Osteology, Volume 5, Issue 4 (December 2025) – 6 articles

The present study aimed to determine the acute effects of high-intensity dynamic resistance training (HI-DRT) and whole-body electromyostimulation (WB-EMS) on markers of bone formation and resorption in young healthy women. Using a crossover design, 17 students of dentistry (26.5 ± 4.0 years, 21.5 ± 2.5 kg/m²) were randomly assigned to begin either with HI-DRT (five exercises, three sets to repetition maximum) or 20 min of non-superimposed, low-frequency (85 Hz), intermitted (6 s impulse/4 s impulse break) WB-EMS. The study outcome parameters were total Procollagen Type-1 N-Terminal Propeptide (P1NP) and Type-I Collagen Cross-Linked C-Telopeptide (CTX), which were sampled immediately prior to and 15 min post intervention. ANCOVA was applied to determine the main effects, i.e., differences in pre–post changes in CTX and P1NP between the interventions. No participant was lost to follow-up or reported adverse effects related to the exercises. Briefly, we observed significant differences (p = 0.019, d′ = 1.19) for changes in P1NP that were maintained in the HI-DRT (p = 0.446) and decreased in the WB-EMS group (p = 0.002). In contrast, we did not observe differences for HI-DRT- vs. WB-EMS-induced CTX changes (p = 0.509; d′ = 0.134). In summary, while HI-DRT provides significantly more favorable effects on bone formation markers compared to WB-EMS, the clinical significance of this finding in predicting the general effectiveness of an exercise protocol on bone strength remains to be determined. (Clinical trials.gov; registration date: 2025-02-06; ID: NCT06813092.) Full article

Background: Nutritional status affects bone fragility and related fractures. We investigated the relationships between bone fragility fractures and nutritional indicators, including the Geriatric Nutrition Risk Index (GNRI), Prognostic Nutrition Index (PNI), Control Nutrition Status (CONUT) score, and body mass index (BMI). Methods: Postmenopausal female outpatients aged 75 or older who experienced a hip fracture 2 to 4 weeks ago (hip fracture group; G-HF) or who have no history of hip fracture without secondary osteoporosis but have a T-score of bone mineral density less than −2.5 (primary osteoporosis group; G-POP) were studied using both cross-sectional and longitudinal methods. Variables, including blood test results, T-scores, and nutritional indicators at baseline, were compared between the two groups using a crude dataset and after propensity score matching (PSM). Correlations between hip fracture (HF) and baseline variables were statistically analyzed. The relationship between nutritional indicators and the development of subsequent major osteoporotic fractures (MOFs) after baseline was examined, and the relationship between dietary indicators and functional capacity was also investigated. Results: A total of 1201 patients were recruited from these 113 G-HF and 1088 G-POP groups (crude dataset), of whom 113 were included after PSM. There were many differences between the two groups using the crude dataset. However, no items were significantly different after PSM except for white blood cell count (WBC) and serum phosphorus levels. GNRI < 105.5 demonstrated a typical regression curve regarding prevalent hip fractures. Developing MOF was significantly correlated with T-scores in the femoral neck and the presence of a prevalent fragility fracture. PNI and GNRI demonstrated a significant correlation between functional capacity; however, there was no correlation with the development of MOF. Conclusions: GNRI < 105.5 was significantly correlated with the presence of hip fracture, although no significant association was found with the development of MOF. Full article

Background/Objective: Major research demonstrates that longitudinal loading affects the vertebral growth and disc wedging in the scoliotic animal models; however, there is a scarcity of research on the effect of torque on the vertebral growth. Comparison of the effect of static and dynamic torque on growth is also lacking. The aims of this study were to assess the morphological, histological, and immunohistochemical changes in caudal vertebrae of rats under controlled, static, and dynamic torque. Methods: Adjacent vertebral bodies of female Sprague-Dawley rats were loaded with a torque for 4 weeks. Six rats received a static torque of 1.25 Nm while 6 additional rats received a dynamic torque (2.4 Nm, 1.0 Hz for 15 min/time, 3 times/week). An additional 6 rats formed the control group and received no torque at all. All the rats were later sacrificed, and the tails for histological analysis, immunocytochemistry, and X-rays were obtained. Results: Among the three groups, there were significant differences in right side disc height and average disc height on the proximal vertebrae space in the coronal plane of the X-ray. There were significant differences in the physeal height between static torque and control, or between dynamic torque and control (p < 0.05). The proliferating cell nuclear antigens were detected with variable percentages in samples among the three physeal zones for all groups. Conclusions: Both static and dynamic torque induced asymmetric reduction in the physis and intervertebral disc, which may help to explain the development and vertebral tethering of scoliosis. Full article

Background/Objectives: Osteoporotic vertebral fractures (OVFs) are common in older adults. While surgery is generally reserved for unstable or painful fractures, some OVFs conceal underlying malignancies, including metastatic and hematologic cancers. This study aimed to determine the pooled prevalence of unsuspected malignancy in patients initially diagnosed with OVFs. Methods: A systematic search of PubMed and Scopus was conducted from inception to September 2025 in accordance with PRISMA guidelines. Eligible studies included adults with presumed OVFs who underwent vertebral biopsy and histopathological evaluation. Prevalence estimates were pooled using a random-effects model, and study quality was assessed with the Newcastle–Ottawa Scale. Results: Thirteen studies involving 3513 patients were included. The pooled prevalence of malignancy was 8.0% (95% CI: 5.4–10.6), comprising metastatic solid tumors (4.9%; 95% CI: 2.3–7.4) and multiple myeloma (2.6%; 95% CI: 1.3–3.9). Malignancy was detected in 2.7% (95% CI: 1.8–4.1) of routine biopsy cohorts versus 36.8% (95% CI: 22.1–54.4) of clinically suspected cases. Diagnostic yield exceeded 45% in patients selected by combined history, imaging, or known malignancy. No biopsy-related complications or procedure-related mortality were reported. Moderate heterogeneity was observed, mainly in suspected cohorts. Conclusions: Vertebral biopsy is a safe and diagnostically valuable procedure in vertebral compression fractures. Its yield ranges from about one in 30 patients in routine settings to nearly one in two in high-risk groups, underscoring the importance of structured patient selection to facilitate timely cancer detection and referral. Full article

Background/Objectives: Metallic surgical implants are commonly used in Orthopaedic surgery. There is a paucity of the literature on patient perspectives and awareness regarding their use. This study aims to investigate patients’ self-perceived awareness, knowledge and concerns toward metallic implant usage in Orthopaedic surgery, in order to provide a tailored and efficient means of pre-operative counselling. Methods: A single-centred, cross-sectional questionnaire-based study was performed in a single tertiary centre in Singapore. Patients between 21 and 75 years who were on follow-up with an Orthopaedic surgeon were recruited from the Orthopaedic specialist outpatient clinic. This questionnaire consisted of three main parts. Firstly, patients were asked to grade their self-perceived knowledge on metallic implants on a Likert scale of 1 to 5. The second part included questions designed to determine the level of knowledge of patients on metallic implants. For the third part, patients were asked to grade how comfortable they were with having metal implants in their bodies on a Likert scale of 0 (Strongly Disagree) to 4 (Strongly Agree). Results: A total of 100 patients were recruited, with 56 males and 44 females. The majority of the patients were Chinese (59%), and 32% had tertiary education. The self-perceived awareness regarding metallic implants was low with a median score of 3 (IQR 1–9) (1—unaware, 10—fully aware). There was no significant difference between younger and older patients (>50 years) or between patients of different educational levels. In total, 17% of the participants stated that they preferred to use non-metallic implants. The most significant concerns were surgical costs (51%), post-operation discomfort (50%) and potential rejection of metallic implants (50%). Conclusions: There is a poor level of self-reported awareness on metallic implants and a lack of knowledge regarding the use of metallic implants in Orthopaedic procedures among patients in our local population. The top concerns regarding the usage of metallic implants were cost, adverse reaction to metal and persistent discomfort. A significant percentage of patients prefer to use non-metallic implant options if available. This highlights the need for tailored pre-operative counselling for the provision of information and to address patients’ concerns accurately. Full article

Background/Objectives: Comparison between the 10-year probability of major osteoporotic fracture (MOF) calculated with FRAX (pFRAX) and the actual MOF rate was conducted, and the availability of pFRAX was evaluated with a one-center cohort study. Methods: Eligible patients were followed up for 10 years. Risk factors listed as items in the FRAX, and presence of lifestyle-related diseases (LS-RDs), escalated ability to fall (Fall-ability), cognitive impairment (CI), etc., were evaluated concerning MOF. The 10-year probability and actual MOF rate were compared. Risk factors contributing to the discrepancy between the probability and the actual rate were evaluated after dividing subgroups. Results: The study included 931 patients. Factors that contributed to the significantly higher ratio for incident MOF besides items in the FRAX were LS-RD, Fall-ability, CI, and anti-osteoporotic drug intervention. The higher the number of factors presented, the higher the actual MOF prevalence compared to the probability rise. Presenting LS-RD, Fall-ability, and CI are independent of the items in the FRAX. pFRAX was overestimated in the low-risk groups and underestimated in the high-risk group compared to the actual MOF rate. These phenomena are caused by the lack of consideration of these three comorbidity risks. Conclusions: A discrepancy between pFRAX and the actual MOF rate exists. LS-RD, Fall-ability, and CI should be listed in the items of the FRAX for more concision. Full article