Erxian decoction for postmenopausal osteoporosis: An updated systematic review and meta-analysis.

BackgroundLow bone mineral density (BMD) and subsequent fractures are a major public health problem in postmenopausal women. The purpose of this study was to use the aggregate data meta-analytic approach to examine the effects of ground (for example, walking) and/or joint reaction (for example, strength training) exercise on femoral neck (FN) and lumbar spine (LS) BMD in postmenopausal women.MethodsThe a priori inclusion criteria were: (1) randomized controlled trials, (2) exercise intervention ≥ 24 weeks, (3) comparative control group, (4) postmenopausal women, (5) participants not regularly active, i.e., less than 150 minutes of moderate intensity (3.0 to 5.9 metabolic equivalents) weight bearing endurance activity per week, less than 75 minutes of vigorous intensity (> 6.0 metabolic equivalents) weight bearing endurance activity per week, resistance training < 2 times per week, (6) published and unpublished studies in any language since January 1, 1989, (7) BMD data available at the FN and/or LS. Studies were located by searching six electronic databases, cross-referencing, hand searching and expert review. Dual selection of studies and data abstraction were performed. Hedge’s standardized effect size (g) was calculated for each FN and LS BMD result and pooled using random-effects models. Z-score alpha values, 95%confidence intervals (CI) and number-needed-to-treat (NNT) were calculated for pooled results. Heterogeneity was examined using Q and I2. Mixed-effects ANOVA and simple meta-regression were used to examine changes in FN and LS BMD according to selected categorical and continuous variables. Statistical significance was set at an alpha value ≤0.05 and a trend at >0.05 to ≤ 0.10.ResultsSmall, statistically significant exercise minus control group improvements were found for both FN (28 g’s, 1632 participants, g = 0.288, 95% CI = 0.102, 0.474, p = 0.002, Q = 90.5, p < 0.0001, I2 = 70.1%, NNT = 6) and LS (28 g’s, 1504 participants, g = 0.179, 95% CI = −0.003, 0.361, p = 0.05, Q = 77.7, p < 0.0001, I2 = 65.3%, NNT = 6) BMD. Clinically, it was estimated that the overall changes in FN and LS would reduce the 20-year relative risk of osteoporotic fracture at any site by approximately 11% and 10%, respectively. None of the mixed-effects ANOVA analyses were statistically significant. Statistically significant, or a trend for statistically significant, associations were observed for changes in FN and LS BMD and 20 different predictors.ConclusionsThe overall findings suggest that exercise may result in clinically relevant benefits to FN and LS BMD in postmenopausal women. Several of the observed associations appear worthy of further investigation in well-designed randomized controlled trials.

Efficacy of zoledronic acid for prevention of bone loss in early-stage breast cancer patients receiving adjuvant therapy: A meta-analysis of 13 randomized controlled trials

Objective: To explore potential factors that could be associated with low bone mineral density (BMD) in female endurance runners. Methods: Fifty two female endurance runners (1500 m to marathon), aged...

<b>Objective:</b> To explore potential factors that could be associated with low bone mineral density (BMD) in female endurance runners. <b>Methods:</b> Fifty two female endurance runners (1500 m to marathon), aged 18–44 years, took part. Body fat percentage, lumbar spine BMD, and femoral neck BMD were measured using the Hologic QDR 4500w bone densitometer. Data on training, menstrual cycle status, osteoporosis, and health related factors were obtained by questionnaire. Dietary variables were assessed from a prospective seven day dietary record of macronutrients and micronutrients. <b>Results:</b> The mean (SD) lumbar spine and femoral neck BMD were 1.11 (0.11) and 0.89 (0.12) g/cm² respectively. A backward elimination regression analysis showed that age, body mass, body fat, distance run, magnesium, and zinc intake were the variables significantly associated with BMD. Lumbar spine BMD (g/cm²) = −1.90 + (0.0486 × age (years)) + (0.342 × log mass (kg)) − (0.000861 × age² (years)) − (0.00128 × distance (km/week)), with an <i>R</i>² = 30.1% (SEE = 0.089 (95% confidence interval (CI) 0.05 to 0.23); p&lt;0.001). Femoral neck BMD (g/cm²) = −2.51 − (0.00989 × age (years)) + (0.720 × log mass (kg)) + (0.000951 × magnesium (mg/day)) −(0.0289 × zinc (mg/day)) − (0.00821 × body fat (%)) − (0.00226 × distance (km/week)), with an <i>R</i>² = 50.2% (SEE = 0.100 (95% CI 0.06 to 0.22); p&lt;0.001). The negative association between skeletal BMD and distance run suggested that participants who ran longer distances had a lower BMD of the lumbar spine and femoral neck. Further, the results indicated a positive association between body mass and BMD, and a negative association between body fat and BMD. <b>Conclusions:</b> The results suggest a negative association between endurance running distance and lumbar spine and femoral neck BMD, with a positive association between body mass and femoral neck and lumbar spine BMD. However, longitudinal studies are required to assess directly the effect of endurance running and body mass on BMD, and to see if the addition of alternative exercise that would increase lean body mass would have a positive effect on BMD and therefore help to prevent osteoporosis.

THU0392 Bone Mineral Density Changes in Patients with Early Axial Spondyloarthritis

AB0996 Bone mineral density at different sites as a predictor of rib fractures: a case-control study

BackgroundReports on the association of perfluoroalkyl substances (PFASs) exposure with adolescent bone health are scarce, and studies have primarily targeted maternal serum.ObjectiveWe evaluated the relationship between autologous serum perfluorooctanoic acid (PFOA), perfluorooctane sulfonic acid (PFOS), perfluorohexane sulfonic acid (PFHxS) and perfluorononanoic acid (PFNA) levels and bone mineral density (BMD) in adolescents.MethodsWe analyzed data from 1228 adolescents aged 12-19 years in the National Health and Nutrition Examination Survey (NHANES) 2005-2010 and used multiple regression analysis to identify the relationship between serum PFOA, PFOS, PFHxS, and PFNA concentrations and total femur, femoral neck, and lumbar spine BMD, in addition to multiple stratified subgroup analyses.ResultsThe mean age of participants was 15 years, males had higher serum PFAS concentrations than females. The results of multiple regression analysis showed that the natural log(ln)-transformed serum PFOA, PFOS, and PFNA concentrations were negatively correlated with total femur, femoral neck, and lumbar spine BMD (all p < 0.05), and ln-PFHxS was positively correlated with total femur and femoral neck BMD (all p< 0.05). In males, ln-PFOA was negatively associated with total femur and lumbar spine BMD (all p< 0.05), ln-PFOS was associated with the reduced total femur, femoral neck, and lumbar spine BMD (all p< 0.05), while ln-PFHxS and ln-PFNA were not observed to correlate with BMD at these three sites. In females, both ln-PFOA and ln-PFOS were negatively correlated with total femur and lumbar spine BMD (all p< 0.05), ln-PFHxS is associated with the increased total femur and femoral neck BMD (all p< 0.05), and ln-PFNA was negatively correlated with total femur and femoral neck BMD (all p< 0.05), most of the associations were confined to females. The associations of ln-PFOS with femoral neck BMD and ln-PFNA with total femur BMD were more significant in those who were overweight/obese and had anemia, respectively (all p for interaction < 0.05).ConclusionsIn this representative sample of US adolescents aged 12-19 years, certain PFAS were associated with lower bone mineral density, and most of the associations were confined to females. The negative effect of PFAS on BMD is more pronounced in those who are overweight/obese and have anemia. However, further studies are needed to confirm this finding.

Bone Mineral Density and Related Scores in Parkinson's Disease: A Systematic Review and Meta-Analysis

Objective: To systematically review the effects of different resistance training (RT) protocols on bone mineral density (BMD) in postmenopausal women.Methods: Randomized controlled trials (RCTs) on the resistance training in improving bone mineral density for postmenopausal women were searched in databases including ProQuest, PubMed, Cochrane Library, Embase, and Web of Science. The retrieval time range was from the establishment of the database to May 2022. The included literature was independently screened and relevant data was extracted by two reviewers. The systematic review followed the Joanna Briggs Institute (JBI) methodology for reviews of quantitative evidence. Quality of risk was assessed using the Physical Therapy Evidence Database (PEDro) scale, risk of bias was assessedusing the Cochrane RoB2 tool and a network Meta-analysis was performed on the data using Stata 16.0.Results: A total of 19 studies, which included 919 subjects, were eventually acquired. The results of the network Meta-analysis showed that moderate intensity resistance training was superior in improving lumbar spine bone mineral density (LS BMD) and femoral neck bone mineral density (FN BMD) compared to the control group (as per usual daily life), with a statistically significant difference (p < 0.05). There was, however, no statistically significant difference between the groups in terms of increasing total hip bone mineral density (TH BMD) and trochanter bone mineral density (Troch BMD), although moderate intensity training tends to increase bone mineral density (p > 0.05). In addition, when training frequency is taken into consideration, 3 days/week of moderate intensity training (3MI) was superior to 2 days/week (2MI) in improving lumbar spine bone mineral density , and moderate intensity training was superior to low and high intensity resistance trainings at training frequency of 3 day/week, with statistically significant differences (p < 0.05). The cumulative probability ranking results indicated that 3MI was the optimal option in improving lumbar spine, femoral neck, total hip and Troch bone mineral density. Subgroup analyses combining interventions time showed that for lumbar spine and femoral neck bone mineral density, 3MI protocol with intervention duration within 1 year (≤48 weeks) had a significant advantage over other interventions, while this advantage was no longer significant with the intervention duration of more than 1 year (>48 weeks).Conclusion: Current evidence shows that moderate intensity resistance training for 3 days/week can be preferred clinically to improve bone mineral density in postmenopausal women, and it is recommended that the duration of the same training should not exceed 1 year. Nevertheless, more high-quality studies are needed to verify the above conclusion.

Women with functional hypothalamic amenorrhea (FHA) are at high risk of poor bone health. When lifestyle measures fail to restore menses, pharmacological interventions are needed for bone health, but comparative efficacy remains unclear. To compare the efficacy of available pharmacological interventions to improve bone mineral density (BMD), in women with FHA, employing network meta-analysis (NMA). Medline, Embase, Emcare, Cochrane CENTRAL, ISRCTN, and ClinicalTrials.gov were searched up to 20 September 2025. Eligible randomized-controlled trials evaluated pharmacological interventions for lumbar spine (LS), femoral neck (FN), or total hip (TH) BMD in women with FHA. Two independent reviewers screened titles, abstracts, and texts. Two reviewers independently extracted data following the Preferred Reporting Items for Systematic Reviews-network meta-analysis guidelines. Outcomes were expressed as standardized mean differences (SMDs) with 95% confidence intervals (CIs) using random-effects NMA. Evidence certainty was assessed with CINeMA. Thirteen randomized-controlled trials (n = 897 participant observations across all pharmacotherapy comparisons) were included (LS BMD: n = 897; FN BMD: n = 370; TH BMD: n = 750). Transdermal hormone replacement therapy (HRT) was superior to control (placebo or no intervention) for LS BMD with SMD: 0.34 (0.03, 0.64) and FN BMD with SMD: 0.57 (0.04, 1.10). Oral HRT and the combined oral contraceptive pill (COCP) showed no significant benefit for any BMD site. Teriparatide was superior to transdermal HRT and COCP for LS BMD with SMDs: 1.48 (0.38, 2.59) and 1.75 (0.66, 2.83), but not FN or TH BMD. Transdermal HRT and teriparatide improve LS BMD in women with FHA, with transdermal HRT also improving FN BMD. PROSPERO (CRD42024576872).

Mini abstractOsteoporosis is a major health issue worldwide. This study analyzes the effects of non-supervised osteoporosis prevention programs on bone mineral density. Non-supervised exercise increases femoral neck and lumbar spine bone mineral density in adult women. Thus, it might be effective for preventing or treating osteoporosis or osteopenia in this population.IntroductionOsteoporosis is a major health issue worldwide. Social distancing measures due to COVID-19 have hindered the chances to take part in supervised osteoporosis prevention exercise programs. The purpose of the present study is to systematically review and meta-analyze the effects of non-supervised osteoporosis prevention exercise programs on bone mineral density (BMD) in adult women.MethodsA comprehensive search of electronic databases (n = 7) was conducted including (a) prospective randomized controlled trials (RCTs) comparing at least one exercise group vs. a control group with sedentary lifestyle or sham exercises; (b) baseline and follow-up BMD values, or BMD changes from baseline, at any skeletal site; (c) women over 30 years old; and (d) non-supervised exercise programs only. Subgroup analyses were performed for menopausal status, intervention duration, type of exercise, and osteopenia/osteoporosis status.ResultsTen studies were included (n = 668). Random effect analyses showed that unsupervised exercise had beneficial effects on lumbar spine (LS) BMD with standardized mean difference (SMD) = 0.40 (95% confidence interval (CI): 0.03–0.77), and femoral neck (FN) BMD with SMD = 0.51 (95% CI: 0.16–0.85). Unsupervised exercise increased LS (SMD = 0.73 (95% CI: 0.13–1.33)) and FN BMD (SMD = 0.85 (95% CI: 0.33–1.37)) in women with osteopenia/osteoporosis, but not in healthy counterparts.ConclusionNon-supervised exercise improves FN and LS BMD in adult women. Beneficial effects of exercise on FN and LS BMD might be more pronounced in those with poor bone health compared with healthy counterparts. More RCTs prescribing non-supervised, osteogenic exercise are required in this population. It is necessary to investigate the efficacy of remote/assistive technologies for delivering and monitoring non-supervised exercise interventions.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00198-022-06357-3.

To evaluate the occurrence of low bone mineral density (BMD) and its relationship with clinical and laboratorial characteristics in children and young adults with sickle cell anaemia living in Northeast-Brazil, and to assess the role of radiography in diagnosing low BMD. Bone mineral density of lumbar spine was measured by dual energy X-ray absorptiometry (DXA) in 27 patients with Sickle cell anaemia (SCA) aged 7-28years. Clinical history, calcium and calorie intake, laboratory measurements, anthropometrics and pubertal development were assessed, and X-rays were obtained. Z-scores and T-scores for weight, height, Body Mass Index (BMI) and BMD were calculated using age and gender matched reference data. Mean lumbar spine BMD Z-scores and T-scores were -1.81 SD in boys and -0.80 SD in girls. BMD Z-scores were below -2 SD in 33.3% of girls and in 46.7% of boys. Low BMD (<-2 SD) occurred significantly more in patients with low height-for-age (P=0.02), low weight-for-age (P=0.001) and low BMI-for-age (P=0.006). No significant relationships were found between BMD and other clinical and laboratory parameters. Radiography had a sensitivity of 75% and a specificity of 36% to detect low BMD, and was considered not useful in this context. Patients with low height and/or low weight-for-age seem to be at high risk for developing low BMD.

The objective of our systematic review and network meta-analysis (NMA) is to investigate which vitamin D and/or calcium regimen would yield the greatest increase in lumbar spine, femoral neck, and total hip bone mineral density (BMD) in adult patients undergoing glucocorticoid therapy. We performed NMAs based on a prospectively developed protocol. A database search of MEDLINE, EMBASE, Web of Science, CINAHL, CENTRAL and Chinese databases were conducted for relevant randomized controlled trials (RCTs). Outcomes were percentage change in lumbar spine, femoral neck, and total hip BMD from baseline. We included 16 RCTs containing 1073 eligible patients in our analysis. We found alfacalcidol+calcium to yield the greatest percentage increase in lumbar spine BMD (MD 6.05, 95% credible interval [CrI] - 4.18 to 16.18) compared to no treatment, and calcitriol+calcium to yield the greatest percentage increase in femoral neck BMD (MD 8.46, 95% CrI - 4.74 to 21.51) compared to no treatment. Cholecalciferol+calcium ranked first in terms of its ability to increase total hip BMD; however this finding needs to be interpreted with caution due to low sample sizes in the cholecalciferol+calcium treatment arm. None of the treatment arms ruled out the possibility of no effect for any outcome. Alfacalcidol and calcitriol were the most efficacious treatment arms for increasing lumbar spine and femoral neck BMD, respectively. Our findings need to be validated by further investigations using larger, better-designed RCTs. Key Points •The efficacy of calcium/vitamin D compounds was examined using network meta-analyses. •Alfacalcidol + calcium yielded the greatest increase in lumbar spine BMD, calcitriol + calcium yielded the greatest increase in femoral neck BMD. •Future guidelines should place greater emphasis on the efficacy of different vitamin D compounds.

Background: Type 1 Diabetes mellitus (T1DM) is a well-known condition associated with low bone mineral density (BMD) and bone fracture, in which one of the risk factor is impaired endogenous insulin secretion. However, the association between the rate of impaired insulin secretory capacity in T1DM and BMD remains to be elucidated. Objective: To clarify the effect of the rate of impaired insulin secretion on BMD in T1DM. Patients and Methods: This a retrospective single-center cross-sectional study, in which consecutive one-hundred seventy Japanese patients with T1DM at Kobe University Hospital were registered. According to the diagnostic criteria of The Japan Diabetes Society, patients were stratified into three subtypes; acute-onset (AO) (n =51, male 25%, 39 ± 15 years), slowly-progressive (SP) (n =37, male 37%, 57 ± 14 years), and fulminant (F) (n =12, male 33%, 51 ± 15 years) mainly by insulin secretory capacity at onset of T1DM. Lumbar spine (LS) and femoral neck (FN) BMD Z-score between three groups were evaluated. Results: The LS BMD is lower in AO than SP (p =0.03), while no differences were observed compared to F (SP/AO/F; 0.38 ± 1.08/-0.25 ± 0.96/-0.35 ± 1.01). The FN BMD also tended to be lower in AO than in SP (p =0.08) and in F (p =1.00) (SP/AO/F;0.03 ± 1.01/-0.44 ± 0.96/-0.35 ± 0.70). To identify the factors associated with decreased BMD, the multivariate regression analysis was performed using AO and SP. The LS BMD was associated with the pathogenic group (p =0.01). Since a negative correlation was seen between durations and CPR both in AO and SP group (p <0.01, p <0.01), we divided these subjects into following 5 groups; 1 to 4, 5 to 9, 10 to 14, 15 to 19, and more than 20 years. In these groups, the CPR was lower in AO than in SP in 1 to 4 years (p <0.01). Intriguingly, LS BMD was started to decline in 5 to 9 years (p =0.03) and was still continued in 10 to 14 years (p =0.01). In FN, BMD was started to decline in 10 to 14 years (p =0.01), suggesting the BMD decline followed by impaired insulin secretion. However, the difference of both BMD and CPR between AO and SP groups were not seen in more than 15 years group, indicating this tangent BMD difference is link to the difference of insulin secretion. Conclusions: This study firstly showed that pathogenic subtypes of T1DM differently affected on BMD. A detailed examination of each disease period showed that BMD continued to decrease as impaired insulin secretion.

Bisphosphonates are effective in the treatment of postmenopausal osteoporosis. However, their prolonged use induces adverse events and may lead to a rapid decline in bone mineral density (BMD) after discontinuation. Denosumab, a human monoclonal antibody, is a widely used antiresorptive agent that is more effective than bisphosphonates in improving bone density. Whether sequential treatment with denosumab after bisphosphonate therapy can maintain or further increase BMD at all sites has not been conclusively demonstrated. Thus, we performed a meta-analysis of randomized controlled trials (RCTs) to assess the effects of this sequential therapy on BMD. We searched the PubMed, Embase, and Cochrane Library databases from December 1, 1986, to May 2, 2024, for all RCTs that assessed the efficacy of sequential therapy of bisphosphonate transition to denosumab in postmenopausal women with osteoporosis. BMD changes at the lumbar spine, femoral neck, and total hip were used as outcomes. We assessed methodological quality, extracted relevant data according to the Cochrane Handbook for Systematic Reviews of Interventions, applied random-effects models for meta-analyses, performed heterogeneity analyses, and assessed publication bias. A total of 3290 patients from 4 RCTs were included in the meta-analysis. Forest plot analysis showed that sequential treatment with bisphosphonate-denosumab was associated with higher lumbar spine BMD gain than continuous bisphosphonate treatment [mean difference (MD) = 5.50, 95% confidence interval (CI) = 5.26-5.75, I2 = 32.88%). No risk of bias was observed for the 4 trials, but there was an increase in femoral neck and total hip BMD. Moreover, analyses could not be performed because of high heterogeneity (femoral neck BMD: MD = 3.85, 95% CI = 2.84-4.85, I2 = 97.88%; total hip BMD: MD = 5.65, 95% CI = 4.28-7.02, I2 = 97.91%). Sequential therapy that involves a transition from bisphosphonates to denosumab had a positive effect on lumbar spine bone density, and this type of therapy may be a potential treatment option for increasing lumbar spine bone density in postmenopausal women.