Percutaneous vertebral augmentation is widely used to provide symptom relief for patients with painful vertebral compression fractures (VCFs), but adjacent fractures remain a known complication. This retrospective study evaluated the risk of adjacent vertebral fractures following different percutaneous vertebral augmentation techniques. A total of 985 encounters from 878 patients who underwent vertebroplasty, kyphoplasty, or bone tumor radiofrequency ablation (BT-RFA) with cement augmentation were included. The primary outcome was incidence of postprocedural adjacent fractures. Associations with demographic and clinical factors including age, sex, BMI, pathologic fractures, bone density, imaging guidance, and number of treated levels were assessed. Statistical analyses included a generalized linear mixed model and Cox proportional hazards models clustered by patient. Adjacent fracture occurred in 17.8% of encounters. BT-RFA was associated with a significantly lower risk of adjacent fractures compared with kyphoplasty (HR: 0.54, 95% CI:0.36-0.81; p = 0.003) and vertebroplasty (HR: 0.40, 95% CI: 0.27-0.60; p < 0.0001). Multilevel vertebral augmentations increased fracture risk by 1.42-fold, while pathologic fractures lowered the odds of adjacent fracture. No significant associations were found for age, BMI, sex, cement extravasation, or bone density. BT-RFA combined with cement augmentation significantly reduced the risk of adjacent fractures compared to kyphoplasty or vertebroplasty.

Sagittal abdominal diameter (SAD), a measure of visceral adiposity, has been linked to major adverse cardiovascular events (MACE). However, the relationship between SAD and abdominal aortic calcification (AAC), a marker of subclinical vascular disease, and whether they independently and jointly predict MACE remains unclear. To investigate whether weight-normalized SAD and AAC scored using a validated machine learning algorithm (ML-AAC24) are independently and jointly associated with incident MACE. SAD and ML-AAC24 were measured from dual-energy X-ray absorptiometry (DXA) posteroanterior and lateral spine images, respectively, from the Manitoba Bone Density registry. Among 8806 individuals (mean age 75.1±6.6years, 93.9% women), 11.3% experienced MACE during a mean follow-up of 3.8years. SAD/weight and ML-AAC24 were positively correlated (Spearman r=0.11, P<0.001). Individuals with moderate and high ML-AAC24 had 1.1% and 3.0% higher mean SAD/weight, respectively, than those with low ML-AAC24. Both ML-AAC24 and SAD/weight were independently associated with higher risk of MACE. Adjusted hazard ratios [HRs] for MACE were 1.45, 95%CI 1.24-1.71 and 1.99, 95%CI 1.67-2.35 for moderate and high ML-AAC24, respectively, vs. low. The HR for the highest vs. lowest tertile of SAD/weight was 1.37, 95%CI 1.16-1.61. Individuals who had both high ML-AAC24 and were in the highest SAD/weight tertile had the highest MACE risk (HR 2.63, 95% CI 2.02-3.44). Higher baseline SAD/weight was associated with higher ML-AAC24 scores. Both measures independently and jointly associated with MACE. Their combined use may potentially help identify individuals at high risk for cardiovascular disease during routine bone density testing.

Prospective cohort study. To establish a simple and clinically available paraspinal muscle and bone density (PMBD) score to predict mechanical complications after lumbar fusion. Mechanical complications are common issues in posterior lumbar interbody fusion (PLIF). Current evaluations are often unidimensional and complex, with lack of clinical relevance for treatment. The study analyzed a cohort of 255 patients (165 women and 90 men) followed for at least 1 year after posterior lumbar interbody fusion. The PMBD score comprised 3 parameters identified by binary logistic regression analysis: paraspinal muscle endurance and morphology (PMEM) score, L1 vertebral body computed tomography Hounsfield Units value (L1CT), and age. The statistical weights of each parameter were created by rounding odds ratios (OR) to the nearest integer. The predictive performance of the PMBD score was evaluated by the area under the receiver operating characteristic curve (AUC). Fifty-three patients (20.7%) experienced mechanical complications. The PMBD score ranged from 0 to 4. Patients with higher PMBD score exhibited higher rates of mechanical complications ( P <0.001). Binary logistic regression revealed that the PMBD score was an independent factor of mechanical complications ( P <0.001). The AUC of the score was 0.818, significantly higher than PMEM score (AUC=0.761, P <0.05), L1CT (AUC=0.690, P <0.05), and age (AUC=0.634, P <0.05). Sensitivity of PMBD was 0.714 (30/42), and specificity was 0.822 (175/213). In terms of the PMBD categories, patients were categorized as low (0-1 score), moderate (2 score), high risk (3-4 score) with a progressive complications rate (7.0%, 31.1%, and 62.5%, P <0.001). The PMBD score was a practical assessment tool integrating muscle and bone density to predict mechanical complications after PLIF, with a superior predictive performance compared with previous evaluation methods. Surgeons could utilize the PMBD score for preoperative risk stratification and might formulate individualized surgery procedure.

The circadian rhythm system plays an essential role in maintaining skeletal homeostasis, yet the precise impact of circadian rhythm abnormalities on bone mineral density (BMD) remains poorly understood. In this study, we systematically investigated the effects of rhythm disruption on bone metabolism by establishing murine models exposed to winter-simulated extended darkness (8-h light:16-h dark) and severe non-24-h light-dark cycles (8L:8D, 6L:6D, and 4L:4D). Our structural and histological analyses revealed that abnormal circadian rhythms profoundly uncouple bone remodeling, leading to a precipitous decline in trabecular bone mass. Crucially, we demonstrated that enhanced osteoclast activity due to the extended period of darkness in winter increases the risk of fractures, and this skeletal deterioration is further exacerbated under increasingly fragmented non-24-h rhythms. Mechanistically, circadian misalignment induced a severe downregulation of the Sirt3-SOD2 signaling pathway in bone tissue, which released physiological constraints on RANKL expression and subsequently drove rampant osteoclastogenesis. Pharmacological intervention with the endogenous circadian synchronizer melatonin partially mitigated this rhythm-disrupted bone loss by restoring Sirt3 expression and predominantly enhancing osteoblast anabolism; however, its capacity to directly suppress rhythm-induced osteoclast hyperactivation was limited. Furthermore, co-treatment with the Sirt3 inhibitor 3-TYP abolished the osteoprotective effects of melatonin by concurrently impairing osteoblast function. Collectively, these findings identify circadian rhythm disruption as a critical intrinsic driver of BMD decline. This chronobiological perspective elucidates that photoperiod-induced circadian disruptions may act as a risk factor for diminished bone density by driving osteoclastogenesis, warranting further translational research in humans.

Study DesignExperimental ex vivo biomechanical cadaver study.ObjectivesThoracic pedicle screws are essential for stabilizing spinal injuries, but misplacement remains a frequent complication. While many studies focus on neurovascular injuries, the impact of the degree of lateral misplacement (offset) on the biomechanical stability of thoracic pedicle screws has not been examined. Therefore, this study aimed to evaluate the influence of lateral offset on pullout force (POF) and peak insertion torque (PIT), and to analyse additional factors such as screw diameter, screw length, and bone quality.MethodsIn this ex vivo cadaveric study, 61 thoracic vertebrae (T1-T12) from seven human cadavers were instrumented using pedicle screws placed with predefined lateral offsets via 3D-printed templates. Each vertebra received one optimal and one offset screw for pairwise comparison. Biomechanical testing included cyclic loading followed by axial pullout testing. Linear mixed-effects models assessed the influence of offset, screw diameter, screw length, and bone density on POF and PIT.ResultsLateral offset significantly reduced POF and PIT. Each millimeter of offset decreased POF by 41.1 N (-9.2%; p<0.001) and PIT by 0.079 Nm (-5.9%; p=0.002). Larger screw diameter significantly increased both POF and PIT (p=0.020; p<0.001). Screw length and bone quality showed no significant independent effects. POF and PIT were strongly correlated (r=0.637, p<0.001).ConclusionsLateral offset significantly reduced both pullout force and peak insertion torque of thoracic pedicle screws, demonstrating a progressive loss of biomechanical stability with increasing misplacement. These findings underline the biomechanical relevance of accurate thoracic pedicle screw placement.

Age-related structural changes of the facial skeleton: insights from sutural ossification and CT-based analysis.

Exploring the bone-vascular axis: AI-augmented chest CT analysis in COPD highlights association between vertebral bone density and arterial calcifications.

Evaluation of primary lumbar vertebral osteoporosis by MRI fat quantification technique.

Impact of Multiple Operative Levels on Radiographic Subsidence in Stand-Alone Lateral Lumbar Interbody Fusion.

Dental extractions are among the most frequently performed procedures in dentistry. While anatomical, behavioral, and access-related factors are known to influence extraction outcomes, the role of racial and ethnic characteristics in shaping extraction techniques, preferences, and disparities has not been synthesized. This scoping review aimed to explore and map the existing evidence on how racial, ethnic factors influence dental tooth extraction. A search was conducted across PubMed, Scopus, Google Scholar using a combination of MeSH terms and keywords related to dental extraction, race, ethnicity, anatomy, and sociocultural behavior. The review followed PRISMA-ScR guidelines. A total of 15 studies were included, encompassing anthropological, clinical, forensic, public health perspectives. The review identified key racial anatomical traits (e.g., root morphology, dental arch form, bone density) that affect extraction difficulty, particularly among Caucasoid, Mongoloid, and Negroid populations. Ethnic and cultural factors-health beliefs, care-seeking behavior, and access disparities-played a role in extraction timing and technique. Provider bias, lack of diversity within the dental workforce emerged as contributing factors to inequitable care delivery. Integrating this understanding into dental education, clinical guidelines can support equitable, culturally competent care. Further research is warranted to bridge anatomical evidence with behavioral and structural determinants of extraction disparities.

Adaptive remodeling of trabecular bone surrounding orthopedic implants plays a critical role in maintaining prosthesis stability and preventing aseptic loosening caused by stress shielding and osteolysis. This study presents a numerical model approach combining Finite Element Analysis and Weinans' bone remodeling model to evaluate the initial density adaptation response of peri-prosthetic femoral trabecular bone under the critical loading condition occurring during the toe-off phase of normal gait. A high-fidelity model incorporating cortical and trabecular bone regions was developed to calculate stress distribution and strain energy density within the peri-prosthetic region. The mechanical stimulus field obtained from the Finite Element Model was subsequently used to evaluate localized remodeling activation and density-related adaptation tendencies. The results showed that localized regions near the stem tip exceeded the ultimate compressive strength of trabecular bone (7.18 MPa), suggesting potential osteolytic activity confined to a limited area. In contrast, stress in the cortical bone remained below reported failure thresholds. Regions subjected to elevated mechanical stimulus exhibited increased trabecular bone density and corresponding improvements in predicted mechanical strength, reaching values close to 10 MPa. The simulations also demonstrated that density adaptation reduced local deformation, thereby promoting mechanical stabilization at the prosthesis-bone interface. These findings support the trabecular bone's capacity to adapt mechanically to implant-induced loading conditions and demonstrate the usefulness of the proposed framework for evaluating peri-prosthetic remodeling behavior and implant load-transfer mechanisms.

Metabolic Bone Disease of Prematurity (MBDP) results from disrupted third-trimester mineral accretion in preterm neonates, leading to inadequate bone mineralization. Despite adherence to standard nutritional guidelines, MBDP remains common. This systematic review assesses the effectiveness of nutritional supplementation and physiotherapy in reducing MBDP incidence and severity. The review was conducted under PRISMA guidelines and registered with PROSPERO. We retrieved 942 studies from PubMed and Embase. Eligible studies included RCTs/cohort studies published 2020-2025 that investigated postnatal calcium, phosphate, vitamin D supplementation, or physiotherapy in preterm infants (<37 weeks), while recognising that the highest MBDP burden occurs in infants born <32 weeks or with very low birth weight and that selected moderate-to-late preterm infants may remain vulnerable when additional nutritional or clinical risk factors are present. Studies were screened with Covidence, and relevant data were qualitatively synthesized by intervention type and outcomes. From a total of 942 records initially identified, sixteen studies were included (eleven supplementation, five physiotherapy). Higher-dose calcium and organic phosphate, especially when administered continuously, improved biochemical and radiological outcomes. High-dose vitamin D offered no benefit over standard dosing, but individualized monitoring improved safety. Limited evidence demonstrated that active or reflex-based physiotherapy improved bone density and growth but with some concerns for safety; passive approaches had limited effect. Continuous high-dose calcium and organic phosphate are particularly beneficial. Standardized diagnostic criteria for biochemical and radiological MBDP assessment are needed, as the absence of consensus disease definitions remains a major barrier to interstudy comparability, evidence synthesis, and the development of clinical intervention protocols. This systematic review was prospectively registered with PROSPERO (CRD420251116486).

Female Patients Exhibit a Narrower Glenoid Rim and Lower Bone Density in the Anteroinferior Quadrant Compared With Male Patients.

Editorial Commentary: Understanding Glenoid Morphology and Bone Density: Should Female Glenoids Be Treated Differently?

Nutrition plays a vital role in musculoskeletal health, bone density, fall risk, and postural stability, alongside being a reflection of overall health status. Nutritional assessment indices are rapid and noninvasive tools for several indications, yet their association with falls remains uncertain. We aimed to investigate four commonly used nutritional indices: GNRI (Geriatric Nutritional Index), PNI (Prognostic Nutritional Index), CONUT (Controlling Nutritional Status), and MNA-SF (Mini Nutritional Assessment Short Form) to establish their relationship with falls in older adults with potential implications for clinical practice. Patients aged ≥ 65 years who underwent comprehensive geriatric assessment between 1 January 2022 and 31 January 2024 were included in the analysis. After application of the exclusion criteria, the final study population comprised 952 individuals. Fall history and fall frequency during the preceding 12 months were recorded. Associations between nutritional indices and falls were evaluated using receiver operating characteristic (ROC) analysis and logistic regression models, with additional post-hoc group comparisons based on fall frequency. MNA-SF, GNRI, and PNI were significantly associated with both fall risk and fall frequency (all p < 0.001), whereas CONUT showed no significant association (p = 0.171). Post-hoc analyses demonstrated that MNA-SF was the only index that showed significant differences between single and recurrent fallers in post-hoc group comparisons (p = 0.010). MNA-SF (OR:0.67, 95% CI:0.62-0.74), GNRI (OR:0.85, 95% CI:0.82-0.88), and PNI (OR:0.92, 95% CI:0.86-0.97) continued to have an independent association with falls in regression analysis (all p < 0.005). ROC analysis showed the highest discrimination for MNA-SF (AUC: 0.697, 95% CI: 0.660-0.733), followed by GNRI (AUC: 0.619, 95% CI: 0.581-0.656) and PNI (AUC: 0.615, 95% CI: 0.578-0.653). Fallers also exhibited greater frailty, poorer physical performance, and higher medication burden (all p < 0.001). In older adults, poorer nutritional status assessed by MNA-SF, GNRI, and PNI was independently associated with falls, supporting the potential role of nutritional assessment within a broader fall-risk evaluation framework. However, the discriminative performance of all indices was low, indicating that these tools should not be solely considered predictors of falls, but rather complementary markers. In exploratory analyses, MNA-SF showed differences between single and recurrent fallers, which suggests a potentially relevant association that warrants prospective validation. Variability in cut-off definitions across nutritional indices remains an important limitation, underscoring the need for prospective studies to refine clinically relevant thresholds.

Introduction: Fluoride exposure can influence bone metabolism and structure, but its effects on the mechanical properties of developing craniofacial bones remain poorly understood. Purpose: The aim of this study was to evaluate the effect of maternal sodium fluoride (NaF) exposure during gestation and lactation on bone mineral density and biomechanical properties of mandibular bone in suckling rat pups. Methodology: Twelve female Wistar rats were randomly assigned to two groups receiving either tap water (0.3 mg F⁻/L) or water supplemented with NaF (50 mg/L; equivalent to 23 mg F⁻/L) beginning four weeks before mating and continuing throughout gestation and lactation. Offspring were euthanized at 15 and 21 days of age. Bone mineral density (BMD) of the gonion and mandibular condyle was determined radiographically, and biomechanical properties of mandibular trabecular bone were evaluated by compression testing of transverse sections obtained at the level of the first molar. Structural mechanical parameters (stiffness, ultimate load, and energy absorption) were obtained from load–displacement curves, while material properties were derived from stress–strain curves. Results: Pups from fluoride-treated dams showed significantly higher BMD values in both mandibular regions compared with controls. However, fluoride exposure was associated with decreased structural mechanical parameters and reduced material properties, including stress and Young’s modulus. Conclusions: These findings indicate that maternal fluoride exposure during early development increases mandibular bone mineral density but impairs the mechanical competence of bone tissue. The results highlight the importance of considering bone quality, in addition to bone mineral density, when evaluating the effects of fluoride on skeletal tissues during development.

Quantitative assessment of bone mineral density in donkey (Equus asinus) metacarpal and metatarsal bones using aluminum-calibrated digital radiography in comparison with DEXA.

Osteoporosis is a progressive bone disorder characterized by reduced bone density, structural deterioration, and impaired regeneration. Current pharmacological treatments, including bisphosphonates, hormone therapy, and monoclonal antibodies, often exhibit limited long-term efficacy and systemic side effects, underscoring the need for biocompatible and stable delivery systems that can sustain osteogenic signalling within compromised bone microenvironments. Here, we report the development of nanoarchaeosomes loaded with osteopontin (NAO) - a colloidally stable, lipid-based nanocarrier engineered to enhance osteogenesis and bone regeneration. NAO exhibited a uniform morphology with an average size of 56 ± 1.0 nm, high stability, and a drug-loading efficiency of 98 ± 1%. In vitro assays with MG63 osteoblasts revealed concentration-dependent increases in alkaline phosphatase (ALP) activity, confirming enhanced osteogenic differentiation. In vivo studies demonstrated high biocompatibility in zebrafish embryos, along with increased bone count, mineral density, and regenerative capacity in both fin-fracture and amputation models. Furthermore, zebrafish models of osteoporosis treated with NAO showed improved Ca : P ratios, enhanced mineralization, and upregulation of key osteogenic genes, indicating robust bone regeneration. Collectively, these findings establish osteopontin-loaded nanoarchaeosomes as an efficient nanoplatform capable of sustaining osteogenic signaling and accelerating bone repair, offering a therapeutic strategy to overcome the limitations of current osteoporosis treatment.

Subtype-specific bone mineralization defects and early treatment amelioration in murine models of autosomal recessive osteopetrosis revealed by Raman spectroscopy.

Patients with multiple myeloma undergoing dorsal spinal instrumentation for malignant spinal lesions remain at high risk for postoperative complications and limited survival. Acute kidney injury (AKI) is common in myeloma and after major surgery, but its prognostic relevance in surgically treated myeloma patients and its association with subsequent CT-based body composition and bone density trajectories, remains insufficiently defined. We performed a retrospective cohort study of consecutive multiple myeloma patients undergoing dorsal spinal instrumentation between 2011 and 2024 at a tertiary referral center. Postoperative AKI was defined and staged according to KDIGO criteria based on serum creatinine changes within 7 postoperative days. Clinical outcomes included overall survival (OS), surgical site infection (SSI), and length of hospital stay (LOHS). CT-based morphometry was assessed on non-contrast whole-body CT at L3 level on a preoperative baseline scan (tCT1) and a postoperative follow-up scan. The follow-up CT scan (tCT2) was obtained approximately 9 months postoperatively as part of routine oncologic follow-up or clinical indication rather than a fixed imaging schedule, reflecting real-world clinical practice. The mean interval between tCT1 and tCT2 was 9.1 ± 1.2 months. Analysis included skeletal muscle index (SMI), skeletal muscle density (SMD), visceral adipose tissue (VAT), and vertebral trabecular bone status assessed by Hounsfield Units (HU). Multivariable Cox regression, logistic regression, and log-linear regression were used to evaluate the independent association of AKI with OS, SSI, and LOHS, adjusting for clinically relevant covariates. 59 patients were included (median age 69.0 years; 40.7% female); postoperative AKI occurred in 16 patients (27.1%). AKI was associated with significantly worse OS (median 224 vs. 396 days without AKI; log-rank p = 0.01), with progressively shorter OS across KDIGO stages. In multivariable Cox regression, AKI remained independently associated with worse OS (adjusted hazard ratio 2.35, 95% CI 1.22-4.54; p = 0.011). AKI was also associated with higher SSI rates (63% vs. 12%; p < 0.01) and longer LOHS (median 29 (IQR 8) vs. 19 (IQR 9) days; p < 0.001). After adjustment for age, sex, preoperative ECOG, and Charlson Comorbidity Index, AKI remained independently associated with higher SSI rates (adjusted odds ratio 3.20, 95% CI 1.11-9.26; p = 0.031) and prolonged hospitalization (LOS ratio 1.34, 95% CI 1.06-1.69; p = 0.014). Longitudinal CT analyses demonstrated significantly greater postoperative declines in the AKI group versus no AKI for SMI (median - 44.6% vs. -18.5%; p < 0.001), SMD (- 20.5% vs. -9.2%; p = 0.02), VAT (- 29.1% vs. -24.1%; p < 0.001), and HU (- 46.2% vs. -37.7%; p < 0.001). In multiple myeloma patients undergoing dorsal spinal instrumentation, postoperative AKI is independently associated with reduced survival, increased postoperative morbidity, and accelerated loss of muscle quantity, muscle quality, visceral fat, and vertebral bone density. These findings highlight AKI as a clinically meaningful systemic event with downstream catabolic consequences and support intensified perioperative nephroprotective and multidisciplinary supportive strategies in this high-risk population.