Osteoporosis International最新文献

Osteoporosis is defined as a bone disease that is characterized by a reduction in bone mass and an elevated risk of fracture. Irisin, which is regulated by peroxisome proliferator-activated receptor γ coactivator-1α (PGC1α), is a muscle-derived protein that is induced by exercise. A number of studies have indicated that irisin has the capacity to stimulate bone formation and decrease bone resorption, which plays a crucial role in bone metabolism. Regular exercise has been demonstrated to be an effective method for maintaining and enhancing bone health, with irisin emerging as a key regulatory molecule in this process. In light of these findings, irisin represents a promising approach for the treatment of osteoporosis. Animal studies are an essential part of the clinical trial process, as they are used to assess the efficacy and potential risks associated with proposed interventions. The objective of this review was to conduct a systematic review of animal studies and discuss the effects and mechanisms of irisin on bone in osteoporosis. A systematic search was conducted across eight databases, resulting in the identification, data extraction, and quality assessment of 27 articles. The results demonstrate that irisin can restore the steady state of bone homeostasis through the activation or inhibition of multiple pathways. It can ameliorate the microstructural damage and bone turnover caused by osteoporosis; improve the response to bone mechanical stress; promote the proliferation, differentiation, and mineralization of osteoblasts; and play an important role in exercise-based prevention and treatment of osteoporosis. Furthermore, irisin can attenuate inflammatory changes in bone and participate in the regulation of cell death. This review was registered at PROSPERO (CRD42024539678).

Although obesity is generally associated with increased bone mass, recent data have challenged its potential protective effect. Our study found that increased BMI showed beneficial effects on BMD in a non-linear way. However, individuals with obesity, especially women, were more likely to have vertebral fractures. There was a U-shaped relationship between BMI and the prevalent fractures.

Purpose: To estimate the association of obesity with the prevalence of fractures in the Mainland Chinese population.

Methods: A total of 8251 individuals from the COPS cohort were enrolled in this cross-sectional study and grouped by BMI level. The Five-Repetition Sit-to-Stand Test (5R-STS) and the Sharpened Romberg test were used to evaluate the balance ability. Vertebral fractures (VFs) were confirmed by spine X-ray examination. Prevalent fractures were defined by a self-report questionnaire which happened in the recent 5 years. The restricted cubic spline (RCS) was used to explore the non-linear relationship. Multiple linear regression and multivariable logistic regression were conducted to adjust the covariates.

Results: Obesity was correlated with a reduced bone turnover rate and increased BMD. Nevertheless, there were significant non-linear correlations between BMI and BMD, with a rapid increase and plateau at extremely high BMI levels (p for non-linear < 0.001 for all). Individuals with obesity were associated with a longer time of the 5R-STS and more likely to have a positive Sharpened Romberg test, especially in women. Compared with the normal weight group, the likelihood of prevalence of VFs and the prevalent fractures were significantly increased in the obesity group, independent of the Sharpened Romberg test and lumbar spine BMD (VFs: OR = 1.88 [95% CI 1.38-2.56]; prevalent fractures: OR = 2.18 [95% CI 1.39-3.41]). Per standard deviations (SD) increase in BMI was associated with 21% and 22% increase in the prevalence of VFs and prevalent fractures, respectively. Moreover, the prevalence of prevalent fractures also elevated in the low-weight individuals (OR = 2.62 [95% CI 1.34-4.75]), which indicated a U-shaped relationship between BMI and the prevalence of prevalent fractures.

Conclusion: Obesity was associated with higher BMD in a non-linear manner. However, BMI was positively associated with the prevalence of VFs, and there was a U-shaped relationship between BMI and the prevalent fractures.

Tumor-induced osteomalacia (TIO) is a rare paraneoplastic syndrome caused by excess fibroblast growth factor 23 (FGF23), leading to hypophosphatemia and osteomalacia. It typically manifests in adulthood, with pediatric cases being exceedingly rare. Early diagnosis is critical to prevent irreversible skeletal deformities. We report the case of a 19-year-old man with severe lower limb deformities and loss of ambulation since childhood. Initially misdiagnosed with X-linked hypophosphatemia (XLH) and treated with burosumab, genetic testing ruled out hereditary hypophosphatemic disorders. Further evaluation revealed an FGF23-secreting mesenchymal tumor in the right femur, confirming TIO. Surgical resection of the tumor led to biochemical remission, while burosumab treatment contributed to pain relief, functional improvement, and increased bone mineral density. Histological examination suggested potential tumor modifications linked to burosumab exposure. This case highlights the diagnostic challenge of pediatric-onset TIO, emphasizing the importance of considering oncogenic rickets in cases of early hypophosphatemic osteomalacia with severe deformities. The risk of persistent skeletal abnormalities despite treatment underscores the need for early recognition and intervention. Moreover, burosumab showed clinical efficacy in managing hypophosphatemia and symptoms, suggesting a therapeutic role in TIO when surgery is delayed or inoperable. Pediatric-onset TIO is an underrecognized entity that can lead to severe disability if not diagnosed early. This case underscores the importance of early tumor identification.

In this retrospective cohort study, people with intellectual disabilities (ID) had higher risks of fractures, including any fractures, vertebral fractures, and hip fractures, compared to those without ID. The risk was especially pronounced in younger adults (20-39 years), emphasizing the importance of targeted healthcare interventions in individuals with ID.

Background: Life expectancies of individuals with ID have increased over the past few decades. We aimed to evaluate the risk of any fractures, vertebral fractures, and hip fractures in people with ID compared to those without ID.

Methods: This retrospective cohort study analysed Korean National Disability Registry data with the Korean National Health Insurance Service database. A total of 3,815,545 individuals who underwent national health examinations in 2009 were followed until 2020. Cox-proportional hazard analyses were performed to estimate the hazard ratios (HRs) of any fractures, vertebral fractures, and hip fractures in individuals with compared to those without ID with adjustment for covariates.

Results: During a mean follow-up period of 10.0 years, among 3582 individuals with ID, there were 207 cases of any fractures, 47 cases of vertebral fractures, and 27 cases of hip fractures. The multivariable-adjusted hazard ratios for risk of any fractures, vertebral fractures, and hip fractures in the ID group compared to those without ID were 1.69 (95% CI 1.47-1.94), 2.07 (95% CI 1.55-2.75), and 3.01 (95% CI 2.07-4.39), respectively. In subgroup analysis, individuals with ID aged 20-39 years had higher risk of fractures compared to those in older age groups.

Conclusion: Individuals with ID are at an increased risk of any fractures, vertebral fractures, and hip fractures compared to those without ID. Healthcare professionals should be aware of the elevated risk of fractures in this population.

Video-estimated peak jump power (vJP) using deep learning showed strong agreement with ground truth jump power (gJP). vJP was associated with sarcopenia, age, and muscle parameters in adults, with providing a proof-of-concept that markerless monitoring of peak jump power could be feasible in daily life space.

Objectives: Low peak countermovement jump power measured by ground force plate (GFP) is associated with sarcopenia, impaired physical function, and elevated risk of fracture in older adults. GFP is available at research setting yet, limiting its clinical applicability. Video-based estimation of peak jump power could enhance clinical applicability of jump power measurement over research setting.

Methods: Data were collected prospectively in osteoporosis clinic of Severance Hospital, Korea, between March and August 2022. Individuals performed three jump attempts on GFP (ground truth, gJP) under video recording, along with measurement of handgrip strength (HGS), 5-time chair rise (CRT) test, and appendicular lean mass (ALM). Open source deep learning pose estimation and machine learning algorithms were used to estimate video-estimated peak jump power (vJP) in 80% train set. Sarcopenia was defined by Korean Working Group for Sarcopenia 2023 definition.

Results: A total of 658 jump motion data from 220 patients (mean age 62 years; 77% women; sarcopenia 19%) were analyzed. In test set (20% hold-out set), average difference between predicted and actual jump power was 0.27 W/kg (95% limit of agreement - 5.01 to + 5.54 W/kg; correlation coefficient 0.93). vJP detected gJP-defined low jump power with 81.8% sensitivity and 91.3% specificity. vJP showed a steep decline across age like gJP, with modest to strong correlation with HGS and CRT. Eight landmarks (both shoulders, hip, knee joints, and ears) were the most contributing features to vJP estimation. vJP was associated with the presence of sarcopenia (unadjusted and adjusted, - 3.95 and - 2.30 W/kg), HGS (- 3.69 and - 1.96 W/kg per 1 SD decrement), and CRT performance (- 2.79 and - 1.87 W/kg per 1 SD decrement in log-CRT) similar to that of gJP.

Conclusion: vJP was associated with sarcopenia, age, and muscle parameters in adults, with good agreement with ground truth jump power.

Hip fractures in elderly women pose significant healthcare challenges. Promoting walking for exercise as a cost-effective intervention may help reduce the risk of fractures in this population.

Purpose: This study aimed to examine the relationship between walking and hip fracture risk among women aged 65 years and older.

Methods: A 20-year prospective study (1986-2006) included 9704 women from the Study of Osteoporotic Fractures (SOF) in the USA. Participants were followed biennially, and walking exposure was assessed by the number of city blocks walked for exercise, routine activity, and total blocks walked daily. Cox regression models with time-varying covariates assessed associations, with competing risks addressed using Fine and Gray models. Penalized splines were used to explore dose-response relationships.

Results: In total, 1419 hip fractures were identified through the study period. The mean and median follow-up times for hip fractures or censoring were 15.0 and 15.8 years in the walking for exercise group, vs. 13.2 and 13.7 years in the not walking for exercise group. The hip fracture incidence rate was 10.0 cases per 1000 person-years (py) in the walking for exercise group compared to 10.9 per 1000 py in the not walking for exercise group. All-cause mortality was 37.1 per 1000 py in the walking for exercise group compared to 46.4 per 1000 py in the not walking for exercise group. Adjusted models showed that walking for exercise significantly reduced hip fracture risk (HR, 0.864; 95% CI, 0.762-0.980; P = 0.0230), with each additional block walked for exercise reducing risk (HR per block, 0.986; 95% CI, 0.978-0.995; P = 0.0022). Walking for routine activities showed no significant association. Spline analysis indicated walking 16 blocks (≈3200 steps) daily significantly lowered hip fracture risk.

Conclusion: Walking for exercise is linked to a reduced risk of hip fractures in elderly women. Walking the equivalent of 16 blocks or more (> 3200 steps) per day might be an effective way to reduce the risk of hip fractures in this vulnerable population.