Pub Date : 2026-01-12DOI: 10.1007/s11657-025-01639-9
Ya-Jun Xiao, Yan-Ling Zhang, Xiao-Zhou Mao, Di Yang, Yan-Qun Liu, Yan Cheng, Xiao-Ling Liu, Chang-Feng Sun, Hao Sun, Cun-Liang Deng
Background
Metabolic dysfunction-associated steatotic liver disease (MASLD) and osteoporosis are prevalent chronic metabolic disorders. Although a pathophysiological plausibility for their association exists, clinical evidence demonstrates substantial controversy and heterogeneity.
Aims
First, review and critically evaluate the controversial evidence regarding their association; second, analyze the sources of research heterogeneity, elucidate the regulatory roles of key effect modifiers; and third, integrate shared pathophysiological mechanisms to provide insights for future research and clinical practice.
Methods
We conducted a literature search in PubMed, Embase, Cochrane Library, Scopus, and Web of Science up to September 16, 2025, using relevant keywords and terms.
Results
Current studies have reported varying associations between MASLD and bone mineral density, ranging from negative to null to positive. The relationship between MASLD and bone metabolism exhibits highly complex, conditional, and context-dependent characteristics. The strength and direction of this association may be significantly influenced by a range of effect modifiers, including gender, age, ethnicity, visceral fat distribution, the severity of MASLD, and the sites of skeletal measurement. Factors such as chronic inflammatory responses, insulin resistance, and adipokine dysregulation may be involved in modulating this association.
Conclusions
The association between MASLD and osteoporosis is highly complex, conditional, and context-dependent, as its direction and magnitude are significantly modulated by multiple effect modifiers. Future research requires large-scale, long-term, multicenter prospective cohort studies to thoroughly investigate their causal relationship and underlying mechanisms.
背景：代谢功能障碍相关脂肪变性肝病（MASLD）和骨质疏松症是常见的慢性代谢性疾病。尽管两者之间存在病理生理上的联系，但临床证据却存在很大的争议和异质性。目的：首先，回顾和批判性地评估有关它们之间关联的有争议的证据；第二，分析研究异质性来源，阐明关键效应调节剂的调控作用；第三，整合共享的病理生理机制，为未来的研究和临床实践提供见解。方法：检索PubMed、Embase、Cochrane Library、Scopus、Web of Science截止到2025年9月16日的相关关键词和术语。结果：目前的研究报告了MASLD与骨矿物质密度之间的不同相关性，从阴性到零到阳性。MASLD和骨代谢之间的关系表现出高度复杂的、有条件的和环境依赖的特征。这种关联的强度和方向可能受到一系列影响因素的显著影响，包括性别、年龄、种族、内脏脂肪分布、MASLD的严重程度和骨骼测量的位置。慢性炎症反应、胰岛素抵抗和脂肪因子失调等因素可能参与调节这种关联。结论：MASLD与骨质疏松症之间的关联是高度复杂的、有条件的、依赖于环境的，因为其方向和程度受到多种效应调节剂的显著调节。未来的研究需要大规模、长期、多中心的前瞻性队列研究，以彻底调查其因果关系和潜在机制。
{"title":"The contested association between MASLD and osteoporosis: a narrative review of heterogeneous evidence and modifying factors","authors":"Ya-Jun Xiao, Yan-Ling Zhang, Xiao-Zhou Mao, Di Yang, Yan-Qun Liu, Yan Cheng, Xiao-Ling Liu, Chang-Feng Sun, Hao Sun, Cun-Liang Deng","doi":"10.1007/s11657-025-01639-9","DOIUrl":"10.1007/s11657-025-01639-9","url":null,"abstract":"<div><h3>Background</h3><p>Metabolic dysfunction-associated steatotic liver disease (MASLD) and osteoporosis are prevalent chronic metabolic disorders. Although a pathophysiological plausibility for their association exists, clinical evidence demonstrates substantial controversy and heterogeneity.</p><h3>Aims</h3><p>First, review and critically evaluate the controversial evidence regarding their association; second, analyze the sources of research heterogeneity, elucidate the regulatory roles of key effect modifiers; and third, integrate shared pathophysiological mechanisms to provide insights for future research and clinical practice.</p><h3>Methods</h3><p>We conducted a literature search in PubMed, Embase, Cochrane Library, Scopus, and Web of Science up to September 16, 2025, using relevant keywords and terms.</p><h3>Results</h3><p>Current studies have reported varying associations between MASLD and bone mineral density, ranging from negative to null to positive. The relationship between MASLD and bone metabolism exhibits highly complex, conditional, and context-dependent characteristics. The strength and direction of this association may be significantly influenced by a range of effect modifiers, including gender, age, ethnicity, visceral fat distribution, the severity of MASLD, and the sites of skeletal measurement. Factors such as chronic inflammatory responses, insulin resistance, and adipokine dysregulation may be involved in modulating this association.</p><h3>Conclusions</h3><p>The association between MASLD and osteoporosis is highly complex, conditional, and context-dependent, as its direction and magnitude are significantly modulated by multiple effect modifiers. Future research requires large-scale, long-term, multicenter prospective cohort studies to thoroughly investigate their causal relationship and underlying mechanisms.</p></div>","PeriodicalId":8283,"journal":{"name":"Archives of Osteoporosis","volume":"21 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145951485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-12DOI: 10.1007/s11657-025-01643-z
Amany A. Mousa, Alaa M. Wafa, Randa Ramadan, Rasha Elzehery, Nehal Tharwat
Summary
We examined type 2 diabetic patients by diffusion tensor imaging, an advanced magnetic resonance technique, and found significant differences than healthy subjects that correlated with markers of bone turnover. This could help in assessment of bone quality in diabetics where bone density often appears normal despite high fracture risk.
Introduction
Type 2 diabetes (T2DM) induced bone fragility is mainly due to alteration of bone quality rather than a decline in bone mineral density. The aim of the present study was to assess the ability of diffusion tensor imaging (DTI) to assess bone quality in T2DM.
Methods
A total of 68 patients with T2DM were enrolled and stratified into two groups: those with microvascular complications (n = 38) and those without (n = 30). Additionally, 30 age- and sex-matched healthy controls were included. All participants underwent DTI of the lumbosacral spines and both hips, dual-energy X-ray absorptiometry (DEXA) scanning, and assessment of bone turnover biomarkers, including C-terminal telopeptide of type I collagen (CTX) and procollagen type I N-terminal propeptide (P1NP).
Results
DTI parameters—fractional anisotropy (FA) and apparent diffusion coefficient (ADC)—differed between patients and controls. FA values for the spine and hips were lower, while ADC values for the hips were higher in both diabetic patient groups compared to control subjects. ADC values for the spine were higher in diabetic patients with complications than in controls. A significant positive correlation was observed between FA and CTX levels in patients with complications. No significant differences were found in DEXA scan results between patients and controls. FA and ADC values for the hips showed the highest area under the curve (AUC) values (0.868 and 0.818, respectively), followed by FA and ADC for the spine (0.779 and 0.721), according to ROC curve analysis. The optimal cutoffs yielding the best sensitivity and specificity were observed for FA over ADC.
Conclusion
DTI can provide information about the microstructural changes associated with the development of a low bone turnover state in type 2 diabetes mellitus, where bone mineral density typically remains within the normal range.
{"title":"Utility of diffusion tensor imaging for assessing bone quality in type 2 diabetes: correlation with bone turnover biomarkers","authors":"Amany A. Mousa, Alaa M. Wafa, Randa Ramadan, Rasha Elzehery, Nehal Tharwat","doi":"10.1007/s11657-025-01643-z","DOIUrl":"10.1007/s11657-025-01643-z","url":null,"abstract":"<div><h3>\u0000 <i>Summary</i>\u0000 </h3><p>We examined type 2 diabetic patients by diffusion tensor imaging, an advanced magnetic resonance technique, and found significant differences than healthy subjects that correlated with markers of bone turnover. This could help in assessment of bone quality in diabetics where bone density often appears normal despite high fracture risk.</p><h3>Introduction</h3><p>Type 2 diabetes (T2DM) induced bone fragility is mainly due to alteration of bone quality rather than a decline in bone mineral density. The aim of the present study was to assess the ability of diffusion tensor imaging (DTI) to assess bone quality in T2DM.</p><h3>Methods</h3><p>A total of 68 patients with T2DM were enrolled and stratified into two groups: those with microvascular complications (<i>n</i> = 38) and those without (<i>n</i> = 30). Additionally, 30 age- and sex-matched healthy controls were included. All participants underwent DTI of the lumbosacral spines and both hips, dual-energy X-ray absorptiometry (DEXA) scanning, and assessment of bone turnover biomarkers, including C-terminal telopeptide of type I collagen (CTX) and procollagen type I N-terminal propeptide (P1NP).</p><h3>Results</h3><p>DTI parameters—fractional anisotropy (FA) and apparent diffusion coefficient (ADC)—differed between patients and controls. FA values for the spine and hips were lower, while ADC values for the hips were higher in both diabetic patient groups compared to control subjects. ADC values for the spine were higher in diabetic patients with complications than in controls. A significant positive correlation was observed between FA and CTX levels in patients with complications. No significant differences were found in DEXA scan results between patients and controls. FA and ADC values for the hips showed the highest area under the curve (AUC) values (0.868 and 0.818, respectively), followed by FA and ADC for the spine (0.779 and 0.721), according to ROC curve analysis. The optimal cutoffs yielding the best sensitivity and specificity were observed for FA over ADC.</p><h3>Conclusion</h3><p>DTI can provide information about the microstructural changes associated with the development of a low bone turnover state in type 2 diabetes mellitus, where bone mineral density typically remains within the normal range.</p></div>","PeriodicalId":8283,"journal":{"name":"Archives of Osteoporosis","volume":"21 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12795938/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145951476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-08DOI: 10.1007/s11657-025-01635-z
Rachel E. Elam, Joan C. Lo, John T. Schousboe, Robert A. Adler, Howard A. Fink, Susan M. Ott, Joshua Barzilay, Frances M. Weaver, Emily Budde, Zhiping Huo, Reside Jacob, Laura D. Carbone
In the U.S’s largest integrated health system, during a 24-year period (1999–2022), bisphosphonate treatment initiation for fracture prevention in men shifted towards higher-risk populations, including older men and those with prior fracture and frailty.
To evaluate 24-year trends in bisphosphonate (BP) initiation among older U.S. male Veterans and shifts in demographic and clinical characteristics of BP-treated men over time.
U.S. national Veterans Health Administration (VHA) data (1999–2022) were queried to identify men aged ≥ 50 years with a first prescription for an FDA-approved BP for fracture prevention. Age, race, ethnicity, BP drug and route, prior fracture, and, in those aged ≥ 65 years, Veterans Affairs Frailty Index (VA-FI), were examined across five time periods. Temporal trends were analyzed using chi-square and nonparametric trend tests.
A total of 298,340 men initiated a BP during 1999–2022, of whom 233,857 (78.4%) were aged ≥ 65 years. BP initiation rose sharply after FDA approval of BPs for men in 2000, peaked in 2004–2005, then declined by about 50% between 2006 and 2012, and then plateaued. Over time, the proportion of BP initiators aged < 65 years declined from a peak of 28.2% during the middle time period (2008–2012) to a nadir of 13.3% during the final years (2018–2022, p < 0.001 for trend). Among the subset of men age 65 and older who initiated BP, the proportion with prior fracture increased from 8.3% in 1999–2002 to 24.5% in 2018–2022 (p < 0.001). Notably, over half of the men who initiated BP during 1999–2002 were classified as non-frail, whereas in the most recent time period (2018–2022), over half of BP initiators were frail (mildly, moderately, or severely) and only 14.8% of them were non-frail (p < 0.001).
In the VHA, BP initiating patterns shifted over time towards treating older men, with much larger proportions of men who had a prior fracture and were classified as frail.
{"title":"Shifting bisphosphonate prescribing patterns for fracture prevention: a 24-year national surveillance of men in the U.S. Veterans Health Administration","authors":"Rachel E. Elam, Joan C. Lo, John T. Schousboe, Robert A. Adler, Howard A. Fink, Susan M. Ott, Joshua Barzilay, Frances M. Weaver, Emily Budde, Zhiping Huo, Reside Jacob, Laura D. Carbone","doi":"10.1007/s11657-025-01635-z","DOIUrl":"10.1007/s11657-025-01635-z","url":null,"abstract":"<p>In the U.S’s largest integrated health system, during a 24-year period (1999–2022), bisphosphonate treatment initiation for fracture prevention in men shifted towards higher-risk populations, including older men and those with prior fracture and frailty.</p><p>To evaluate 24-year trends in bisphosphonate (BP) initiation among older U.S. male Veterans and shifts in demographic and clinical characteristics of BP-treated men over time.</p><p>U.S. national Veterans Health Administration (VHA) data (1999–2022) were queried to identify men aged ≥ 50 years with a first prescription for an FDA-approved BP for fracture prevention. Age, race, ethnicity, BP drug and route, prior fracture, and, in those aged ≥ 65 years, Veterans Affairs Frailty Index (VA-FI), were examined across five time periods. Temporal trends were analyzed using chi-square and nonparametric trend tests.</p><p>A total of 298,340 men initiated a BP during 1999–2022, of whom 233,857 (78.4%) were aged ≥ 65 years. BP initiation rose sharply after FDA approval of BPs for men in 2000, peaked in 2004–2005, then declined by about 50% between 2006 and 2012, and then plateaued. Over time, the proportion of BP initiators aged < 65 years declined from a peak of 28.2% during the middle time period (2008–2012) to a nadir of 13.3% during the final years (2018–2022, <i>p</i> < 0.001 for trend). Among the subset of men age 65 and older who initiated BP, the proportion with prior fracture increased from 8.3% in 1999–2002 to 24.5% in 2018–2022 (<i>p</i> < 0.001). Notably, over half of the men who initiated BP during 1999–2002 were classified as non-frail, whereas in the most recent time period (2018–2022), over half of BP initiators were frail (mildly, moderately, or severely) and only 14.8% of them were non-frail (<i>p</i> < 0.001).</p><p>In the VHA, BP initiating patterns shifted over time towards treating older men, with much larger proportions of men who had a prior fracture and were classified as frail.\u0000</p>","PeriodicalId":8283,"journal":{"name":"Archives of Osteoporosis","volume":"21 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s11657-025-01635-z.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145930635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-08DOI: 10.1007/s11657-025-01619-z
Marije C. Koelé, Nathalie van der Velde, Jos P.C.M. van Campen, Saskia A.E. van Haelst, Hanna C. Willems
Summary
Currently, it is unknown whether hyperkyphosis is associated with lower physical function in older persons with frailty, who have a high risk of functional decline. Hyperkyphosis was highly prevalent and independently associated with lower physical function. Early detection and treatment of hyperkyphosis may contribute to the preservation of physical function.
Purpose
To investigate the association between hyperkyphosis and physical function in older persons with frailty, who have a high risk of functional decline
Methods
Hyperkyphosis was defined as a Cobb angle ≥ 50°, ≥ 3.4 cm of blocks or an occiput-to-wall distance of ≥ 5.0 cm. The association with physical function (Timed Up and Go Test, Short Physical Performance Battery, Berg Balance Scale, and hand grip strength) was assessed through multifactorial regression analyses.
Results
Hyperkyphosis was highly prevalent in the cohort (n = 337, mean age 80.0 ± 7.9 years) with a prevalence ranging from 43 to 84%, depending on which measurement method was used. Hyperkyphosis was independently associated with a longer Timed Up and Go time and a lower Berg Balance Scale score, only when kyphosis was measured with the blocks method (Timed Up and Go: adjusted OR 3.86, 95% CI 1.50–9.91; Berg Balance Scale: adjusted OR 9.42, 95% CI 2.27–39.12). Hyperkyphosis was not associated with Short Physical Function Battery or hand grip strength.
Conclusion
Hyperkyphosis was highly prevalent and independently associated with the Timed Up and Go test and Berg Balance Scale, even in this population of geriatric outpatients with frailty and multimorbidity, thereby more at risk for functional decline. Early detection and treatment of hyperkyphosis may contribute to the preservation of physical function.
目前，尚不清楚后凸过度是否与身体虚弱的老年人身体功能下降有关，他们有很高的功能下降风险。后凸过度是非常普遍的，并且独立地与较低的身体功能相关。早期发现和治疗后凸过度可能有助于身体功能的保存。目的探讨功能衰退高危老年人后凸过度与身体功能的关系。方法将后凸过度定义为Cobb角≥50°、脑块≥3.4 cm或枕壁距离≥5.0 cm。通过多因素回归分析评估与身体功能（计时向上和向前测试，短物理性能电池，伯格平衡量表和手握力）的关系。结果重度后凸畸形在该队列中非常普遍（n = 337，平均年龄80.0±7.9岁），根据不同的测量方法，患病率在43 - 84%之间。仅当使用块法测量后凸时，后凸过度与较长的Timed Up和Go时间以及较低的Berg Balance Scale评分独立相关（Timed Up和Go：调整OR 3.86, 95% CI 1.50-9.91； Berg Balance Scale：调整OR 9.42, 95% CI 2.27-39.12）。后凸过度与短的身体功能电池或手握力无关。结论：高后凸是非常普遍的，并且与Timed Up and Go测试和Berg平衡量表独立相关，即使在虚弱和多病的老年门诊患者中也是如此，因此功能下降的风险更大。早期发现和治疗后凸过度可能有助于身体功能的保存。
{"title":"The association between hyperkyphosis and physical function in geriatric outpatients with frailty","authors":"Marije C. Koelé, Nathalie van der Velde, Jos P.C.M. van Campen, Saskia A.E. van Haelst, Hanna C. Willems","doi":"10.1007/s11657-025-01619-z","DOIUrl":"10.1007/s11657-025-01619-z","url":null,"abstract":"<div><h3>Summary</h3><p>Currently, it is unknown whether hyperkyphosis is associated with lower physical function in older persons with frailty, who have a high risk of functional decline. Hyperkyphosis was highly prevalent and independently associated with lower physical function. Early detection and treatment of hyperkyphosis may contribute to the preservation of physical function.</p><h3>Purpose</h3><p>To investigate the association between hyperkyphosis and physical function in older persons with frailty, who have a high risk of functional decline</p><h3>Methods</h3><p>Hyperkyphosis was defined as a Cobb angle ≥ 50°, ≥ 3.4 cm of blocks or an occiput-to-wall distance of ≥ 5.0 cm. The association with physical function (Timed Up and Go Test, Short Physical Performance Battery, Berg Balance Scale, and hand grip strength) was assessed through multifactorial regression analyses.</p><h3>Results</h3><p>Hyperkyphosis was highly prevalent in the cohort (<i>n</i> = 337, mean age 80.0 ± 7.9 years) with a prevalence ranging from 43 to 84%, depending on which measurement method was used. Hyperkyphosis was independently associated with a longer Timed Up and Go time and a lower Berg Balance Scale score, only when kyphosis was measured with the blocks method (Timed Up and Go: adjusted OR 3.86, 95% CI 1.50–9.91; Berg Balance Scale: adjusted OR 9.42, 95% CI 2.27–39.12). Hyperkyphosis was not associated with Short Physical Function Battery or hand grip strength.</p><h3>Conclusion</h3><p>Hyperkyphosis was highly prevalent and independently associated with the Timed Up and Go test and Berg Balance Scale, even in this population of geriatric outpatients with frailty and multimorbidity, thereby more at risk for functional decline. Early detection and treatment of hyperkyphosis may contribute to the preservation of physical function.</p></div>","PeriodicalId":8283,"journal":{"name":"Archives of Osteoporosis","volume":"21 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s11657-025-01619-z.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145930634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-03DOI: 10.1007/s11657-025-01652-y
Katarina Greve, Stina Ek, Erzsébet Bartha, Maria Sääf, Margareta Hedström, Karin Modig
Summary
Rationale: To investigate geographic and seasonal differences in the occurrence of hip fracture within Sweden in the years 2020–2022. Main Results: There were differences in hip fracture incidence rates depending on geographic location as well as sex and season. Significance: Unexplained differences in hip fracture occurrence remain, warranting further investigation.
Purpose
To investigate geographic differences in hip fracture incidence in Sweden and to explore potential factors underlying this variation.
Methods
The populations of people ≥ 60 years of each Swedish county were identified using the Total Population Register. First hip fractures occurring between 2020 and 2022 were identified in the National Patient Register. Sex-, and County specific as well as seasonal hip fracture incidence rates were calculated. Stratified Poisson regression was used to compare incidence in the first quarter of the year with that in the remaining quarters. Additionally, sex stratified adjusted Poisson regression was performed to compare the incidence in Stockholm with other counties.
Results
2,879,444 individuals were included in the study. Hip fracture incidence rates varied across Swedish counties, with the age standardized rate per 10,000 person-years ranging from 54 (Kalmar) to 67 (Västernorrland) in women and from 35 (Södermanland) to 52 (Norrbotten) in men. Incidence tended to be lower during the summer months, except among women 60–79 years in southern Sweden. Seasonal variations were most pronounced among men 60–79 years in northern Sweden. Geographic differences persisted after adjusting for age, income level, care dependency, hospital frailty risk score, place of birth, and usage of fall-risk increasing drugs.
Conclusion
Geographic disparities in first hip fracture incidence were observed among both women and men in Sweden, with the highest rates in the northernmost counties. These differences could not be fully explained by uneven distribution of the risk factors examined in this study. Additionally, sex differences were noted in the counties with the highest and lowest incidence rates. Seasonal variation in hip fracture incidence was evident.
{"title":"Geographic and seasonal variations in hip fracture incidence in Sweden: a nationwide population-based study","authors":"Katarina Greve, Stina Ek, Erzsébet Bartha, Maria Sääf, Margareta Hedström, Karin Modig","doi":"10.1007/s11657-025-01652-y","DOIUrl":"10.1007/s11657-025-01652-y","url":null,"abstract":"<div><h3>\u0000 <i>Summary</i>\u0000 </h3><p>Rationale: To investigate geographic and seasonal differences in the occurrence of hip fracture within Sweden in the years 2020–2022. Main Results: There were differences in hip fracture incidence rates depending on geographic location as well as sex and season. Significance: Unexplained differences in hip fracture occurrence remain, warranting further investigation.</p><h3>Purpose</h3><p>To investigate geographic differences in hip fracture incidence in Sweden and to explore potential factors underlying this variation.</p><h3>Methods</h3><p>The populations of people ≥ 60 years of each Swedish county were identified using the Total Population Register. First hip fractures occurring between 2020 and 2022 were identified in the National Patient Register. Sex-, and County specific as well as seasonal hip fracture incidence rates were calculated. Stratified Poisson regression was used to compare incidence in the first quarter of the year with that in the remaining quarters. Additionally, sex stratified adjusted Poisson regression was performed to compare the incidence in Stockholm with other counties.</p><h3>Results</h3><p>2,879,444 individuals were included in the study. Hip fracture incidence rates varied across Swedish counties, with the age standardized rate per 10,000 person-years ranging from 54 (Kalmar) to 67 (Västernorrland) in women and from 35 (Södermanland) to 52 (Norrbotten) in men. Incidence tended to be lower during the summer months, except among women 60–79 years in southern Sweden. Seasonal variations were most pronounced among men 60–79 years in northern Sweden. Geographic differences persisted after adjusting for age, income level, care dependency, hospital frailty risk score, place of birth, and usage of fall-risk increasing drugs.</p><h3>Conclusion</h3><p>Geographic disparities in first hip fracture incidence were observed among both women and men in Sweden, with the highest rates in the northernmost counties. These differences could not be fully explained by uneven distribution of the risk factors examined in this study. Additionally, sex differences were noted in the counties with the highest and lowest incidence rates. Seasonal variation in hip fracture incidence was evident.</p></div>","PeriodicalId":8283,"journal":{"name":"Archives of Osteoporosis","volume":"21 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12764589/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145892084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-21DOI: 10.1007/s11657-025-01641-1
Jing Cheng, Ai-Jun Chao, Zhe Ren, Shu-Jun Yu, Zhe Han
Summary
This pioneering study validates a novel ortho-internal treatment model providing integrated fracture and comorbidity management for high-risk elderly hip fracture patients. Results confirm significantly reduced mortality versus conventional approaches, demonstrating its unique capacity to optimize both surgical and non-surgical therapies while establishing surgery as the preferred option for eligible patients under this model.
Background
Hip fractures in aged individuals with comorbidities pose complex treatment challenges and high mortality rates. While multiple multidisciplinary care models have been proposed globally, outcomes remain suboptimal for such cases. The present study assessed the efficacy of an ortho-internal treatment model, an integrated healthcare approach where physicians provide comprehensive care for patients with hip fractures and associated multiple comorbidities, to determine whether this novel model yields superior outcomes compared to existing multidisciplinary standards.
Methods
We retrospectively analyzed 1410 hip fracture patients treated at Tianjin Hospital’s Ortho-internal Department (2015–2021), collecting demographic data, clinical information, and 1-year survival status. The main outcomes were mortality at 30, 60, 90, and 180 days and 1 year.
Results
Of 1410 patients (mean age 80.61 ± 8.28 years, 68.16% with Charlson Comorbidity Index ≥ 5), 353 underwent surgery and 1057 received non-surgical treatment. Overall mortality rates at 30, 60, 90, and 180 days and 1 year were 7.01%, 10.07%, 12.41%, 17.09%, and 21.56%, respectively. Surgical group mortality rates at these time points (3.40%, 5.10%, 6.23%, 9.35%, 12.18%) were significantly lower than the non-surgical group (8.23%, 11.73%, 14.47%, 19.68%, 24.69%). The overall 5-year survival rate exceeded 50%, with the surgery group (66.6%) significantly higher than the non-surgery group (46.7%) and the entire cohort.
Conclusion
The ortho-internal model shows advantages in treating aged hip fracture patients with multiple comorbidities, outperforming published outcomes and offering a novel, effective approach to their care. Its capacity to optimize both surgical and conservative outcomes suggests this approach should be prioritized for complex cases. Notably, the model enables surgical access for previously ineligible patients, with surgery remaining beneficial despite higher perioperative risks.
{"title":"Integrated ortho-internal model reduces mortality in high-risk aged hip fractures","authors":"Jing Cheng, Ai-Jun Chao, Zhe Ren, Shu-Jun Yu, Zhe Han","doi":"10.1007/s11657-025-01641-1","DOIUrl":"10.1007/s11657-025-01641-1","url":null,"abstract":"<div><h3>\u0000 <i>Summary</i>\u0000 </h3><p>This pioneering study validates a novel ortho-internal treatment model providing integrated fracture and comorbidity management for high-risk elderly hip fracture patients. Results confirm significantly reduced mortality versus conventional approaches, demonstrating its unique capacity to optimize both surgical and non-surgical therapies while establishing surgery as the preferred option for eligible patients under this model.</p><h3>Background</h3><p>Hip fractures in aged individuals with comorbidities pose complex treatment challenges and high mortality rates. While multiple multidisciplinary care models have been proposed globally, outcomes remain suboptimal for such cases. The present study assessed the efficacy of an ortho-internal treatment model, an integrated healthcare approach where physicians provide comprehensive care for patients with hip fractures and associated multiple comorbidities, to determine whether this novel model yields superior outcomes compared to existing multidisciplinary standards.</p><h3>Methods</h3><p>We retrospectively analyzed 1410 hip fracture patients treated at Tianjin Hospital’s Ortho-internal Department (2015–2021), collecting demographic data, clinical information, and 1-year survival status. The main outcomes were mortality at 30, 60, 90, and 180 days and 1 year.</p><h3>Results</h3><p>Of 1410 patients (mean age 80.61 ± 8.28 years, 68.16% with Charlson Comorbidity Index ≥ 5), 353 underwent surgery and 1057 received non-surgical treatment. Overall mortality rates at 30, 60, 90, and 180 days and 1 year were 7.01%, 10.07%, 12.41%, 17.09%, and 21.56%, respectively. Surgical group mortality rates at these time points (3.40%, 5.10%, 6.23%, 9.35%, 12.18%) were significantly lower than the non-surgical group (8.23%, 11.73%, 14.47%, 19.68%, 24.69%). The overall 5-year survival rate exceeded 50%, with the surgery group (66.6%) significantly higher than the non-surgery group (46.7%) and the entire cohort.</p><h3>Conclusion</h3><p>The ortho-internal model shows advantages in treating aged hip fracture patients with multiple comorbidities, outperforming published outcomes and offering a novel, effective approach to their care. Its capacity to optimize both surgical and conservative outcomes suggests this approach should be prioritized for complex cases. Notably, the model enables surgical access for previously ineligible patients, with surgery remaining beneficial despite higher perioperative risks.</p></div>","PeriodicalId":8283,"journal":{"name":"Archives of Osteoporosis","volume":"21 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145803046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Although the number of patients with hip fracture increased till FY2017, it remained stable over the next 3 years, possibly owing to enhanced treatment rates and changed medications. However, the number of patients with hip fracture again increased FY2021 onwards, coinciding with the COVID-19 pandemic.
Purpose
To clarify the trends in hip fracture incidence and its relationship with pre-fracture pharmacotherapy over time in Japan.
Methods
Using Japan’s National Database of Health Insurance Claims and Specific Health Checkups, we examined the number of patients with hip fracture and their osteoporosis medication status from fiscal year (FY) 2012 to FY2023.
Results
A total of 1,636,198 females and 460,898 males had hip fractures. The crude number of patients in FY2020 was 181,443, indicating a decrease of 654 from the previous year. The number of patients per 10,000 females decreased in FY2018 and FY2020 compared with the previous year. The osteoporosis medication rate in the year before the fracture was 33.5%–34.3% for females from FY2013 to FY2019, but it was significantly decreased to 32.4%–32.9% from FY2020 to FY2023 (p < 0.01). The pre-fracture medication rate was significantly related to the number of patients per 10,000 population (p < 0.05). Bisphosphonates were the most common drug administered after 2015. Denosumab, romosozumab, and eldecalcitol tended to increase over time.
Conclusion
Although the number of patients with hip fractures increased until FY2017, it remained stagnant over the next 3 years, possibly due to enhanced treatment rates and changed medications. However, the number of patients with hip fractures again increased from FY2021 onwards, coinciding with the coronavirus disease 2019 (COVID-19) pandemic in Japan. Post-COVID-19, increasing adherence to effective osteoporosis medications may curb or even reduce the number of patients with hip fractures.
{"title":"Trends in the incidence of hip fractures and osteoporosis treatment in Japan (FY2012–FY2023)","authors":"Shinichi Nakatoh, Kenji Fujimori, Shigeyuki Ishii, Junko Tamaki, Nobukazu Okimoto, Sumito Ogawa, Masayuki Iki","doi":"10.1007/s11657-025-01650-0","DOIUrl":"10.1007/s11657-025-01650-0","url":null,"abstract":"<div><h3>\u0000 <i>Summary</i>\u0000 </h3><p>Although the number of patients with hip fracture increased till FY2017, it remained stable over the next 3 years, possibly owing to enhanced treatment rates and changed medications. However, the number of patients with hip fracture again increased FY2021 onwards, coinciding with the COVID-19 pandemic.</p><h3>Purpose</h3><p>To clarify the trends in hip fracture incidence and its relationship with pre-fracture pharmacotherapy over time in Japan.</p><h3>Methods</h3><p>Using Japan’s National Database of Health Insurance Claims and Specific Health Checkups, we examined the number of patients with hip fracture and their osteoporosis medication status from fiscal year (FY) 2012 to FY2023.</p><h3>Results</h3><p>A total of 1,636,198 females and 460,898 males had hip fractures. The crude number of patients in FY2020 was 181,443, indicating a decrease of 654 from the previous year. The number of patients per 10,000 females decreased in FY2018 and FY2020 compared with the previous year. The osteoporosis medication rate in the year before the fracture was 33.5%–34.3% for females from FY2013 to FY2019, but it was significantly decreased to 32.4%–32.9% from FY2020 to FY2023 (<i>p</i> < 0.01). The pre-fracture medication rate was significantly related to the number of patients per 10,000 population (<i>p</i> < 0.05). Bisphosphonates were the most common drug administered after 2015. Denosumab, romosozumab, and eldecalcitol tended to increase over time.</p><h3>Conclusion</h3><p>Although the number of patients with hip fractures increased until FY2017, it remained stagnant over the next 3 years, possibly due to enhanced treatment rates and changed medications. However, the number of patients with hip fractures again increased from FY2021 onwards, coinciding with the coronavirus disease 2019 (COVID-19) pandemic in Japan. Post-COVID-19, increasing adherence to effective osteoporosis medications may curb or even reduce the number of patients with hip fractures.</p></div>","PeriodicalId":8283,"journal":{"name":"Archives of Osteoporosis","volume":"21 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145779260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study investigated whether low hip bone density (as measured by CT scans) can predict implant failure in hip fracture patients undergoing nail fixation. Based on an analysis of 143 cases, patients with CT Hounsfield units below 27.6 HU had a significantly higher risk of failure. This preoperative metric offers a quantifiable tool to guide surgical decisions and improve outcomes in patients with fragile bones.
Purpose
To determine whether reduced proximal femoral computed tomography (CT) Hounsfield units constitute an independent risk factor for internal fixation failure after intramedullary nail fixation for intertrochanteric fractures.
Methods
In this retrospective cohort study, patients who underwent intramedullary fixation for intertrochanteric fractures were categorized into fixation failure and non-failure groups on the basis of follow-up outcomes. Demographic, clinical, and imaging parameters were analyzed, with a focus on proximal femoral CT values measured in Hounsfield units (HU). Logistic regression models were employed to identify independent risk factors, while receiver operating characteristic (ROC) curve analysis established optimal CT value thresholds for predicting failure.
Results
Among the 143 enrolled patients, 21 (14.7%) developed fixation failure. Compared with the control group, the failure group exhibited significantly lower proximal femoral CT Hounsfield units (14.6(19.4) HU vs. 46.9(37.3) HU; P < 0.001). Multivariate analysis demonstrated that each 1 HU increase in CT value reduced the risk of failure by 5.1% (P < 0.001). ROC analysis revealed 27.6 HU as the optimal predictive threshold, yielding 81% sensitivity and 86% specificity.
Conclusion
Proximal femoral CT Hounsfield units below 27.6 HU significantly predict internal fixation failure in patients with intertrochanteric fractures treated with intramedullary nails, providing a quantifiable preoperative risk assessment tool.
{"title":"The predictive value of proximal femoral CT attenuation in intramedullary fixation failure of intertrochanteric fractures: a retrospective cohort analysis","authors":"Kaifeng Ye, YouLiang Hao, Yanlei Dong, Yuanyu Hu, Junbo Qi, Yutian Luo, Yun Tian","doi":"10.1007/s11657-025-01651-z","DOIUrl":"10.1007/s11657-025-01651-z","url":null,"abstract":"<div><h3>\u0000 <i>Summary</i>\u0000 </h3><p>This study investigated whether low hip bone density (as measured by CT scans) can predict implant failure in hip fracture patients undergoing nail fixation. Based on an analysis of 143 cases, patients with CT Hounsfield units below 27.6 HU had a significantly higher risk of failure. This preoperative metric offers a quantifiable tool to guide surgical decisions and improve outcomes in patients with fragile bones.</p><h3>Purpose</h3><p>To determine whether reduced proximal femoral computed tomography (CT) Hounsfield units constitute an independent risk factor for internal fixation failure after intramedullary nail fixation for intertrochanteric fractures.</p><h3>Methods</h3><p>In this retrospective cohort study, patients who underwent intramedullary fixation for intertrochanteric fractures were categorized into fixation failure and non-failure groups on the basis of follow-up outcomes. Demographic, clinical, and imaging parameters were analyzed, with a focus on proximal femoral CT values measured in Hounsfield units (HU). Logistic regression models were employed to identify independent risk factors, while receiver operating characteristic (ROC) curve analysis established optimal CT value thresholds for predicting failure.</p><h3>Results</h3><p>Among the 143 enrolled patients, 21 (14.7%) developed fixation failure. Compared with the control group, the failure group exhibited significantly lower proximal femoral CT Hounsfield units (14.6(19.4) HU vs. 46.9(37.3) HU; <i>P</i> < 0.001). Multivariate analysis demonstrated that each 1 HU increase in CT value reduced the risk of failure by 5.1% (<i>P</i> < 0.001). ROC analysis revealed 27.6 HU as the optimal predictive threshold, yielding 81% sensitivity and 86% specificity.</p><h3>Conclusion</h3><p>Proximal femoral CT Hounsfield units below 27.6 HU significantly predict internal fixation failure in patients with intertrochanteric fractures treated with intramedullary nails, providing a quantifiable preoperative risk assessment tool.</p></div>","PeriodicalId":8283,"journal":{"name":"Archives of Osteoporosis","volume":"21 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s11657-025-01651-z.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145779206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-16DOI: 10.1007/s11657-025-01642-0
Laura Bogliolo, Silvia Grignaschi, Catherine Klersy, Pietro Perotti, Simona Dalle Carbonare, Silvia Balduzzi, Michela Milanesi , Giuseppe Giuffrè, Carmelinda Ruggiero, Maria Cristina Caffetti
Summary
As the global population ages, osteoporosis and fragility fractures (FF) are emerging health concerns worldwide. This study assesses the effectiveness of an integrated hospital-community pathway in improving prescription and adherence to anti-fracture treatment. Additionally, it analyzes the re-fracture rate and mortality at a 24-month follow-up from an index FF.
Purpose
Evaluate the effectiveness of an integrated healthcare pathway (IHCP) on appropriateness and adherence to anti-fracture treatment (AFT) in adults aged ≥ 50 years, hospitalized due to fragility fracture (FF). Re-fractures and mortality rates were explored as secondary outcomes.
Methods
Subjects aged 50 years and more, resident in the province of Pavia, Italy, were enrolled at the time of hospital admission due to major FF, in the period 2016–2018 and 2019–2020 before and after the implementation of the IHCP, respectively. Data were extracted from the administrative database of the Health Protection Agency of Pavia, starting from the index event and until 24 months. Data analyses were conducted for the primary and secondary outcomes. Univariate and multivariate Cox regression models were fitted.
Results
Among 9186 participants (74.7% women), aged 78 years, 12.7% initiated an AFT, and half of them (6.3%) within 6 months after the index FF. Comparing pre- and post- IHCP implementation phases, the appropriateness of AFT initiation increased in subjects with index humerus/wrist FF, oral AFT prescription decreased, while subcutaneous or intravenous treatments increased (p < 0.001). Total adherence to AFT slightly increased. The re-fracture rate was 5.2 per 100 person/year, with age, IHCP implementation, and hip FF associated with a higher likelihood of refracture. The mortality rate was 13.4 per 100 person/year, with age, male gender, IHCP, and hip fracture as independent risk factors. Appropriate AFT significantly reduced mortality compared to no treatment (HR 0.55), with one-year adherence showing the strongest benefit (HR 0.18). Adherent patients had threefold lower mortality than non-adherent ones. Hip and vertebral fractures had an increased death risk (p < 0.001) compared to wrist and/or humerus. AFT results in an effect modifier of the association between the site of FF and mortality risk (p = 0.003).
Conclusion
The implementation of an IHCP, based on a FLS integrated model, shows a tendency to improve FF management, especially among younger patients with humerus or wrist FF. We confirmed a lower mortality among subjects received appropriate AFT.
{"title":"Effectiveness of an integrated hospital-community care pathway for fragility fractures’ secondary prevention: the PROMOTER-II study","authors":"Laura Bogliolo, Silvia Grignaschi, Catherine Klersy, Pietro Perotti, Simona Dalle Carbonare, Silvia Balduzzi, Michela Milanesi , Giuseppe Giuffrè, Carmelinda Ruggiero, Maria Cristina Caffetti","doi":"10.1007/s11657-025-01642-0","DOIUrl":"10.1007/s11657-025-01642-0","url":null,"abstract":"<div><h3>\u0000 <i>Summary</i>\u0000 </h3><p>As the global population ages, osteoporosis and fragility fractures (FF) are emerging health concerns worldwide. This study assesses the effectiveness of an integrated hospital-community pathway in improving prescription and adherence to anti-fracture treatment. Additionally, it analyzes the re-fracture rate and mortality at a 24-month follow-up from an index FF.</p><h3>Purpose</h3><p>Evaluate the effectiveness of an integrated healthcare pathway (IHCP) on appropriateness and adherence to anti-fracture treatment (AFT) in adults aged ≥ 50 years, hospitalized due to fragility fracture (FF). Re-fractures and mortality rates were explored as secondary outcomes.</p><h3>Methods</h3><p>Subjects aged 50 years and more, resident in the province of Pavia, Italy, were enrolled at the time of hospital admission due to major FF, in the period 2016–2018 and 2019–2020 before and after the implementation of the IHCP, respectively. Data were extracted from the administrative database of the Health Protection Agency of Pavia, starting from the index event and until 24 months. Data analyses were conducted for the primary and secondary outcomes. Univariate and multivariate Cox regression models were fitted.</p><h3>Results</h3><p>Among 9186 participants (74.7% women), aged 78 years, 12.7% initiated an AFT, and half of them (6.3%) within 6 months after the index FF. Comparing pre- and post- IHCP implementation phases, the appropriateness of AFT initiation increased in subjects with index humerus/wrist FF, oral AFT prescription decreased, while subcutaneous or intravenous treatments increased (<i>p</i> < 0.001). Total adherence to AFT slightly increased. The re-fracture rate was 5.2 per 100 person/year, with age, IHCP implementation, and hip FF associated with a higher likelihood of refracture. The mortality rate was 13.4 per 100 person/year, with age, male gender, IHCP, and hip fracture as independent risk factors. Appropriate AFT significantly reduced mortality compared to no treatment (HR 0.55), with one-year adherence showing the strongest benefit (HR 0.18). Adherent patients had threefold lower mortality than non-adherent ones. Hip and vertebral fractures had an increased death risk (<i>p</i> < 0.001) compared to wrist and/or humerus. AFT results in an effect modifier of the association between the site of FF and mortality risk (<i>p</i> = 0.003).</p><h3>Conclusion</h3><p>The implementation of an IHCP, based on a FLS integrated model, shows a tendency to improve FF management, especially among younger patients with humerus or wrist FF. We confirmed a lower mortality among subjects received appropriate AFT.</p></div>","PeriodicalId":8283,"journal":{"name":"Archives of Osteoporosis","volume":"21 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s11657-025-01642-0.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145762012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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