Studiendatenbank

<h4>Objective</h4>To investigate the association between Graves' disease (GD) and bone mineral density by integrating a meta-analysis with a large-scale cross-sectional analysis in the UK Biobank.<h4>Methods</h4>We systematically searched PubMed, Web of Science, and Cochrane Library for cohort and cross-sectional studies. The pooled findings were then examined in the UK Biobank using multivariable linear regression models with adjustment for age, BMI, lifestyle factors, vitamin D, calcium, and sex.<h4>Results</h4>The meta-analysis (14 studies, 3,643 participants) showed that GD patients had significantly lower bone mineral density than controls (Mean Difference = -0.09, 95% CI [-0.10, -0.07], <i>P</i> < 0.001) and higher serum calcium (Standard Mean Difference = 0.37, 95% CI [0.18, 0.57], <i>P</i> = 0.023). However, substantial between-study heterogeneity was observed (I² = 92.1%), indicating considerable variation across studies. Meta-regression and subgroup analyses identified postmenopausal women, older age (>50 years), and lower BMI as key factors amplifying the association. In the UK Biobank (n = 42374), after rigorous adjustment for all covariates, the association was substantially attenuated and remained statistically significant only at the ribs (<i>P</i> < 0.05), while other skeletal sites, including the lumbar spine and femoral neck, showed no significant differences.<h4>Conclusion</h4>This dual-evidence approach provides suggestive, rather than definitiv

<h4>Background</h4>Nutritional and therapeutic methods are used to enhance bone health and assist in fracture healing while improving functional ability and reducing inflammation and bettering surgical results. The overall effectiveness of these methods for multiple applications remains unknown. This meta-analysis assessed the impact of various treatments on patients with orthopedic and musculoskeletal disorders.<h4>Methods</h4>The systematic review examined 95 studies which were organized into seven distinct outcome domains. The study used random-effects meta-analysis with inverse variance weighting to determine standardized mean differences (SMD) and 95% confidence intervals (CI). The study used the Jadad scale and Cochrane Risk of Bias and GRADE criteria to evaluate study quality while the researchers used funnel plots and Egger's test to assess publication bias.<h4>Results</h4>Interventions significantly improved BMD (SMD = 0.47; 95% CI: 0.31-0.62; <i>p</i> < 0.001; I² = 79%), bone turnover markers (SMD = -0.69; 95% CI: -1.17 to -0.20; <i>p</i> = 0.004; I² = 99%), inflammation/oxidative stress markers (SMD = -1.34; 95% CI: -1.45 to -1.23; <i>p</i> < 0.001; I² = 0%), and postoperative recovery/metabolic outcomes (SMD = -2.04; 95% CI: -2.31 to -1.77; <i>p</i> < 0.001; I² = 86%). No significant effects were observed for fracture healing (SMD = -0.43; 95% CI: -0.96-0.10), functional/muscle outcomes (SMD = 0.37; 95% CI: -0.06-0.80),

Postmenopausal women experience ongoing loss of bone mass, with resulting increases in the risk of fracture. This review describes the nature of postmenopausal bone loss, the definition of osteoporosis, and the current status of fracture risk estimation, which is pivotal in osteoporosis management. Important lifestyle measures include taking a balanced diet to maintain a healthy weight throughout life, safe physical activity, not smoking, and moderating alcohol intake. Severe vitamin D deficiency accelerates bone loss so should be avoided. Falls prevention becomes increasingly important with age, since falls cause most fractures. Pharmaceuticals to increase bone mass and prevent fractures either act by inhibiting bone resorption or by stimulating bone formation. Bisphosphonates are the most widely used antiresorptives, often taken as weekly oral doses. The intravenous bisphosphonate, zoledronate, has a long duration of action with effects on bone turnover, density, and fractures over a decade after a single dose. It is increasingly used in both prevention and treatment of osteoporosis. Denosumab is effective in preventing fractures but has a rapid offset of effect after its cessation. Some anabolic agents act via the PTH1 receptor, producing substantial increases in spine bone density but are not yet proven to prevent hip fractures. Romosozumab is a monoclonal antibody directed at sclerostin. It has both anabolic and antiresorptive effects and shows broad antifracture efficac

<h4>Objective</h4>To examine the association between kinesiophobia (fear of movement) and lumbar spine Bone mineral density (BMD) among hospitalized older adults with osteoporosis.<h4>Methods</h4>This cross-sectional study included 246 hospitalized adults aged 60 years or older with osteoporosis who were admitted to orthopedic wards at the Affiliated Hospital of Chengdu University between August and October 2025. Kinesiophobia was assessed using the 17-item Tampa Scale for Kinesiophobia (TSK-17), with scores ≥37 indicating the presence of kinesiophobia. The primary outcome, volumetric trabecular bone mineral density (BMD), was measured at the lumbar spine (L1-L4) using quantitative computed tomography (QCT). Spearman correlation and multivariable linear regression analyses were performed to evaluate factors associated with BMD.<h4>Results</h4>Among 246 participants (53 men,193 women),186 (75.6%) exhibited kinesiophobia. CT-measured BMD was significantly lower in participants with kinesiophobia (p < 0.001). Kinesiophobia showed a moderate negative correlation with BMD (ρ = -0.286, <i>p</i> < 0.001), while age demonstrated a strong negative correlation (ρ = -0.443, <i>p</i> < 0.001), and BMI a weak positive correlation (ρ = 0.148, <i>p</i> = 0.02). In multivariable analyses, kinesiophobia was independently associated with lower BMD (β, -8.897 mg/cm³; 95% CI, -13.715 to -4.079; <i>P</i> <.001). Older age was also associated with lower BMD (per 1-year increase: β, -0.516 mg/cm³;

<b>Background:</b> Osteoporosis is a prevalent metabolic bone disorder characterized by reduced bone mineral density (BMD) and increased fracture risk, particularly among older adults. While individual medications have been implicated in bone loss, the cumulative impact of polypharmacy on skeletal health remains underexplored. <b>Methods:</b> This cross-sectional study included 1155 geriatric inpatients undergoing routine bone mineral density assessment. Medication use, demographic characteristics, and clinical variables were extracted from electronic medical records. BMD at the lumbar spine (L1-L4) and total hip was measured using dual-energy X-ray absorptiometry (DXA). Unadjusted analyses and multivariable linear regression models were used to examine associations between medication use, polypharmacy (defined as the use of ≥5 medications), and BMD, adjusting for age, sex, body mass index, and relevant clinical covariates. <b>Results:</b> The mean age of the study population was 85.0 ± 7.1 years, and 80.1% were female. Polypharmacy was present in 64.5% of patients. In medication-specific analyses, thyroid hormone use was associated with lower lumbar spine BMD (<i>p</i> = 0.032), and concomitant use of diuretics and proton pump inhibitors was associated with lower hip BMD (<i>p</i> = 0.049). Steroid use showed a marginally non-significant correlation with reduced BMD (<i>p</i> = 0.057). Polypharmacy was associated with lower lumbar spine BMD (<i>p</i> = 0.022), whereas no sig

Glucocorticoids (GCs) are widely used for their potent anti-inflammatory and immunosuppressive effects, but their use is strongly associated with negative impacts on bone health. Rapid bone loss and an increased risk of fragility fractures are characteristics of glucocorticoid-induced osteoporosis (GIOP), the most common type of secondary osteoporosis. While oral GCs are a well-known cause of GIOP, growing evidence suggests that non-oral routes of administration may also negatively affect the skeleton. This review summarizes current knowledge on the pathophysiology of GIOP, highlighting the complex relationship between direct and indirect mechanisms. It examines the effects of various routes of GC administration-oral, intravenous, inhaled, topical, and epidural-on bone mineral density, microarchitecture, and fracture. While parenteral GCs may have fewer systemic effects than oral therapy, long-term exposure or high cumulative doses may still cause clinically significant skeletal deterioration. This review also discusses current methods for assessing, preventing, and treating the fracture risk associated with GIOP. These strategies include lifestyle modifications, calcium and vitamin D supplements, and medications such as denosumab, bisphosphonates, and anabolic agents. Reducing the incidence of glucocorticoid-associated fractures and improving prevention and treatment requires an understanding of how GCs impact bone.

<b>Background:</b> Fibroblast growth factor 23 (FGF23) and α-Klotho are key regulators of mineral metabolism and bone homeostasis; however, their combined diagnostic value in postmenopausal osteoporosis remains incompletely understood. This study investigated the associations of serum FGF23, α-Klotho, and the FGF23/α-Klotho ratio with bone mineral density (BMD), bone turnover markers, and their diagnostic performance for postmenopausal osteoporosis. <b>Methods:</b> This cross-sectional study included 165 women divided into three groups: premenopausal healthy controls (n = 55), postmenopausal non-osteoporotic women (n = 55), and postmenopausal women with osteoporosis (n = 55). Serum FGF23 and α-Klotho concentrations were measured by enzyme-linked immunosorbent assay. Bone mineral density was assessed by dual-energy X-ray absorptiometry. Correlation analyses, age- and BMI-adjusted partial correlations, multivariable linear and logistic regression analyses, receiver operating characteristic (ROC) analyses, and incremental diagnostic models were performed. Diagnostic ROC and incremental model analyses were restricted to postmenopausal women (n = 110). <b>Results:</b> Serum FGF23 concentrations and the FGF23/α-Klotho ratio increased progressively across the study groups, whereas α-Klotho levels decreased (all <i>p</i> < 0.001). FGF23 was inversely correlated with lumbar spine, femoral neck, and total hip BMD and T-scores (all <i>p</i> < 0.001), whereas α-Klotho demonstrated positi

<h4>Background</h4>Myasthenia gravis (MG) is an autoimmune disease affecting the postsynaptic neuromuscular junction. Treatment often includes corticosteroids, which may reduce bone mass.<h4>Objective</h4>To evaluate the prevalence and predictors of low bone mineral density (BMD) in MG patients.<h4>Methods</h4>A cross-sectional study included patients over 18 years with MG followed at the Neuromuscular Diseases Service, Hospital de Clínicas, Universidade Federal do Paraná (2018-2022). Data were obtained through clinical evaluation, medical records, MG Composite Scale, and Quantitative MG Test. Lumbar spine and proximal femur BMD were assessed using a GE Lunar densitometer, with T or Z-scores according to age/menopausal status. Logistic regression identified factors independently associated with BMD alterations.<h4>Results</h4>In total, 92 patients (64.1% female, mean age: 51.3 years) were included, of whom 79.3% had early-onset MG. Past or present corticosteroid use were reported in 94.5 and 45.6%, respectively. Only 27.6% practiced regular physical activity, though most had adequate calcium intake. There were six (7.8%) patients with fragility fractures, and ⅕ were at high fracture risk according to the FRAX results. We found that BMD alterations occurred in 43.5% of patients. No significant association was found with corticosteroid use or MG severity. Age was independently associated with BMD (OR = 1.06, 95% CI: 1.03-1.09, <i>p</i> = 0.0005). A cutoff age ≥ 49 years yielded

<h4>Background</h4>Osteoporosis is a major global public health challenge, with lifestyle as a key modifiable factor. This study aimed to examine associations between lifestyle patterns and bone mineral density (BMD) in Chinese adults.<h4>Methods</h4>In this cross-sectional, multi-center study, 5,324 adults from Beijing (2016-2020) with complete lifestyle questionnaires were analyzed (lumbar spine BMD available for 4,028; hip BMD available for 4,654). Each of eight lifestyle variables was residualized on age and sex before k-means clustering (k = 3) categorized participants into three groups: office/mental-labor workers with low leisure-time activity (OL), physical-labor workers (PL), and office/mental-labor workers with an active leisure-time lifestyle (OA). Differences in lumbar spine and hip BMD among clusters were examined using multivariable-adjusted models (age modeled via restricted cubic spline, sex, body mass index [BMI], hospital fixed effects), with stratification by sex, age group, and BMI group, alongside full-cohort dose-response and cluster × exposure interaction analyses.<h4>Results</h4>After adjustment, the OA cluster showed higher lumbar spine BMD than the OL cluster (adjusted difference = 0.024 g/cm², 95% CI 0.012-0.036, <i>P</i> < 0.001). The PL cluster showed lower hip BMD than both the OL cluster (adjusted difference = -0.041 g/cm², 95% CI -0.056 to -0.027, <i>P</i> < 0.001) and the OA cluster (adjusted difference = 0.028 g/cm<sup>2

<h4>Objectives</h4>This study evaluated the association between Body Roundness Index (BRI) and QUS-defined osteoporosis, its discriminative ability, empirical cutoff, and subgroup heterogeneity in middle-aged and older adults.<h4>Methods</h4>We analyzed cross-sectional data from 1,444 community-dwelling adults aged 35-75 years. Osteoporosis was defined using tibial quantitative ultrasound-derived T-scores. Receiver operating characteristic curves assessed discrimination, restricted cubic splines examined dose-response relationships, logistic and robust regression analyses quantified associations, and subgroup analyses evaluated effect modification.<h4>Results</h4>The Youden index identified an optimal BRI cutoff of 4.5. High BRI (≥ 4.5) was associated with higher odds of osteoporosis in the unadjusted model (OR = 1.606, 95% CI: 1.292-1.996; P < 0.001), the age- and sex-adjusted model (OR = 1.432, 95% CI: 1.141-1.797; P = 0.002), and the fully adjusted model excluding BMI (OR = 1.404, 95% CI: 1.105-1.783; P = 0.005). The association was approximately linear (P for non-linearity = 0.539; P-overall < 0.001). BRI alone showed modest discrimination (AUC = 0.562, 95% CI: 0.529-0.594), which increased after adjustment for age and sex (AUC = 0.680, 95% CI: 0.652-0.710) and after full covariate adjustment (AUC = 0.695, 95% CI: 0.674-0.731). The association was stronger among participants with metabolic syndrome (OR = 2.62, 95% CI: 1.641-4.179) than among those without it (OR = 1.39, 9

<h4>Objective</h4>To explore and compare the clinical efficacy and safety of denosumab versus zoledronic acid for the treatment of primary osteoporosis.<h4>Methods</h4>This retrospective cohort study included 413 primary osteoporosis patients (denosumab, <i>n</i> = 198; zoledronic acid, <i>n</i> = 215). All received daily calcium (600 mg) and vitamin D (400 IU), representing the total combined daily intake from diet and supplements. The denosumab group received subcutaneous denosumab 60 mg every 6 months and the zoledronic acid group annual intravenous zoledronic acid 5 mg over 36 months. Outcomes assessed at baseline and after 36 months included bone mineral density (BMD) at the lumbar spine, femoral neck, and total hip; bone turnover markers β-CTX (β-isomerized C-terminal telopeptide of type I collagen) and P1NP (procollagen type I N-terminal propeptide); pain severity using the Visual Analog Scale (VAS); functional impairment using the Oswestry Disability Index (ODI); and incidence of adverse reactions.<h4>Results</h4>After 36 months, BMD at all sites significantly increased from baseline in both groups (<i>P</i> < 0.001). The denosumab group demonstrated greater mean absolute increases in BMD at the lumbar spine (0.13 ± 0.10 vs. 0.10 ± 0.10 g/cm², <i>P</i> < 0.001), femoral neck (0.14 ± 0.06 vs. 0.12 ± 0.05 g/cm², <i>P</i> < 0.001), and total hip (0.09 ± 0.12 vs. 0.05 ± 0.09 g/cm², <i>P</i> < 0.001) compared to the zoledronic acid group. B

Sestrin2 is a stress-inducible protein that plays a significant role in maintaining antioxidant balance and metabolic homeostasis via the AMPK/mTOR pathways. Animal models suggested that Sestrin2 deficiency may be associated with high bone mass; however, how this may translate into humans, especially in aging and stress conditions, is unknown. We performed a cross-sectional analysis of 910 adults recruited from the Qatar Biobank cohort. Participants were stratified into 3 groups: younger than 40 yr, 40-55 yr, and older than 55 yr. We investigated the relationship between plasma Sestrin2 and FN BMD T-score in adults using multiple linear regression, controlling for age, sex, BMI, diabetes, and estimated glomerular filtration rate. We observed a significant interaction between Sestrin2 and age (<i>p</i> < .001). In younger and middle-aged adults, Sestrin2 was not correlated with BMD. However, in adults aged >55 yr, Sestrin2 was strongly and positively correlated with FN T-scores (β = .131, 95% CI: 0.062-0.201, <i>p</i> < .001). This association remained significant after adjustment for all possible confounders, with an effect size reduction of only 7.7%. Further analysis showed that this association is more pronounced in males (β = .155, <i>p</i> < .001) but is not significant in females (β = -.008, <i>p</i> = .935). Our study indicates that Sestrin2 and BMD are significantly correlated but only in aged adults. In contrast to animal models, we showed that Sestrin2 in aged adult

Despite the availability of multiple highly effective pharmacologic therapies for osteoporosis, fracture rates in the United States have plateaued or increased in recent years. At the same time, individuals with osteoporosis are exposed to an abundance of digital health information and frequently seek guidance on nutrition, exercise, and other lifestyle strategies to improve bone health. Many endocrinologists, however, may have limited time or expertise to address these questions comprehensively during routine clinical encounters. Current clinical practice guidelines provide valuable direction on selecting pharmacotherapy based on fracture risk, yet they offer limited guidance on how to personalize treatment plans by integrating patient values, beliefs, and preferences. The aim of this manuscript is to equip clinicians with practical, preference-sensitive strategies to address common concerns raised by postmenopausal women with osteoporosis, including evidence-based guidance on nutrition and on safe, effective resistance, impact, and balance-focused exercises for bone health and fall prevention. We also outline suggested approaches for responding to common concerns among patients who are reluctant to initiate pharmacologic therapy. Through 2 illustrative cases, we highlight how clinicians can integrate pharmacologic options with evidence-based lifestyle guidance and engage patients in shared decision making to develop individualized, goal-concordant care plans. Our goal is to

<h4>Background</h4>Resistance training improves bone health in patients with osteopenia, but high-load programs may not be ideal for everyone. This pilot study examined the effect of a progressive multimodal resistance training program on bone mineral density (BMD) in osteopenic women.<h4>Methods</h4>Twenty older women (65.3 [3.23] years; 1.58 [0.08] m; 69.3 [12.9] kg) diagnosed with osteopenia were non-randomly assigned to experimental (<i>n</i> = 10) or control (<i>n</i> = 10) groups. After obtaining ethics approval and informed consent, experimental participants completed a 16-week multimodal resistance training program with varying muscle actions and range of motion (ROM). Lumbar spine and femoral neck BMD were assessed pre- and post-intervention by DXA. Estimation, robust, and Bayesian statistics were employed.<h4>Results</h4>The experimental group showed BMD increases at the lumbar spine (Δ=+0.05 (0.04) [95% CI: 0.03, 0.08] g·cm^-2; d_unb=0.20; p=0.026) and the femoral neck (Δ=+0.05 (0.03) [95% CI: 0.02, 0.07] g·cm^-2; d_unb=0.35; p=0.003), exceeding the predefined MCID threshold (+0.03 g·cm^-2). No changes were found in control. Between-group comparisons favored the experimental group (lumbar: p=0.003; femoral: p=0.010). Bayesian ANCOVA provided strong support treatment effects (BF_m>10⁷; P(M|data)>0.96), consistent with frequentist ANCOVA findings (η²p>0.48).<h4>Conclusion</h4>This non-randomized p

<h4>Background</h4>Population ageing is associated with increasing rates of osteoporosis, frailty, and functional decline. Vitamin D deficiency and disturbances in calcium-parathyroid hormone (PTH) homeostasis are common in older adults and may contribute to bone loss. However, real-world data describing the frequency and skeletal relevance of these endocrine abnormalities in very old hospitalized populations remain limited.<h4>Materials and methods</h4>We conducted a retrospective cross-sectional study including 1,202 hospitalized patients aged ≥70 years (mean age 85.0 ± 7.1 years) who underwent dual-energy X-ray absorptiometry at a tertiary endocrine and geriatric centre in Germany. Serum 25-hydroxyvitamin D, calcium, parathyroid hormone (PTH), thyroid-stimulating hormone (TSH), and renal function parameters were extracted from electronic medical records. Hip bone mineral density (BMD) served as the primary skeletal outcome. Multivariable linear regression models were used to assess associations between endocrine parameters and BMD after adjustment for age, sex, body mass index, and living setting.<h4>Results</h4>Vitamin D deficiency was highly prevalent in this very old cohort. Vitamin D levels <20 ng/mL were present in 68.6% of participants with available vitamin D measurements, and levels <10 ng/mL in 45.5%. Hypocalcaemia was observed in 39.1% of participants, while elevated PTH levels occurred in 29.9%. The combination of hypocalcaemia and elevated PTH-consistent with s

Osteoporosis often lacks accessible screening tools, leading to underdiagnosis and increased fracture risk. We explored the potential of a retinal aging biomarker, measured by the RetiAGE algorithm, in stratifying osteoporosis risk. Cross-sectional and prospective cohort study. The retinal biological aging biomarker, RetiAGE, indicates the probability of being older than 65 years, was derived from retinal photographs using a deep learning algorithm. In the cross-sectional PopulatION HEalth and Eye Disease PRofilE in Elderly Singaporeans (PIONEER) study with 1,965 participants with both retinal images and Dual-energy X-ray Absorptiometry (DEXA) measurements, we assessed the association of RetiAGE with bone mineral density (BMD) and BMD's standard deviation (SD) score (T-score), and major osteoporotic and hip fracture risk scores calculated from fracture assessment tool (FRAX) using linear regression models, and its association with osteoporosis using logistic model. In the prospective UK Biobank cohort with 43,938 participants with retinal photographs and without osteoporosis at baseline, we evaluated the association between RetiAGE and the onset of osteoporosis using multivariable Cox proportional hazard models. Subgroup analyses were performed by further adjusting for menopause, hormone replacement therapy and glucocorticoids in women. In the PIONEER study, older RetiAGE was inversely associated with BMD and T-scores in various femoral regions after adjusting for risk factor