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Medicina
Special Issues
Clinical Diagnosis and Treatment of Osteoporosis and Fractures
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Clinical Diagnosis and Treatment of Osteoporosis and Fractures

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: 25 November 2026 | Viewed by 2628

Special Issue Editors

Dr. Nicolas Martinez-Velilla

E-Mail Website
Guest Editor
Heath Sciences Department, Navarre Public University (UPNA), 31006 Pamplona, Spain
Interests: frailty; exercise; geroscience; pharmacy; cognition disorders
Dr. Bernardo Abel Cedeño-Veloz

E-Mail Website
Guest Editor Assistant
Heath Sciences Department, Navarre Public University (UPNA), 31006 Pamplona, Spain
Interests: osteoporosis; biomarkers; inflammaging; fracture
Dr. Jose Manuel Cancio-Trujillo

E-Mail Website
Guest Editor Assistant
Consorcio Sanitario del Maresme, Mataró, Spain
Interests: osteoporosis; fractures; FLS; osteosarcopenia

Special Issue Information

Dear Colleagues,

Osteoporosis was first recognised as a clinical entity in the mid‑20th century, when researchers described post‑menopausal bone loss and its link to vertebral and hip fractures. Subsequent decades saw the development of non‑invasive bone mineral density testing—most notably, dual‑energy X‑ray absorptiometry (DXA)—and the adoption of World Health Organization definitions for osteopenia and osteoporosis. Despite advances in imaging and pharmacotherapy, the prevalence of osteoporotic fractures continues to rise with population ageing. The emergence of tools such as the FRAX and integral approaches such as Fracture Liaison Services (FLS) has improved risk stratification, yet many patients remain undiagnosed or undertreated.

This Special Issue will provide a comprehensive platform for clinicians and researchers to address current challenges in the diagnosis and management of osteoporosis and fragility fractures. We aim to cover the full spectrum from basic pathophysiology to clinical implementation, emphasising both traditional diagnostic measures (clinical risk assessment, biochemical testing, DXA, trabecular bone scores, and FRAX) and novel precision medicine approaches such as artificial intelligence‑driven imaging analysis and proteomic biomarkers. The scope also includes prevention strategies, established and emerging pharmacologic therapies, and integrated care models for patients who have sustained fragility fractures.

Recent breakthroughs in bone health research will be highlighted. These include TBS or 3D-DXA techniques that assess bone microarchitecture; machine learning algorithms that combine imaging and clinical data to predict fracture risk; and omics‑based biomarkers (genomic, proteomic, and metabolomic signatures) that may enable personalised treatment. On the therapeutic front, anabolic agents such as romosozumab and abaloparatide, sequential therapy protocols, and regenerative strategies such as mesenchymal stem cell-based bone regeneration are transforming the management landscape. Additionally, research into patient‑centred intervention exercise regimens, nutritional optimisation, and anti‑inflammatory approaches aims to improve recovery after fractures and reduce subsequent fracture risk.

We invite the submission of original research articles, clinical trials, translational studies, and high‑quality reviews that will advance our understanding of osteoporosis and fragility fractures. Suitable topics include (but are not limited to) novel diagnostic modalities and risk assessment tools, studies on bone biology and microarchitecture, randomised controlled trials and real‑world evaluations of pharmacological agents (bisphosphonates, denosumab, teriparatide, abaloparatide, romosozumab, selective oestrogen receptor modulators, calcium/vitamin D supplementation), integrated care pathways combining medical therapy with exercise and nutritional interventions, and investigations into the molecular mechanisms underlying bone loss and repair. We also welcome systematic reviews, meta‑analyses, and interdisciplinary contributions from across the fields of geriatrics, endocrinology, orthopaedics, physiotherapy and public health.

Dr. Nicolas Martinez-Velilla
Guest Editor

Dr. Bernardo Abel Cedeño-Veloz
Dr. Jose Manuel Cancio-Trujillo
Guest Editor Assistants

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • osteoporosis
  • fragility fractures
  • bone mineral density (DXA)
  • FRAX score
  • bone turnover markers
  • precision medicine
  • artificial intelligence
  • proteomic biomarkers
  • anabolic and antiresorptive therapies
  • integrated care for fracture patients

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Published Papers (2 papers)

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18 pages, 2116 KB  
Article
Limited Impact of Short-Term Osteoporosis Medication on Vertebral Height Loss in the Acute Phase of Osteoporotic Vertebral Compression Fractures: A 3-Month Longitudinal Analysis
by Jaehoon Kim, Bong-Ju Lee, Jae-Beom Bae, Sang-bum Kim, Dong-Hwan Kim and Ja-Yeong Yoon
Medicina 2026, 62(2), 299; https://doi.org/10.3390/medicina62020299 - 2 Feb 2026
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Abstract
Background and Objectives: The optimal pharmacological strategy to mitigate progressive vertebral collapse during the acute phase of osteoporotic vertebral compression fractures (OVCFs) remains a subject of debate. This initial 3-month window is the most critical period for evaluating the structural stability of [...] Read more.
Background and Objectives: The optimal pharmacological strategy to mitigate progressive vertebral collapse during the acute phase of osteoporotic vertebral compression fractures (OVCFs) remains a subject of debate. This initial 3-month window is the most critical period for evaluating the structural stability of the fracture, as the majority of progressive height loss occurs before solid bone union is achieved, directly influencing the decision to continue conservative management or transition to surgical intervention. Materials and Methods: In this retrospective study, 123 patients were allocated to control (n = 26), denosumab (n = 35), teriparatide (n = 30), or romosozumab (n = 32) groups. Treatment choice was non-randomized, driven by clinical pragmatism and patient preference. Serial changes in vertebral compression rate (VCR) and pain (VAS) were analyzed over 3 months using linear mixed models (LMMs) specifically adjusted for baseline imbalances in initial VCR. Results: In the unadjusted analysis, DMAB appeared to show a slower progression of compression compared to the control group. However, after adjusting for the initial VCR, no significant structural benefit was observed in any medication group (p > 0.05), with all groups showing small effect sizes (Cohen’s d < 0.4). In contrast, unstable fracture morphology was identified as the most potent driver of vertebral collapse (β = 2.758, 95% CI: 1.51–4.01, p < 0.001). Clinically, the RM group showed significantly lower overall pain levels throughout the follow-up period compared to the control group (p = 0.014). Conclusions: Short-term osteoporosis medication does not significantly mitigate vertebral collapse during the acute phase of OVCFs. Practically, these findings suggest that unstable fracture morphology and the baseline VCR—reflecting a potential ‘floor effect’ where less initially collapsed vertebrae may undergo more significant progression—are more informative predictors of acute collapse than medication choice. Consequently, early imaging-based risk stratification is crucial to identify patients at high risk for progressive deformity, regardless of their pharmacological regimen. Full article
(This article belongs to the Special Issue Clinical Diagnosis and Treatment of Osteoporosis and Fractures)
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15 pages, 2371 KB  
Systematic Review
The Anabolic-First Strategy in Osteoporosis: A Systematic Review and Meta-Analysis of Fracture Outcomes in Patients at Very High Fracture Risk
by Valerio Cipolloni, Marco Bonifacio, Syeda Maryam Hassny, Giulia Melara, Linda Lucchetti, Martina Gentile and Alessandro Conforti
Medicina 2026, 62(4), 687; https://doi.org/10.3390/medicina62040687 - 3 Apr 2026
Viewed by 1287
Abstract
Background and Objectives: Individuals classified as having very high fracture risk remain vulnerable to imminent fractures even when treated with antiresorptive therapies. This meta-analysis evaluated whether initiating treatment with anabolic agents, including teriparatide, abaloparatide, and romosozumab, provides superior fracture protection in this [...] Read more.
Background and Objectives: Individuals classified as having very high fracture risk remain vulnerable to imminent fractures even when treated with antiresorptive therapies. This meta-analysis evaluated whether initiating treatment with anabolic agents, including teriparatide, abaloparatide, and romosozumab, provides superior fracture protection in this high-risk population. Materials and Methods: A systematic review and meta-analysis of randomized controlled trials was conducted following PRISMA standards. Eligible studies included adults at very high fracture risk, defined by recent or multiple fragility fractures or markedly low bone mineral density, who received anabolic therapy as initial treatment compared with placebo or antiresorptive agents. Outcomes of interest were new vertebral, non-vertebral, hip, and clinical fractures. Effect estimates were pooled using random-effects models. Results: Six randomized trials encompassing 17,872 participants were analyzed. Initiation with anabolic therapy was associated with a marked reduction in incident vertebral fractures. The labeled pooled summary estimate for vertebral fractures was 0.43 (95% confidence interval 0.34–0.54). Significant risk reductions were also observed for clinical fractures (hazard ratio 0.62, 95% confidence interval 0.51–0.75), non-vertebral fractures (pooled effect estimate 0.71, 95% confidence interval 0.59–0.85), and hip fractures (risk ratio 0.65, 95% confidence interval 0.45–0.96). Exploratory subgroup analyses suggested greater vertebral fracture protection versus placebo and persistent benefit versus active antiresorptive comparators. Sequential therapy using an anabolic agent followed by an antiresorptive reduced spinal fracture risk by approximately half. Considerable heterogeneity was noted for vertebral fracture outcomes. Conclusions: Starting osteoporosis treatment with anabolic agents results in faster and more-pronounced fracture risk reduction across all major fracture categories in patients at very high fracture risk. These findings support a shift toward anabolic-first treatment sequencing in this particularly vulnerable group. Full article
(This article belongs to the Special Issue Clinical Diagnosis and Treatment of Osteoporosis and Fractures)
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