osteoporosis

A rare case of severe prolonged persistent Teriparatide-induced hypercalcemia (14.3mg/dL on admission) in an osteoporotic patient after ceasing the Teriparatide is reported. This 67-year-old female was admitted with polyuria, xerostomia, constipation, progressive weakness, and a history of Triparatide use due to a previous osteoporotic fracture. Her serum calcium, PTH, and vitamin D levels had been normal before starting Teriparatide. Ninety six hours after ceasing the Teriparatide along with rehydration and Calcitonin treatment, the patient's serum calcium levels returned to normal. Severe Teriparatide-induced hypercalcemia does not follow any defined pattern and may persist for days and can usually be controlled through ceasing the Teriparatide, rehydration, and close monitoring of the serum calcium level and symptoms.
        Level of evidence: IV

The intricate orchestration of cell types and developmental processes in multicellular organisms hinges upon signaling pathways, such as Wnt, which play a pivotal role in embryonic development and adult tissue homeostasis. Over the past four decades, significant efforts have been made to elucidate the complexities of the Wnt signaling pathway and its diverse physiological functions. Wnt signaling has emerged as a crucial regulator in orthopedic contexts, particularly in fracture healing and osteoarthritis. This review delves into the intricate involvement of the Wnt pathway in these orthopedic conditions and explores its impact on bone formation, chondrogenesis, and joint pathologies. Moreover, it examines the therapeutic potential of targeting Wnt signaling in the treatment of osteoporosis, highlighting the promising avenues opened by advancements in understanding rare bone disorders, such as sclerosteosis and van Buchem disease. By elucidating the multifaceted roles of Wnt signaling in orthopedic health and disease, this review offers insights into potential therapeutic strategies to enhance fracture healing, mitigate osteoarthritis progression, and address bone-related disorders.

 Statin therapy is widely used for the management of dyslipidemia and the prevention of cardiovascular diseases (CVDs). However, there is a growing concern about its potential effects on bone metabolism markers and mineral density. The aim of this systematic review and meta-analysis was to investigate the effect of statin therapy on these parameters.

 PubMed/MEDLINE, Scopus, and Clarivate Analytics Web of Science databases were searched from inception to August 2023, using MESH terms and keywords.

 After screening 2450 articles, 16 studies that met the inclusion criteria were included, of which 12 randomized controlled trials (RCTs) were used for meta-analysis. The findings showed that statin therapy significantly reduced bone-specific alkaline phosphatase (B-ALP) levels (WMD=-1.1 U/L; 95% CI -2.2 to -0.07; P=0.03; I2=0%,), and bone mineral density (BMD) at different sites (WMD=-0.06 g/cm2 ; 95% CI -0.08 to -0.04; P<0.001; I2=97.7%, P<0.001). However, this treatment did not have a significant effect on osteocalcin, serum C-terminal peptide of type I collagen (S-CTx), serum N-telopeptides of type I collagen (NTx) concentration, or overall fracture risk.

 This systematic review and meta-analysis provide evidence that statin therapy is associated with a significant reduction in B-ALP levels and BMD at different sites of the skeleton. Further studies are needed to investigate the long-term effects of statin therapy on bone health and to identify the potential underlying mechanisms.

Osteoporosis is a significant public health concern due to its association with fragility fractures. Despite experiencing such fractures, many patients remain at high risk of future fractures due to inadequate management and treatment of their underlying osteoporosis. This research presents a comprehensive intervention to enhance osteoporosis management in patients with fragility fractures. The intervention involves a thorough personalized assessment of fracture risk using clinical factors and bone density testing, followed by customized treatment based on the individual’s fracture risk level. It also addresses non-compliance through patient education, counseling, reminders, and improved care coordination among acute, primary, and specialty providers. 

The aim is to create and characterize sodium alginate/hydroxyapatite (HA) scaffolds reinforced with zinc oxide nanoparticles (ZnO-NP) for bone tissue engineering. Freeze-drying was used to produce scaffolds with 0–15% ZnO-NP. Analyses confirmed the composite structure, uniform ZnO-NP distribution, and decreasing pore size with higher ZnO-NP content. Mechanical testing showed increased compressive strength with greater ZnO-NP. 

The scaffolds exhibited over 70% porosity, neutral pH, and increased apatite deposition and bioactivity with higher ZnO-NP. They also demonstrated decreased swelling and strong antibacterial activity against Escherichia coli and Staphylococcus aureus, making them a promising candidate for bone regeneration. 

Additionally, the researchers used an artificial neural network (ANN) to better understand the relationships between various scaffold properties, and the ANN-based predictions showed that changes in pore size and porosity affect the other properties, with acceptable error compared to experimental results.

This article discusses regarding the impact of night shift work on osteoporosis using evidences from epidemiological evidences. Nowadays, night shift work is characterized as a common risk factors which contributes in decrease of bone mineral density (BMD) content as well as increase of bone fracture risk (1). Osteoporosis is defined by the National Institutes of Health (NIH) as "a skeletal disorder characterized by compromised bone strength, predisposing a person to an increased risk of fracture." BMD, a measure of bone strength, is assessed via dual-energy X-ray absorptiometry (DXA), with fractures most common in the hip, spine, and forearm. According to the International Osteoporosis Foundation, approximately 9 million low-energy fractures occur globally each year, affecting more than 200 million women, especially those over the age of 60 (1-2).In conclusion, the findings from current evidences support an association between night shift work and osteoporosis. Based on the available evidence shift work could impacted on mineral bone density through various mechanism such as normal homostasis, dysregulation of endocrin-hormones and immune system to alternating the bone mineral density content. However, the current body of research is limited, and further studies are needed to clarify the link between night shift work and osteoporosis, as well as the underlying biological mechanisms.

Osteoporosis is the most common systemic skeletal disease worldwide. We aimed to review the latest studies related to osteocalcin and osteoporosis to clarify this relationship more precisely.

A systematic literature search was performed to review studies on the effects of osteocalcin on osteoporosis, on studied published between January 2013 and January 2023. We systematically reviewed Web of Science, PubMed, ProQuest, Scopus, and Google Scholar.

The search yielded 4903 records, including 1063 from PubMed, 2307 from Scopus, 1084 from Web of Science, 408 from ProQuest, and 41 from Google Scholar, and twelve articles were included for data extraction and quality assessment. A significant increase in the serum level of osteocalcin was observed in postmenopausal women with osteoporosis (P<0.05), and there was a negative correlation between bone mineral density and the serum level of osteocalcin.

Osteocalcin could be a promising marker for the diagnosis and screening of patients with osteoporosis.

Osteoporosis is a skeletal disorder characterized by reduced bone strength leading to an increased risk for fracture. Patients with osteoporotic fractures are at an increased risk for refracture. Understanding the crucial importance of preventing recurring fractures to maintain physical activity and improve the quality of life (QoL) for individuals with osteoporosis underscores the necessity of precisely examining the factors that contribute to these fractures. 

This study evaluates the prevalence and risk factors associated with recurrent osteoporotic fractures, emphasizing the critical importance of targeted interventions for fracture prevention and overall well-being.

This observational prospective cohort study focused on patients with osteoporosis-related fractures attending the Fracture Liaison Service (FLS) Clinic of Shafa Yahyaeian Orthopedic Hospital in Tehran City, Iran, from 2021 to 2023. The hospital is affiliated with Iran University of Medical Sciences. The census-based sampling method included all eligible patients with a history of osteoporotic fractures. Demographic and clinical information were collected.

Out of 1532 osteoporotic patients with a fracture history, 282(18.4%) experienced refractures between 2021 and 2023. Regression analysis demonstrated that higher age (P=0.005; OR=1.033) and female gender (P=0.010; OR=0.437) were the only factors significantly associated with refracture (R2=0.040). Fracture Recency evaluation indicated an mean interval of 2.8±2.5 (range: 0.5-12) years between the last two fractures. Furthermore, recurrent fractures after the index fracture occurred in 41% of patients during the first year.

The prevalence of refracture was 18.4%, with higher age and female gender as independent predictive factors. Notably, fracture recency was mainly observed in the first year.

Celiac disease (CD) is an autoimmune disease characterized by inflammation in the intestine, causing atrophy of the mucosal villi of the small intestine. Celiac disease can manifest with various signs and symptoms, including extra-intestinal symptoms such as osteopenia and osteoporosis.

Our study aimed to determine the frequency of osteopenia/osteoporosis in newly diagnosed CD cases and to evaluate the effect of different independent variables on the development of osteopenia/osteoporosis in these patients.

Adult patients with CD who were referred to a celiac clinic were evaluated for osteopenia/osteoporosis using dual-energy X-ray absorptiometry. This cross-sectional analytical study took place from October 2017 to July 2022. Logistic regression analysis was used to assess the odds ratio (OR) of different independent variables for osteopenia/osteoporosis.

A total of 302 patients enrolled in this study, with 64.2% being female and 35.8% male. The mean ± SD age was 29.73 ± 12.39. Overall, 71.2% of patients had osteopenia or osteoporosis. The odds of developing osteopenia/osteoporosis were significantly higher in participants older than 30 years (OR: 2.19; 95% CI: 1.22 - 3.92; P = 0.008), underweight patients (OR: 2.38; 95% CI: 1.30 - 4.34; P = 0.005), and those with histologically severe atrophy (OR: 2.22; 95% CI: 1.14 - 4.32; P = 0.019). The mean ± SD serum levels of 25-hydroxy vitamin D in CD patients without and with osteopenia/osteoporosis were 34.0 ± 17.1 ng/mL and 25.8 ± 14.2 ng/mL, respectively. Participants with normal levels of 25-hydroxy vitamin D had a significantly lower OR of developing osteopenia/osteoporosis than patients with vitamin D deficiency (OR: 0.37; 95% CI: 0.21 - 0.62; P < 0.001). Other variables, including gender, anti-tTG levels, and GI manifestations, did not significantly increase the OR of developing osteopenia/osteoporosis.

The present study showed that increasing age, weight loss, severe villous atrophy, and low levels of vitamin D can significantly increase the OR of developing osteopenia/osteoporosis in CD patients. Until further studies are conducted, bone mineral density (BMD) evaluation is especially recommended in these high-risk subgroups of CD patients.

To explore the radiomics features of osteoporotic and malignant neoplastic vertebral compression fractures (VCFs), and to analyze the application value of radiomics in differential diagnosis of osteoporotic and malignant neoplastic VCFs.

Fifty-one patients with VCFs caused by malignant tumors and forty-nine patients with osteoporosis-induced VCFs treated in the Xiaoshan Hospital Affiliated to Hangzhou Normal University from January 2020 to June 2023 were retrospectively collected into a training set (70 cases) and a verification set (30 cases) according to a stratified random sampling design and a 7:3 ratio. The radiomics parameters of T2WI images of the diseased vertebral bodies were extracted, and the parameters with statistical differences were screened out by dimensionality reduction, so as to build a prediction model. Receiver operating characteristic (ROC) curves were drawn to evaluate the differential diagnosis performance of radiomics for the etiology of vertebral fractures.

Eight radiomics features were obtained after dimensionality reduction using the LASSO algorithm. The constructed model was effective in differentiating osteoporotic and malignant neoplastic VCFs, with an area under the ROC curve (AUC) of 0.95; while the AUC for the validation set was 0.84.

The radiomics features of T2WI images of vertebral fractures have high efficiency in the differential diagnosis of fracture etiology.

Sclerostin, a protein encoded by the SOST gene, is an important genetic risk factor for osteoporosis in postmenopausal women. This study was conducted on the Iranian postmenopausal women, to investigate the association between this gene and the Trabecular Bone Score (TBS) as a novel index used for assessing osteoporosis.

The present study, conducted in 2024, was performed on 1071 women aged 60 years and older who participated in the Bushehr Elderly Health (BEH) program. The associations between seven independent Single Nucleotide Polymorphisms (SNPs) within the SOST gene and mean TBS of L1 to L4 were examined using the additive, dominant, and recessive models. Genetic risk scores (GRS) were calculated for each postmenopausal woman based on the coefficient regressions derived from the additive and dominant models. The relationship between the GRS quartiles and TBS was evaluated using a linear regression model.

After adjusting for age and Body Mass Index (BMI), the associations between the rs2023794-C and TBS were significant in the additive (β = 0.03, P= 4.7×10-5, PFDR= 0.0003) and dominant (β = 0.032, P= 5×10-5, PFDR= 0.0003) models. The GRS derived from both additive and dominant models were related to TBS (P<0.05). For the additive model GRS, TBS showed an average increase of 0.022 score for the fourth quartile in comparison with the first quartile, adjusted for age, BMI, type 2 diabetes mellitus (T2DM), and smoking status (P=0.001).

SOST gene is associated with TBS and may have implications for personalized medicine. Targeting sclerostin through SOST could offer a therapeutic approach in managing osteoporosis in high-risk postmenopausal women.

Osteoporosis is a significant concern, especially for individuals undergoing renal transplantation, as it disrupts bone health and increases the risk of fractures. Interventions for osteoporosis aim to address bone-related challenges in patients with renal transplantation, yet concerns persist regarding both efficacy and potential adverse events.

We searched PubMed/MEDLINE, EMBASE, and the Cochrane CENTRAL databases until December 15, 2023, seeking studies that evaluated the efficacy and adverse events of osteoporosis medications in patients with renal transplantation. The Cochrane tool was utilized to assess the quality of the studies. The statistical analysis was performed using Comprehensive Meta-Analysis software, version 3.0.

We enrolled 594 participants from 7 randomized controlled trials. Combining trial results reveals that using anti-osteoporotic agents (Ibandronate, Risedronate, and Pamidronate) reduces the risk of vertebral fractures compared to the placebo. However, the reduction was not statistically significant (OR: 0.49, CI 95%: 0.20-1.22). Additionally, lumbar spine, femoral neck, and total hip BMD showed no significant differences between anti-osteoporotic agents (Denosumab, Zoledronic acid, Ibandronate, Risedronate, and Pamidronate) and placebo. Moreover, there were no significant differences in adverse events between the interventions and placebo.

The study suggests that anti-osteoporotic agents in renal transplantation patients may be associated with a non-significant lower risk of vertebral fractures compared to a placebo. Findings also indicate no significant differences in adverse events between interventions and placebos. Caution is advised in interpreting these results due to the absence of statistically significant differences, emphasizing the need for further research to enhance our understanding of efficacy and safety in renal transplantation.

Osteoporosis is a chronic metabolic disease that leads to decreased bone mass due to an imbalance in bone resorption/formation. The aim of this research was to evaluate the effect of Lactobacillus rhamnosus and propranolol on disorders caused by this disease.

Forty female rats (250±15 g) were divided into control and ovariectomy groups, as well as ovariectomy treated with probiotics, propranolol, and probiotics with propranolol groups. Blood parameters, concentration of parathyroid hormone, alkaline phosphatase (ALP) activity, and bone calcium (Ca) and phosphorus (P) levels were measured after the treatment period. The histopathological changes in bone were compared among the experimental groups.

No significant changes were observed in the blood parameters among the groups. Despite the significant increase in the parathyroid hormone and ALP levels in ovariectomized rats, in the treatment groups (especially treatment with both probiotics and propranolol), the level of these two factors decreased significantly. Ca and P concentrations also showed a significant increase in the treatment group with probiotics and propranolol compared to the ovariectomy group. Histopathological studies demonstrated an increase in the thickness of trabeculae, the number of bone cells, and the repair of the diaphysis in rats treated with probiotics and propranolol.

It seems that L. rhamnosus and propranolol, by inhibiting the stimulation of the sympathetic system and increasing the reabsorption of minerals from the intestine, led to the inhibition of osteoclastogenesis and the increase of the bone mineral content, followed by the improvement of disorders caused by osteoporosis.

Diabetes mellitus (DM) disrupts bone metabolism, leading to slowed bone development, poor bone quality, and osteoporosis.

The aim of this study was to examine changes in the bones of adolescents with type-1 diabetes mellitus (T1DM) using fractal dimension (FD) analysis method and panoramic radiomorphometric indices.

Fractal dimension values and radiomorphometric measurements of 36 children with T1DM and 36 healthy individuals were compared using panoramic radiographs. The panoramic mandibular index (PMI), mental index (MI), mandibular cortical width (MCW), amount of alveolar bone resorption (AABR), antegonial index (AI), and gonial index (GI) were measured. Mandibular cortical index (MCI) was recorded as C1, C2, and C3 classes.

For the angulus and corpus regions, the T1DM patient group had lower FD values, and there was a statistically significant difference between the T1DM patient group and the control group (P = 0.003, P = 0.029). Mental index, MCW, and AI values were higher in the control group than in the T1DM patient group and were statistically significant (P = 0.014, P = 0.001, P < 0.001, respectively).

In this study examining the mandible in pediatric patients with T1DM using radiomorphometric measurements and fractal analysis method, it can be concluded that T1DM affects bone morphology and trabecular structure