Current Osteoporosis Reports最新文献

Purpose of Review

This review synthesizes recent advancements in understanding subchondral bone (SCB) biomechanics using computed tomography (CT) and micro-computed tomography (micro-CT) imaging in large animal models, particularly horses.

Recent Findings

Recent studies highlight the complexity of SCB biomechanics, revealing variability in density, microstructure, and biomechanical properties across the depth of SCB from the joint surface, as well as at different joint locations. Early SCB abnormalities have been identified as predictive markers for both osteoarthritis (OA) and stress fractures. The development of standing CT systems has improved the practicality and accuracy of live animal imaging, aiding early diagnosis of SCB pathologies.

Summary

While imaging advancements have enhanced our understanding of SCB, further research is required to elucidate the underlying mechanisms of joint disease and articular surface failure. Combining imaging with mechanical testing, computational modelling, and artificial intelligence (AI) promises earlier detection and better management of joint disease. Future research should refine these modalities and integrate them into clinical practice to enhance joint health outcomes in veterinary and human medicine.

Purpose of Review

In this review, we outline the different etiologies of osteoporosis in the oncologic setting and describe the basis for using PET/CT as screening tool for osteoporosis with a focus on the radiotracers [¹⁸F]FDG and [¹⁸F]NaF.

Recent Findings

Osteoporosis is a condition commonly affecting cancer patients due to their age, cancer-specific treatment agents, and effects of cancer. In terms of the unifying mechanism, decreased ratio of osteoblast-bone formation to osteoclast-bone resorption is responsible for causing osteoporosis. PET/CT, a crucial metabolic imaging modality in the oncologic imaging, could be a useful tool for the opportunistic screening of osteoporosis.

Summary

There are two approaches with which osteoporosis could be identified with PET/CT—using either the (1) CT- based or (2) PET- based approaches. While the CT-based approach has been used with [¹⁸F]FDG PET/CT, both CT- and PET-based approaches can be employed with [¹⁸F]NaF-PET/CT as [¹⁸F]NaF is a radiotracer specific for osteoblast activity.

Purpose of Review

To examine evidence from randomized controlled trials (RCTs) on how modifiable factors such as exercise and nutrition, with a focus on dairy products, play a role in improving bone health across the lifespan.

Recent Findings

Meta-analyses of RCTs demonstrate the advantages of consuming dairy products to improve bone mineral density/content (BMD/BMC) and markers of bone metabolism and turnover (BTMs). Eighteen RCTs were conducted investigating the combined effects of dairy and exercise, with most indicating a benefit in youth and adult populations. Results were less conclusive in older adults, perhaps due to altered requirements for dairy/nutrients and exercise with increased age.

Summary

RCTs demonstrate that dairy product consumption alone benefits bone health and can enhance the effects of exercise on bone. This may help improve skeletal growth and development in adolescence and prevent osteoporosis with increased age. Future RCTs should account for habitual nutrient intakes, and dairy dosage, timing, and matrix effects.

Purpose of Review

We review the literature about patients 50 years and older with a recent clinical fracture for the presence of skeletal and extra-skeletal risks, their perspectives of imminent subsequent fracture, falls, mortality, and other risks, and on the role of the fracture liaison service (FLS) for timely secondary fracture prevention.

Recent Findings

Patients with a recent clinical fracture present with heterogeneous patterns of bone-, fall-, and comorbidity-related risks. Short-term perspectives include bone loss, increased risk of fractures, falls, and mortality, and a decrease in physical performance and quality of life. Combined evaluation of bone, fall risk, and the presence of associated comorbidities contributes to treatment strategies.

Summary

Since fractures are related to interactions of bone-, fall-, and comorbidity-related risks, there is no one-single-discipline-fits-all approach but a need for a multidisciplinary approach at the FLS to consider all phenotypes for evaluation and treatment in an individual patient.

Purpose of Review

This review summarizes evidence on osteocyte support of extramedullary and bone marrow adipocyte development and discusses the role of endogenous osteocyte activities of nuclear receptors peroxisome proliferator-activated receptor gamma (PPARG) and alpha (PPARA) in this support.

Recent Findings

PPARG and PPARA proteins, key regulators of glucose and fatty acid metabolism, are highly expressed in osteocytes. They play significant roles in the regulation of osteocyte secretome and osteocyte bioenergetics; both activities contributing to the levels of systemic energy metabolism in part through an effect on metabolic function of extramedullary and bone marrow adipocytes. The PPARs-controlled osteocyte endocrine/paracrine activities, including sclerostin expression, directly regulate adipocyte function, while the PPARs-controlled osteocyte fuel utilization and oxidative phosphorylation contribute to the skeletal demands for glucose and fatty acids, whose availability is under the control of adipocytes.

Summary

Bone is an inherent element of systemic energy metabolism with PPAR nuclear receptors regulating osteocyte-adipocyte metabolic axes.

Purpose of Review

The purpose of this review is to summarize what is known in the literature about the role inflammation plays during bone fracture healing. Bone fracture healing progresses through four distinct yet overlapping phases: formation of the hematoma, development of the cartilaginous callus, development of the bony callus, and finally remodeling of the fracture callus. Throughout this process, inflammation plays a critical role in robust bone fracture healing.

Recent Findings

At the onset of injury, vessel and matrix disruption lead to the generation of an inflammatory response: inflammatory cells are recruited to the injury site where they differentiate, activate, and/or polarize to secrete cytokines for the purposes of cell signaling and cell recruitment. This process is altered by age and by sex.

Summary

Bone fracture healing is heavily influenced by the presence of inflammatory cells and cytokines within the healing tissue.

Graphical Abstract

Purpose of Review

The purpose of this review is to outline the principles of clinical genetic testing and to provide practical guidance to clinicians in navigating genetic testing for patients with suspected monogenic forms of osteoporosis.

Recent Findings

Heritability assessments and genome-wide association studies have clearly shown the significant contributions of genetic variations to the pathogenesis of osteoporosis. Currently, over 50 monogenic disorders that present primarily with low bone mass and increased risk of fractures have been described. The widespread availability of clinical genetic testing offers a valuable opportunity to correctly diagnose individuals with monogenic forms of osteoporosis, thus instituting appropriate surveillance and treatment.

Summary

Clinical genetic testing may identify the appropriate diagnosis in a subset of patients with low bone mass, multiple or unusual fractures, and severe or early-onset osteoporosis, and thus clinicians should be aware of how to incorporate such testing into their clinical practices.

Abstract

Purpose of the Review

The purpose of the review is to summarise the current scientific evidence on the efficacy of osteoporosis medications in patients with type 2 diabetes.

Recent Findings

Type 2 diabetes (T2D) is a growing global epidemic. The highest prevalence is observed in the elderly, the same population affected by osteoporosis. Despite normal or even increased bone mineral density and low bone turnover, T2D is associated with an increased risk of fractures in most skeletal sites. These findings raised concerns over the efficacy of anti-osteoporosis drugs in this population. There is no randomised controlled trial designed specifically for people with T2D. However, observational studies and post-hoc analyses of randomised controlled trials have provided valuable insights into the effects of various anti-osteoporosis treatments in this population. Overall, most anti-osteoporosis drugs seem to have similar efficacy and safety profiles for people with and without type 2 diabetes. However, continued research and long-term safety data are needed to optimise treatment strategies and improve bone health outcomes in this population.

Summary

The current evidence suggests that most anti-osteoporosis drugs exhibit comparable efficacy in people with and without T2D.

Purpose of review: To summarise the evidence regarding the effects of gender-affirming hormone therapy (GAHT) on bone health in transgender people, to identify key knowledge gaps and how these gaps can be addressed using preclinical rodent models.

Recent findings: Sex hormones play a critical role in bone physiology, yet there is a paucity of research regarding the effects of GAHT on bone microstructure and fracture risk in transgender individuals. The controlled clinical studies required to yield fracture data are unethical to conduct making clinically translatable preclinical research of the utmost importance. Novel genetic and surgical preclinical models have yielded significant mechanistic insight into the roles of sex steroids on skeletal integrity. Preclinical models of GAHT have the potential inform clinical approaches to preserve skeletal integrity and prevent fractures in transgender people undergoing GAHT. This review highlights the key considerations required to ensure the information gained from preclinical models of GAHT are informative.