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Diagnosis, Treatment, Prevention and Rehabilitation in Osteoporosis

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: 31 May 2025 | Viewed by 10598

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Dr. Gianluca Testa

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Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University of Catania, 95124 Catania, Italy
Interests: orthopaedics and traumatology; osteoporosis; sarcopenia; fall risk fragility fractures; pediatric orthopaedics; nutritional supplementations; bone disease
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Special Issue Information

Dear Colleagues,

It is my pleasure to present this Special Issue on the diagnosis, treatment, and rehabilitation of osteoporosis, a very common pathology, which contributes to frailty in the elderly. Osteoporosis has various clinical features, which vary from a simple osteopenia to a more complex presentation, as fragility fractures. The purpose of this Special Issue is to provide an update on modern diagnostic and therapeutic approaches to osteoporosis, collecting original articles and systematic or narrative reviews on this multidisciplinary pathology and providing experience on diagnostic techniques, diet and drugs, and conservative and surgical treatment of the main fragility fractures.

Dr. Gianluca Testa
Guest Editor

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Keywords

osteoporosis
bone mass density
bone densitometry
osteoporosis drug
diet
bisphosphonates
femoral neck fractures
vertebral fractures
fragility fractures

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Published Papers (7 papers)

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Research

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16 pages, 2351 KiB

Open AccessArticle

Functional Recovery Predictors in Hip Fractures: Insights from a Community Clinical Pathway

by Ai Takahashi, Hiroaki Naruse, Daiki Hasegawa, Hideaki Nakajima and Akihiko Matsumine

J. Clin. Med. 2025, 14(10), 3430; https://doi.org/10.3390/jcm14103430 - 14 May 2025

Viewed by 197

Abstract

Background: Osteoporotic hip fractures in the elderly significantly impact mobility and quality of life. Optimising early management is crucial for improving the functional outcomes. Methods: This single-centre retrospective cohort study included patients with femoral trochanteric (n = 142) or femoral neck fractures (n = 127) treated between January 2016 and March 2023. The patients were divided into ambulatory and non-ambulatory groups based on their walking ability at discharge from the rehabilitation hospital. The explanatory variables included age, sex, fracture type, surgical method, pre-surgical days, hospital days, dementia, and the Nursing Needs Score (NNS). Results: The most common age group was 85–89 years old. Only 23.4% of patients underwent surgery within 2 days of admission. The median hospital stay was 20 days in acute care and 52 days in rehabilitation hospitals. Walking ability declined in 66.9% of the patients. Pre-injury mobility and acute care hospital NNS were identified as independent predictors of ambulatory outcomes. Conclusions: Pre-injury mobility and the Nursing Needs Score (NNS) assessed at the acute care hospital were identified as critical determinants of postoperative ambulatory status. These findings highlight the importance of community collaboration and preventive rehabilitation strategies aimed at improving basic mobility, maintaining cognitive function, and preserving walking ability. Full article

(This article belongs to the Special Issue Diagnosis, Treatment, Prevention and Rehabilitation in Osteoporosis)

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14 pages, 2868 KiB

Open AccessArticle

Trabecular Bone Score as a Complementary Tool for the Assessment of Bone Mineral Density in Patients with Asymptomatic Monoclonal Gammopathies

by Styliani Drakoulidou, Ioannis Ntanasis-Stathopoulos, Aikaterini Kyritsi, Vassilis Koutoulidis, Panagiotis Malandrakis, Nikolaos Kanellias, Efstathios Kastritis, Meletios A. Dimopoulos, Maria Gavriatopoulou, Athanasios Chalazonitis and Evangelos Terpos

J. Clin. Med. 2024, 13(21), 6461; https://doi.org/10.3390/jcm13216461 - 28 Oct 2024

Viewed by 1566

Abstract

Background/Objectives: Monoclonal gammopathies, such as Monoclonal Gammopathy of Undetermined Significance (MGUS) and Smoldering Multiple Myeloma (SMM), are conditions marked by the overproduction of specific monoclonal proteins. Patients with these conditions are known to have a higher risk of fractures compared to the general population, yet there are no established guidelines for assessing or managing their skeletal health. The Trabecular Bone Score (TBS), which can be calculated from DXA images of the lumbar spine, provides additional insights into bone microarchitecture. Methods: This study aimed to determine whether TBS can serve as a supplementary tool in assessing bone loss in MGUS and SMM patients. Conducted from 2020 to 2023, the study involved 148 participants—74 diagnosed with a myeloma precursor state and 74 healthy controls—who underwent simultaneous DXA and TBS measurements. Results: The results indicated a weak positive correlation (R = 0.405) between DXA and TBS T-scores, suggesting that other factors may influence the measurements. When analyzed separately, the correlations remained weak for both MGUS (R = 0.250) and SMM (R = 0.485). Interestingly, discrepancies were noted in T-score classifications; for instance, a patient classified as normal via DXA could be deemed osteopenic or osteoporotic with TBS. Conclusions: Overall, the findings suggest that incorporating TBS alongside DXA can enhance the accuracy of bone density assessments, facilitating earlier diagnosis and treatment initiation for osteoporosis in asymptomatic patients with monoclonal gammopathies. Full article

(This article belongs to the Special Issue Diagnosis, Treatment, Prevention and Rehabilitation in Osteoporosis)

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9 pages, 225 KiB

Open AccessArticle

Importance of Bilateral Hip Assessments in Unilateral Lower-Limb Amputees: A Retrospective Review Involving Older Veterans

by Seong Jin, Chi Hwan An, Ho Yong Jeong, Woohwa Choi, Sun-Won Hong, Hoon Ki Song, Hyun Sung Kim, Yun Kyung Lee, Hyo Jung Kang, Dong-young Ahn and Hea-Eun Yang

J. Clin. Med. 2024, 13(14), 4033; https://doi.org/10.3390/jcm13144033 - 10 Jul 2024

Viewed by 1087

Abstract

Background/Objectives: This study aimed to evaluate bone mineral density (BMD) discordance and its implications in veterans with unilateral lower-limb amputation, emphasizing the need for comprehensive hip assessments. Methods: Data were collected from 84 male veterans, and BMD was measured using dual-energy X-ray absorptiometry (DXA) at the lumbar spine, intact hip, and amputated hip. Results: The T-scores for the lumbar spine, intact hip, and amputated hip were −0.27 ± 1.69, −0.25 ± 1.20, and −1.07 ± 1.33, respectively. Osteoporosis and osteopenia were present in 19% and 34.6% of patients, respectively. Osteopenia and osteoporosis were most prevalent in the hips on the amputated side (32.1% and 13.1%, respectively), followed by the lumbar spines (22.6% and 8.3%) and the hips on the intact side (17.9% and 2.4%). BMD discordance between the lumbar spine and hip was found in 47.6% of participants, while discordance between both hips was observed in 39.3%. Transfemoral amputees had significantly lower BMD at the amputated hip compared to transtibial amputees (−2.38 ± 1.72 vs. −0.87 ± 1.16, p < 0.001). Conclusions: Veterans with unilateral lower-limb amputation exhibit a high prevalence of osteoporosis and significant BMD discordance, particularly between both hips. These findings underscore the necessity for bilateral hip assessments to ensure the accurate diagnosis and effective management of osteoporosis in this population. Full article

(This article belongs to the Special Issue Diagnosis, Treatment, Prevention and Rehabilitation in Osteoporosis)

12 pages, 1179 KiB

Open AccessArticle

Comparison of the Efficacy of Zoledronate and Denosumab in Patients with Acute Osteoporotic Vertebral Compression Fractures: A Randomized Controlled Trial

by Seong Son, Michael Y. Oh, Byung-Rhae Yoo and Han-Byeol Park

J. Clin. Med. 2024, 13(7), 2040; https://doi.org/10.3390/jcm13072040 - 1 Apr 2024

Cited by 2 | Viewed by 1919

Abstract

Background: The comparison of the efficacy of zoledronate and denosumab for treating osteoporosis is controversial, and few randomized controlled trials have compared these two drugs in practical patients with acute osteoporotic vertebral compression fractures (OVCFs). We conducted a randomized controlled study to compare the efficacy of zoledronate and denosumab in patients with acute OVCF, with a focus on the occurrence of new OVCF. Methods: We enrolled 206 subjects who had their first acute OVCF, without any previous history of osteoporosis medication. The patients were randomly assigned to receive either intravenous zoledronate once a year or subcutaneous denosumab twice a year. We investigated the OVCF recurrence, clinical outcome, bone mineral density (BMD), and bone turnover markers over 12 months. Results: The final cohort comprised 89 participants (mean age of 75.82 ± 9.34 years, including 74 women [83.15%]) in the zoledronate group and 86 patients (mean age of 75.53 ± 10.23 years, including 71 women [82.56%]) in the denosumab group. New OVCFs occurred in 8 patients (8.89%) in the zoledronate group and 11 patients (12.79%) in the denosumab group (odds ratio, 1.485 [95% confidence interval, 0.567–3.891], p = 0.419). No significant difference was observed in the survival analysis between the two groups (p = 0.407). The clinical outcome, including the visual analog scale score for pain and simple radiographic findings, did not differ between the two groups. The changes in BMD and bone turnover markers were also not significantly different between the two groups. Additionally, drug-related adverse events did not differ between the groups in terms of safety. Conclusions: The efficacy of zoledronate was comparable to that of denosumab in terms of the occurrence of new OVCFs, as well as of the overall clinical course in patients with their first acute OVCF. Notably, this study represents the first comparison of these two drugs in patients with acute OVCF. However, further research with large-scale and long-term follow-up is necessary. Full article

(This article belongs to the Special Issue Diagnosis, Treatment, Prevention and Rehabilitation in Osteoporosis)

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8 pages, 255 KiB

Open AccessArticle

Clinical Significance of Discordance between Hip and Spine Bone Mineral Density in Korean Elderly Patients with Hip Fractures

by Se-Won Lee, Younghyun Yoon, Junhyuk Kwon, Jun-Young Heu and Jihyo Hwang

J. Clin. Med. 2023, 12(20), 6448; https://doi.org/10.3390/jcm12206448 - 10 Oct 2023

Cited by 3 | Viewed by 2208

Abstract

The clinical significance of BMD discordance has not yet been elucidated. The objective of this study was to evaluate the clinical significance of BMD discordance between the hip and spine for hip fractures. The BMD was measured and related factors were investigated in 109 elderly patients hospitalized for a hip fracture (fracture group) and 109 patients hospitalized without a hip fracture (non-fracture group). BMD discordance of the hip and spine was classified as minor discordance (normal and osteopenia, and osteopenia and osteoporosis) and major discordance (normal and osteoporosis). The risk of hip fracture was calculated according to the type of discordance: no discordance, low hip, and lower spine. There was no significant difference between the general characteristics of the fracture group and the non-fracture group. The rate of BMD discordance and low hip discordance were significantly higher in the fracture group (53.2%, 43.1%) than in the non-fracture group (28.4%, 19.3%). The odds ratio of hip fracture was 2.86 times higher in patients with BMD discordance than in those without discordance and 3.42 times higher in the patients with low hip discordance than in those without no hip discordance. The presence of discordance, particularly when there is low hip discordance, might be related to the hip fractures. Full article

(This article belongs to the Special Issue Diagnosis, Treatment, Prevention and Rehabilitation in Osteoporosis)

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11 pages, 887 KiB

Open AccessSystematic Review

Use of Hexapod External Fixation in Limb Lengthening in Patients with Disproportionate Short Stature: A Systematic Review of the Last 20 Years

by Gianluca Testa, Michela Marchetti, Marco Sapienza, Martina Ilardo, Sebastiano Mangano, Giuseppe Condorelli and Vito Pavone

J. Clin. Med. 2025, 14(4), 1091; https://doi.org/10.3390/jcm14041091 - 8 Feb 2025

Cited by 1 | Viewed by 769

Abstract

Background: Limb lengthening is a surgical procedure intended to correct discrepancies and deformities in limb length or to enhance limb length for functional or cosmetic reasons. Short stature, often seen as a physical condition, can significantly affect a patient’s quality of life. The advancement of limb lengthening methods, including the creation of hexapod external fixation systems, has heightened the precision and efficacy of these procedures. The Taylor spatial frame (TSF), a form of hexapod external fixator, grants three-dimensional control of bone movement and is increasingly used to rectify deformities and lengthen limbs. This systematic review aims to assess the effectiveness of the hexapod external fixator in limb lengthening and deformity correction compared to other external fixation systems, focusing on outcomes such as achieved lengthening, healing index, complications, and follow-up duration. Methods: A structured search was engineered in four crucial search engines (PubMed, Scopus, Web of Science, and Medline) spanning 2004 to 2024. Results: The studies included in this review indicate that the average lengthening accomplished with the hexapod fixator ranged from 3 to 5.9 cm, with a healing index between 37 and 68.6 days/cm. The most frequent complications were pin site infections, compartment syndrome, and delayed union. The follow-up duration ranged from 6.8 months to 6 years. These studies also compared the hexapod external fixator with other external fixators, showing that while the TSF allowed more accurate deformity corrections, it often displayed a higher healing index. Conclusions: The hexapod external fixator, specifically the TSF, is an effective instrument for limb lengthening and deformity correction in patients with short stature. Although it provides superior three-dimensional control for deformity correction, the healing index and treatment duration can be longer compared to traditional external fixators. Further studies with larger sample sizes and extended follow-up are needed to perfect treatment protocols and thoroughly evaluate the long-term outcomes and complications associated with this technique. Full article

(This article belongs to the Special Issue Diagnosis, Treatment, Prevention and Rehabilitation in Osteoporosis)

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8 pages, 258 KiB

Open AccessBrief Report

Assessment of Awareness and Knowledge about Osteoporosis in Relation to Health Prevention among Patients Treated in Osteoporosis Clinics

by Agnieszka Barańska, Bartłomiej Drop, Urszula Religioni, Joanna Dolar-Szczasny, Maria Malm, Krystian Wdowiak, Magdalena Bogdan, Anna Kłak, Piotr Merks and Robert Rejdak

J. Clin. Med. 2023, 12(19), 6157; https://doi.org/10.3390/jcm12196157 - 24 Sep 2023

Cited by 5 | Viewed by 2006

Abstract

The increasing incidence of osteoporosis indicates that the disease is a serious public health problem, with about 200 million people being affected worldwide. The aims of this research are to assess the awareness and knowledge about osteoporosis in relation to risk factors, health condition, supplementation used, socio-demographic factors and other variables among osteoporosis patients. The study was conducted in 2016–2018 in osteoporosis clinics in Poland. The study involved 312 patients with a diagnosis of osteoporosis. In the diagnostic survey method, the authors’ own questionnaire was used. The results indicate that the more frequent the symptoms associated with the disease, the lower the general self-assessment of the health condition of the respondents (rho = −0.682, p < 0.001). In addition, almost half of the respondents stated that their knowledge of osteoporosis is negligible. Moreover, the use of dietary supplements significantly differentiated respondents in terms of health self-assessed (p < 0.001), and it is noteworthy that users of dietary supplements assessed their health significantly better. We also saw a statistically significant relationship between the self-assessment of knowledge about osteoporosis and the use of dietary supplements (p < 0.001). Accordingly, significantly more respondents rating their knowledge as good or very good used dietary supplements. The conducted study demonstrates the need to educate patients and implement educational programs at central and provincial levels to improve patient knowledge concerning the disease. Supporting adaptation to chronic diseases and appropriate therapeutic management may contribute to improved osteoporosis treatment and enhanced patient quality of life. Full article

(This article belongs to the Special Issue Diagnosis, Treatment, Prevention and Rehabilitation in Osteoporosis)

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