Current Osteoporosis Reports最新文献

Purpose of review: Spatial transcriptomics enables to capture the whole transcriptome within the local microenvironment in bone. Within this review, we provide an overview of recent spatial transcriptomics applications and indicate its potential for advancing basic and translational research in skeletal development and maintenance, bone-related disorders, as well as fracture healing.

Recent findings: Recent developments in sample preparation protocols have enabled the application of spatial transcriptomics to bone. However, there is a lack of standardized data analyses pipelines for spatial transcriptomics in bone. The interpretability of current data sets further suffers from low sample sizes. We consider spatial transcriptomics a cornerstone technology for unravelling bone's spatial and molecular complexity. Via integration into emerging multi-omics and multi-modal imaging approaches, spatial transcriptomics has the potential to advance translational-targeted research in the fields of orthopaedics and musculoskeletal research.

Purpose of review: This review evaluates established risk factors, examines pathogenic mechanisms, determines optimal treatment durations, and proposes evidence-based management strategies for Osteoporosis to enhance clinical practice.

Recent findings: Key risk factors include advanced age, Asian descent, prolonged Bisphosphonates therapy (exceeding 5 years for alendronate or 3 years for zoledronic acid) without drug holidays, and distinct femoral geometry. The underlying pathophysiology is primarily linked to excessive suppression of bone turnover, resulting in progressive microdamage accumulation. Current clinical guidelines suggest implementing Bisphosphonates treatment interruptions (1-3 years for oral regimens; 3-5 years for intravenous administration) in patients with moderate fracture risk (femoral neck T-score > -2.5). Importantly, denosumab withdrawal necessitates a transition to alternative therapies-typically Bisphosphonates or teriparatide-to mitigate rebound bone loss. For managing Atypical Femoral Fractures, teriparatide demonstrates efficacy in promoting healing of active lesions, whereas intramedullary nailing represents the gold standard for complete fractures or high-risk incomplete fractures. Atypical Femoral Fractures management requires balancing Anti-Resorptive benefits against risks via individualized treatment, timely drug holidays, and rapid transition to bone-forming agents post-denosumab. Prophylactic surgery benefits high-risk fractures. Future research should elucidate denosumab's mechanisms and develop targeted therapies.

Purpose of review: This review synthesizes the recently published scientific evidence on sociodemographic (age-, sex-, race/ethnicity-, or income/insurance-based) differences in epidemiology and management of osteoporosis-related vertebral fractures.

Recent findings: We identified 23 studies that investigated and reported on the presence of age-, sex-, race/ethnicity-, insurance, and income-based differences in the epidemiology and management of osteoporosis-related vertebral fractures. These fractures are generally more common in older adults and less common in Black adults compared to White adults. Vertebral augmentation is sometimes used in the treatment of osteoporosis-related vertebral fractures and has been shown to be less common in racial and ethnic minorities. Reported sociodemographic differences in the epidemiology and management of osteoporosis-related vertebral fractures are not consistent across studies. However, comparatively few studies have investigated causes of these differences, which are important for determining whether the differences represent true disparities in care, and consequently inform interventions that could reduce those disparities. Age-, sex-, race/ethnicity- insurance, and income-based differences in the epidemiology and management of osteoporosis-related vertebral fractures exist. Further work is needed to understand the underlying causes of these differences so that interventions can be developed to address them.

Purpose of review: In this review, we describe the interaction between B cells and bone during development, aging, and disease.  RECENT FINDINGS: There is an increased interest in identifying the mechanisms of interaction between immune cells and the skeletal system. This knowledge is critical for understanding the pathology of autoimmune diseases and developing therapeutic interventions. Humoral immunity depends on B cells and their secreted immunoglobulin (antibodies). Earlier studies described B cell influence on the skeletal system, with a major focus on the role of plasma cells and secreted antibodies. The contribution of bone marrow developing B cells to the skeletal system was still poorly studied and represents a gap in our knowledge. This is an active area of investigation in our research group. The crosstalk between B cells and bone starts as early as the commitment of hematopoietic stem cells to the B cell lineage and the differentiation of mesenchymal stem cells to osteoblast progenitors. This crosstalk is active during different developmental stages and continues throughout the life of the individual, especially since both B cells and bone cells share the same developmental niche. Bi-directional interaction of developing B cells and osteoblasts, osteoclasts, and chondroblasts ensures their normal development and functional activity. During aging, this interaction is disrupted, leading to disease progression, decreased bone mass, and osteoporosis. A better understanding of B cell-bone interactions will help identify novel immune targets that might provide therapeutic benefit for the elderly and patients.

Purpose of review: Proximal humerus fractures are common osteoporosis-related fractures in the elderly population. Due to these fractures, the quality of life of patients decreases significantly. This review aims to (1) describe the epidemiology of osteoporosis-related proximal humerus fractures, (2) evaluate the current management of these fractures, and (3) address the economic burden of these fractures.

Recent findings: Recent studies highlight that the incidence of proximal humerus fractures due to osteoporosis is increasing due to the increase in the elderly population. There are many methods in the literature for the treatment of these fractures, including nonsurgical treatment, minimally invasive surgery, open reduction internal fixation, intramedullary nailing and arthroplasty. Reverse shoulder arthroplasty is gaining popularity for the treatment of osteoporosis-related comminuted and displaced proximal humerus fractures in the elderly population. Post-treatment rehabilitation is as critical as the treatment itself. Osteoporosis-related proximal humeral fractures pose a serious problem in the elderly population. Multiple treatment options are available, and there is no consensus in the literature regarding treatment and rehabilitation protocols. The characteristics of the patient and the fracture should be evaluated together, and the appropriate treatment and rehabilitation protocol should be determined accordingly. Future studies should aim to standardize treatment and rehabilitation protocols and alleviate the economic burden caused by these fractures.

Purpose of review: Intravital imaging technologies have significantly transformed our understanding of osteocyte biology by enabling real-time visualization of these cells within their native microenvironment. Historically viewed as static, embedded cells, osteocytes are now recognized as dynamic and responsive, actively participating in bone remodeling, mechanotransduction, and intercellular communication. This review highlights recent advances in intravital microscopy techniques-including two-photon and three-photon imaging-and their application to studying osteocyte function in situ and in vivo.

Recent findings: Innovations in intravital imaging have allowed researchers to visualize osteocyte structural plasticity, intracellular signaling dynamics, and cell-cell interactions within the dense, mineralized bone matrix. These approaches have provided new insights into osteocyte mechanosensitivity and functional heterogeneity. However, challenges remain, including optical scattering in cortical bone and the technical complexity required for imaging preparation and data acquisition. The continued refinement of intravital imaging methods will further enhance our ability to investigate key questions regarding osteocyte network connectivity, mechanotransduction, and plasticity over extended timescales. Advances in imaging technology hold great promise to bridge the experimental flexibility of in vitro systems with the physiological complexity of living bone, opening new avenues for discovery in musculoskeletal biology.

Purpose of review: Sex specific differences in the determinants, occurrence, and distribution of osteoporosis and osteoporotic fractures play a pivotal role in the implementation of timely surveillance, prevention and effective treatment approaches. This review is aimed at synthesizing recently published scientific evidence on disparities in the epidemiology and management of osteoporosis and related fragility fractures in men.

Recent findings: Several studies have identified race-, sex-, geographic-, socioeconomic-, and comorbidity-based disparities in osteoporosis care. Over the last decade, the awareness and imperative for identifying osteoporosis in men have increased. Nonetheless, the treatment gap is increasing and osteoporosis in men remains severely underappreciated and undertreated. Fewer studies in men have focused on the factors beyond osteoporosis awareness. Recent data of individuals aged 50 years and older show an alarmingly greater increase in hip fractures in men compared to women. This coupled with the existing knowledge of greater disability burden and excess mortality due to fragility fractures in men is a cause of public health concern. This review offers a comprehensive examination of widespread and profound disparities across the spectrum of osteoporosis care and post-fracture management in men and highlights the considerable health economic aspect of this burden. We call for targeted multifaceted interventions: develop novel methods to engage patients and health professionals, increase screening and treatment of osteoporosis in men, conduct epidemiological studies focused on disease phenotyping and risk factor assessment, studies on the identification of perceptions and barriers to effective screening and treatment, expansion and further evaluation of cost-effective therapies and primary prevention strategies for fractures, implementation of fracture liaison services to address the treatment gap in secondary prevention, and promote inclusivity in outcome studies and therapeutic trials. These interventions are paramount to reduce inequities in osteoporosis care and post-fracture care in men.

Purpose of review: This review evaluates current management options for managing ankle fractures in geriatric patients with osteoporosis. It addresses the challenges posed by compromised bone integrity and examines operative and non-operative approaches to promote early mobility and functional recovery in elderly individuals.

Recent findings: Recent studies show that both surgical and non-surgical management can yield comparable functional outcomes, but complication profiles differ. Studies have assessed advanced fixation options such as standard and extended ORIF, hindfoot nailing, and fibular nailing, with growing interest in methods that accommodate poor bone quality and enable early weightbearing. Individualised care pathways and the need for standardisation in rehabilitation protocols are important. Personalised and multidisciplinary treatment is essential for this group of patients. No single intervention is optimal; treatment must consider patient frailty, comorbidities, and functional demands. Future research should focus on randomised controlled trials to refine surgical indications and rehabilitation strategies, improving outcomes and reducing complications.

Purpose: To synthesize evidence on the efficacy of osteoanabolic therapies (teriparatide, abaloparatide, romosozumab) in adults with type 2 diabetes mellitus (T2D), focusing on changes in bone mineral density (BMD) and fractures, and to explore whether responses differ between people with and without diabetes.

Findings: Following PRISMA guidelines, we searched PubMed/MEDLINE, Embase and Scopus databases till April 30, 2025 (PROSPERO: CRD420251044760). Five studies met criteria (n = 1,469 with T2D; n = 12,052 without diabetes): two post hoc analyses of randomized controlled trials (RCTs) (ACTIVE and ARCH trials) and three observational studies. Using random-effects model, osteoanabolic therapy in T2D increased lumbar spine BMD by a mean difference (MD) of 5.06% (95% CI: 1.62, 8.50; I²=93.3%). Sensitivity analysis restricted to RCTs demonstrated a larger, highly consistent effect at lumbar spine (MD 7.49%, 95% CI: 6.56, 8.41; I²=0%). Femoral neck BMD increased by 2.61% (95% CI: 1.84, 3.38; I²=0%). Evidence for fracture outcomes in T2D was limited to a single RCT (ACTIVE), in which non-vertebral fractures were reduced with abaloparatide versus placebo (p = 0.04), whereas new vertebral fractures were not different between groups. Two observational studies showed that in people with T2D, osteoanabolic agents improved BMD as much as, or more than, in non-diabetic individuals, while fracture rates were mostly similar between the groups. Osteoanabolic agents yield meaningful BMD gains in T2D, particularly at lumbar spine, with modest improvements at femoral neck. Limited fracture data suggest possible benefit but remain underpowered, underscoring the need for diabetes-specific RCTs with fracture endpoints.