Search Results (264)

Falls are a leading cause of bone fractures among the elderly, particularly hip fractures resulting from side falls. This research deals with the feasibility of application of shear-thickening fluids (STFs) to design self-protective wearable devices to rapidly respond to sudden impact due to falls. The device consists of a lightweight, flexible foam structure embedded with STF-filled compartments, which remain soft during normal movements but stiffen upon sudden impact, effectively dissipating energy and reducing force trans-mission to the bones. First, a foam-based sandwich panel filled with STF is fabricated and subjected to several falling scenarios through a ball drop test. The induced strain of the device with and without STF is measured using Fiber Bragg Grating (FBG) sensors. Then, the effect of localized STF is explored by fabricating a soft 3D-printed (TPU) sandwich panel filled with STF at selected cavities. It was observed that the application of STF reduces the induced strain by approximately 50% for the TPU skin device and 30% for the foam-based device. This adaptive response mechanism offers a balance between comfort and protection, ensuring wearability for daily use while significantly lowering fracture risks. The proposed solution aims to enhance fall-related injury prevention for the elderly, improving their quality of life and reducing healthcare burdens associated with fall-related fractures. Full article

Background/Objectives: Abaloparatide is an osteoanabolic therapy used in patients at high risk of fracture; however, the breadth of evidence across routes, comparators, and sequential strategies has not yet been comprehensively summarized. This study aimed to evaluate the efficacy and safety of abaloparatide for reducing fractures and improving bone mineral density (BMD) in adults with osteoporosis. Methods: Following PRISMA 2020, we searched PubMed, Embase, CENTRAL, and Web of Science (2016–2024) for randomized controlled trials and comparative real-world studies. Additional meta-analyses and network meta-analyses were included as contextual evidence but not pooled to avoid double-counting. Primary outcomes were vertebral, non-vertebral, and hip fractures; secondary outcomes included percentage change in BMD and safety endpoints. Random-effects models were used; heterogeneity, influence analyses, and prediction intervals were examined. Risk of bias was assessed using RoB 2 and AMSTAR 2. Results: Nine quantitative evidence sources met the criteria. Abaloparatide reduced vertebral fractures (RR 0.13–0.21) and showed moderate reductions in non-vertebral fractures. Lumbar spine BMD increased substantially, while hip and femoral neck gains were smaller and heterogeneous. Hypercalcemia risk was consistently lower compared to teriparatide. Transdermal delivery was less effective, and sequential abaloparatide → antiresorptive therapy further reduced fractures. Serious adverse events were not increased. Conclusions: Abaloparatide provides strong vertebral protection, significant BMD improvement, and shows a favorable calcemic profile, with moderate certainty for non-vertebral effects. Evidence in men and long-term safety remains limited. Full article

Background. Glucocorticoid-induced osteoporosis represents a well-known type of secondary osteoporosis (SOp). While the most prevalent sub-category includes corticotherapy, another important contributor is represented by Cushing’s syndrome. In this traditional landscape, adrenal incidentalomas do not involve a standard cause of SOp, since most of them are non-functioning adrenal tumours (NFATs). Yet, 30–40% of them are not entirely “non-functioning”, due to mild autonomous cortisol secretion (MACS). Despite not being a guideline-based diagnosis, a lower ACTH might point to various NFATs/MACS complications. Objective. This study aimed to determine the relationship between the bone health status of post-menopausal women with NFATs/MACS and their baseline morning ACTH level. The bone health indicators were DXA, FRAX, and bone remodelling markers. Methods. This was a retrospective, real-life, transversal study in adult females who were hospitalized in a single tertiary centre of endocrinology. They were all anti-osteoporotic drug-naïve. The subjects underwent CT and DXA scanning and a 1 mg dexamethasone suppression test (DST). Results. The cohort (sample size of N = 84 patients, 61.49 ± 7.86 years) had a type 2 diabetes rate of 18%, arterial hypertension rate of 75%, and a dyslipidemia rate of 78%. Median ACTH was 11.89 pg/mL. The prevalence of MACS was 30.95%. The mean largest tumour diameter (LTD) was 2.25 ± 0.99 cm. ACTH correlated with second-day cortisol after the 1 mg DST (r = −0.301, p = 0.024), and LTD (r = −0.434, p < 0.001). ROC analysis for the bone resorption marker CrossLaps showed an AUC of 0.647 (p = 0.05), with the highest Youden index for the cut-off at 0.32 ng/mL (sensitivity 87.50%, specificity 39.50%). Bone impairment (osteoporosis + osteopenia) was found in 65% of patients, with an osteoporotic fracture prevalence of 4.76%. The lowest mean T-score (−1.12 ± 1.00) showed osteopenia, and the median trabecular bone score pointed a partially degraded microarchitecture [median (interquartile interval): 1.320 (1.230, 1.392)]. FRAX and FRAXplus estimations correlated with bone mineral density (BMD) at all three central DXA sites, regardless of the ACTH cut-off. Patients with a low ACTH (<10 pg/mL) displayed similar bone/adrenal features when compared to those with normal ACTH, except forbut they had a higher MACS rate (45.45% versus 21.57%, p = 0.021) and a larger LTD (2.67 ± 0.98 versus 1.98 ± 0.92 cm, p = 0.003). Fracture estimation showed that only in patients with a low ACTH, the 10-year fracture risk for major osteoporotic fractures (MOF) adjusted for lumbar BMD was lower than the risk for MOF adjusted for diabetes (p = 0.036), and the 10-year hip fracture risk was lower when adjusted for lumbar BMD (p = 0.007). ACTH correlated with lumbar BMD (r = 0.591, p = 0.002) only in the group with an ACTH < 10 pg/mL, suggesting its potential usefulness as a bone biomarker in these cases. On the other hand, MACS-negative subjects with a low ACTH versus those with a normal ACTH showed higher CrossLaps (0.60 ± 0.27 versus 0.42 ± 0.21 ng/mL, p = 0.022), indicating an elevated bone resorption even in patients with tumours that are regarded as true non-secretors. Conclusions. A subgroup of patients diagnosed with NFATs/MACS might be prone to skeletal damage, and biomarkers such as ACTH (specifically, suppressed ACTH) might serve as a surrogate pointer to help refine this higher risk in daily practice. Further research to address other ACTH cut-offs will place ACTH assays in the overall bone status evaluation in these patients, most probably not as a single biomarker, but in addition to other assays. Full article

Background and Objectives: Handgrip strength (HGS) is a simple marker of muscular fitness that has been linked to adverse outcomes in older adults, while menopause is accompanied by skeletal deterioration and increased psychological vulnerability. Resilience and self-regulation may be associated with lower levels of these risks, but their relationship with bone microarchitecture has not been clarified. We aimed to examine the associations between HGS and trabecular bone score (TBS), bone mineral density (BMD), mental health, resilience, and self-regulation in postmenopausal women. Materials and Methods: In this study, 200 postmenopausal women were recruited. HGS was assessed with a dynamometer, BMD at the lumbar spine, total hip and femoral neck by DXA, and lumbar TBS was derived from spine images. Psychological distress was measured with the DASS-21, resilience with the Brief Resilience Scale (BRS), and self-regulation with the Short Self-Regulation Questionnaire (SSRQ). Results: TBS was significantly higher in women with higher HGS (p < 0.001). Higher HGS was also associated with lower anxiety and depression scores (p = 0.011 and p = 0.013), fewer self-reported mental health disorders, and greater resilience (p < 0.001) and self-regulation (p = 0.004). Resilience and self-regulation were inversely related to all DASS-21 subscales (all p < 0.001), and HGS correlated positively with BRS (p < 0.001) and SSRQ (p < 0.001). TBS correlated modestly with both BRS (p = 0.003) and HGS (p < 0.001). In multiple linear regression, both BRS (β = 0.018, p = 0.013) and HGS (β = 0.003, p = 0.006) remained independently associated with TBS after adjustment for age, BMI, menopause duration, and SSRQ. Conclusions: In postmenopausal women, higher handgrip strength is associated to better trabecular bone microarchitecture and a more favorable psychological profile. Incorporating HGS and brief psychosocial assessment alongside TBS may enrich fracture risk stratification and support more integrated musculoskeletal and mental health care. Full article

Background/Objectives: Unstable intertrochanteric femur fractures (IFFs) in geriatric patients are associated with high rates of morbidity and mortality due to poor bone quality, multiple comorbidities, and limited functional capacity. This study aimed to compare the clinical outcomes of cementless bipolar hemiarthroplasty (BHA) performed via a transtrochanteric approach and proximal femoral nailing (PFN) in elderly patients with unstable IFFs. Methods: This retrospective comparative study included 131 patients aged ≥70 years who underwent surgery for AO/OTA 31-A2 and 31-A3 unstable fractures between January 2021 and July 2025 were retrospectively reviewed. 64 patients received cementless BHA and 67 underwent PFN. Eligible patients were ambulatory prior to fracture (independently or with a cane/walker); patients with pathological fractures/malignancy, alternative procedures (cemented or posterolateral BHA, total hip arthroplasty, tumor prosthesis, or other osteosynthesis methods), incomplete records, or <6 months of follow-up were excluded. Demographics, perioperative variables, mechanical complications, revision requirement, time to mobilization, and 1- and 6-month mortality rates were analyzed. Primary outcomes were mortality and perioperative clinical parameters. Results: The two groups were comparable in age, sex, ASA scores, and fracture patterns. Intraoperative blood loss and transfusion requirements were significantly higher in the BHA group (both p < 0.001). Mobilization was observed earlier in patients treated with BHA (1 [1,2] vs. 3 [2,3] days; p < 0.001). Mechanical complications were more frequently observed after PFN, which was associated with a higher revision requirement (17.9% vs. 4.7%; p = 0.018). Operative time, hospital stay, and 1- and 6-month mortality rates showed no significant differences between the groups. Conclusions: In geriatric patients with unstable IFFs, cementless BHA performed via a transtrochanteric approach may be considered a viable surgical option with appropriate patient selection, taking into account its association with earlier mobilization and the observed mechanical complication profile. PFN offers advantages of reduced blood loss and lower transfusion needs. Surgical decision-making should be individualized based on fracture morphology, bone quality, and the patient’s overall medical condition. Given the heterogeneity of unstable fractures within the AO/OTA classification and the retrospective nature of the present study, larger, multicenter prospective investigations incorporating functional outcomes are warranted to further clarify optimal treatment strategies. Full article

Osteoporosis and fragility fractures are among the most prevalent and clinically significant complications in patients with chronic kidney disease (CKD), particularly in stages G4–G5 and in those undergoing dialysis (G5D). These skeletal disorders are associated with markedly increased morbidity and mortality, including a 2- to 9-fold higher risk of hip fractures compared to the general population, prolonged hospitalization, functional decline, and excess postoperative mortality. Despite this substantial burden, CKD-associated osteoporosis remains underrecognized and undertreated. Limited inclusion of CKD patients in pivotal osteoporosis trials and the absence of high-evidence guidance in clinical guidelines have contributed to a persistent therapeutic gap. PTH analog agents such as teriparatide and abaloparatide have demonstrated robust efficacy in increasing bone mass and reducing fracture risk in the general population. However, their use in CKD remains limited. PTH analog are poorly prescribed in patients with CKD stage G3 and remain off-label for stages G4–G5D, despite the high prevalence of adynamic bone disease across all stages of CKD. Abaloparatide, a selective PTH1 receptor agonist, exerts potent anabolic effects with a lower incidence of hypercalcemia than teriparatide and may offer a favourable safety profile in carefully selected patients. Preliminary data suggest preservation of bone microarchitecture and potential benefits in low-turnover bone disease, although evidence in CKD is still limited. This narrative review examines current evidence on abaloparatide’s potential role in CKD, emphasizing its mechanism of action, efficacy, safety, and relevance for patients with low bone turnover and high fracture risk. Full article

The next frontier in postmenopausal osteoporosis management lies not in novel pharmacological agents, but in the systematic integration of mechanism-guided drug selection, fall prevention, and long-term adherence strategies into a unified patient-centered care model. This review is intended for clinicians and clinical researchers involved in the diagnosis, treatment, and long-term management of postmenopausal osteoporosis. We provide a mechanism-to-practice framework that explicitly maps each therapeutic class to the specific molecular pathway it targets: bisphosphonates inhibit osteoclast function downstream of RANKL activation; denosumab blocks RANKL directly at the cytokine level; romosozumab inhibits sclerostin to restore Wnt-mediated bone formation. This mechanistic foundation supports a risk-stratified treatment paradigm in which antiresorptives address accelerated remodeling in moderate-risk patients, while patients at very high fracture risk—characterized by severe bone deficit or recent fragility fractures—benefit from an anabolic-first approach followed by consolidation. Beyond drug selection, we examine the persistent treatment gap in which fewer than 20% of post-fracture patients receive therapy, arguing that fall prevention—responsible for >90% of hip fractures—and medication adherence deserve equal priority in clinical practice. We further analyze key controversies, including T-score- versus FRAX-based intervention thresholds, limitations of the trabecular bone score, cost-effectiveness constraints on anabolic-first sequencing, and evidence gaps in post-denosumab transition strategies. By synthesizing mechanistic insights, guideline recommendations, and critical appraisal of current limitations, this review offers not only an overview of existing knowledge but a coherent decision-support model aimed at improving fracture prevention through comprehensive, individualized care. Full article

Background/Objectives: Cement augmentation of cephalomedullary head elements can improve the purchase of osteoporotic bone; however, it does not eliminate the need for accurate implant positioning or the preservation of sliding. We report the case of an 87-year-old woman who underwent intramedullary nailing with a cement-augmented helical blade for intertrochanteric fracture. Methods: This is a single-patient case report. Calibrated radiographic measurements—tip–apex distance (TAD), calcar-referenced TAD (CalTAD), neck–shaft angle (NSA), and telescoping—were obtained immediately postoperatively and at 4, 7, 12, and 15 months. CT was performed at postoperative week 1 and at failure, and MRI was performed for clinical deterioration. In addition, a targeted narrative review summarizes the evidence on the head-element position, sliding behavior, reduction alignment, and augmentation. Results: Immediate postoperative indices were within the accepted targets: TAD 22.6 mm, CalTAD 22.8 mm, NSA 134°, with the head element inferior on the anteroposterior view and central on the lateral view. Rehabilitation proceeded with full weight bearing as tolerated. Early telescoping was minimal (3.8–3.9 mm). Between 7 and 15 months, progressive varus with shortening of TAD/CalTAD and little additional telescoping was observed, radiographically consistent with relative proximal migration of the head–cement complex and a cleavage plane along the inferior cement mantle, culminating in a subcapital femoral neck fracture with the implant in situ. Emphasis should be placed on accurate implant positioning and preservation of sliding capacity, because cement augmentation alone may not prevent mechanical failure when the implant position or load transfer is suboptimal. Conclusions: Cement augmentation stiffens the interface and reduces micromotion but does not neutralize malposition-induced stresses. Accurate positioning, preservation of sliding, and timely conversion when sliding fails to progress are advisable; these findings are hypothesis-generating from a single case. We propose a position- and sliding-based decision guide to support clinical decision-making; its usefulness remains to be validated in larger studies. Full article

Background and Objectives: Organ dysfunctions affect the quality of bone and body fluids. This case report seeks links between the underlying conditions of three patients undergoing hip arthroplasty (HA) with uncemented implants, the quality of their bones, and their Ti-6Al-4V orthopaedic implants, on different time spans. Femoral stems are investigated. A brief review supports our findings. Materials and Methods: Cases: two women (F1 35+, F2 80+), and one man (M 65+), all having diabetes, dyslipidaemia, and kidney dysfunction. Samples: a segment of a broken 7-year-old stem, bone with a metallic layer, soft tissue, segments of one spare stem, and synthetic plasma enriched with glucose and urea according to the biochemistry tests of the respective patients. Vast studies show that cholesterol influences bone quality only. The stem pieces were ultrasonicated for 7 h at 37 °C in synthetic plasma. Scanning electron microscopy (SEM), energy dispersive X-ray spectroscopy (EDX), and profilometry investigated the Ti-alloy samples, electrochemistry analysed the post-sonication plasma, and histopathology examination was performed on the soft tissue remnants on the broken stem. Results: EDX show that all stem samples are Ti-6Al-4V with minute additions of other elements and hydroxyapatite (HAp) coating. SEM and profilometry analysis are consistent for the roughness in the outer layers of the stems. Electrochemistry on the bone fragment shows migration of vanadium during the 6 months since fracture to revision for M. Conclusions: Stems in altered synthetic plasma are affected by glucose and urea. Metal migration from the prostheses can occur through the chemical interactions between body fluids with abnormal biochemistry and the orthopaedic prostheses, favoured by cracks and concurring with wear following friction during usual movements. Cholesterol influences on the bone quality. Full article

Background: Osteoporotic vertebral fractures in the thoracic–lumbar spine are common in older adults and can lead to pain, kyphotic posture, impaired postural control, and altered gait. These changes increase the risk of falls and reduce functional mobility, highlighting the need for effective assessment and intervention strategies. Objectives: To analyze stability and gait in patients who sustained a thoracic–lumbar spinal fracture and underwent minimally invasive surgery. Methods: Seventeen patients participated in this study (women = 11, age 68.36 ± 6.15 years, body weight 68.18 ± 12.8 kg, height 161.45 ± 5.26 cm; men = 6, age 62.67 ± 4.41 years, body weight 78.5 ± 20.36 kg, height 176.67 ± 12.64 cm). All participants had undergone minimally invasive spinal surgery using percutaneous screws reinforced with bone cement 12 months prior. Each patient underwent two assessments: postural stability measurement and biomechanical gait analysis. Statistical analysis was performed using Statistica software (StatSoft, PL), with significance set at p < 0.05. Results: In the stability test, seven participants could not complete the measurement due to falls (FRT = 6.45 ± 2.43), six performed within the normal range (FRT = 2.41 ± 0.9), and four were below the normal range for their age group (FRT = 2.22 ± 1.7). Patients exhibited slower walking speed, shorter stride length, and reduced hip extension during the stance phase (approximately 5° less) due to a forward-leaning posture and cautious gait. Foot placement was flat rather than heel-first, likely as a compensatory strategy to enhance safety. Conclusions: Patients after osteoporotic thoracic–lumbar vertebral fractures treated with minimally invasive surgery demonstrate shorter, wider, and slower steps, along with reduced postural stability, indicating a persistent risk of forward falls. Full article

Background: Osteoarthritis is a leading cause of chronic pain and long-term disability in adults, which commonly affects the hip and knee joints. Joint arthroplasties are one of the management strategies for end-stage osteoarthritis. Periprosthetic fractures after hip or knee arthroplasties have mortality rates comparable to hip fractures. Recent studies assessed bone health optimization and the use of anti-osteoporotic agents in elective hip and knee arthroplasty surgeries. This systematic review and meta-analysis aimed to determine the prevalence of osteoporosis before surgery and the effect of bone health optimization on periprosthetic fractures and revisions. Methods: A systematic search was carried out on three databases, including PubMed, Embase, and Web of Science. The keywords used were (Revision or Periprosthetic fracture) AND (osteop*) and (Total Knee* or Total Hip*). Studies that included subjects aged >50 years with investigated outcomes were included in the review. The quality of selected randomized controlled trials was assessed using the Cochrane Collaboration tool, and non-randomized studies were assessed using the Newcastle–Ottawa Scale. The review was not registered with the International Prospective Register of Systematic Reviews (PROSPERO). Results: A total of 2482 records were identified. Twenty-three studies were included, and eighteen were used for quantitative analysis. Pooled overall prevalence of osteopenia in patients undergoing total knee arthroplasty (TKA)/total hip arthroplasty (THA) surgery was 42.87% (95% confidence interval (CI) 32.65 to 53.09). Pooled overall prevalence of osteoporosis in patients undergoing TKA/THA surgery was 23.99% (95% CI 15.72 to 32.26). The overall mean difference was in favor of anti-resorptive treatment on periprosthetic BMD of the medial calcar region (Gruen zone 7) after THA (12.16% (95% CI 8.78 to 15.53, p < 0.00001). Pooled odds ratio of periprosthetic fracture was 1.27 (95% CI 1.08 to 1.48, p = 0.003) in favor of the control group compared to bisphosphonate treatment. The pooled hazard ratio for all-cause revisions after TKA/THA for both osteopenia and osteoporotic patients was 0.26 (95% CI 0.13 to 0.51, p = 0.0001, I² 76%), signifying an improvement with bisphosphonates. Limitations of this study include the heterogeneity and retrospective nature of the included studies, with the average level of evidence subject to bias. Conclusions: There was a high prevalence of osteopenia/osteoporosis amongst patients undergoing total knee and total hip arthroplasty at 66.86%. Whilst bone health optimization with bisphosphonates may decrease the risk of revisions, the risk of periprosthetic fracture appeared to increase. Further research will be required to evaluate the effects of bone health optimization on the risk of periprosthetic fracture and revisions, and the effects of anabolic agents on periprosthetic fractures. Full article

Background/Objectives: Dietary patterns play a crucial role in musculoskeletal health; however, the effects of different diets on bone mineral density (BMD), fracture risk, and bone metabolism remain inconsistent across studies. This systematic review and meta-analysis aimed to evaluate the impact of Mediterranean, calorie restriction, high-protein, low-carbohydrate, and ketogenic diets on skeletal outcomes in adults. Methods: A comprehensive search of PubMed/MEDLINE, CENTRAL, and Web of Science was conducted for studies published between January 2000 and June 2025. Eligible randomised controlled trials (RCTs) and cohort studies involving adults (≥18 years) and reporting outcomes related to BMD, fractures, bone turnover markers, and vitamin D or calcium status were included. Risk of bias was assessed using the Cochrane’s Risk of Bias tool for RCTs and the Joanna Briggs Institute checklist for observational studies. Random-effects meta-analyses were performed for outcomes reported by ≥3 comparable studies, presenting standardised mean differences (SMDs) for BMD and hazard ratios (HRs) for fractures. Results: Thirty studies met inclusion criteria, comprising 14 RCTs and 16 observational studies with over 500,000 participants. Pooled analyses showed no significant differences in BMD at the femoral neck (SMD = 0.12, 95% CI −0.80 to 1.04), lumbar spine (SMD = 0.04, 95% CI: −1.12 to 1.03), total hip (SMD = −0.07, 95% CI −0.36 to 0.21), or whole body (SMD = 0.03, 95% CI −0.07 to 0.14) across diet categories. However, adherence to a Mediterranean diet was associated with a significantly reduced hazard of hip and overall fractures (pooled HR = 0.95, 95% CI 0.93–0.96). Calorie restriction consistently increased bone resorption markers, whereas Mediterranean and high-protein diets showed neutral or modestly favourable effects. Vitamin D and calcium status were minimally affected across interventions. Conclusions: While dietary patterns exert diverse effects on skeletal health, consistent evidence supports Mediterranean-style diets as protective against fractures. Calorie restriction may elevate bone turnover, whereas ketogenic and high-protein diets show mixed effects on bone. However, across all analyses, high heterogeneity was observed. Further high-quality RCTs are warranted to clarify these relationships and inform dietary guidance for bone health. Full article

Background: Bone mineral density (BMD) assessed by DXA is a well-established predictor of osteoporotic fracture risk. However, data regarding the Polish female population remains limited. Objective: To evaluate the predictive value of BMD measurements for vertebral, hip, and all low-energy fractures in women aged 50 years and older. Methods: A total of 1.311 women from the Małopolska region underwent BMD assessment at the femoral neck, lumbar spine. The average follow-up period was 10.2 years, during which 479 osteoporotic fractures were recorded. Results: DXA measurements at the femoral neck showed the strongest correlation with hip fracture risk. Each one standard deviation decrease in the femoral neck T-score increased the risk of hip fracture by 2.1 times (HR 2.10; 95% CI 1.28–3.46; p = 0.003), after adjusting for age, but is not linear. A 1 SD decrease in the hip T-score was associated with a 28% increase in the risk of all osteoporotic fractures (HR 1.28; CI 1.17–1.40; p < 0.001), 53% increase in vertebral (HR 1.53; CI 1.13–2.08; p = 0.006) and 30% in hip (HR 1.30; CI 0.81–2.09; p = 0.278). The AUC values for hip BMD and hip T-score had the highest predictive value—AUC (area under the curve was 0.732 and 0.720, p < 0.01). Conclusions: BMD at the femoral neck proved to be a stronger predictor of hip fractures than measurements at the spine, radius. The risk increase associated with BMD/T-score reduction was non-linear. These findings confirm results from other benchmark studies. Full article

Aim: Periprosthetic fracture-related infections (PFRIs) are a serious complication of total arthroplasty, with incidence rates increasing in line with the growing number of joint replacements. PFRI can lead to prolonged hospitalization, multiple surgical procedures and suboptimal functional outcomes. The diagnosis of PFRI remains challenging due to the overlap of clinical symptoms with other post-traumatic conditions, and identification of the pathogen often fails through conventional methods. This study also highlights the importance of a personalized medicine approach in managing PFRI, where diagnostic and therapeutic decisions are tailored to the individual patient’s comorbidities, immune status and bone healing capacity. By integrating clinical, microbiological and imaging data, our findings support precision-based strategies to optimize outcomes and minimize complication. Methods: This retrospective case series was conducted at the Unit of Osteoarticular Infection of the University of Turin, Italy, from January 2018 to December 2023. Patients who developed septic complications after open reduction and internal fixation (ORIF) of periprosthetic fractures involving hip or knee implants were included. The infection was diagnosed in accordance with established guidelines, and treatment decisions were based on clinical, microbiological and radiological findings. Results: In the present study, periprosthetic fractures complicated by infections were identified in nine patients (5.4%), constituting a small but significant subset of cases. The cases were then categorized into four clinical scenarios based on the following variables: joint involvement, fracture healing and infection progression. Scenario A, involving fractures without prosthetic involvement and unhealed fractures, included three patients (33%) and was treated with debridement and change of the fixation device. Scenario B, involving fractures without prosthetic involvement but with healed fractures, involved one patient (11%), where the ongoing infection was confirmed despite the healed fracture and where the device could be removed. The third scenario (C), which pertains to cases involving prosthetic involvement, included three patients (33%) who required replacement or removal of the prosthesis and, in some cases, a second stage. The fourth scenario, involving patients with limited operability, included two patients (22%) for whom no surgery was performed. Despite the significant clinical challenges encountered, the paucity of literature on the management of periprosthetic fractures with septic complications is limited, highlighting the need for further research in this understudied area. Conclusions: PFRI remains a challenging complication that necessitates a multidisciplinary approach to diagnosis and treatment. Despite advances in imaging and microbiological testing, the early detection and identification of pathogens remain challenging, emphasizing the necessity for enhanced diagnostic methods. This study offers valuable insights into the management of PFRI and provides a foundation for future research to develop optimal diagnostic and therapeutic strategies. Full article

Background/Objectives: Type 2 diabetes mellitus (T2DM) is increasingly recognized as a contributor to skeletal fragility despite patients often having a normal or even elevated bone mineral density (BMD), a phenomenon described as the “T2DM bone paradox.” This study aimed to use DEXA screening to explore how metabolic and demographic factors, particularly body mass index (BMI), age, sex, and glycated hemoglobin (HbA1c), influence Bone Mineral Density (BMD) among Saudi adults, a population where diabetes and obesity are highly prevalent. Methods: A retrospective cross-sectional study was conducted among 89 adults (mean age 61.1 years; 82% female) who underwent dual-energy X-ray absorptiometry (DEXA) at King Fahad Specialist Hospital in Tabuk, Saudi Arabia. Bone mineral density was evaluated at the lumbar spine, femoral neck, and total hip. Correlation and multiple regression analyses were conducted to assess how age, sex, body mass index (BMI), and glycated hemoglobin (HbA1c) were related to BMD T-scores. Results: The prevalence of osteopenia and osteoporosis was 43.8% and 23.6%, respectively, with women and older adults showing the highest rates of low bone mass. Participants had a mean age of 61.1 ± 12.1 years, average BMI of 32 kg/m², and mean HbA1c of 6.6 ± 1.8%. Females showed slightly lower T-scores at all skeletal sites compared with males (lumbar spine −1.81 vs. −1.55; femoral neck −1.15 vs. −0.76; total hip −0.62 vs. −0.12), indicating greater bone loss in women. BMI was consistently and positively associated with BMD across all skeletal sites (p < 0.05), whereas age and female sex were negative predictors at the femoral neck and hip. HbA1c showed a paradoxical positive relationship with BMD at weight-bearing sites, reflecting the complexity of metabolic effects on bone quality. The models explained up to 28% of the variance in BMD. Conclusions: Individuals with higher level BMI tended to have better bone mass, while older age and female sex were related to decreased BMD. The positive association between HbA1c and BMD supports the concept of the “diabetic bone paradox” and emphasizes the value of combining the evaluation of both metabolic and skeletal factors when assessing fracture risk in Middle Eastern populations. Full article