01733-6","url":null,"abstract":"<div><h3>Summary</h3><p>In our study, patients with cancer underwent bone mineral density testing more frequently than matched non-cancer patients. High-mortality cancers showed the highest relative rates of both BMD testing and osteoporotic fracture, whereas thyroid cancer showed comparatively low fracture risk despite higher testing rates.</p><h3>Background</h3><p>We aimed to compare the rates of bone mineral density (BMD) testing and osteoporotic fractures among patients with incident cancer and matched non-cancer patients according to cancer mortality risk.</p><h3>Methods</h3><p>We conducted a nationwide matched cohort study of individuals aged ≥ 50 years between 2005 and 2019. Patients with incident cancer were risk-set matched 1:2 to non-cancer patients using time-dependent propensity scores. Cancer types were categorized by mortality risk (thyroid, intermediate-, and high-mortality). Outcomes included receipt of BMD testing and incidence of osteoporotic fractures within 5 years. Cox proportional hazards models with robust variance estimators were used, with stratified analyses according to prior osteoporosis medication use.</p><h3>Results</h3><p>The final cohort comprised 28,537 patients with cancer and 57,074 matched non-cancer patients. Overall, patients with cancer were more likely to undergo BMD testing than non-cancer patients; however, the magnitude varied by cancer mortality risk. Among patients without prior osteoporosis treatment, BMD testing was most frequent in high-mortality cancers (adjusted hazard ratio [aHR] 2.17; 95% CI 2.12–2.23), followed by thyroid (aHR 1.59; 95% CI 1.48–1.71) and intermediate-mortality cancers (aHR 1.49; 95% CI 1.45–1.54). In contrast, osteoporotic fracture risk increased stepwise with worsening cancer prognosis, with the highest risk observed in high-mortality cancers (aHR 2.80; 95% CI 2.72–2.89), while thyroid cancer was not associated with increased fracture risk.</p><h3>Conclusions</h3><p>Both BMD testing and fracture risk varied across cancer mortality groups, with high-mortality cancers showing the highest relative fracture risk. These findings demonstrate differing rates of BMD testing and osteoporotic fracture across cancer populations with differing prognoses.</p></div>","PeriodicalId":8283,"journal":{"name":"Archives of Osteoporosis","volume":"21 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148314913","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 association between lumbar spine-total hip T-score discordance and all-cause mortality: a prospective cohort study from NHANES","authors":"Rıdvan Erten,&nbsp;Mehmet Poyrazer","doi":"10.1007/s11657-026-01729-2","DOIUrl":"10.1007/s11657-026-01729-2","url":null,"abstract":"<div><h3>Summary</h3><p>In 6364 US adults aged ≥ 50 with up to 15 years of follow-up, lumbar spine–total hip T-score discordance was associated with all-cause mortality in women but not in men. Total hip T-score was the strongest single-site predictor in both sexes.</p><h3>Purpose</h3><p>Lumbar spine bone mineral density may be influenced by degenerative and non-skeletal mineralization in older adults. Whether the discrepancy between lumbar spine and hip T-scores carries prognostic information for mortality remains unclear. We examined the sex-specific association of the lumbar spine–total hip T-score difference (ΔT_LS − TH) with all-cause mortality, alongside site-specific T-scores at the lumbar spine, femoral neck, and total hip.</p><h3>Methods</h3><p>Prospective cohort study of 6364 adults aged ≥ 50 years from five NHANES cycles (2005–2018) linked to the National Death Index through December 31, 2019. Survey-weighted Cox models estimated hazard ratios (HR) for ΔT (LS T-score minus TH T-score), adjusting for age, sex, BMI, eGFR, smoking, and albumin. Sex-specific associations and a sex × ΔT interaction were tested. Candidate joint models were compared to evaluate whether ΔT_LS − TH provided information beyond total hip T-score. Sensitivity analyses included landmark exclusion of early deaths and additional adjustment for baseline comorbidities<b>.</b></p><h3>Results</h3><p>Over a median follow-up of 9.3 years, 1155 deaths occurred. A significant sex × ΔT_LS − TH interaction was observed (<i>p</i> = 0.001). In women, ΔT_LS − TH was associated with higher all-cause mortality (HR 1.259 per unit; 95% CI 1.146–1.382; <i>p</i> &lt; 0.001), and comparative models favored ΔT_LS − TH over the conventional lumbar spine–femoral neck difference. In men, the corresponding estimate was smaller and did not meet the conventional threshold for statistical significance (HR 1.084 per unit; 95% CI 0.9998–1.175; exact <i>p</i> = 0.0504). Total hip T-score was the strongest single-site predictor in both sexes (women HR 0.751, <i>p</i> &lt; 0.001; men HR 0.854, <i>p</i> = 0.002). Lumbar spine T-score showed no association with mortality in women after multivariable adjustment. Parallel analyses using raw BMD values supported the same site-specific ranking, with total hip BMD showing the strongest single-site association.</p><h3>Conclusion</h3><p>In older US adults, the lumbar spine–total hip T-score difference was associated with all-cause mortality in women but not in men, while total hip T-score remained the strongest single-site predictor in both sexes. These findings are consistent with the clinical emphasis on hip measurements when interpreting DXA results in older adults. ΔT_LS − TH may identify a higher-risk pattern of site-specific discordance at the population level, but it should not be used for individual mortality prediction.</p></div>","PeriodicalId":8283,"journal":{"name":"Archives of Osteoporosis","volume":"21 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s11657-026-01729-2.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148306581","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":"Cost-effectiveness thresholds for initiating osteoporosis treatment in postmenopausal women in China: a microsimulation analysis based on real-world data","authors":"Lijia Cui,&nbsp;Qichao Sun,&nbsp;Xiangjun Yin,&nbsp;Wei Yu,&nbsp;Wanping Cai,&nbsp;Nan Zhao,&nbsp;Lin Chen,&nbsp;Shunyu Tang,&nbsp;Hua Lin,&nbsp;Lu Cui,&nbsp;Xiaolan Jin,&nbsp;Zhongjian Xie,&nbsp;Steven R. Cummings,&nbsp;Zhixin Li,&nbsp;Linhong Wang,&nbsp;Qianqian Pang,&nbsp;Yue Chi,&nbsp;Ruizhi Jiajue,&nbsp;Wei Liu,&nbsp;Yan Jiang,&nbsp;Ou Wang,&nbsp;Mei Li,&nbsp;Xiaoping Xing,&nbsp;Xiang Li,&nbsp;Weibo Xia","doi":"10.1007/s11657-026-01722-9","DOIUrl":"10.1007/s11657-026-01722-9","url":null,"abstract":"<div><h3>\u0000 <i>Summary</i>\u0000 </h3><p>This study estimated FRAX^®-based intervention thresholds for initiating osteoporosis treatment in Chinese postmenopausal women, using real-world data from the largest nationally representative osteoporosis survey in China and a validated Markov microsimulation model. Denosumab became cost-effective at a 10-year major osteoporotic fracture probability of 7%, and zoledronate at 12%, whereas alendronate and teriparatide did not reach cost-effectiveness at any FRAX probability evaluated.</p><h3>Purpose</h3><p>To determine drug-specific FRAX^® thresholds for cost-effective initiation of osteoporosis treatment (alendronate, zoledronate, denosumab, teriparatide) in Chinese postmenopausal women using real-world data.</p><h3>Methods</h3><p>A validated Markov microsimulation model was used to simulate lifetime costs and quality-adjusted life years (QALYs) of no treatment versus alendronate, zoledronate, denosumab, and teriparatide treatment. Baseline patient characteristics and risk factor distribution were sampled from the largest national osteoporosis survey in mainland China. The analysis was conducted from the societal perspective, applying a willingness-to-pay threshold of USD 13,000 per QALY gained (equivalent to one times China’s GDP per capita).</p><h3>Results</h3><p>Denosumab was cost-effective at a 10-year major osteoporotic fracture probability of 7% and zoledronate at 12%; neither alendronate nor teriparatide became cost-effective. For denosumab, the cost-effective threshold of 10-year major osteoporotic fracture probability increased with age from 51 to 65 years and then declined in older women, ranging from 5 to 12%. For zoledronate treatment, the cost-effective thresholds of a 10-year major osteoporotic fracture probability were 8% at 51–55 years, 12% at 71–75 years, and 8.5% at 76–80 years.</p><h3>Conclusions</h3><p>For Chinese postmenopausal women, denosumab was the most cost-effective treatment, while zoledronate also reached favorable thresholds in selected age groups. Implementing drug-specific FRAX®-guided thresholds may optimize treatment decisions for osteoporosis and support efficient healthcare resource use.</p></div>","PeriodicalId":8283,"journal":{"name":"Archives of Osteoporosis","volume":"21 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148293302","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":"Under-recognized, under-referred: a multidisciplinary evaluation of fragility fracture management in the emergency setting","authors":"Francesco Bertoldo,&nbsp;Fabio De Iaco,&nbsp;Carlo Trevisan,&nbsp;Andrea Marcellusi,&nbsp;Ombretta Viapiana,&nbsp;Giovannella Baggio,&nbsp;Giorgio De Conti,&nbsp;Ferdinando Silveri,&nbsp;Antonella Cocorocchio,&nbsp;Sandro Giannini","doi":"10.1007/s11657-026-01684-y","DOIUrl":"10.1007/s11657-026-01684-y","url":null,"abstract":"<div><h3>\u0000 <i>Summary</i>\u0000 </h3><p>Fragility fractures are frequently under-recognized in emergency departments. A survey of 34 professionals revealed inconsistent assessment of key risk factors. Relevant gaps emerged between awareness and routine practice across professional roles. These findings highlight opportunities to improve recognition, documentation, and secondary prevention in ED settings.</p><h3>Purpose</h3><p>Fragility fractures are often under-recognized in the emergency setting, where the absence of standardized procedures leads to missed opportunities for diagnosis and secondary prevention. This project aimed to explore current emergency department (ED) practices regarding the identification and management of fragility fractures.</p><h3>Methods</h3><p>A qualitative, cross-sectional survey was conducted among 34 healthcare professionals (10 emergency physicians, 11 radiologists, and 13 emergency nurses) from various Italian regions. The questionnaire, developed by a multidisciplinary expert panel, investigated propensities and self-reported practices related to fracture assessment, risk factor identification, and diagnosis of fragility fracture. All responses were grouped by role and represented graphically. Findings were then discussed during an expert meeting with the same panel.</p><h3>Results</h3><p>Survey data revealed a generally high level of self-reported awareness of fragility risk factors among ED professionals but inconsistent implementation of the necessary diagnostic workup in daily practice. Important indicators, such as prior fractures, history of falls, family history of hip fracture, and use of risky medications, were often under-assessed. The term “fragility fracture” at discharge from the ED was rarely used, and role-based discrepancies emerged in risk assessment practices.</p><h3>Conclusion</h3><p>This survey highlights relevant gaps between awareness and clinical practice in the identification of fragility fractures in the emergency setting. Improving consistency in risk assessment and documentation may represent a key step toward optimizing secondary prevention and standardizing fragility fracture management in EDs.</p></div>","PeriodicalId":8283,"journal":{"name":"Archives of Osteoporosis","volume":"21 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s11657-026-01684-y.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148270158","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}