Bone Mineral Density Research Articles

Fracture Prevention with Infrequent Zoledronate in Women 50 to 60 Years of Age

BackgroundZoledronate prevents fractures in older women when administered every 12 to 18 months, but its effects on bone density and bone turnover persist beyond 5 years. Whether infrequent zoledronate administration would prevent vertebral fractures in early postmenopausal women is unknown.MethodsWe conducted a 10-year, prospective, double-blind, randomized, placebo-controlled trial involving early postmenopausal women (50 to 60 years of age) with bone mineral density T scores lower than 0 and higher than −2.5 (scores of −1 or higher typically indicate normal bone mineral density) at the lumbar spine, femoral neck, or hip. Participants were randomly assigned to receive an infusion of zoledronate at a dose of 5 mg at baseline and at 5 years (zoledronate–zoledronate group), zoledronate at a dose of 5 mg at baseline and placebo at 5 years (zoledronate–placebo group), or placebo at both baseline and 5 years (placebo–placebo group). Spinal radiographs were obtained at baseline, 5 years, and 10 years. The primary end point was morphometric vertebral fracture, which was assessed semiquantitatively and defined as at least a 20% change in vertebral height from that seen on the baseline radiograph. Secondary end points were fragility fracture, any fracture, and major osteoporotic fracture.ResultsOf 1054 women with a mean age of 56.0 years at baseline, 1003 (95.2%) completed 10 years of follow-up. A new morphometric fracture occurred in 22 women (6.3%) in the zoledronate–zoledronate group, in 23 women (6.6%) in the zoledronate–placebo group, and in 39 women (11.1%) in the placebo–placebo group (relative risk, zoledronate–zoledronate vs. placebo–placebo, 0.56 [95% confidence interval {CI}, 0.34 to 0.92; P=0.04]; and zoledronate–placebo vs. placebo–placebo, 0.59 [95% CI, 0.36 to 0.97; P=0.08]). The relative risk of fragility fracture, any fracture, and major osteoporotic fracture was 0.72 (95% CI, 0.55 to 0.93), 0.70 (95% CI, 0.56 to 0.88), and 0.60 (95% CI, 0.42 to 0.86), respectively, when zoledronate–zoledronate was compared with placebo–placebo and 0.79 (95% CI, 0.61 to 1.02), 0.77 (95% CI, 0.62 to 0.97), and 0.71 (95% CI, 0.51 to 0.99), respectively, when zoledronate–placebo was compared with placebo–placebo.ConclusionsTen years after trial initiation, zoledronate administered at baseline and 5 years was effective in preventing morphometric vertebral fracture in early postmenopausal women. (Funded by the Health Research Council of New Zealand; Australian New Zealand Clinical Trials Registry number, ACTRN12612000270819.)

The nonlinear correlation between total bilirubin and lumbar spine bone mineral density in patients receiving maintenance hemodialysis.

Patients receiving maintenance hemodialysis (MHD) are at increased risk of osteoporosis. The effects of bilirubin on bone metabolism vary among different disease populations. However, the relationship between total bilirubin (TBIL) and bone metabolism in MHD has not been investigated yet. This cross-sectional study included 122 MHD patients aged ≥ 18 years who underwent regular hemodialysis at the Blood Purification Center of Aerospace Central Hospital from April 2021 to April 2023. Blood sampling and bone mineral density (BMD) examinations were conducted. Multivariate linear regression, restricted cubic spline and subgroup analyses were performed to evaluate the association between TBIL and BMD. TBIL (correlation coefficient: 1.7 (0.17, 3.25); p = 0.04) was independently associated with BMD in the multivariate linear regression analysis. The results showed that BMD was nonlinearly related to TBIL in MHD patients, exhibiting a J shaped curve (p = 0.035). When plasma TBIL level < 0.64 mg/dL, there is an average increase of 5.3 (95% CI: 2.0 - 8.7; p = 0.002) g/cm2 in BMD for every 1-unit increase in plasma TBIL level. The association between TBIL and BMD was not significant when the plasma TBIL level was ≥ 0.64 mg/dL. The relationship between TBIL and BMD in MHD patients is J-shaped, with an inflection point of 0.64 mg/dL.

Dapagliflozin combined with metformin improves blood glucose, bone metabolism and bone mineral density in elderly patients with type 2 diabetes mellitus complicated with osteoporosis.

The incidence of type 2 diabetes mellitus (T2DM) complicated with osteoporosis (OP) (T2DM-OP) is growing. Dapagliflozin and metformin are commonly prescribed to manage glycemic levels in T2DM patients. We investigated the clinical efficacy of combining dapagliflozin with metformin in elderly patients with T2DM-OP. Totally 144 T2DM-OP patients were prospectively enrolled and allocated into two groups: the Metformin and Dapagliflozin + Metformin groups. Each group received treatment for 12 months. Fasting peripheral blood samples were collected before and after 12 months of treatment. Glycemic parameters and bone metabolic parameters were measured using oral glucose tolerance test, automatic biochemical analyzers, or liquid chromatography. Bone mineral density (BMD) changes at lumbar vertebrae (L1-4), femoral neck (FN) and total hip (TH) were assessed using dual-energy X-ray bone mineral densitometry. Pain severity was evaluated using the visual analog scale (VAS). The total effective rate, fracture incidence, and adverse reaction rate were also evaluated. After 12 months, both groups showed improvements in glycemic parameters, bone metabolic parameters, and BMD at L1-4, FN, and TH, and reductions in VAS scores. The Dapagliflozin + Metformin group exhibited more significant improvements. The overall effective rate was higher and fracture incidence, was lower in Dapagliflozin + Metformin group, with comparable rates of adverse reactions and safety profiles between the two groups. Taken together, treatment with a combination of dapagliflozin and metformin led to improvements in blood glucose levels, bone metabolism, and BMD in elderly patients with T2DM-OP, demonstrating superior efficacy and safety compared to metformin monotherapy.

Plasma levels of anti phosphocholine IgM antibodies are negatively correlated with bone mineral density in humans

Phosphatidylcholine is a ubiquitous phospholipid. It contains a phosphocholine (PC) headgroup and polyunsaturated fatty acids that, when oxidized, form reactive oxidized phospholipids (PC-OxPLs). PC-OxPLs are pathogenic in multiple diseases and neutralized by anti-PC IgM antibodies. The levels of anti-PC IgM increase as the levels of PC-OxPLs increase and, in humans, are inversely correlated with the incidence of cardiovascular diseases and steatohepatitis. PC-OxPLs also decrease bone mass in mice. Overexpression of anti-PC IgM ameliorates atherosclerosis and steatohepatitis, increases bone mass in young mice, and protects against high fat diet- and age-associated osteoporosis. We investigated the relationship between anti-PC IgM plasma levels and bone mineral density (BMD) in a cross-sectional study of 247 participants [mean age: 65.5 (± 8.6) years] without medical conditions known to influence BMD or antibody production. Anti-PC IgM levels negatively correlated with both T- and Z-scores at the lumbar spine, femur and, to a lesser extent, the forearm. These correlations were maintained after adjustment for age, race, and sex. These results raise the possibility that higher levels of anti-PC IgM in patients with lower BMD reflect exposure to higher levels of PC-OxPLs, which are known to affect bone mass, and could be a novel risk marker for osteoporosis.

Effect of romosozumab on bone mineral density and trabecular bone score in premenopausal women with low bone mass.

Romosozumab, an anti-sclerostin antibody, is a promising anabolic agent that increases bone formation and decreases bone resorption. However, its efficacy in premenopausal women with low bone mass remains understudied. We retrospectively reviewed premenopausal women with low bone mass treated with romosozumab (ROMO group) or drug-naïve patients (control group). Patients in the ROMO group were classified into the glucocorticoid-induced osteoporosis (GIOP), idiopathic osteoporosis (IOP), and pregnancy and lactation-induced osteoporosis (PLO) subgroups. Bone mineral density (BMD) and trabecular bone score (TBS) were measured before and after one year of romosozumab treatment. Twenty-five patients in the ROMO group and five in the control group were included in the study. Among patients in the ROMO group, 12 were in the GIOP, 9 in the IOP, and 4 in the PLO subgroups. The mean age was 37.0years [32.0-42.0], and the median body mass index was 18.8kg/m2 [17.5-21.3]. After romosozumab treatment, lumbar spine (LS), femur neck (FN) BMD, and TBS increased from baseline (LSBMD, 12.8% [8.2-19.3], p < 0.001; FNBMD, 4.6% [- 0.6-10.7], p = 0.016; TBS, 4.1% ± 3.8, p < 0.001) in the ROMO group. Patients in both the GIOP and IOP subgroups showed a significant increase in LSBMD, while those in the IOP subgroup demonstrated significant increases in FNBMD. We demonstrated romosozumab's efficacy in BMD increment in premenopausal women. Romosozumab may be a potential treatment option for premenopausal women with low bone mass, regardless of etiologies, although further research on fracture risk reduction is warranted.

Construction and validation of a prediction model for fall risk in hospitalized older adults with osteoporosis

ObjectiveThe aim of this study is to develop and validate a prediction model for fall risk factors in hospitalized older adults with osteoporosis.MethodsA total of 615 older adults with osteoporosis hospitalized at a tertiary (grade 3A) hospital in Nantong City, Jiangsu Province, China, between September 2022 and August 2023 were selected for the study using convenience sampling. Fall risk factors were identified using univariate and logistic regression analyses, and a predictive risk model was constructed and visualized through a nomogram. Model performance was evaluated using the area under the receiver operator characteristic curve (AUC), Hosmer-Lemeshow goodness-of-fit test, and clinical decision curve analysis, assessing the discrimination ability, calibration, and clinical utility of the model.ResultsBased on logistic regression analysis, we identified several significant fall risk factors for older adults with osteoporosis: gender of the study participant, bone mineral density, serum calcium levels, history of falls, fear of falling, use of walking aids, and impaired balance. The AUC was 0.798 (95% CI: 0.763–0.830), with a sensitivity of 80.6%, a specificity of 67.9%, a maximum Youden index of 0.485, and a critical threshold of 121.97 points. The Hosmer-Lemeshow test yielded a χ2 value of 8.147 and p = 0.419, indicating good model calibration. Internal validation showed a C-index of 0.799 (95% CI: 0.768–0.801), indicating the model’s high discrimination ability. Calibration curves showed good agreement between predicted and observed values, confirming good calibration. The clinical decision curve analysis further supported the model’s clinical utility.ConclusionThe prediction model constructed and verified in this study was to predict fall risk for hospitalized older adults with osteoporosis, providing a valuable tool for clinicians to implement targeted interventions for patients with high fall risks.

Correlation between serum high-density lipoprotein cholesterol and bone mineral density in vitamin D-deficient populations

Correlation between serum high-density lipoprotein cholesterol and bone mineral density in vitamin D-deficient populations

Trends in screening and treatment of osteoporosis after periprosthetic fractures from 2010 to 2020.

Periprosthetic fractures (PPF) typically occur from low-energy mechanisms and are pathognomonic for osteoporosis. However, osteoporosis is often underrecognized and undertreated. The aim of this study was to examine trends in dual energy X-ray absorptiometry (DXA) scans and treatment of osteoporosis after PPF between 2010 and 2020. Patients older than 40 who experienced a lower extremity PPF between 2010 and 2020 and had no prior history of osteoporosis screening or treatment were identified utilizing a large national administrative database. Rates of bone mineral density (BMD) measurement using DXA and anti-osteoporotic treatment with pharmacotherapy, or either intervention within 1year following experiencing a PPF were determined. The rate of change for these interventions was calculated using the compounded annual growth rate (CAGR), with linear regression used to determine whether trends were statistically significant. In total, 5.7% and 3.6% of patients were screened and treated for osteoporosis, respectively. Between 2010 and 2020, there was no significant change in rates of osteoporosis screening (CAGR + 0.1%; p = 0.13), treatment (CAGR - 2.4%; p = 0.29), or either intervention (CAGR - 1.1%; p = 0.77) within 1year following PPF. Factors associated with intervention included older age, female sex, and increased comorbidities. Our study found that there has been no significant change in the rates of osteoporosis screening or treatment within 1year following PPF. Orthopedic surgeons and allied healthcare workers can play an integral role in helping to curtail the osteoporosis epidemic.

Eldecalcitol Add-On to Risedronate Reduces Bone Loss from Aromatase Inhibitors in Postmenopausal Breast Cancer Patients.

Aromatase inhibitors (AIs) cause bone loss and increase fracture risk in women with hormone receptor-positive early-stage breast cancer (HR+EBC). Bone antiresorptive agents are recommended for patients at risk of fragility fractures. Eldecalcitol, combined with bisphosphonate, increases bone mineral density (BMD) in primary osteoporosis. To determine the effect of eldecalcitol (0.75 ug/day) add-on therapy to risedronate (17.5 mg/week) on bone quantity and quality in women treated with AI. Open-label randomized control trial. Postmenopausal women with HR+EBC (TNM stage 0-3A) treated with risedronate for more than 12 months. 200 patients were enrolled; 196 patients were eligible for the full analysis set after excluding those without follow-up BMD data. Participants were advised to take vitamin D and calcium, yet many were vitamin D deficient or insufficient. Participants were randomly assigned in a 1:1 ratio to receive either eldecalcitol add-on therapy or risedronate monotherapy. Primary outcome was the group difference in the change of LS-BMD in 24 months. Secondary outcomes included FN-BMD, TH-BMD, trabecular bone score (TBS), and the incidence of vertebral and non-vertebral fractures. The increase at LS-, FN-, and TH-BMD at 24 months was larger in the add-on therapy group than in the monotherapy group, with a group difference (add-on therapy minus monotherapy) estimate of 0.020 g/cm2 (95% confidence interval (CI): 0.010-0.029 g/cm2, p< 0.001) for LS-BMD. The incidence rate ratio (add-on therapy/monotherapy) for morphometric vertebral fractures was 0.292 (95% CI: 0.080-1.061, p= 0.061). No group difference was detected in the change in TBS. Eldecalcitol add-on therapy increased LS-BMD in osteopenic to osteoporotic postmenopausal women treated with an AI and risedronate.

Proteins and pathways involved in inflammation are longitudinally associated with total body bone mineral density among primarily hispanic overweight/obese adolescents and young adults.

Bone mineral density (BMD), an important marker of bone health, is regulated by a complex interaction of proteins. Plasma proteomic analyses can contribute to identification of proteins associated with changes in BMD. This may be especially informative in stages of bone accrual and peak BMD achievement (i.e., adolescence and young adulthood), but existing research has focused on older adults. This analysis in the Study of Latino Adolescents at Risk for Type 2 Diabetes (SOLAR; n = 304; baseline age 8-13, 100% Hispanic) explored associations between baseline proteins (n = 653 proteins) measured with Olink® plasma protein profiling and repeated annual DXA measures of BMD (average of 3.2 visits per participant). Covariate-adjusted linear mixed effect regression models were applied to estimate longitudinal protein-BMD associations using an adjusted p-value cutoff (P < 0.00068). Identified proteins were imported into the Search Tool for the Retrieval of Interacting Genes/Proteins (STRING) database to determine significantly enriched protein pathways. Forty-four proteins, many of which are involved in inflammatory processes, were associated with longitudinal changes in total body BMD, including several proteins previously linked to bone health such as osteopontin (SPP1) and microfibrillar-associated protein 5 (MFAP5; both P < 0.00068). These 44 proteins were associated with enrichment of pathways including PI3K-Akt Signaling Pathway and Cytokine-Cytokine Receptor Interaction, supporting results from existing proteomics analyses in older adults. To evaluate whether protein associations were consistent into young adulthood, linear mixed effect models were repeated in a young adult cohort (n = 169; baseline age 17-22; 62.1% Hispanic) with 346 available overlapping Olink® protein measures. While there were no significant overlapping longitudinal protein associations between the cohorts, these findings suggest differences in protein regulation at different ages and provide novel insight on longitudinal protein associations with BMD in overweight/obese adolescents and young adults of primarily Hispanic origin, which may inform the development of biomarkers for bone health in youth.

Screening for Osteoporosis to Prevent Fractures: A Systematic Evidence Review for the US Preventive Services Task Force.

Fragility fractures result in significant morbidity. To review evidence on osteoporosis screening to inform the US Preventive Services Task Force. PubMed, Embase, Cochrane Library, and trial registries through January 9, 2024; references, experts, and literature surveillance through July 31, 2024. Randomized clinical trials (RCTs) and systematic reviews of screening; pharmacotherapy studies for primary osteoporosis; predictive and diagnostic accuracy studies. Two reviewers assessed titles/abstracts, full-text articles, study quality, and extracted data; when at least 2 similar studies were available, meta-analyses were conducted. Hip, clinical vertebral, major osteoporotic, and total fractures; mortality; harms; accuracy. Three RCTs and 3 systematic reviews reported benefits of screening in older, higher-risk women. Two RCTs used 2-stage screening: Fracture Risk Assessment Tool estimate with bone mineral density (BMD) testing if risk threshold exceeded. One RCT used BMD plus additional tests. Screening was associated with reduced hip (pooled relative risk [RR], 0.83 [95% CI, 0.73-0.93]; 3 RCTs; 42 009 participants) and major osteoporotic fracture (pooled RR, 0.94 [95% CI, 0.88-0.99]; 3 RCTs; 42 009 participants) compared with usual care. Corresponding absolute risk differences were 5 to 6 fewer fractures per 1000 participants screened. The discriminative accuracy of risk assessment instruments to predict fracture or identify osteoporosis varied by instrument and fracture type; most had an area under the curve between 0.60 and 0.80 to predict major osteoporotic fracture, hip fracture, or both. Calibration outcomes were limited. Compared with placebo, bisphosphonates (pooled RR, 0.67 [95% CI, 0.45-1.00]; 6 RCTs; 12 055 participants) and denosumab (RR, 0.60 [95% CI, 0.37-0.97] from the largest RCT [7808 participants]) were associated with reduced hip fractures. Compared with placebo, no statistically significant associations were observed for adverse events. Screening in higher-risk women 65 years or older was associated with a small absolute risk reduction in hip and major fractures compared with usual care. No evidence evaluated screening with BMD alone or screening in men or younger women. Risk assessment instruments, BMD alone, or both have poor to modest discrimination for predicting fracture. Osteoporosis treatment with bisphosphonates or denosumab over several years was associated with fracture reductions and no meaningful increase in adverse events.

Low Bone Mineral Density and Associated Factors Among People Living With HIV in Kerman, Iran: A Cross-Sectional Study in 2021-2022.

Chronic diseases such as osteoporosis and low bone mineral density (BMD) are significant public health concerns for people living with HIV (PLWH), especially with the increased life expectancy because of antiretroviral therapy (ART). This study evaluated the prevalence and associated factors of low BMD among 94 PLWH in Kerman, Iran, from September 2021 to February 2022. Using dual-energy X-ray absorptiometry, BMD was measured, with low BMD defined by specific T-scores and Z-scores. Predictors were assessed through interviews, medical records, and blood tests. Bivariable and multivariable logistic regression models identified associations between low BMD and various factors. The study found a 51.1% prevalence of low BMD, with significant associations with hypogonadism (adjusted odds ratio [aOR]: 3.19), longer ART duration (aOR per month: 1.02), and lower body mass index (aOR per unit: 0.83). The findings highlight the need for regular screening and timely intervention for low BMD among PLWH, particularly with prolonged ART use.

Unexpected Increase in Bone Mineral Density With Rapamycin and Low-Dose Naltrexone: A Case Report of a 52-Year-Old Woman With Osteopenia

Unexpected Increase in Bone Mineral Density With Rapamycin and Low-Dose Naltrexone: A Case Report of a 52-Year-Old Woman With Osteopenia

Global Publication Trends and Research Hotspots of Diabetes and Osteoporosis

Background: Diabetes and osteoporosis, as chronic diseases with high incidence, have caused deep concern in the field of global public health due to their high morbidity and mortality. More importantly, the complex and close relationship between diabetes and osteoporosis has gradually become the focus of scientific research. It is very meaningful to carry out bibliometric analysis in the research field of diabetes and osteoporosis to describe the current international trend and present a visual representation of the past and emerging trends of diabetes and osteoporosis in the past decade. Methods: In this study, the characteristics of the articles on “diabetes and osteoporosis” retrieved and downloaded from the Web of Science Core Collection [WoSCC] database from January 1, 2011 to December 1, 2022 were analyzed by bibliometrics to clarify the evolution and theme trends between the two diseases. Citespace software was used for data analysis and visualization, including countries, academic institutions, journals, authors, subject categories, keywords, references, and citations. In addition, some important subtopics identified by bibliometric characterization were further discussed and reviewed. Results: Finally, 3372 articles were included in the analysis, including a total of 96 countries, 407 organizations, 1161 journals, and 617 keywords. Articles related to diabetes and osteoporosis were first published in 2011 and then showed an increasing trend year by year. The United States, China, Italy, England, and Japan were the top 5 countries associated with the largest number of publications. University of California-San Francisco, China Medical University, University of Toronto, Shanghai Jiao Tong University, and Mayo Clinic were the top 5 academic institutions in terms of the number of published papers. The top 5 authors with the highest number of publications were William D, Ann V, Nicola, Peter, and Toshitsugu. Osteoporosis International has published 130 articles in this field, ranking first among highly productive journals. In addition to diabetes and osteoporosis, the most frequently used keywords were bone mineral density, obesity, and fracture. Conclusions: More and more studies have been conducted on diabetes and osteoporosis, and the current research mainly focuses on the pathogenesis of various chronic diseases. In the future, more attention may be paid to the prevention and management of these two chronic diseases and the production and application of new drugs.

Biomimetic Extracellular Vesicles Containing Biominerals for Targeted Osteoporosis Therapy.

Osteoporosis (OP) is a systemic skeletal disorder characterized by decreased bone mineral density and a heightened risk of fractures. Therapies for OP have primarily focused on balancing bone formation and bone resorption, but enhancing the remineralization of osteoporotic bone is also a key strategy for effective repair. Recent insights into biomineralization mechanisms have highlighted the essential role of mineral-containing extracellular vesicles (EVs) secreted by osteoblasts in promoting bone marrow mesenchymal stromal/stem cell (BMSC) differentiation and initiating matrix mineralization. Drawing from these principles, we developed a biomimetic approach to replicate the structure and function of the osteoblast-derived EVs by engineering biomimetic mitochondrial minerals with bone marrow homing cell membranes (CMs). This bone-targeted biomimetic system exhibits excellent biocompatibility, enhancing osteogenic differentiation and stimulating angiogenesis by regulating cellular energy metabolism. Additionally, the CM-coated structure shows affinity for collagen fibrils, effectively enhancing intrafibrillar collagen mineralization, thereby facilitating osteoporotic bone repair. Overall, the biomimetic system offers a safe and efficient therapeutic alternative, positioning it as a platform for bone tissue engineering and regenerative medicine.

Association of caffeine intake and sleep duration with bone mineral density: a cross-sectional study from National Health and Nutrition Examination Survey between 2011 and 2018

ObjectiveThe association between sleep duration, caffeine intake, and bone mineral density (BMD) is not well understood, with previous studies providing controversial results. This study explores the associations among caffeine intake, sleep duration, and BMD.MethodsData were sourced from the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2018, including 13,457 participants who self-reported sleep duration and caffeine intake, with BMD measured via dual X-ray absorptiometry. Multivariable linear regression models, adjusted for confounders, were used alongside restricted cubic splines to examine dose-response association.ResultsOf all participants, 6821 (50.7%) were males and 6636 were females (49.3%). The mean caffeine intake and sleep duration were 93.4 mg/day and 7.19 h, respectively. RCS results showed that BMD increased with the increase in caffeine intake, especially in the low dose range of 0-200 mg/day. The dose-response association between sleep duration and BMD showed that sleep durations of 0–6 h may promote the increase of BMD, but after sleep durations greater than 6 h, BMD decreases. After adjustment for potential confounders, compared to the lowest referent quartile, individuals with caffeine intake in quartiles 2, 3, and 4 had a positive correlation with BMD (0.62 95% CI: 0.24–1.37; 0.51 95% CI: 0.22–1.13; 0.75 95% CI: 0.41–1.46; P for trend < 0.05). In covariate-adjusted linear regression models, compared with those sleeping 6 h or less per night, the difference in BMD among those sleeping 6–7 h, 7–8 h, and 8–14.5 h per night were 1.81 (95% CI: 0.4122.71), 1.25 (95% CI: 0.55–2.93), and 0.87 (95% CI: 0.38–1.69). Associations of caffeine intake, sleep duration, and BMD stratified by sex and age failed to reach statistical significance.ConclusionsAssociation might exist between the consumption of caffeine, sleep duration, and BMD; however, when stratified by sex and age, the association did not reach statistical significance.

Effects of Anti-obesity Strategies on Bone Mineral Density: A Comprehensive Meta-analysis of Randomized Controlled Trials.

Although an appropriate weight management strategy is essential for obese individuals, weight loss can have adverse effects on bone mineral density (BMD). We conducted a systematic review of randomized controlled trials to evaluate changes in BMD after the implementation of various weight loss strategies. The PubMed, Embase, Web of Science, and Cochrane Library databases were searched to find articles published from database inception until June 2023. Randomized controlled trials of various treatments for obese patients that reported changes in BMD were selected. The primary outcome was BMD of the whole body, lumbar spine, and total hip, measured using dual X-ray absorptiometry. Eighteen randomized controlled trials involving 2,510 participants with obesity were included in the analysis. At follow-up examination, the BMD of the lumbar spine decreased significantly after metabolic surgery (mean difference [MD]=-0.40 g/cm2; 95% confidence interval [CI], -0.73 to -0.07; I2=0%); lifestyle and pharmacological interventions did not result in a significant decrease in BMD at any location. Metabolic surgery also produced the most substantial difference in weight, with an MD of -3.14 (95% CI, -3.82 to -2.47). This meta-analysis is the first to examine the effects of all categories of anti-obesity strategies, including the use of anti-obesity medications, on BMD. Bariatric metabolic surgery can have adverse effects on BMD. Moreover, medications can be used as a treatment for weight loss without compromising bone quality.

Age-related trends in trabecular bone scores and bone mineral density in Chinese men with type 2 diabetes mellitus: a cross-sectional study

Patients with Type 2 diabetes mellitus(T2DM) typically have an average or higher bone mineral density (BMD) but are at a significantly higher risk of fracture than patients without diabetes. Trabecular bone score (TBS) is a textural index derived from pixel gray-level variations in lumbar spine DXA image, which has been introduced as an indirect measure of bone quality. This study aimed to discuss the trends and annual rates of change in BMD and TBS with age in Chinese men with T2DM and men without diabetes mellitus. Lumbar spine(LS) TBS was significantly lower in males with T2DM compared to men without diabetes(1.279 ± 0.117 vs. 1.299 ± 0.090, P = 0.005). However, TBS in men with T2DM peaked around age 60, which occurred later and was lower than the peak observed in men without diabetes, who reached their peak TBS around age 50 (1.294 ± 0.126 vs. 1.328 ± 0.088). Femoral neck, total hip, and lumbar spine BMD in men with T2DM were not significantly different from those in men without diabetes. The results showed that both men with or without T2DM exhibited the lowest annual rates of change in TBS at 66–75 years of age, with values of -1.05%(P < 0.001) and − 0.90%(P < 0.001), respectively. Patients with great glycemic control demonstrated higher TBS and BMD. Men with T2DM have later and lower peak TBS and faster bone loss, suggesting that diabetes may negatively impact bone microarchitecture and mineralization.

Long-Term Efficacy and Safety of Denosumab: Insights beyond 10 Years of Use.

Osteoporosis management in post-menopausal women focuses on fracture prevention, with denosumab as a key therapeutic option. Despite its proven efficacy in reducing fracture risk and increasing bone mineral density (BMD) over 10 years, its long-term impact remains uncertain. We evaluated the literature on its efficacy and safety beyond the initial decade. Clinical trials and real-world studies confirm denosumab's sustained efficacy, especially in lumbar spine BMD, with hip BMD stabilizing. Concerns about adverse events (AEs) like hypocalcemia and osteonecrosis of the jaw necessitate vigilant monitoring. Risks of atypical femoral fractures and malignancies also require attention, despite unclear links to treatment duration. Clinical guidelines for denosumab beyond 10 years are limited, emphasizing the need for careful monitoring. In certain scenarios, such as advanced chronic kidney disease, prolonged denosumab may be required to balance AE risks with fracture prevention benefits. Denosumab shows potential for long-term efficacy in augmenting BMD; however, monitoring for AEs is crucial to guide clinical decision-making effectively.

Correlation between paraspinal muscle fat infiltration and thoracic vertebral degeneration based on phantom-less QCT: a novel insight into thoracic vertebral degeneration.

This study aimed to elucidate the correlation between the degree of fat infiltration (FI) in thoracic paraspinal muscles and thoracic vertebral degeneration (TVD). This cross-sectional study comprised 474 patients who underwent standard thoracic computed tomography (CT) scans. The FI was quantified as the percentage of adipose tissues within the cross-sectional area of thoracic paraspinal muscles. Thoracic vertebra was assessed in terms of osteoporosis, ossification of the anterior longitudinal ligament (OALL), ossification of the posterior longitudinal ligament (OPLL), intervertebral disc calcification, intervertebral disc cavity, and facet joint osteoarthritis (FJO). Logistic regression, linear regression, subgroup, and receiver operating characteristic (ROC) analyses were assessed to evaluate the association between FI and TVD. Multivariate logistic regression revealed that more severe FI was closely associated with more serious osteoporosis (P < 0.001). Furthermore, after adjusting for only age, higher FI was significantly associated with nastier FJO (P < 0.05). In male patients, severe FI was greatly associated with worse osteoporosis (P < 0.05). In female patients, severe FI maintained close correlations with more severe osteoporosis and FJO (P < 0.05). Furthermore, in patients aged < 60 or ≥ 60 years, higher FI had a strong correlation with more severe osteoporosis (P < 0.001). In patients aged < 60 years, higher FI was associated with worse intervertebral disc calcification, OALL, and FJO (P < 0.05). Meanwhile, in patients aged ≥ 60 years, increased FI was only associated with severe OPLL (P < 0.05). Multivariate linear regression showed that FI negatively correlated with bone mineral density in the general population and different sex and age groups (P < 0.001). ROC analysis indicated that FI could predict the occurrence of TVD (P < 0.05). Higher FI is associated with more severe TVD. Studies on TVD are currently limited; therefore, this study enriches the related research on TVD, and our findings would facilitate the early prediction and diagnosis of TVD in clinical practice. Furthermore, our findings indicate that thoracic spine pain (TSP) caused by TVD can be prevented, potentially improving the prognosis of patients with TSP.