Fracture Risk Research Articles

Osteogenesis imperfecta (OI) is a rare disorder causing multiple fractures throughout life. No treatment has been shown to reduce the risk of fractures in OI. Here, we present the baseline characteristics of participants in the Treatment of Osteogenesis Imperfecta with Parathyroid Hormone and Zoledronic Acid (TOPaZ) trial. The aim of the trial is to determine whether teriparatide and zoledronic acid are superior to standard care in reducing the risk of clinical fractures. We summarised data on the baseline characteristics of TOPaZ participants, including demographics, genetic diagnosis, clinical features, bone density measurements, previous treatments, and fracture history. We recruited 350 adults with a clinical diagnosis of OI in 27 European referral centres between June 2017 and October 2022. Overall, 266 (76.2%) had type I OI, 55 (15.8%) had type IV, and 19 (5.4%) had type III. The type was unknown in 9 (2.6%). Blue sclera were noted in 80.8%, and 35.8% had dentinogenesis imperfecta. Bisphosphonates had been administered to 28.1% in the 2 years prior to enrolment. Pathogenic variants in COL1A1 or COL1A2 were found in 87.6%. Fractures occurring in the 2 years prior to enrolment were not associated with bone density. The TOPaZ population represents a unique cohort with which to study the genetic epidemiology and outcome of OI in relation to bone density and biochemical markers of bone turnover. When the trial reports, it will also provide new insights into the effect of an anabolic therapy, followed by antiresorptive treatment in the management of OI.

Bone mineral density (BMD) is a key indicator of bone health, particularly in older populations, where lower BMD is linked to increased risk of osteoporosis and fractures. Metabolic factors like serum uric acid (UA) and high-density lipoprotein cholesterol (HDL-C) have emerged as possible determinants of bone health. The uric acid to HDL cholesterol ratio (UHR) may offer a new perspective on these metabolic influences. This study explores the association between UHR and femoral neck BMD, with a focus on non-linear relationships and subgroup variations by body mass index (BMI), age, and sex. The study used data from 2178 participants from the 2017-2018 National Health and Nutrition Examination Survey (NHANES). UHR was calculated as the ratio of serum UA to HDL-C. BMD measurements were obtained using dual-energy X-ray absorptiometry (DXA) at the femoral neck. A two-piecewise linear regression model was applied to examine the non-linear relationship between UHR and BMD. Stratified analyses were conducted by BMI, gender, and age groups. A significant inflection point was found at UHR 19. Below this threshold, UHR was positively associated with femoral neck BMD (β = 0.0054, p = 0.013), while above the threshold, the association was negative but not statistically significant (β = -0.0016, p = 0.478). Stratified analysis revealed that the relationship between UHR and BMD remained significant among Mexican Americans even after adjusting for covariates (β = 0.0145, p = 0.012). This study identifies a non-linear association between UHR and femoral neck BMD, with a key inflection point at UHR 19. These findings suggest that UHR could be a useful biomarker for bone health, especially in populations with higher metabolic risks. Further longitudinal studies are necessary to establish causality and explore potential interventions targeting UHR to improve bone health.

Bone-anchored prostheses (BAPs) address many of the shortcomings of socket prostheses, driving the adoption of the technology for lower limb amputees. However, higher femoral fracture rates have been observed in these patients compared to socket users. It is believed that this increased fracture rate is due to the direct transmission of loads to bone through the bone-anchored implant. While low-impact activities, such as walking, have been extensively studied using finite element (FE) models, other more demanding low-impact activities such as ambulating on stairs and inclines remain poorly understood. Most previously reported subject-specific FE models of femurs fitted with osseointegrated implants were not validated against experimental data. The current study aimed to validate an FE modelling methodology using implanted cadaveric specimens and to calculate the fracture risk of implanted femurs during various activities of daily living. Strain responses of cadaveric femurs fitted with press-fit osseointegrated implants under load were recorded and compared to strain predicted by specimen-specific FE models created from CT data. Five different published relationships between Hounsfield units and Young's Moduli were investigated to determine which relationship gave the most accurate model predictions. The validated FE models of the implanted femurs were later used to simulate in-vivo force measurements during five routine activities of daily living. Lastly, the fracture risk of the implanted femurs during these activities was quantified using factor of safety (FOS), where FOS = 1 denoted fracture was predicted at the given load. The validated FE model predicted the experimental strain responses with a coefficient of determination (R2) of 0.91 and a root mean square error (RMSE) of 81.27με. The FOS for the activities of daily living of individual specimens ranged from 1.8 to 5.0, with walking up an incline having the lowest average FOS (1.9) across all specimens. Compared across different environments, the average FOS for level walking (4.3) and ambulating on stairs (4.0) were similar but almost double that of ambulating on an incline (2.2). Male BAP FE models predicted the experimental bone strains and suggested that peak loads during ambulation on level ground, stairs, and inclines are unlikely to cause bone fracture.

Abstract Denosumab is a fully human monoclonal antibody that increases bone mineral density, inhibits bone resorption and reduces fracture risk. This double-blind, randomised, parallel group study aimed to demonstrate the pharmacokinetic (PK) equivalence and compare the pharmacodynamic (PD), safety and immunogenicity profiles of the proposed denosumab biosimilar FKS518 versus the originator (reference) denosumab. Healthy males (28–55 years) were randomised to a single 60 mg subcutaneous injection of FKS518 or the reference denosumab (Prolia®) and were followed for 40 weeks after drug injection. The primary endpoints were area under the concentration-time curve (AUC) from time zero to infinity, AUC from time zero to the last quantifiable concentration, and maximum observed serum concentration. A total of 213 subjects were injected. PK equivalence was demonstrated as the 90% confidence intervals for the geometric least squares means ratio FKS518/reference denosumab for the three primary PK parameters were fully contained within the predefined bioequivalence limits. Secondary PK, PD, safety and local tolerability endpoints also supported the similarity of FKS518 and reference denosumab. No anti-drug antibodies were detected in either treatment group. These results demonstrate that FKS518 is equivalent to originator denosumab with respect to PK profile.

Osteoporosis is a prevalent skeletal disorder characterized by reduced bone mass and increased fracture risk. This study employed a 2-sample Mendelian randomization analysis to investigate the causal relationships between circulating micronutrient levels and bone health indicators, including heel broadband ultrasound attenuation, quantitative ultrasound index, bone mineral density, and osteoporosis risk. Genetic instruments were derived from large-scale genome-wide association studies. Among all tested micronutrients, zinc uniquely demonstrated causal associations with heel bone parameters. Specifically, genetically predicted higher zinc levels were negatively associated with heel broadband ultrasound attenuation (odds ratio [OR] = 0.972, P = .001), quantitative ultrasound index (OR = 0.981, P = .002), and bone mineral density (OR = 0.969, P < .001). However, no significant causal effect was observed on overall osteoporosis risk (OR = 0.999, P = .217). Sensitivity analyses confirmed the robustness of these findings, with no evidence of horizontal pleiotropy. These results help clarify the complex relationship between zinc and bone quality and fill a critical knowledge gap by demonstrating that while zinc correlates with specific bone parameters, it may not directly reduce osteoporosis risk. Further randomized controlled trials are needed to validate these findings and explore their clinical implications.

This study assessed osteoporosis, sarcopenia and osteosarcopenia as risk factors for fractures and mortality during 19-year follow-up. We analyzed 2506 individuals aged ≥ 55 from the Finnish Health 2000 Survey. Probable sarcopenia was defined as grip strength < 27kg for men and < 16kg for women. Osteoporosis was identified by a bone density T-score < -2,5 via ultrasound or a self-reported diagnosis. Participants were categorized in four groups: reference group with no sarcopenia and no osteoporosis, probable sarcopenia only, osteoporosis only, or osteosarcopenia. Fractures and deaths were identified from national registers until 2019. Four adjustment models were used, adjusting for age, sex, smoking, education, physical activity, and mobility limitation. Over a mean follow-up of 19.1 years, 580 (23.1%) participants sustained a low-energy fracture of any type and 1,375 (54.9%) died. Osteosarcopenia, probable sarcopenia and osteoporosis were all associated with increased risk of any fracture and mortality compared to the reference group. Osteoporosis alone was associated with lower mortality than osteosarcopenia (HR 0.69, 95% CI 0.50-0.95), but mortality did not differ between probable sarcopenia and osteosarcopenia (HR 0.79, 95% CI 0.59-1.06). No differences in the fracture risk between osteosarcopenia, sarcopenia and osteoporosis were observed. While both sarcopenia and osteoporosis increase fracture and mortality risks, their combination does not seem to additively elevate fracture risks. Osteoporosis is a stronger predictor for future fractures, whereas probable sarcopenia is more closely linked to mortality. Further research is warranted to determine the best ways to incorporate sarcopenia assessment into comprehensive fracture risk evaluation.

Hip resurfacing is often reserved for younger, active patients due to concerns over implant durability and fracture risk in older patients. However, there is a lack of long-term data evaluating outcomes in patients over 65years old at time of surgery. This study addresses this gap by directly comparing implant survivorship, failure and complication rates, and clinical outcomes in a younger control cohort from the same large single-surgeon series (> 6000 cases). We queried a large, prospective institutional clinical database comprising over 7000 hip resurfacing cases performed by a single, high-volume surgeon; findings may not be generalizable to lower-volume or less-experienced centers. From this cohort, we identified 395 cases in patients ≥ 65years (mean age 68.8) and 5,106 cases in patients < 65years of age at time of surgery. All included patients had a minimum of 2-year follow-up, and 88.4% of the study cohort had up-to-date follow-up. There was no difference in the 98.6% 10- and 98.2% 16-year Kaplan-Meier implant survivorship of our over-65 study group when compared to a younger under-65 control group. These results exceed the NICE (National Institute for Clinical Excellence) criteria and registry benchmarks for total hip replacement from three major registries. The early femoral failure rate (femoral failure occurring < 1year postoperative) was only 0.3%, which compares favorably with total hip arthroplasty perioperative fracture data. The long-term femoral fracture rate over the duration of this study was 1.3% for this older cohort, lower than what was reported for total hip arthroplasty. This is the first known long-term study to demonstrate that hip resurfacing patients over 65 can achieve implant survivorship rates equivalent to younger resurfacing patients and superior to national total hip arthroplasty registry benchmarks. These findings challenge age-based restrictions and support expanded candidacy for hip resurfacing in select older adults when managed by experienced surgeons.

Patients with radiographic axial spondyloarthritis (r-axSpA) are at an increased risk of osteoporotic fractures compared to the general population. To evaluate the clinical utility of trabecular bone score (TBS) compared with bone mineral density (BMD) for predicting major osteoporotic fractures (MOF) in patients with radiographic axial spondyloarthritis (r-axSpA). A total of 63 patients with r-axSpA were included. At baseline, lumbar spine DXA, thoracic and lumbar spine X-rays, and basic demographic data were collected. Patients were followed for 3 years, after which new major osteoporotic fractures (MOF) and follow-up spine X-rays were recorded. During the observation period, 7 patients experienced MOF. Of these, 6 had been classified at high risk based on TBS (TBS ≤ 1.31). On the other hand, only 1 was identified as osteopenic and none as osteoporotic based on BMD T-scores. Strongest relative risk (RR) factors for MOF included a prior MOF (RR = 13.3; p < 0.001) and presence of syndesmophytes/ankylosis (RR = 2.0; p = 0.020). Low TBS (≤ 1.31) was associated with a RR of 4.5 (hence being only a trend due to low numbers). BMD T-score < - 1.0 seemed to be not helpful in this cohort (RR = 0.64). TBS may provide greater clinical value than BMD in identifying r-axSpA patients at increased risk of MOF. Despite limited sample size, these findings highlight the potential of TBS as a complementary diagnostic tool in routine practice.

In Thoroughbred horses, a highly prevalent short interspersed nuclear element (SINE) mutation in the myostatin gene (MSTN) promoter influences circulating myostatin concentration and is associated with muscle morphology, fracture risk and optimal race distance. Our prior data reveal that within horses there is substantial variation in serum myostatin concentration, particularly in MSTN heterozygotes and wild type horses but it was unclear whether such variation relates to within-horse differences or to environmental or temporal effects. Here we report the intra-horse consistency of circulating myostatin, and investigated the hypothesis that it is affected by season. 49 racing Thoroughbreds under identical management were genotyped for the MSTN promoter SINE insertion and myostatin concentrations were measured in plasma with a validated enzyme-linked immunosorbent assay, from blood samples collected repeatedly over a year. As expected, genotype was significantly associated with circulating myostatin, with homozygotes having the lowest concentration, followed by heterozygous and then wild-type horses. Intra-horse plasma myostatin had low to moderate variability throughout the year, within genotyped groups (coefficient of variation: 17 to 23%): aside from a direct mutation effect, horses tended to be low, moderate, or higher myostatin expressers. Neither season, sex, nor age significantly influenced plasma myostatin concentration. Further work is necessary to determine whether an individual's plasma myostatin concentration is associated with any performance advantages, muscle characteristics or fracture risk within SINE genotyped groups.

Objectives Hip fracture, a critical public health concern in aging populations, are associated with significant morbidity, mortality, and disability and have been referred to as “the last fracture of life.” While vitamin D influences bone mineral density (BMD) and fragility fracture risk, its impact on muscle function and its relationship with fracture risk remains underexplored. This study aimed to investigate whether vitamin D deficiency increases hip fracture risk primarily through its effects on muscle function. Methods In this retrospective study, 138 patients aged ≥ 50 years with initial low-energy hip fracture treated between January 2024 and June 2024 were compared with 182 community residents aged ≥ 50 years recruited from the hospital physical examination center. Clinical baseline data such as age, sex, and body mass index (BMI), were recorded. Through regression analysis, independent factors influencing hip fracture risk were analyzed. The effects of vitamin D on BMD and muscle function were evaluated using femoral neck areal BMD (FN aBMD) and pectoralis muscle index (PMI), respectively. Results Patients with hip fracture were significantly older and had lower BMI, vitamin D level, muscle function, and FN aBMD than controls (P &amp;lt; 0.05). Univariate analysis identified age, BMI, vitamin D, PMI, and FN aBMD as key factors influencing hip fracture risk. After adjusting for age, sex and BMI, vitamin D, PMI, and FN aBMD emerged as independent protective factors against hip fracture in patients. Vitamin D was also found to be an independent protective factor against sarcopenia. However, Vitamin D levels did not significantly affect osteoporosis after adjusting for sex, age, and BMI. FN aBMD and PMI mediated 33.3% and 50.0%, respectively, of the association between vitamin D and HF. Conclusions Vitamin D deficiency is associated with an increased risk of hip fracture, primarily through its impact on muscle function rather than BMD. Although vitamin D supplementation is crucial in older adults, integrating muscle function assessments into fracture prevention strategies is essential.

This study aimed to use explainable artificial intelligence to improve the Fracture Risk Evaluation Model (FREM), in the prediction of imminent (one-year) risk of major osteoporotic fractures (MOFs). FREMML was trained and validated using complete registry data extracted for the Danish population ≥ 45years without previous osteoporosis diagnoses or treatment (N = 2,438,140). A Dropouts meet multiple Additive Regression Tree (DART) boosting algorithm was used. Predictors of MOFs (2022), automatically extracted for the 15-year lookback period (2007-2021), included hospital diagnoses, filled medication prescriptions, days since the last redemption of medications specific to fall and osteoporosis risk, as well as markers of polypharmacy and multi-morbidity. Stratified analyses were carried out, and model outputs were evaluated in the context of explainable artificial intelligence (AI). FREMML displayed an overall area under the curve (95% confidence interval) of 0.77 (0.76, 0.77) - making it superior to previous versions of FREM. While age and sex were the most relevant predictors of MOF events, advanced feature engineering, including temporal information, contributed to model performance. Importantly, stratified analyses highlighted changing model performance across age groups and poorer prediction performance in males. Shapley Additive exPlanations values, a feature importance metric in explainable AI, facilitated clinical interpretation of relative MOF risk. The publicly available FREMML boosting model, combined with explainable AI, may be an effective decision support approach in a physician's referral of individuals at high imminent risk of fractures to dual-energy X-ray absorptiometry.

The ultimate goal of a genome-wide association study (GWAS) is to translate its discoveries into clinical practice. To explore the clinical use of GWAS findings in the bone field, we conducted a GWAS of dual-energy X-ray absorptiometry (DXA)-derived bone mineral density (BMD) traits at 11 skeletal sites, within over 30,000 European individuals from the UK Biobank. A total of 91 unique and independent loci were identified for 11 DXA-derived BMD traits and fractures, including five novel loci (harboring the genes ABCA1, CHSY1, CYP24A1, SWAP70, and PAX1) for six BMD traits. These loci exhibited evidence of association in both males and females, which could serve as independent replication. We demonstrated that each polygenic risk score (PRS) was independently associated with fracture risk. Although incorporating multiple PRSs (ie, metaPRS) with clinical risk factors from the Fracture Risk Assessment Tool exhibited the highest predictive performance, the improvement was modest in fracture prediction. Additionally, we uncovered genetic correlation and shared polygenicity between head BMD and intracranial aneurysm. Finally, by integrating gene expression and GWAS datasets, we prioritized genes (e.g., ESR1 and SREBF1) encoding druggable human proteins along with their respective inhibitors/antagonists. In conclusion, this comprehensive investigation revealed a new genetic basis for BMD and its clinical relevance to fracture prediction. More importantly, it is suggested that head BMD was genetically correlated with intracranial aneurysm. The prioritization of genetically supported targets implies the potential repurposing of drugs (e.g., the n-3 PUFA supplement) for the prevention of osteoporosis.

Background: Osteoporosis is a systemic skeletal disease characterized by reduced bone mineral density (BMD) and microarchitectural deterioration, leading to increased fragility and fracture risk. It represents a major global public health challenge, disproportionately affecting postmenopausal females due to the abrupt decline in estrogen, which accelerates bone resorption. The condition is often asymptomatic until a fragility fracture occurs, resulting in significant pain, disability, mortality, and societal cost. Aim: This article synthesizes the etiology, epidemiology, and pathophysiology of osteoporosis in females and advocates for an interdisciplinary management approach. It aims to outline comprehensive evaluation strategies and evidence-based treatments, integrating the roles of nursing, family medicine, laboratory services, and social care to close pervasive screening and treatment gaps. Methods: A comprehensive review is presented, covering the disease's historical context, pathophysiological mechanisms (including the RANKL/RANK/OPG axis), and diagnostic criteria using dual-energy X-ray absorptiometry (DXA). Risk assessment tools like FRAX and laboratory evaluations for secondary causes are detailed. Management strategies, including pharmacological and non-pharmacological interventions, are systematically reviewed. Results: Osteoporosis management requires a multifaceted strategy. First-line pharmacotherapy includes bisphosphonates and denosumab, while anabolic agents (e.g., teriparatide, romosozumab) are reserved for very high-risk patients. Non-pharmacological foundations encompass calcium, vitamin D, weight-bearing exercise, and fall prevention. Successful outcomes depend on coordinated, interprofessional care to improve diagnosis, treatment adherence, and persistence. Conclusion: A proactive, interdisciplinary model is essential to transform osteoporosis from a "silent epidemic" into a managed chronic condition, thereby reducing the immense personal and economic burden of fragility fractures.

Children with arthrogryposis often undergo lower extremity long bone osteotomy for improved biomechanical alignment with subsequent hardware removal. The incidence of fracture and infection is unknown in this population. Therefore, the aim of this study was to identify the incidence of these complications following hardware removal and compare them to a matched cohort of patients with cerebral palsy. Patients with arthrogryposis aged 0 to 20 years who underwent lower extremity osteotomy with subsequent hardware removal were included. All hardware removal events were recorded and evaluated for postoperative fracture or infection. For comparative analysis, each patient with arthrogryposis was matched 1:1 with a patient with cerebral palsy based on age, osteotomy location, and implant type at the time of the first hardware removal event. Fifty-three patients with arthrogryposis were included with a total of 73 hardware removal procedures. Postoperative fractures occurred in 9.4% of patients, and infections in 5.3%. When calculated per hardware removal event, the incidence of both fracture and infection was 6.8%. Thirty-seven patients were successfully matched with a cerebral palsy counterpart. There were no differences in infection rates between groups (P=1.0); however, the arthrogryposis cohort sustained 3 fractures postremoval, while no fractures were observed in the cerebral palsy cohort. Children with arthrogryposis have a relatively high risk of fracture following hardware removal after lower extremity osteotomy. Caution is advised when removing metallic implants in this population. Level III-retrospective comparative study.

Background In Sweden 70,000 people suffer fragility fractures annually, including 16,000 hip fractures with one-year mortality of up to 25%. Strategies to prevent falls, improve physical function, and enhance bone strength have shown mixed results. Aim To evaluate the incidence of hip and other fragility fractures following a fracture prevention intervention and assess baseline risk factors for long-term fracture outcomes. Methods 1,233 rural Swedish women aged 70–100 years in 2002 were followed until 2021 after a primary care-based, non-randomized graded fracture prevention intervention 2002–2004 that included physical activity, fall prevention, and pharmacological treatment tailored to hip fracture risk. Fractures were identified through radiology reports 2002–2021. Results The most common fractures occurred in the hip with 236 women sustaining 268 hip fractures with highest incidence in women aged 90–94 years. One-year hip fracture mortality was 27%. Hip fractures occurred in 17.7% of the intervention group (77/434) and 19.9% of controls (159/799, p = 0.36). Repeated fragility fractures occurred in 14.1% of the intervention group and 18.6% of controls (OR 0.71; 95% CI 0.53–1.0, p = 0.047), particularly when one fracture involved the hip (OR 0.54 (95% CI 0.31–0.95), p = 0.037). Increasing age (HR 1.8–4.0), height >167 cm (HR 1.6; 95% CI 1.1–2.2), and weight <60 kg (HR 1.5; 95% CI 1.1–2.0) were significant baseline risk factors. Conclusions We noticed a non-significant reduction in hip fractures after 20 years, yet repeated fractures were less frequent in the intervention group suggesting a potential long-term benefit. Older, taller and lighter women were at greater risk for hip fracture.

Facial skin aging (FSA) is a very easily observable indicator of aging, but whether FSA is associated with osteoporosis is still unknown. Based on the individual-level datasets from UK Biobank, this study calculated the PhenoAge (an accurate aging parameter), genetic risk score (GRS) and PhenoAge_advance, and performed multiple linear correlation analyses and Cox regression analyses. Based on the summary data from genome-wide association Studies (GWAS), linkage disequilibrium regression (LDSC), pleiotropic analysis under composite null hypothesis (PLACO) and Mendelian randomization (MR) analysis were performed to reveal shared genetic components and infer causal effects, respectively. Higher degrees of FSA were associated with lower eBMD (p < 0.001), and FSA was positively associated with the risks of osteoporosis (HR = 1.852, p < 0.001) and fracture (HR = 1.501, p < 0.001). However, FSA was not genetically associated as well as causally associated with all studied osteoporosis-related traits. In addition, we found significant phenotypic and genetic correlations between FSA and PhenoAge (rp = -0.137, p < 0.05) as well as between PhenoAge and fractures (rg = 0.092, p < 0.05). FSA, PhenoAge and osteoporosis are three aging-related parameters that coexist with aging, and the aging process is accompanied by FSA and osteoporosis. FSA may serve as a marker for the onset of osteoporosis. These findings provide clues for early detection of bone loss in at-risk populations and for OP diagnosis using accurate clinical tools.

ObjectiveTo investigate the impact of air pollutants on the incidence of hip fractures among older hospitalized patients in Hebei Province.MethodsThis epidemiological study was conducted across multiple hospitals in Hebei Province over a five-year period, focusing on older people with hip fractures. A generalized linear model (GLM) and a generalized additive model (GAM) were applied to identify potential factors influencing hospitalization risk. To evaluate the association between exposure to air pollutants (PM2.5, PM10, NO2 SO2, CO, and O3) and the incidence of hip fractures, a distributed lag nonlinear model (DLNM) based on the GLM framework was employed to account for lag effects. Air quality data were obtained from fixed monitoring stations within the environmental monitoring networks of each city. The selection of monitoring sites strictly followed national standards, ensuring locations were distant from major roads, industrial emission sources, and clusters of high-rise buildings, while avoiding direct residential coal-burning emissions. This ensured that the air pollutant measurements accurately reflected regional pollution levels. Natural cubic spline functions and categorical variables were incorporated to adjust for long-term trends, seasonality, and day-of-week effects. Sensitivity analyses were performed by varying the degrees of freedom (6–8 df per year) for the time trend to assess the robustness of the results.ResultsThe study included 16,765 older hip fracture patients with an average age of 77.33 ± 7.60 years; the majority were female (7,216 cases, 68.50%). Using the P50 concentration of air pollutants as a reference, each 10 µg/m³ increase in PM2.5, PM10, and NO2 concentrations over 1 day (or a 0.1 mg/m³ increase in CO) was linked to a higher risk of hip fractures (PM2.5: RR = 1.02, 95% CI: 1.012, 1.027; PM10: RR = 1.017, 95% CI: 1.013, 1.023; NO2: RR = 1.068, 95% CI: 1.049, 1.088). Cumulative 12-day exposure to SO2 and CO increased hospitalization risk (SO2: RR = 1.19, 95% CI: 1.12, 1.28; CO: RR = 1.035, 95% CI: 1.027, 1.044). A 14-day cumulative lag showed that SO2 levels between 0 and 6 µg/m³ significantly increased the likelihood of hospitalization.ConclusionShort-term and cumulative exposure to air pollutants, including PM2.5, PM10, SO2, CO, and NO2 may be associated with an increased risk of hospitalization for hip fractures in older people. It should be noted that, as an observational study, the potential influence of unmeasured confounding factors cannot be excluded.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12877-025-06409-3.

Background/Aim: Immature permanent teeth with necrotic pulps present thin dentinal walls and open apices, making them highly susceptible to cervical fractures even after apexification. This study aimed to compare stress distribution patterns produced by different coronal base materials following mineral trioxide aggregate (MTA) apexification using three-dimensional finite element analysis (FEA). Materials and Methods: A CBCT-based model of a maxillary immature incisor was reconstructed and modified to simulate six restorative scenarios: control (sound tooth), MTA + conventional glass ionomer cement (GIC), MTA + resin-modified glass ionomer cement (RMGIC), MTA + bulk-fill flowable composite, MTA + conventional composite resin, and MTA + flowable composite resin. A 100 N oblique load (45°) was applied, and von Mises stress, displacement, and periodontal ligament strain were analyzed. Inter-model comparisons were performed using one-way ANOVA with Tukey post hoc tests (p &lt; 0.05). Results: All models exhibited maximum stress concentration in the cervical third of the root. Bulk-fill flowable composite and RMGIC generated lower cervical stress and more homogeneous distribution compared with GIC or conventional composite resin. Conventional composite resin produced the highest stress concentration due to its higher stiffness. Derived biomechanical metrics confirmed statistically significant differences between groups (p &lt; 0.05). Conclusions: The coronal base material strongly affects the biomechanical behavior of immature incisors restored after MTA apexification. Selecting low-modulus, stress-dissipating materials such as bulk-fill flowable composites or RMGICs may minimize cervical stress and potentially reduce fracture risk. These computational findings warrant validation through in vitro and clinical studies.

Background Osteoporosis is a metabolic bone disease characterized by decreased bone mass and increased fracture risk. Bone turnover markers, such as osteocalcin (OC), undercarboxylated osteocalcin (ucOC), and other biochemical indicators, are important for assessing bone metabolism. Vitamin K2 influences bone metabolism by enhancing osteocalcin γ-carboxylation. Methods This study followed PRISMA guidelines and included randomized controlled trials on the effects of vitamin K2 supplementation on bone turnover biomarkers in postmenopausal osteoporosis patients. Key outcomes included changes in OC, ucOC, and other bone metabolism markers. Results Nine studies with 2,570 participants were included. Vitamin K2 (VK2) increased osteocalcin (OC; MD 1.86, 95% CI 1.17–2.56) and bone-specific alkaline phosphatase (BAP; MD 1.49, 95% CI 0.98–2.00). It reduced undercarboxylated OC (ucOC; WMD −1.54, 95% CI −2.44 to −0.64) and tartrate-resistant acid phosphatase (TRAP; MD −0.83, 95% CI −1.21 to −0.46). C-terminal telopeptide (CTX) showed a small, statistically significant reduction (MD −0.09, 95% CI −0.14 to −0.05) with uncertain clinical relevance. N-telopeptide (NTX) showed no significant change. Conclusions Vitamin K2 supplementation improves key bone turnover biomarkers, particularly OC and ucOC. These findings support its role in bone metabolism, though further long-term studies are needed to confirm clinical benefits, such as increased bone mineral density. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420251087067 , identifier CRD420251087067.

To explore the risk of osteoporotic fractures in lymphoma patients compared with that in the general Swedish population. Fracture risk was evaluated in a retrospective cohort comprising lymphoma patients (aged ≥ 18years) diagnosed between 2000 and 2018 (n = 36,864), as recorded in the Swedish Lymphoma Register, and a matched cohort from the general population (n = 368,082). The risk of major osteoporotic fracture (MOF) overall (n = 1009, 60% women) and specifically hip fracture (n = 594) within 18months of lymphoma diagnosis was greater in the overall cohort of lymphoma patients than in the matched cohort [incidence rate ratio (IRR) of MOF 1.14 (95% CI 1.07-1.21) and hip fracture 1.14 (95% CI 1.05-1.24), respectively], with a particularly pronounced increase observed in the 51-60 age group [IRR MOF 1.64 (95% CI 1.47-2.27), hip fracture 2.60 (95% CI 1.85-3.63)]. The IRRs for MOF and hip fracture in patients with diffuse large B cell lymphoma were 1.27 (95% CI 1.14-1.42) and 1.24 (95% CI 1.07-1.44), respectively. At 15years postdiagnosis, the risk of MOF and hip fracture among lymphoma patients was nearly equivalent to that of the general population. Compared with those of matched controls, the incidence of osteoporotic fractures among lymphoma patients within 18months after lymphoma diagnosis was significantly greater. The risk was especially increased in the 51-60-year age group.