DXA densitometry is the current gold standard for the diagnosis of osteoporosis, but alternatives have been proposed. REMS densitometry shows high correlation with DXA in the identification of osteoporosis, especially in the lumbar spine. REMS can be a useful tool for the identification of osteoporosis. Osteoporosis is characterized by reduced bone mineral density (BMD). The gold standard for diagnosis is bone densitometry using dual-energy X-ray absorptiometry (DXA). However, a non-ionizing technique based on quantitative ultrasound-radiofrequency echographic multispectrometry (REMS)-has recently emerged as a potential alternative. To evaluate the diagnostic concordance between REMS and DXA in identifying osteoporosis among postmenopausal women attending the endocrinology clinic at Hospital de San José in Bogotá, Colombia, between June and December 2024. This descriptive cross-sectional study included 50 women with clinical indications for densitometry, for whom BMD was assessed using both DXA and REMS. Diagnostic agreement was evaluated based on the proportion of patients classified into the same diagnostic category by both methods and the corresponding concordance correlation coefficient (CCC). The mean age of participants was 67 ± 12.4years. According to DXA, 56% were diagnosed with osteoporosis and 38% with osteopenia. Among those diagnosed with osteoporosis by DXA, 92.9% were similarly classified by REMS. The CCC between methods was 0.53 (95% CI 0.32-0.68; p < 0.01) for the lumbar spine and 0.38 (95% CI 0.13-0.58; p < 0.01) for the femoral neck. REMS demonstrates substantial concordance with DXA in diagnosing osteoporosis, particularly in the lumbar spine. However, agreement varies by anatomical site, and influencing factors should be considered. This is the first study in Colombia to assess diagnostic agreement between these two techniques, and further research is recommended to validate and expand upon these findings.

SummaryOsteoporosis is a growing health burden requiring early risk assessment. In Saudi adults ≥ 60 years, FRAX scores with and without BMD showed minimal reclassification, with most shifts toward higher risk in younger groups. FRAX without BMD offers reliable stratification, supporting its use as a first-line screening tool.MethodsA retrospective cross-sectional study included patients aged ≥ 60 years attending family medicine clinics at King Faisal Specialist Hospital & Research Centre, Riyadh, undergoing DXA screening between January 1, 2016, and December 31, 2022. Baseline variables were age, sex, and BMI. FRAX variables assessed were family history of hip fracture (HF), prior fracture, smoking, glucocorticoid use, rheumatoid arthritis, and alcohol intake. Fracture risk was categorized using fixed and age-specific thresholds; differences in FRAX scores and reclassification patterns were evaluated.ResultsAmong 1,429 patients (mean age 68.07 ± 6.62 years), FRAX scores for major osteoporotic fracture (MOF) and HF) differed significantly with and without BMD. Subgroup analysis revealed no significant differences within specific age ranges (70–75 years for MOF and 60–75 years for HF) or among men across all age groups. Reclassification occurred in a small subset of patients, predominantly shifting toward higher-risk categories, particularly in younger age groups.ConclusionFRAX without BMD provides robust risk stratification, with minimal impact on reclassification across age categories. These results highlight its utility as a primary screening strategy, whereas BMD assessment may be reserved for cases requiring further refinement.PurposeOsteoporosis is a skeletal disorder defined by reduced bone mineral density (BMD), commonly assessed by dual-energy X-ray absorptiometry (DXA). The Fracture Risk Assessment Tool (FRAX) estimates 10-year fracture risk. Saudi Arabia was recently included in FRAX, enabling population-specific risk estimation. Notably, FRAX can be applied with or without BMD, but limited Saudi data exist comparing both methods.

Osteoporosis is a systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue, resulting in increased bone fragility and fracture risk. Recent studies have suggested a potential association between nonalcoholic fatty liver disease (NAFLD) and osteoporosis; however, findings have been inconsistent. The aim of this study was to investigate the longitudinal association between NAFLD and osteoporosis in a middle-aged Korean population. A total of 5,149 individuals (2,386 men and 2,763 women) aged 40-60years were included in the Korean Genome and Epidemiology Study, after excluding those with liver disease, heavy alcohol consumption, or osteoporosis at baseline. Osteoporosis was defined as a T-score ≤ -2.5 at any site, and normal bone density as a T-score ≥ -1.0, based on World Health Organization criteria. Participants were categorized into three groups according to their fatty liver index (FLI): non-NAFLD (< 30), intermediate (30-59), and NAFLD (≥ 60). Multivariable Cox proportional hazards regression was used to assess the risk of osteoporosis across FLI categories. Propensity score (PS) matching was performed to further assess the association between NAFLD and osteoporosis. Over a 12-years follow-up, the incidence of osteoporosis was 10.52% in the non-NAFLD group, 13.79% in the intermediate group, and 13.03% in the NAFLD groups, showing a significant linear trend (p for trend = 0.002). After adjusting for potential confounders, the hazard ratios (95% confidence interval) were 1.36 (1.09-1.70) in the intermediate group and 1.80 (1.30-2.49) in the NAFLD group, compared with the non-NAFLD group. In postmenopausal women, the association between NAFLD and increased risk of osteoporosis remained significant after adjusting for confounders. Furthermore, among the PS-matched participants (449 pairs), the NAFLD group showed a significantly higher risk of osteoporosis than the non-NAFLD group. NAFLD was independently associated with an increased risk of developing osteoporosis. These findings suggest that osteoporosis screening may be warranted in middle-aged adults with NAFLD.

Sarcopenia is widely recognized as a significant risk factor for fractures; however, its role in osteoporotic vertebral fractures (OVFs) remains underexplored. This study aimed to evaluate the prevalence of sarcopenia in patients with OVFs and its relationship with clinical characteristics and outcomes. This retrospective analysis included 142 patients treated for OVFs at a single institution from January 2022 to June 2024. Quantitative assessments of sarcopenia were performed using axial MRI images at the L4 vertebral level. Measurements included the psoas cross-sectional area (pCSA), which was normalized using the psoas muscle index (PMI = pCSA/height2) and the psoas muscle lumbar vertebral body index (PLVI = pCSA/vertebral body area). Fat infiltration (FI) and functional cross-sectional areas (fCSA) were determined using ImageJ®. Sarcopenia was defined using established PMI cutoffs. Clinical parameters, osteoporosis diagnostics (DXA T-scores, CT-based Hounsfield units [HU]), and patientoutcomes were collected. Patients had a median age of 81years (IQR 74-85), and 94 (66.2%) were female. Sarcopenia was identified in 103 patients (72.5%). Patients with sarcopenia had significantly lower BMI, lower serum albumin, and reduced T-scores of the lumbar spine compared to those without sarcopenia. Multiple (≥ 2) vertebralfractures were significantly more frequent in patients with sarcopenia (37.2% vs 18%, p = 0.018). Logistic regression revealed that patients with sarcopenia were 2.78 times more likely to have multiple fractures (95% CI; 1.1-6.9, p = 0.027). Additionally, a significant negative correlation between FI and T-scores of the lumbar spine was observed (r = -0.242, p = 0.037). By contrast, no significant differences were seen in CT HU values, time to postoperative mobilization, length of hospital stay, or incidence of postoperative wound infections. Sarcopenia is highly prevalent among OVF patients and significantly increases the risk of multiple acute fractures. Assessment and management strategies for OVF patients should routinely incorporate evaluation for sarcopenia.

Fragility fractures are a major public health concern, particularly among older adults. While osteoporosis is widely recognized as a risk factor, the cumulative impact of multiple chronic conditions on fracture risk and post-fracture outcomes remains underexplored. This study examines the multimorbidity, fragility fractures, and financial burden in older Indian adults. The current study examines the association between multimorbidity, fragility fractures, and the subsequent financial burden among older adults in India. We conducted a secondary analysis of 66,066 older adults (≥ 45years)from the Longitudinal Aging Study in India (Wave 1). Fracture multimorbidity was defined as the presence of two or more chronic conditions, along with fracture, and fragility fractures were identified based on the self-reported history of fractures. The percentage of mediation was also recorded to assess the degree of mediation effect. We reported the direct, indirect, and total effects of mediation analyses. The prevalence of fracture was 4.2%. Of these, 43% underwent surgery, 71% reported fracture with multimorbidity, and falls accounted for 87% of fractures. Hospitalization burden was significantly higheramong fracture multimorbid individuals. Out-of-pocket expenditure was found to be more than twice in private hospitals as compared to public hospitals, which considerably vary by age, sex, place of residence, living status, education level, and wealth quintile. Major predictors of fragility fractures in those with multimorbidity include age, sex, place of residence, living status, education level, and wealth quintile. In addition, ADL disability, cognitive impairment, and depression were also found to be significantly associated with bone or joint fractures. These findings highlight the urgent need for policy interventions, including integrating multimorbidity screening into fracture prevention programs, expanding insurance coverage for pre- and post-fracture treatment, and access to mobility assistive devices. Interpretation A shift towards multimorbidity-inclusive fracture prevention and management policies is essential to mitigate the health and economic burdenof fragility fractures. Future interventions should focus oncomprehensive assessment, fall prevention strategies, and equitable healthcare financing mechanisms.

This study aimed to assess the disease burden of fall-related HFs and the national trend in Ecuador from 1990 to 2021. Using data from GBD 2021, the present study demonstrated trends in the incidence, prevalence, and years lived with disability (YLDs) of fall-related HFs in Ecuador with their corresponding 95% uncertainty intervals. A joinpoint regression analysis was conducted to assess trends in the calculated annual percentage changes (APC) and the average annual percentage change (AAPC) with their corresponding 95% confidence interval. In 2021, among all incident cases of fall-related HFs in the population aged 55years and older in Ecuador, 42% and 58% were men and women, respectively, whereas 47% and 53% were men and women in the population aged 70years and older, respectively. An estimated number of 8836 new cases of fall-related hip HFs occurred in Ecuador in 2021 (3557.05 in men and 5278.90 in women), resulting in 2287.89 YLDs (1362.22 in women and 925.67 in in women and men, with AAPCs of 1.3% and 1.0%, respectively (p < 0.001). YLDs of fall-related HFs decreased in both men and women, with, AAPCs of - 0.1% and - 0.1%, respectively (p < 0.001). Fall-related HFs represents an important health problem in Ecuador. Incidence and prevalence increased, whereas YLDs decreased in the last three decades. This could reflect improvements in medical care, rehabilitation, and complication prevention after HFs. However, future studies are warranted to better assess and understand the reasons for the changing trends.

Osteoporosis and subsequent fractures not only seriously threaten the health of the aging but also escalate healthcare costs and social burdens. Undoubtedly, it is necessary to constantly optimize the diagnosis and treatment of osteoporotic fractures, and further understanding and investigation of the related studies is indispensable. However, the research on osteoporotic fractures is difficult to summarize, with complicated content and multiple disciplines involved. Consequently, this bibliometric analysis was conducted to gain a comprehensive understanding and grasp the hot topic of osteoporosis worldwide, which is beneficial to precisely guide research trends and demonstrate emerging treatments and preventive strategies. The literature published between January 2014 and October 2024 was systematically searched in the Web of Science Core Collection (WoSCC). Visualization software, including Vosviewer and CiteSpace, was used to conduct the analysis. A total of 6682 publications were obtained from 2014 to 2024 for bibliometric analysis. The USA is far ahead of other countries in both the number of publications and frequency of citations, with extensive co-authorship collaborations with nearly all other countries. Cyrus Cooper is the most influential author, and the University of Sheffield is the most influential organization in the related fields. The keywords are categorized as 6 clusters, including "hip fracture," "bone turnover," "denosumab," "atypical femoral fracture," "vitamin D," and "bone strength". The ongoing hotspots include "teriparatide," "hip," "fragility fractures," and "outcome". This study comprehensively summarizes the topic trends and developments in the field of osteoporotic fractures using bibliometric analysis over the past decade. The hotspots and frontiers mainly focused on the prediction of osteoporosis and fractures, drug treatment, and clinical management. The intersection of multiple disciplines and various emerging frontiers has provided great potential for the management of osteoporotic fractures. Further investigation and more clinical translation are necessary.

About 150 million older adults (age > 60y) live in India presently, representing ~ 14% of the global older population. The population is expected to reach 324 million by 2050, leading to higher healthcare burden from conditions like osteoporosis. However, there is limited knowledge about bone health and its determinants in middle-aged rural and urban Indian adults. This study included 744 adults (398 women) aged > 40y from urban and rural areas of Pune, India. We assessed areal bone mineral density (aBMD) at lumbar spine and femur using dual energy x-ray absorptiometry and volumetric bone parameters by peripheral quantitative computed tomography. Socio-economic-status and lifestyle factors (diet, physical activity, tobacco use, sunlight) were evaluated. Differences in bone parameters were analysed and multiple linear regression was used to identify predictors of bone health. Significant differences observed in anthropometry and lifestyle factors in urban and rural population. Rural men and women had lower aBMD than urban, with osteoporosis more common in rural women (43%) than urban (18%), and in women compared to men (31% vs 8%). In both sexes, bone outcomes were influenced by anthropometric, residential, and lifestyle factors. Height and rural residence predicted bone density and geometry in men, while in women, age, height, rural residence, tobacco intake, and sunlight exposure were key determinants CONCLUSION: Rural population showed poor bone health. Bone health in both sexes was influence by age, height, rural residence, lifestyle factors like tobacco use and sunlight exposure. Strategies targeting lifestyle modification may help improving bone health among Indians.

We aimed to investigate trends in patient characteristics and outcomes in patients after hip fractures. We analyzed data from hip fracture patients treated at our trauma center between January 2009 and December 2022. Variables included fracture type, sex, age, BMI, admission/discharge times, anesthesia type, ASA classification, treatment methods, surgery duration, discharge activities of daily living, and complications. This retrospective study of 2965 hip fracture patients revealed a predominance of femoral neck fractures (56.6%) over intertrochanteric fractures (43.4%), with females comprising two-thirds of cases. Mean patient age increased significantly over time, particularly for intertrochanteric fractures (79.4 vs. 75.0 years for femoral neck). Hospital stays markedly decreased (25.5 to 9.1 days for intertrochanteric; 20.2 to 8.9 days for femoral neck). Intertrochanteric fractures were associated with worse functional outcomes (discharge ADL, 38.5 vs. 42.2, P = 0.009) and higher ICU admission (11.4% vs. 6.0%, P < 0.001). Surgical management dominated (92.3%), with intramedullary nailing for intertrochanteric fractures (86.3%) and arthroplasty for femoral neck fractures (73.7%). ASA classification indicated poorer physiological status in intertrochanteric fracture patients (P < 0.001). In-hospital mortality escalated with age and prolonged injury-to-admission time (P < 0.001). During 2009-2022, the mean age of hip fracture patients increased significantly, while hospital stays decreased. Intertrochanteric fractures were associated with poorer functional outcomes and higher complication rates compared to femoral neck fractures. Surgical management, particularly intramedullary nailing and arthroplasty, predominated. Older adults exhibited the higher burden of adverse outcomes, with mortality and complications rising with age.

This study aimed to evaluate the associations between major air pollutants and incident hip fracture in a nationwide Chinese cohort. We included 14,101 participants aged ≥ 45years from the China Health and Retirement Longitudinal Study (2011-2020). Annual concentrations of PM2.5, PM10, O3, and NO2 were estimated using the CHAP dataset. Log-binomial regression models were applied to calculate relative risks (RRs) and 95% confidence intervals (CIs). Subgroup and sensitivity analyses were performed to assess the robustness and consistency of the findings. During a 9-year follow-up, 474 participants (3.37%) experienced hip fracture. Each 10µg/m3 increase in PM2.5 and PM10 concentrations was associated with a higher risk of hip fracture (PM2.5: RR 1.129, 95% CI 1.071-1.191; PM10: RR 1.052, 95% CI 1.024-1.081). In contrast, ozone exposure showed an inverse association (RR 0.518, 95% CI 0.458-0.585). No overall association was found for NO2, although an elevated risk was observed in the third exposure quartile (RR 1.302, 95% CI 1.012-1.675). Subgroup analyses indicated stronger PM2.5-related risks among participants with higher education levels, a more pronounced inverse association with ozone in adults aged < 60years and current smokers, and greater NO2-related risk among non-smokers. Long-term exposure to PM2.5 and PM10 increased hip fracture risk, while ozone exposure appeared protective. Moderate NO2 exposure may also affect bone fragility. These results highlight the need for pollutant-specific prevention strategies.