The relationship between the environment and diseases is a crucial and complex topic that has garnered significant attention in recent years. In our study, we also follow the thread and explore the correlation between microplastics (MPs) and osteoporosis (OP).

We found that MPs were detected in the blood samples of nearly all participants. Moreover, It was compelling that PVC and PET emerged as the most common MP polymers in our study. A verification process was conducted comparing the clinical data with the results of MPs detection. This analysis revealed a significant exposure risk to MPs from sources such as bottled water, take-out containers. Through molecular biology techniques, we confirmed that MPs have a significant toxic effect on osteoblasts and associated with abnormal gene expression.

MPs may be considered to have a potential correlation with the progression of OP.

Osteoporosis arising from estrogen deficiency is characterized by oxidative stress and cellular senescence accompanied by calcium loss and disrupted bone metabolism. The paracrine interaction between osteoblasts and osteoclasts, along with the ratio of receptor activator of nuclear factor-κB ligand (RANKL) to osteoprotegerin (OPG), play a pivotal role in maintaining bone homeostasis. Eldecalcitol (ED-71), a novel active form of vitamin D, can reduce the ratio of RANKL to OPG in osteoblasts. In this study, an ovariectomized (OVX) rat model was established in vivo, and a cell model was constructed in vitro using H₂O₂ to explore the specific mechanism by which ED-71 improved the release of RANKL/OPG in senescent osteoblasts. Mitochondrial dysfunction and calcium imbalance were identified as significant factors. Under oxidative stress conditions, ED-71 alleviated endoplasmic reticulum (ER) stress by decreasing the ratio of phosphorylated protein kinase R-like ER kinase (P-PERK/PERK), and augmented the expression levels of sarcoplasmic reticulum/endoplasmic reticulum calcium ATPase 2 (SCERA2) thereby promoting calcium uptake by the ER, enhancing ER calcium influx, and effectively ameliorating calcium homeostasis between the ER and mitochondria. Consequently, it mitigates mitochondrial calcium overload and associated dysfunction. In contrast, ED-71 increased the expression of silent information regulator 1 (SIRT1) and phosphorylated AMP-activated protein kinase (P-AMPK). This alleviates mitochondrial dysfunction and promotes adenosine triphosphate (ATP). The combined effects of these two factors synergistically contribute to the improvement in osteoblast senescence.

Osteoporosis (OP) is a systemic skeletal disease commonly found in women after 55 years old and men after 65 years old. With the worldwide aging of population, its prevalence rate is increasing rapidly, bringing huge financial burdens to all countries. As a potential alternative to the conventional OP therapeutics with limited efficacies and side effects, a linear peptide FRATtide capable of binding with phosphorylated GSK3β has been discovered by us to inhibit osteoclastogenesis thus reduce bone loss. While its poor proteolytic stability and osteoclast targetability hinder its effective in vivo treatment. As such, bacterial extracellular vesicles secreted by the rationally recombinant probiotics Escherichia coli Nissle 1917 that express pre-osteoclast fusion protein DC-STAMP (BEV-DCS) are engineered and exploited as delivery vehicles. The BEV-DCS not only protect FRAT from enzymatic degradation but also enable its targeted intracellular delivery into pre-osteoclasts. On the ovariectomy mouse model, the FRAT encapsulated BEV-DCS (FRAT@BEV-DCS) exhibit remarkable bone targeting capacity and osteoporosis ameliorating efficacy without any obvious toxicity. These results reveal the great potential of FRAT@BEV-DCS as a novel therapeutic option for the effective and safe OP treatment.

Postmenopausal osteoporosis (PMOP), a prevalent skeletal disorder among women post-menopause, has emerged as a pressing global public health concern. Exosomes derived from serum have exhibited encouraging therapeutic potential in addressing PMOP, albeit with underlying mechanisms requiring deeper exploration. To elucidate these mechanisms, we devised a mouse model by surgically inducing ovariectomy and isolated exosomes from serum samples. Subsequently, we employed qRT-PCR, Western blotting, and immunofluorescence analysis to quantify relevant gene and protein expression patterns. To assess the biological effects on treated cells and tissues, we utilized ARS staining, oil red O staining, and micro-CT analysis. Additionally, we examined the METTL3/FOXO1 m6A site interaction and the FOXO1/YTHDF1 complex using dual-luciferase reporter assays and RIP assays. The m6A modification levels of FOXO1 were quantified via MeRIP-PCR. Furthermore, we engineered bone marrow mesenchymal stem cell exosomes by loading abundant METTL3 mRNA and decorating their surfaces with bone-targeting peptides. The successful synthesis and bone-targeting capabilities of these modified exosomes were validated through electron microscopy, in vivo imaging, and immunofluorescence staining. Our findings reveal that METTL3, in collaboration with YTHDF1 within serum-derived exosomes, enhances FOXO1 gene transcription by fostering m6A modification of FOXO1. This, in turn, promotes osteogenic differentiation of bone marrow mesenchymal stem cells while inhibiting lipogenic differentiation. Notably, our engineered exosomes, BT-oe-METTL3-EXO, not only harbor high levels of METTL3 but also demonstrate exceptional bone-targeting efficiency. In vitro studies demonstrated that BT-oe-METTL3-EXO significantly mitigated bone mass loss induced by ovariectomy in mice, bolstered osteogenic differentiation of mouse bone marrow mesenchymal stem cells, and inhibited lipogenic differentiation. Collectively, our research underscores the pivotal regulatory function of serum-derived exosomes in human bone marrow stem cells (hBMSCs) and underscores the promising therapeutic potential of BT-oe-METTL3-EXO for combating postmenopausal osteoporosis.

Type 2 diabetes (T2D) correlates with an elevated risk of osteoporotic fractures. However, factors influencing bone mineral density (BMD) and trabecular bone score (TBS) in Chinese individuals with T2D remain unclear. This study aimed to investigate the clinical and biochemical determinants of BMD and TBS in patients with T2D, with a focus on elucidating the role of weight-adjusted waist index (WWI) in modulating bone mass and quality in this cohort.

Data of 161 women and 153 men with T2D collected between July 2022 and March 2023 in Shenzhen, China, were analyzed in our cross-sectional study. Lumbar spine BMD and TBS of all participants were obtained using dual-energy X-ray absorptiometry. WWI was defined as waist circumference over the square root of weight.

Multivariate regression analysis demonstrated that lumbar spine TBS was inversely correlated with age, menopausal status, and WWI in women (p < 0.05). In men, TBS was negatively associated with age and WWI (p < 0.05). For women, glycated hemoglobin A1c positively influenced BMD (p < 0.05), whereas age, diabetic retinopathy, and N-mid osteocalcin were negatively associated. No significant predictors of BMD were identified in the male cohort. For predicting degraded TBS, the optimal WWI cut-offs were 11.257 cm/√kg (S: 61.1%, E: 80.7%) in males and 11.247 cm/√kg (S: 70.3%, E: 71.1%) in females.

Our findings highlight WWI as a novel and potentially more precise indicator of body fat, associated with diminished bone quality rather than solely low bone mass in patients with T2D in China. These results suggest that evaluating bone health in individuals with higher WWI may require more than just bone mass assessment. The results also suggest that the optimal WWI cut-off points for predicting degraded TBS are approximately 11.25 cm/√kg, highlighting thresholds for fracture risk.

Advanced glycation end products (AGEs) are associated with osteoporosis (OP) in the diabetic population. However, their relationship with OP in the non-diabetic population remains unclear. This study aimed to investigate cross-sectional associations of AGEs levels in the skin and lens with OP in the non-diabetic population. A retrospective analysis of clinical data of 652 participants was conducted. Bone mineral density (BMD) was quantified by dual-energy X-ray absorptiometry. Lens and skin AGEs were assessed by lens and skin autofluorescence (LAF and SAF). This study included 652 individuals, 280 males (42.9%) and 372 females (57.1%), with a mean age of (55.5 ± 6.9) years. The population with osteopenia exhibited significantly higher levels of SAF-AGEs than those with normal BMD, while the population with OP had significantly higher levels of both SAF- and LAF-AGEs. After adjusting for age and body mass index, LAF-AGEs were negatively correlated with BMD at the femoral neck and total hip. In contrast, SAF-AGEs were negatively correlated with BMD at the lumbar1-4 spine. Furthermore, multiple linear stepwise regression analysis demonstrated that LAF-AGEs were negatively associated with BMD at both the femoral neck and total hip. However, SAF-AGEs showed no association with BMD at any of the three measured sites. Additionally, after adjusting for other covariates, the logistic regression analysis emphasized that LAF-AGEs were associated with OP in the non-diabetic population, but SAF-AGEs do not. The results revealed a significant correlation between LAF-AGEs and OP in the non-diabetic population and their potential clinical utility warrants further validation. Therefore, we urge for larger longitudinal analyses and experimental research to validate and extend these cross-sectional findings.

Growing evidence indicates an interesting interplay between kidney and bone. The pathophysiological condition of the skeletal system is intricately associated with the normal functioning of the kidneys. This relationship is modulated by various factors, including calcium and phosphate, 1-α-hydroxylase, erythropoietin (EPO), klotho, fibroblast growth factor 23 (FGF23), bone morphogenetic protein-7 (BMP-7), and extracellular vesicles (EVs). These interactions are notably evident in conditions such as chronic kidney disease with bone mineral density (CKD-BMD), renal osteodystrophy (ROD), and osteoporosis (OP). Furthermore, innovative methodologies such as cell co-culture, organ-on-a-chip, single-cell sequencing, and spatial transcriptomics are highlighted as instrumental in advancing the study of inter-organ interactions. This review, grounded in the pathogenesis, diagnostic and therapeutic modalities, and pharmacological treatments of OP, synthesizes evidence from molecular biology to clinical perspectives. It aims to establish a foundation for the development of more complex and physiologically relevant in vitro models and to propose potential therapeutic strategies.

Vertebral fractures are linked to significant disability and mortality risks. Yet, existing studies on their global burden are outdated and lack predictive foresight.

Public data from the 2021 GBD study were analyzed to assess the global burden and epidemiological trends of vertebral fractures. The annual percentage change (EAPC) was calculated to represent temporal trends from 1990 to 2021. Machine learning was used to predict the global burden of vertebral fractures over the next 30 years.

From 1990 to 2021, the global burden of vertebral fractures significantly decreased. The age-standardized incidence rates (ASIR) showed the largest decline in Eastern Sub-Saharan Africa (EAPC: -1.5; 95% CI: -2.0 to -1.0), while North Africa and the Middle East were the only regions to report an increase (EAPC: 0.3; 95% CI: 0.1 to 0.5). For age-standardized prevalence rates (ASPR), High-income Asia Pacific saw the steepest decline (EAPC: -1.4; 95% CI: -1.5 to -1.2), while the Caribbean experienced the largest increase (EAPC: 0.8; 95% CI: 0.4 to 1.3). Similarly, in terms of age-standardized years lived with disability rates (ASYR), the most substantial reduction occurred in High-income Asia Pacific (EAPC: -1.4; 95% CI: -1.5 to -1.3), with the Caribbean again showing the greatest rise (EAPC: 0.8; 95% CI: 0.3 to 1.2). Males generally exhibited higher age-standardized rates (ASRs) than females, although females aged 65-70 years old surpassed males. Predictive models suggest continued declines in global ASIR, ASPR, and ASYR by 2050.

Our study shows a steady reduction in the global burden of vertebral fractures from 1990 to 2021. Nevertheless, disparities remain across regions, with a positive correlation between ASRs with SDI.

Leisure activities (LAs) are vital for healthy ageing and are linked to lower mortality risk in older adults. However, most previous longitudinal studies have assessed LAs at only one time point. We aimed to explore the impact of dynamic changes in LAs on subsequent all-cause mortality among older adults.

We enrolled 21 262 older adults who had participated in the six waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) in 1998, 2000, 2002, 2005, 2008, and 2011. All participants completed two consecutive assessments of LAs (including seven typical activities) during the first two waves (mean interval = 2.72 years (standard deviation = 0.08)); we further followed them up until 2018, i.e. beyond the 2011 CLHLS. We divided them into five categories according to the change pattern of LAs: stable low (low-low), stable moderate (moderate-moderate), stable high (high-high), LAs increase (low-moderate, low-high, moderate-high), and LAs decrease (high-moderate, high-low, moderate-low). We used a Cox proportional hazard model to test the association between changes in LAs and all-cause mortality, including demographic characteristics, health behaviours, and disease history as covariates.

We documented 15 065 death events during 80 045.39 person-years of follow-up. Compared with the stable moderate group, the adjusted hazard ratios (aHRs) of mortality for the stable low group and stable high group were 1.27 (95% confidence interval (CI) = 1.21-1.35) and 0.66 (95% CI = 0.62-0.71), respectively. An increase in LAs was associated with a lower risk of mortality (aHR = 0.83; 95% CI = 0.78-0.88), while a decrease in LAs was associated with a higher risk of mortality (aHR = 1.05; 95% CI = 1.01-1.09). The protective effect of LAs increase on premature death was more pronounced in men than in women. The main results remained stable in subgroup and sensitivity analyses.

Maintaining and increasing participation in leisure time activities significantly reduced the risk of all-cause mortality in community-dwelling older individuals in our sample.

To investigate the Wnt signaling pathway and miRNAs mechanism of extracts of Plastrum Testudinis (PT) in the treatment of osteoporosis (OP).

Thirty female Sprague Dawley rats were randomly divided into 5 groups by random number table method, including sham group, ovariectomized group (OVX), ovariectomized groups treated with high-, medium-, and low-dose PT (160, 80, 40 mg/kg per day, respectively), with 6 rats in each group. Except for the sham group, the other rats underwent bilateral ovariectomy to simulate OP and received PT by oral gavage for 10 consecutive weeks. After treatment, bone mineral density was measured by dual-energy X-ray absorptiometry; bone microstructure was analyzed by micro-computed tomography and hematoxylin and eosin staining; and the expressions of osteogenic differentiation-related factors were detected by immunochemistry, Western blot, and quantitative polymerase chain reaction. In addition, Dickkopf-1 (Dkk-1) was used to inhibit the Wnt signaling pathway in bone marrow mesenchymal stem cells (BMSCs) and miRNA overexpression was used to evaluate the effect of miR-214 on the osteogenic differentiation of BMSCs. Subsequently, PT extract was used to rescue the effects of Dkk-1 and miR-214, and its impacts on the osteogenic differentiation-related factors of BMSCs were evaluated.

PT-M and PT-L significantly reduced the weight gain in OVX rats (P<0.05). PT also regulated the bone mass and bone microarchitecture of the femur in OVX rats, and increased the expressions of bone formation-related factors including alkaline phosphatase, bone morphogenetic protein type 2, collagen type I alpha 1, and runt-related transcription factor 2 when compared with the OVX group (P<0.05 or P<0.01). Meanwhile, different doses of PT significantly rescued the inhibition of Wnt signaling pathway-related factors in OVX rats, and increased the mRNA or protein expressions of Wnt3a, β-catenin, glycogen synthase kinase-3β, and low-density lipoprotein receptor-related protein 5 (P<0.05 or P<0.01). PT stimulated the osteogenic differentiation of BMSCs inhibited by Dkk-1 and activated the Wnt signaling pathway. In addition, the expression of miR-214 was decreased in OVX rats (P<0.01), and it was negatively correlated with the osteogenic differentiation of BMSCs (P<0.01). MiR-214 mimic inhibited Wnt signaling pathway in BMSCs (P<0.05 or P<0.01). Conversely, PT effectively counteracted the effect of miR-214 mimic, thereby activating the Wnt signaling pathway and stimulating osteogenic differentiation in BMSCs (P<0.05 or P<0.01).

PT stimulates bone formation in OVX rats through β-catenin-mediated Wnt signaling pathway, which may be related to inhibiting miR-214 in BMSCs.

Osteoporosis is the most common metabolic skeletal disorder of the skeleton, stemming from a cellular imbalance between bone formation by osteoblasts and bone resorption by osteoclasts. This imbalance causes bones to become weak and brittle, thus increasing the risk of fractures. The prevalence of osteoporosis escalates with advancing age, thereby presenting a considerable public health challenge that has elicited substantial public concern. Existing anti-osteoporotic drugs typically act by inhibiting bone resorption, promoting bone formation, and exerting a dual effect. Yet, most of these pharmaceuticals have fundamental limitations, such as targeting only one specific site and a tendency to cause side effects. With advancements in anti-osteoporotic medications, numerous new small-molecule drugs have been developed and synthesized. These novel active compounds exhibit good anti-osteoporotic activity both in vitro and in vivo by enhancing osteoblast differentiation and mineralization, as well as inhibiting osteoclast resorption. The present study seeks to review the development and current status of new compounds exhibiting anti-osteoporotic activity, to establish a solid foundation for preventing and treating osteoporosis, promoting pharmacological research, and aiding in developing new medications.

Quantitative computed tomography (QCT) has received growing attention for its utility in bone mineral density (BMD) assessment and osteoporosis diagnosis.

To assess the accuracy and precision of lumbar spine BMD measurements obtained using low-dose iCare QCT, based on the European Spine Phantom (ESP).

Paired t-test was employed to compare BMD values measured under normal-dose and low-dose scan protocols using Mindways and iCare QCT systems. Accuracy was evaluated using relative measurement error (RME), and precision was assessed via relative standard deviation (RSD). Pearson correlation coefficients and Bland-Altman analysis were used to examine measurement correlation and agreement.

For Mindways QCT, RMEs of L1-L3 were 11.89%, 6.94%, and 6.72% under normal-dose, and 6.65%, 10.5%, and 6.31% under low-dose, respectively. For iCare QCT, RMEs were 1.21%, 4.28%, and 8.88% under normal-dose, and 2.14%, 4.96%, and 8.59% under low-dose, respectively. RSDs of L1-L3 for Mindways QCT were 5.16%, 2.85%, and 0.47% under normal-dose, and 9.08%, 4.69%, and 0.49% under low-dose, respectively. For iCare QCT, RSDs were 1.11%, 0.81%, and 0.45% under normal-dose, and 2.34%, 0.85%, and 0.33% under low-dose, respectively. The radiation dose in the low-dose protocol was significantly reduced compared with the normal-dose protocol.

Low-dose iCare QCT exhibited high accuracy and precision in measuring lumbar spine BMD, achieving an approximately 85% reduction in radiation dose. These findings highlight its potential as a safer and reliable tool for clinical application.

Osteoporosis (OP) is a major metabolic bone disease with significant health and socioeconomic impacts. The triglyceride-glucose (TyG) index and its derivatives, which reflect insulin resistance (IR), may play a role in bone metabolism. However, the relationship between TyG indices and OP is unclear. This study aimed to explore the association between TyG indices and OP in a low-income rural Chinese population.

This cross-sectional study was conducted in rural Tianjin, China, in 2020. Participants aged 60 years or older were included. Data were collected through interviews, including sociodemographic and clinical information, and physical examinations. Bone mineral density (BMD) of the femoral neck was measured using dual-energy X-ray absorptiometry (DXA). Multivariate regression models and restricted cubic spline (RCS) curves were used to assess the relationships between TyG indices and OP.

A total of 437 individuals were included in the final analysis, with 38 diagnosed with osteoporosis (prevalence of 8.7%). After adjusting for all covariates, each 1-unit increase in triglyceride-glucose-body mass index (TyG-BMI) was associated with a 2% lower risk of osteoporosis, (OR: 0.98, 95% CI: 0.96-1.00, P=0.029), especially in women, individuals with hypertension, and non-diabetic populations. The OP risk of the fourth quartile (Q4) of the triglyceride-glucose-waist circumference (TyG-WC) index after correcting for all covariates is 5.58 times that of the first quartile (Q1)(OR: 5.58, 95% CI: 1.14-27.41, P=0.034). Linear regression showed a positive correlation between TyG-BMI and BMD, particularly in women, individuals under 70, and those with hypertension or non-hypertension, with the strongest correlation in the non-hypertensive group.

TyG-related indices are associated with OP, suggesting a potential role in the early prevention and management of osteoporosis in this population, ultimately improving public health outcomes.

Osteoporosis is a chronic disease of bone metabolism with high incidence rates. Recently, exosome therapy has emerged as a promising avenue for the treatment of osteoporosis. However, the role of autophagy-induced osteoblast-derived exosomes (Auto-exo) in osteoporosis has yet to be elucidated.

The effect of Auto-exo in bone formation was assessed in vivo. The composition of gut microbiota was determined through 16S rDNA sequencing, and metabolite profiles were analyzed using liquid chromatography-mass spectrometry (LC-MS). Cell experiments were conducted to explore the role of bilirubin in bone formation.

Auto-exo were successfully isolated and identified. Auto-exo promoted bone formation and alleviated osteoporosis progression in a mouse model of osteoporosis. 16S rDNA sequencing revealed that Auto-exo changed diversity and composition of gut microbiota in osteoporotic mice, with a notable increase in Lactobacillus and a decrease in Dubosiella and Faecalibaculum. LC-MS analysis indicated that Auto-exo treatment reduced the elevated levels of bilirubin in osteoporotic mice. Cell experiments uncovered that bilirubin remarkably inhibited osteoblast differentiation. Furthermore, Auto-exo promoted osteoblast differentiation via inhibiting bilirubin production.

Our findings demonstrated that Auto-exo promoted bone formation by modulating the gut microbiota-metabolites bilirubin axis, thereby alleviating osteoporosis progression. This discovery provides a novel perspective on the mechanisms underlying the therapeutic effects of Auto-exo in osteoporosis.

Few studies have explored the association between the triglyceride-glucose (TyG) index and lumbar bone mineral density (BMD) across different skeletal sites in individuals with osteoporotic fractures (OPFs). The objective of this research was to investigate the relationship between the TyG index and lumbar BMD in individuals with OPFs. Conducted at the Affiliated Kunshan Hospital of Jiangsu University between January 2017 and March 2024, this retrospective cross-sectional study involved 950 OPFs patients requiring hospitalization or surgery. In this study, lumbar BMD the dependent variable, while the TyG index served as the independent variable. Generalized estimating equations (GEE) were used to evaluate the association between the TyG index and lumbar BMD levels. The generalized additive model (GAM) was employed to explore non-linear associations. In the all-adjusted models, a positive association was found between the TyG index and lumbar BMD among the patients with OPFs (β = 0.027; 95% confidence interval [CI] 0.011-0.042; P-value < 0.001). Similar results were observed across the four quantiles of the TyG index, Q4 (β = 0.045; 95% confidence interval [CI] 0.019-0.072; P-value < 0.001). A highly uniform pattern was noted across these findings. The evidence-based discovery of the relationship between the TyG index and lumbar BMD could inform clinical practices, particularly in the assessment and management of bone health in patients with OPFs.

Osteoporosis (OP) is the second most detrimental chronic disease, and thus novel diagnostic and therapeutic approaches are needed. In recent years, there has been an increased emphasis on the utilization of gut microbiota (GM) in the context of OP. However, a comprehensive bibliometric analysis on this subject is currently lacking. Furthermore, a deeper exploration of the role of GM in bone health is imperative, and there is a pressing need to foster international and inter-agency exchange and experience in this field. Accordingly, this study aimed to provide an overview of the research trends in this field and propose suggestions for related scientific and technological research and development.

The Web of Science database was searched for articles related to both GM and OP. Statistical analyses and data visualization were performed using the EXCEL and CiteSpace software.

China exhibited the highest number of publications, followed by the United States. NUTRIENTS and Sichuan University were identified as the journal and institution, respectively, with the highest number of articles. Notably, the keywords "gut microbiota" and "bone loss" have been increasingly used in publications.

In conclusion, this study fills the existing gap in the literature and contributes valuable insights to the understanding of the relationship between GM and OP.

The impact of fatty liver disease on lumbar bone mineral density (BMD) represents an intriguing area of study, particularly in light of established research linking obesity to bone metabolism. However, there remains limited investigation into the correlation between quantifying liver fat content (LFC) and lumbar BMD among overweight and obese populations, particularly within the Chinese demographic. This study aims to accurately quantify LFC and investigate its association with lumbar BMD in overweight or obese individuals.

This cross-sectional study was conducted at the Health Management Center of Henan Provincial People's Hospital from January 2019 to February 2023, involving 6996 participants with a body mass index (BMI) of 24 kg/m² or higher. LFC and lumbar BMD were assessed using computed tomography. The study utilized one-way ANOVA, subgroup analysis, multifactor regression analysis, smooth curve fitting, and threshold and saturation effect analysis to explore the relationship between LFC and lumbar BMD. Furthermore, inflammatory cell analysis was included to investigate the potential mediating role of inflammatory cells in the association between LFC and lumbar BMD.

After adjusting for confounding variables, multivariate regression analysis revealed a significant negative association between LFC and lumbar BMD (β = -0.323, 95% CI: -0.464 to -0.183, P < 0.001). Particularly, participants in the highest baseline LFC quartile (Q4 group) exhibited a more pronounced negative impact on lumbar BMD compared to those in the lowest quartile (Q1 group) (β = -5.026, 95% CI: -7.040 to -3.012, P < 0.001). Threshold saturation effect analysis identified a turning point in the LFC-BMD relationship (K = 5.4). Below this point, LFC showed a positive correlation with lumbar BMD (β = 0.962, 95% CI: 0.016-1.907, P < 0.05), whereas above it, LFC was significantly negatively correlated with lumbar BMD (β = -0.405, 95% CI: -0.558 to -0.253, P < 0.001). Additionally, mediation analysis indicated that leukocytes and monocytes potentially mediated the association between LFC and lumbar BMD, with mediation ratios of -5.78 and -6.68%, respectively.

Among individuals categorized as overweight or obese, elevated levels of LFC were associated with reduced lumbar BMD, particularly noticeable above a threshold of 5.4%. Additionally, various types of inflammatory cells are presumed to exert a substantial mediating influence on the correlation between LFC and lumbar BMD.

Based on the population of postmenopausal women with osteoporotic vertebral compression fractures (OVCFs), this study aimed to identify the optimal and alternative levels of vertebral CT Hounsfield units (HU) for osteoporosis and osteoporosis-related complication assessment, establish age-specific reference intervals (RIs) of HU values, and validate its quantitative predictive value for new vertebral fractures (NVFs) after percutaneous kyphoplasty (PKP).

Consecutive postmenopausal women diagnosed with OVCFs at our department between January 2016 and August 2024 were retrospectively reviewed. The vertebral HU of T12-L2 was measured on CT images by two independent spine surgeons twice, with a 2-week interval. The segmental average HU was assessed in terms of the representativeness of overall osteoporotic status, reproducibility, and association with clinical outcomes to identify the optimal and alternative levels. Age-specific RIs were built using the indirect Hoffmann method. The associations between HU and NVFs were assessed by correlation, receiver operator characteristic (ROC) curve, and multivariate analyses.

A total of 922 patients were enrolled in the optimal level identification and RI establishment study. Intraclass correlation coefficient (ICC) between segmental and average HU values was the highest at L1 (ICC, 0.970), followed by T12 (ICC, 0.955) and L2 (ICC, 0.955) in the whole population. The age-specific RIs determined in postmenopausal women with primary OVCFs were 39.22-170.92 HU (56-65 years), 21.23-132.48 HU (66-75 years), and 11.15-108.85 HU (> 75 years) at T12; 37.25-156.46 HU (56-65 years), 17.83-123.68 HU (66-75 years), and 10.71-103.59 HU (> 75 years) at L1; and 30.88-148.28 HU (56-65 years), 9.61-121.00 HU (66-75 years), and - 1.67 to 99.65 HU (> 75 years) at L2. Significant weak negative correlations were found between NVFs and average/segmental HU value (Spearman r, - 0.146 to - 0.245, P < 0.05), and risks of nonadjacent NVFs, fracture cascade, and overall NVFs after PKP increased in the individuals with decreases in HU (particularly at L1).

This study identified the optimal and alternative levels of CT HU value in postmenopausal women with OVCFs and established its corresponding age-specific RIs. Furthermore, we validated that low HU value posed high risks of NVFs after PKP and quantitatively clarified the dynamic trend of their association. This study may provide inspiration and a novel methodological approach for further research on osteoporotic diseases.

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.

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

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.

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.

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.

This study aimed to investigate the predictive value of the weight-adjusted waist index (WWI) for osteoporosis in postmenopausal patients with type 2 diabetes mellitus (T2DM). This cross-sectional study included 229 postmenopausal patients with T2DM (mean age 64.53 ± 7.4 years). Collect anthropometric data. Bone mineral density (BMD) of the lumbar spine and femoral necks was measured using dual-energy X-ray absorptiometry. Calculate WWI and Osteoporosis Self-Assessment Tool for Asians (OSTA). Use SPSS 25.0 to analyze data employing binary logistic regression and the receiver operating characteristic (ROC) curve. WWI in osteoporosis group was significantly higher than that in non-osteoporosis group (11.54 ± 0.82 vs. 11.07 ± 0.73, P = 0.000), while the OSTA was significantly lower in osteoporosis group compared to non-osteoporosis group (- 1.40 (- 2.8, 0.40) vs. 0.10 (- 1.45,1.80), P = 0.000). Binary logistic regression analysis indicated that the risk of osteoporosis in WWI ≥ 11.55 group was 3.158 times higher than that in WWI < 11.55 group (95% CI 1.714-5.820, P = 0.000). The risk in OSTA ≤ - 1 group was 3.935 times higher than that in OSTA > - 1 group (95% CI 2.168-7.141, P = 0.000). The area under the ROC curve for OSTA and WWI in predicting the risk of osteoporosis in postmenopausal patients with T2DM aged over 70 was 0.761 and 0.808, respectively, with sensitivities of 0.429 and 0.714. In postmenopausal patients with T2DM, WWI is closely associated with osteoporosis and negatively correlates with BMD. Among postmenopausal T2DM patients aged over 70, WWI may be superior to OSTA in predicting osteoporosis.

To investigate the changes in blood levels of calcium and bone metabolism biochemical markers in patients with primary osteoporosis receiving treatment with denosumab.

Seventy-three patients with primary osteoporosis treated in our Department between December, 2021 and December 2023 were enrolled. All the patients were treated with calcium supplements, vitamin D and calcitriol in addition to regular denosumab treatment every 6 months. Blood calcium, parathyroid hormone (PTH), osteocalcin (OC), type I procollagen amino-terminal propeptide (PINP), and type I collagen carboxy-terminal telopeptide β special sequence (β‑CTX) data before and at 3, 6, 9, and 12 months after the first treatment were collected from each patient.

Three months after the first denosumab treatment, the bone turnover markers (BTMs) OC, PINP, and β-CTX were significantly decreased compared to their baseline levels by 39.5% (P<0.001), 56.2% (P<0.001), and 81.8% (P<0.001), respectively. At 6, 9, and 12 months of treatment, OC, PINP, and β-CTX remained significantly lower than their baseline levels (P<0.001). Blood calcium level was decreased (P<0.05) and PTH level increased (P<0.05) significantly in these patients at months of denosumab treatment, but their levels were comparable to the baseline levels at 6, 9, and 12 months of the treatment (P>0.05).

Denosumab can suppress BTMs and has a good therapeutic effect in patients with primary osteoporosis, but reduction of blood calcium and elevation of PTH levels can occur during the first 3 months in spite of calcium supplementation. Blood calcium and PTH levels can recover the baseline levels as the treatment extended, suggesting the importance of monitoring blood calcium and PTH levels during denosumab treatment.

Increasing evidence has demonstrated that non-coding RNAs, including the lncRNA MIR155HG, are involved in the pathogenesis of postmenopausal osteoporosis (PMOP). In the current study, we studied MIR155HG function in regulation of osteogenic differentiation and tried to reveal the underlying mechanisms.

Forty blood samples taken from 20 PMOP patients (PMOP group) and 20 postmenopausal individuals without osteoporosis (control group) were used to compare the contents of MIR155HG and miR-155-5p via RT-PCR. Alizarin red S staining and ALP staining were used to evaluate the osteogenic differentiation potential of bone marrow mesenchymal stem cells (BMSCs).

Elevated levels of MIR155HG and miR-155-5p were observed in the blood samples of the PMOP group. Upregulation of MIR155HG resulted in decreased expression of OPN, OSX, ALP, RUNX2 and β-catenin but increased DKK1 expression, together with decreased Alizarin red S + and ALP + staining areas. However, downregulation of DKK1 did not obviously change the above indices induced by MIR155HG upregulation. Further experiments revealed that MIR155HG caused an increase in the expression of miR-155-5p, which also serves as an inhibitor of the osteogenic differentiation of BMSCs through binding to β-catenin. Consistent with DKK1 knockdown, downregulation of miR-155-5p only also did not obviously reverse the repressive effect of MIR155HG on osteoblastic differentiation, but downregulation of DKK1 and miR-155-5p synchronously restored the osteogenic differentiation ability of BMSCs suppressed by MIR155HG overexpression.

MIR155HG suppressed the osteoblastic differentiation of BMSCs by regulating miR-155-5p and DKK1 expression. Either inhibition of miR-155-5p and DKK1 or direct suppression of MIR155HG may be effective approaches for treating PMOP.

Osteoporotic bone defects significantly affect patient health and quality of life. The gut-bone axis plays a crucial role in osteoporosis, and disruptions in gut microbiota are linked to systemic inflammation and compromised bone metabolism. Irisin, a myokine, has shown potential in protecting against osteoporosis, but its mechanisms of action on the gut-bone axis remain unclear. This study aimed to investigate the role of irisin in mitigating osteoporotic bone defects by examining its effects on gut microbiota, related metabolites, and intestinal barrier integrity.

An osteoporosis model was created using ovariectomized (OVX) mice. The mice were divided into Sham, OVX, and r-irisin groups. Mice in the r-irisin group received intraperitoneal injections of 100 μg/kg irisin twice weekly for five weeks. Bone parameters were analyzed by micro-CT and histological staining. Gut microbiota composition was examined via 16S rDNA sequencing. Intestinal cytokines and barrier proteins were measured using immunohistochemistry and ELISA. Fecal metabolomic profiling was conducted using liquid chromatography-tandem mass spectrometry (LC-MS/MS), and correlations between gut microbiota, metabolites, and bone metabolism markers were evaluated.

Irisin treatment improved bone mineral density (BMD), bone volume/tissue volume (BV/TV), trabecular bone thickness (Tb.Th), and trabecular number (Tb.N), and reduced trabecular separation (Tb.Sp) in OVX mice. It enhanced new bone formation and collagen deposition. Irisin restored intestinal barrier integrity by increasing tight junction protein expression and reducing inflammatory cytokines in intestinal tissues. It also modulated gut microbiota diversity, reducing Firmicutes and increasing Verrucomicrobiota abundance. Key fecal metabolites, including atractylon (r = - 0.60, P < 0.01) and enterodiol (r = + 0.83, P < 0.01), showed strong correlations with BMD.

Irisin mitigates osteoporotic bone defects by enhancing bone formation, restoring intestinal barrier integrity, modulating gut microbiota composition, and influencing fecal metabolites. These preclinical findings highlight irisin's potential to mitigate osteoporosis via the gut-bone axis.

Neural EGFL-like 2 (NELL2) is a secreted protein known for its regulatory functions in the nervous and reproductive systems, yet its role in bone biology remains unexplored. In this study, we observed that NELL2 was diminished in the bone of aged and ovariectomized (OVX) mice, as well as in the serum of osteopenia and osteoporosis patients. In vitro loss-of-function and gain-of-function studies revealed that NELL2 facilitated osteoblast differentiation and impeded adipocyte differentiation from stromal progenitor cells. In vivo studies further demonstrated that the deletion of NELL2 in preosteoblasts resulted in decreased cancellous bone mass in mice. Mechanistically, NELL2 interacted with the FNI-type domain located at the C-terminus of Fibronectin 1 (Fn1). Moreover, we found that NELL2 activated the focal adhesion kinase (FAK)/AKT signaling pathway through Fn1/integrin β1 (ITGB1), leading to the promotion of osteogenesis and the inhibition of adipogenesis. Notably, administration of NELL2-AAV was found to ameliorate bone loss in OVX mice. These findings underscore the significant role of NELL2 in osteoblast differentiation and bone homeostasis, suggesting its potential as a therapeutic target for managing osteoporosis.

This study aimed to assess the impact of different anesthesia methods on postoperative outcomes of lower limb surgeries in elderly patients over 90 years old.

We retrospectively reviewed the medical records of elderly patients over 90 years old who underwent lower limb surgeries at Chongqing University Center Hospital, the Affiliated Hospital of Southwest Medical University, and Chongqing General Hospital from January 2012 to December 2022. The patients were categorized into two groups based on the anesthesia method employed: the general anesthesia (GA) group and the regional anesthesia (RA) group. To minimize potential confounding, propensity score matching (PSM) was conducted in a 1:1 ratio with the caliper value set as 0.1; additionally, further univariable logistic regression was employed to compare the risk of postoperative complications and mortality between the GA and RA groups.

A total of 560 patients were included in our analysis, with 363 cases receiving general anesthesia (GA) and 197 cases receiving regional anesthesia (RA). After conducting propensity score matching (PSM), 139 pairs of data were successfully matched. Compared with the RA group, the GA group had a higher risk of postoperative complications (32.4% vs. 19.4%;OR,1.99; 95% CI, 1.15-3.44; p = 0.015), a higher risk of postoperative ICU admission (44.6% vs. 20.9%;OR,3.05; 95% CI,1.80-5.18;p < 0.001), but a lower risk of intraoperative blood transfusion (46% vs. 59%;OR,0.59; 95% CI,0.37-0.95;P = 0.031).No statistically significant differences were observed in other perioperative indices between the two groups.

In elderly patients over 90 years old undergoing lower limb fracture surgeries, GA is associated with a higher risk of postoperative complications and ICU admission compared to RA. Furthermore, compared with RA, GA is associated with a decreased need for intraoperative blood transfusion.

The study was registered in the Chinese Clinical Trial Registry (ChiCTR2400083103, principal investigator: Hong Fu, 14/04/2024).

Klotho, a protein known for its significant involvement in the aging process and age-related diseases, has been demonstrated to be inextricably linked to osteoporosis. Nevertheless, the relationship between serum Klotho levels and mortality risk among individuals with osteoporosis has not been definitively established. Therefore, the purpose of the current research is to examine the potential relationship between serum Klotho levels and mortality risk in individuals aged 40 and above with osteoporosis.

The current study included adults aged 40 years and older diagnosed with osteoporosis from the National Health and Nutrition Examination Survey. Osteoporosis diagnosis was based on a history of osteoporosis or bone mineral density. Moreover, Cox proportional hazards regression, Kaplan-Meier (KM) curves, and restricted cubic spline (RCS) curves were utilized to assess the relationship between Klotho levels and mortality risk. In addition, subgroup analysis was performed using stratification and interaction analysis for all covariates.

A total of 1004 participants (median age: 65 years) with a median follow-up of 9.33 years were included in the final analysis. This study found that serum Klotho levels established a U-shaped relationship with the risk of all-cause mortality in individuals with osteoporosis, with a nadir of Klotho levels was approximately 900 pg/mL, in which lower (< 850 pg/mL) or higher (> 950 pg/mL) Klotho levels were significantly associated with an increased risk of all-cause mortality. Moreover, the results of subgroup analysis indicated that the associations between Klotho levels and mortality risk were modified by several factors, especially a history of hypertension. Specifically, Klotho levels established an L-shaped relationship with the risk of all-cause mortality among participants with a history of hypertension, while a positive and linear relationship with the risk of all-cause mortality among those without a history of hypertension.

For individuals with osteoporosis, it is necessary to be alert to cases with high or low Klotho levels, which may potentially indicate an increased mortality risk.

To compare and analyze the clinical effects of acupuncture-related therapies for postmenopausal osteoporosis (PMOP) and propose the optimal scheme, we utilized a network meta-analysis to evaluate the therapeutic effects of various commonly used acupuncture methods for PMOP.

Randomized controlled trials of acupuncture-related therapies for PMOP were searched in eight databases (PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, China Science and Technology Journal Database, China Biomedical Literature Database, and Wanfang database) from January 1, 2002 to December 31, 2023. Our primary outcomes included overall clinical effectiveness rate, bone mineral density (BMD), and visual analog scale scores (VAS). The secondary outcome is adverse events. The entire process of literature screening and data analysis was conducted by 2 independent investigators.

A total of 30 studies with 2,342 participants provided data suitable for analysis. We compared six interventions: manual acupuncture, electroacupuncture, acupoint catgut embedding, moxibustion, acupoint application, and warm acupuncture. The results of the network meta-analysis revealed that, when compared to conventional Western medication (CWM), multiple acupuncture therapies had a greater impact on the overall clinical effectiveness rate. Electroacupuncture combined with CWM demonstrated superior clinical effectiveness and lumbar spine BMD improvement. Moxibustion with CWM ranked highest for femoral neck BMD, while warm acupuncture showed optimal effects on Ward's triangle and trochanter BMD. Acupoint catgut embedding provided the greatest pain reduction. The most prevalent minor adverse effects included hematoma, discomfort, and scorching.

The results suggest that several acupuncture-related therapies, either alone or in conjunction with CWM, outperform CWM alone and may be regarded as an alternative or supplementary therapy to PMOP, though higher-quality trials are needed.

This study provides a comprehensive analysis of the global incidence, prevalence, and years lived with disability (YLDs) attributable to vertebral fractures from falls among individuals aged 55 and older between 1990 and 2021, with trends further delineated by gender, geographic region, and socio-demographic index (SDI).

This study utilized data from the 2021 Global Burden of Disease (GBD) study, focusing on trend changes and stratified characteristics of the burden of vertebral fractures caused by falls among individuals aged 55 and older.

In 2021, there were approximately 2.02 million new cases of vertebral fractures due to falls among individuals aged 55 and older globally, with 2.70 million prevalent cases and 264,211 YLDs. The age-standardized incidence rates (ASIR) in 2021 was 140.77 per 100,000, showing an increase compared to 1990 (average annual percent change [AAPC]: 0.27; 95% confidence interval [CI]: 0.23 to 0.30), while the age-standardized prevalence rates (ASPR) and age-standardized years lived with disability rates (ASYR) exhibited a downward trend. Female patients had higher indicators than male patients, but the burden on male patients was increasing. The ASIR, ASPR, and ASYR in high SDI regions were positively correlated with SDI. High-income and densely populated regions and countries bore the greatest burden. Predictive analysis showed that the global burden of vertebral fractures will further increase between 2022 and 2035.

From 1990 to 2021, the burden of vertebral fractures due to falls among individuals aged 55 and older showed an upward trend. The burden on males may have been underestimated, and particular attention is required for high SDI regions, high-income areas like North America and Western Europe, as well as densely populated countries. With the aging population, vertebral fractures caused by falls require continued attention.

Low bone mineral density (BMD) impairs the stability of the bone-screw interface, which leads to screw loosening after spinal instrumentation. Quantitative computed tomography (QCT) and dual-energy X-ray absorptiometry (DXA) were applied to measure BMD of screw trajectories and other regions of the vertebrae in this paper, and the aim was to analyze the best effective tool and BMD of the best appropriate vertebral site to predict pedicle screw loosening after lumbar fusion surgery. 186 patients who underwent lumbar interbody fusion and pedicle screws placement were analyzed retrospectively. Patients were divided into 2 groups according to whether there was screw loosening: fissure is greater than or equal to 1 mm around the screws at follow-up CT scans. The volumetric BMD (vBMD) was measured by QCT in the central vertebral body, pedicle, and screw trajectory region, and DXA was applied for the lumbar spine and hip area BMD (aBMD). The overall pedicle screw loosening rate was 33.9% (63/186). Demographic data, health history, and the lumbar aBMD were not significantly different between the two groups. Multivariate analysis revealed showed that the hip aBMD, vBMD in the central vertebral body, pedicle, and screw trajectory regions were independent risk factors for screw loosening. Additionally, Receiver operating characteristic curve revealed the screw trajectory vBMD had the greatest area under the curve for predicting screw loosening. The screw trajectory vBMD using QCT had a stronger predictive value than the vBMD in other regions of the vertebrae and the hip aBMD, and had a more representative bone quality measurement in the bone-screw binding region.

Osteoporosis characterized by deteriorating bone loss is becoming one of the serious health problems globally. Vitamin B2, also known as riboflavin, exhibiting multiple prominent physiological traits such as antioxidant effects, reducing lipid peroxidation and regulating glutathione redox cycle, allows it to be a potential agent to improve bone loss. However, the relationship between dietary vitamin B2 intake and osteoporosis remains unelucidated. The objective of this study was to explore the association between the dietary intake of vitamin B2 and bone loss in the U.S. female adults using the National Health and Nutrition Examination Survey (NHANES) database.

Female participants with complete information on dietary vitamin B2 intake, dual-energy X-ray absorptiometry, and other essential covariates from NHANES database were included in the current study. Multivariable logistic regression and linear regression analyses were conducted to assess the relationships of dietary vitamin B2 intake with osteoporosis and bone mineral density (BMD) levels, respectively. Subgroup analyses, interaction tests, and restricted cubic spline (RCS) regression analyses were further used to verify the stability, robustness and potential nonlinearity of the association. Mediation analysis was performed to probe the role of serum alkaline phosphatase (ALP) in the aforementioned relationship, and the network pharmacology analysis was also conducted to determine the potential pathways and key targets for vitamin B2 regulating bone health.

A total of 4, 241 female participants from four NHANES cycles were included in this study. After multivariate adjustment, the intake of vitamin B2 was beneficially associated with reduced risk for femur osteoporosis (ORQ4 vs. Q1=0.613; 95%CI: 0.454-0.829). A higher intake of vitamin B2 (quartile 4) was significantly correlated with decreased risk of reduced femoral BMD levels, with the β being 0.020 (95%CI: 0.007-0.033), 0.015 (95%CI: 0.002-0.027), 0.020 (95%CI: 0.009-0.031) and 0.022 (95%CI: 0.006-0.037) for the BMD of total femur, femoral neck, trochanter, and intertrochanter, respectively (all P value < 0.05). Covariate total MET was found to modify the association between vitamin B2 intake and osteoporosis (P interaction = 0.0364), with the aforementioned relationship being more pronounced in the subgroup of insufficiently active individuals. Furthermore, RCS analysis revealed that vitamin B2 intake was positively and linearly associated with reduced risk for femoral OP and increased BMD levels of total femur, trochanter and intertrochanter, while positively and nonlinearly correlated with increased BMD level of femoral neck. Additionally, the association between vitamin B2 intake, osteoporosis and BMD levels was mediated by ALP, with a mediation proportion of 12.43%, 7.58%, 12.17%, 7.64%, and 6.99% for OP, total femur, femoral neck, trochanter, and intertrochanter BMD, respectively. Finally, network pharmacology analysis indicated that vitamin B2 regulating bone health mainly through pathways like HIF-1 signaling pathway, longevity regulating pathway, p53 signaling pathway, etc. CONCLUSIONS: Higher intake of vitamin B2 is positively associated with reduced risks for femoral osteoporosis and bone loss. Vitamin B2 may represent a modifiable lifestyle factor for the prevention and management of osteoporosis.

The lateral femoral wall is an important anatomical parameter of the proximal femur, but intramedullary nail fixation for intertrochanteric fractures may cause iatrogenic lateral wall fractures due to population-based design differences. This study aims to measure the anatomical parameters of the proximal femoral medullary cavity and provide data to help design intramedullary nails tailored to the Chinese population to reduce the risk of complications such as lateral wall fractures.

Consecutive patients undergoing full-length or upper half CT scans of the femur were included from January 2010 to December 2021. The anatomical parameters of medullary cavity were defined and measured, including prominence length, canal-shaft angle and proximal minimum diameter. Intraclass Correlation Coefficient (ICC) was used to estimate the inter- and intra-observer agreements.

A total of 168 patients, comprising 78 men and 90 women, were included. The mean prominence length was 67.4 ± 4.9 mm (males: 70.8 ± 3.6 mm, females: 64.4 ± 3.9 mm). The mean canal-shaft angle was 5.5° ± 0.7° (males: 5.6 ± 0.8°, females: 5.5 ± 0.7°). The mean proximal minimum diameter was 22.7 ± 1.8 mm (males: 24.0 ± 1.5 mm, females: 21.6 ± 1.4 mm) at the level of 1/3 prominence length from bottom to top. Gender differences were observed in these parameters (p < 0.001) except for the canal-shaft angle (p = 0.45). The mean proximal minimum diameter was significantly larger in the group aged 50 years and older (23.1 ± 1.7 mm) compared to the group younger than 50 years (22.4 ± 1.9 mm) (p = 0.02). Inter- and intra-observer agreement was almost perfect for all the parameters (all ICC values > 0.8).

Males have a longer prominence length and larger proximal minimum diameter than females. The proximal minimum diameter is larger in the older population than in the younger population. The measurement results help support the design of intramedullary nails tailored to the Chinese population.

Not applicable.

Lower limb fractures are a significant global public health issue, imposing considerable social and economic burdens. Despite their prevalence, comprehensive analyses of the global epidemiology of lower limb fractures remain scarce. This study aims to address this gap.

Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, we analyzed four types of lower limb fractures: fractures of foot bones excluding the ankle (FFB), hip fractures (FH), fractures of the patella, tibia or fibula, or ankle (FPTFA), and femur fractures excluding the femoral neck (FF), and conducted a detailed assessment of them.

FPTFA was the most burdensome fracture type, with Slovenia showing the highest age-standardized incidence rate (ASIR), and Saudi Arabia having the highest age-standardized prevalence rate (ASPR) and years lived with disability rate (ASYR). The burden of lower limb fractures increased with age, but FFB and FPTFA showed a "double peak" age distribution, with FFB most common in the 20-24 age group. Lower limb fractures were more prevalent in males among younger individuals and in females among older populations. From 1990 to 2021, the burden of lower limb fractures, excluding FH, decreased (EAPC <1), though the incidence of FF is projected to increase (EAPC = 0.14, 95 % CI 0.1-0.18) over the next decade.

Although the global burden of lower limb fractures, excluding FH, has decreased in recent years, vigilance is still needed. Given the projected rise in FF incidence over the next decade, preventive measures should be implemented early.

This study was aimed to explore the link between dietary zinc intake amount and prevalence of osteoporosis in middle-aged and elderly individuals.

A total of 31,034 participants included in the National Health and Nutrition Examination Survey (NHANES) 2005-2010 were detected, and 7355 participants aged ≥ 45 years with integral data were enrolled. Demographic information and dietary intake data were collected via platform of NHANES, and the odds ratio (OR) and 95% confidence interval (CI) of each dietary zinc intake amount tertile category and each unit increase of zinc were analyzed using logistic regression models. Receiver operating characteristic (ROC) curve was applied to determine the optimal cut-off value of dietary zinc intake amount for revealing the prevalence of osteoporosis.

Of 7355 participants with a mean age of 62.5 ± 11.2 years, 682 participants with osteoporosis were identified, and the dietary zinc intake amount of the osteoporosis group was significantly lower than that of the non-osteoporosis group (P < 0.001). By taking the lowest tertile category as reference category, a higher dietary zinc intake amount was noticed to be positively linked to lower odds for prevalence of osteoporosis. This tendency was not altered in univariate model (P < 0.001), as well as the adjustments for combination of different covariates (Model 1, Model 2, Model 3, and Model 4, P all < 0.05).

This NHANES-based study revealed that a lower dietary zinc intake amount was positively correlated to the prevalence of osteoporosis in middle-aged and elderly individuals among the US population.

This study explored the association between the hypersensitive C-reactive protein to albumin ratio (CAR) and fragility fractures in Chinese males. Results show that elevated levels of CAR were associated with an increased risk of fragility fractures and that this association was robust to adjustment for multiple potential confounders.

This study investigates the relationship between the hypersensitive C-reactive protein to albumin ratio (CAR) and fragility fractures in a Chinese male population.

A total of 48,186 male participants (age range 18-98 years old, average age 53.92 years) at baseline were recruited from the Kailuan Study and followed up for outcomes until 2022. The Cox proportional hazards model was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for incident fragility fractures. The dose response between CAR and fracture risk was analyzed using restricted cubic splines. Additionally, the concordance index (C-index), net reclassification index (NRI), and integrated discrimination improvement (IDI) were utilized to assess the incremental predictive value of various indicators for the discrimination of fragility fractures.

During an average follow-up of 11.17 years, 728 incident fragility fractures occurred among the 48,186 participants. Compared to participants in the second quartile of CAR, those in the highest quartile had a 49% increased risk of fragility fractures (HR = 1.49, 95% CI = 1.21-1.84) after adjusting for risk factors. Restricted cubic spline analysis showed a nonlinear relationship between CAR and the risk of fragility fractures. The C-index, continuous NRI, and IDI for predicting the risk of fragility fractures were 61.142%, 0.089 (p < 0.05), and 0.00009 (p < 0.05), respectively, which were higher than those of hs-CRP (C-index 0.6137, NRI 0.086, IDI 0.000074) and albumin (C- index 0.6116, NRI 0.068, IDI - 0.000004).

Elevated levels of CAR were associated with an increased risk of fragility fractures and that this association was robust to adjustment for multiple potential confounders.

Accurate assessment of thoracolumbar kyphosis (TLK) flexibility is paramount in preoperative planning for patients with symptomatic old osteoporotic thoracolumbar fractures (so-OTLF) exhibiting kyphotic deformity. While conventional standing hyperextension lateral radiographs (SHLR) are utilized, comparative analyses with prone computed tomography (CT) scout views in the sagittal plane remain limited. This study aims to evaluate and compare the efficacy of SHLR and full-length spine CT (FLS-CT) scout views in the prone position for assessing TLK flexibility in so-OTLF patients.

A retrospective analysis was conducted on patients with so-OTLF and kyphotic deformity who underwent posterior corrective fusion surgery. Sagittal parameters were measured independently by two spine surgeons using standing radiographs, SHLR, and prone FLS-CT scout views. TLK flexibility was quantified as the difference between standing and either SHLR or FLS-CT measurements. Paired t-tests were employed to compare sagittal Cobb angles and TLK flexibility between hyperextension and prone positions. Intra- and interobserver reliability were assessed using the intraclass correlation coefficient (ICC).

Thirty-four patients (mean age 66.1 ± 7.2 years, 30 females) were included. The mean TLK on standing radiographs was 50.9° ± 13.8°. SHLR demonstrated a mean TLK reduction of 7.8° (95 % CI: 6.6°-9.1°) to 43.1° ± 12.6° (P < 0.05). FLS-CT revealed a mean TLK of 31.8° ± 12.4°, a reduction of 19.1° (95 % CI: 17.4°-20.9°) compared to standing radiographs (P < 0.05). TLK flexibility in the prone position was significantly higher than in the hyperextension position (mean difference: 11.3°, P < 0.001). Both SHLR and FLS-CT demonstrated high intra- and interobserver reliability (ICC >0.82), with FLS-CT exhibiting superior reliability (intraobserver ICC: 0.97, interobserver ICC: 0.94) compared to SHLR (intraobserver ICC: 0.90, interobserver ICC: 0.82).

Prone FLS-CT scout views provide a more accurate assessment of TLK flexibility in patients with so-OTLF and kyphotic deformity compared to conventional SHLR. This enhanced accuracy may facilitate improved preoperative evaluation and surgical planning.

Male osteoporosis is primarily caused by a decrease in testicular testosterone production. Male osteoporosis remains a disease with insufficient diagnosis and treatment, and its consequences are severe, especially in older patients. The gut microbiota plays a crucial role in its occurrence and development. Our study found that the relative abundance of Lactobacillus salivarius in the fecal microbiota of male patients with osteoporosis was significantly lower than that in healthy volunteers. Animal experiments have shown that orchiectomy (ORX) can induce osteoporosis and disrupt the intestinal mucosal barrier, and intestinal microbiota. In addition, we discovered a potential etiological connection between the decreased abundance of the intestinal bacterium L. salivarius and the occurrence of ORX-induced osteoporosis. Cohousing or direct colonization of the intestinal microbiota from healthy rats or direct oral administration of the bacteria alleviated ORX-induced osteoporosis and repaired the intestinal mucosal barrier. Finally, we demonstrated that the extracellular vesicles (EVs) of L. salivarius could be transported to the bones and mitigate ORX-induced osteoporosis in rats. Our results indicate that the gut microbiota participates in protecting bones by secreting and delivering bacterial EVs, and that the reduction of L. salivarius and its EVs is closely related to the development of androgen deficiency-related osteoporosis.