Search Results (434)

Background/Objectives: Cannabinoid use is rising among patients undergoing spinal fusion, yet its influence on bone healing is poorly defined. The endocannabinoid system (ECS)—through cannabinoid receptors 1 (CB1) and 2 (CB2)—modulates skeletal metabolism. We reviewed preclinical, mechanistic and clinical evidence to clarify how individual cannabinoids affect fracture repair and spinal arthrodesis. Methods: PubMed, Web of Science and Scopus were searched from inception to 31 May 2025 with the terms “cannabinoid”, “CB1”, “CB2”, “spinal fusion”, “fracture”, “osteoblast” and “osteoclast”. Animal studies, in vitro experiments and clinical reports that reported bone outcomes were eligible. Results: CB2 signaling was uniformly osteogenic. CB2-knockout mice developed high-turnover osteoporosis, whereas CB2 agonists (HU-308, JWH-133, HU-433, JWH-015) restored trabecular volume, enhanced osteoblast activity and strengthened fracture callus. Cannabidiol (CBD), a non-psychoactive phytocannabinoid with CB2 bias, accelerated early posterolateral fusion in rats and reduced the RANKL/OPG ratio without compromising final union. In contrast, sustained or high-dose Δ⁹-tetrahydrocannabinol (THC) activation of CB1 slowed chondrocyte hypertrophy, decreased mesenchymal-stromal-cell mineralization and correlated clinically with 6–10% lower bone-mineral density and a 1.8–3.6-fold higher pseudarthrosis or revision risk. Short-course or low-dose THC appeared skeletal neutral. Responses varied with sex, age and genetic background; no prospective trials defined safe perioperative dosing thresholds. Conclusions: CB2 activation and CBD consistently favor bone repair, whereas chronic high-THC exposure poses a modifiable risk for nonunion in spine surgery. Prospective, receptor-specific trials stratified by THC/CBD ratio, patient sex and ECS genotype are needed to establish evidence-based cannabinoid use in spinal fusion. Full article

Human Immunodeficiency Virus (HIV) infection remains a major global health issue, with effective antiretroviral therapy (ART) extending life expectancy but also increasing age-related issues like osteopenia and osteoporosis. This cross-sectional study examines bone mineral density (BMD) and related risk factors in Romanian HIV-positive patients, emphasizing regional and therapy influences. The patients varying in HIV infection duration underwent DXA scanning to measure BMD in the lumbar spine, femoral neck, and total femur. A high prevalence of low BMD, especially in the lumbar spine, was identified along with significant associations between reduced BMD and factors such as smoking, alcohol use, vitamin D deficiency and serum phosphorus levels. ART like Protease Inhibitors and Nucleoside Reverse Transcriptase Inhibitors were linked to increased bone loss, emphasizing the multifactorial nature of osteoporosis in HIV-infected individuals and underscore the importance of regular BMD assessments, lifestyle adjustments, and careful management of antiretroviral therapy to minimize fracture risk and enhance overall health and quality of life. Full article

Background: Female collegiate runners may be at high risk for disordered eating and poor bone health, which are characteristics of the female athlete triad. Intuitive eating can promote healthy eating behavior and adequate calorie intake, central variables in calculating energy availability, an underlying cause of low bone mass in athletes. Poor bone health can contribute to injury, preventing optimal performance for athletes. The purpose of this study was to assess intuitive eating, energy availability, and bone mineral density in female college runners with comparison to non-athletes. Methods: Female college athletes (n = 13, 19.5 ± 1.4 yrs) and non-athletes (n = 12, 19.9 ± 1.3 yrs) completed the Intuitive Eating Scale, Eating Disorder Examination Questionnaire, and menstrual history survey. Bone mineral density and body composition were measured using a dual-energy X-ray absorptiometer (DEXA). A 3-day diet record and exercise log were used to assess dietary intake, estimate energy expenditure, and calculate energy availability. Results: Intuitive eating was inversely correlated with disordered eating (r = −0.596, p = 0.002). Intuitive eating scores were not correlated to calorie intake, energy availability, bone mass, or percent body fat. Runners consumed significantly more calories, calcium, magnesium, phosphorus, and protein (g/kg) than non-athletes. Energy availability and bone mineral density were not significantly different between runners and non-athletes. Conclusions: Intuitive eating is associated with healthy eating behaviors in college-age females and was not related to energy availability, bone density, or body composition in this population. Future research could explore the use of intuitive eating principles in reducing disordered eating and addressing low energy availability in female runners and non-athletes. Full article

Objectives: The early detection of low bone mineral density (BMD) is essential for preventing osteoporosis and related complications. While dual-energy X-ray absorptiometry (DXA) remains the gold standard for diagnosis, its cost and limited availability restrict its use in large-scale screening. This study investigated whether raw bioelectrical impedance analysis (BIA) data combined with explainable machine learning (ML) models could accurately classify osteopenia in women aged 40 to 55. Methods: In a cross-sectional design, 138 women underwent same-day BIA and DXA assessments. Participants were categorized as osteopenic (T-score between −1.0 and −2.5; n = 33) or normal (T-score ≥ −1.0) based on DXA results. Overall, 24.1% of the sample were classified as osteopenic, and 32.85% were postmenopausal. Raw BIA outputs were used as input features, including impedance values, phase angles, and segmental tissue parameters. A sequential forward feature selection (SFFS) algorithm was employed to optimize input dimensionality. Four ML classifiers were trained using stratified five-fold cross-validation, and SHapley Additive exPlanations (SHAP) were applied to interpret feature contributions. Results: The neural network (NN) model achieved the highest classification accuracy (92.12%) using 34 selected features, including raw impedance measurements, derived body composition indices such as regional lean mass estimates and the edema index, as well as a limited number of categorical variables, including self-reported physical activity status. SHAP analysis identified muscle mass indices and fluid distribution metrics, features previously associated with bone health, as the most influential predictors in the current model. Other classifiers performed comparably but with lower precision or interpretability. Conclusions: ML models based on raw BIA data can classify osteopenia with high accuracy and clinical transparency. This approach provides a cost-effective and interpretable alternative for the early identification of individuals at risk for low BMD in resource-limited or primary care settings. Full article

Background/Objectives: Cerebral palsy (CP) is the most common cause of neurological disability in children and is frequently associated with low bone mineral density (BMD) and increased risk of fractures. This study aimed to assess BMD in children with CP, compare it with normative standards, and explore potential associations with anthropometric parameters and the clinical characteristics of children with CP. Methods: Thirty-six children with CP aging 6–15 years from both sexes with varying levels of Gross Motor Functional Classification System (GMFCS) and spasticity were evaluated. Areal BMD and Z-scores (total and subtotal) were measured using dual-energy X-ray absorptiometry (DXA). Regression analysis identified predictors of BMD. Results: Children with GMFCS levels III–V had significantly lower total and subtotal Z-scores compared to those with levels I–II (p = 0.001 and p = 0.02, respectively). Total Z-score was significantly predicted by weight (β = 1.02, p = 0.002), height (β = −0.72, p = 0.02), and sedentary time (β = −0.47, p = 0.005). “No walking” was the only significant predictor for subtotal Z-score (β = −0.50, p = 0.004). Conclusions: Children with moderate to severe CP exhibited significantly lower BMD, particularly those with limited ambulation and higher spasticity levels. These findings underscore the importance of early screening and targeted interventions to optimize bone health in this population. Full article

Background: Patients awaiting total hip arthroplasty (THA), particularly those with hip osteoarthritis (OA), face an elevated risk of osteoporosis due to age and gender-related factors. Osteoporosis, indicated by low bone mineral density (BMD), can affect implant osteointegration, long-term stability, and increase the likelihood of periprosthetic fractures. Despite these risks, osteoporosis is often underdiagnosed and undertreated in THA candidates. While several studies have addressed this issue in Northern populations, data on Southern European cohorts, particularly Italian patients, remain limited. This study aims to evaluate the prevalence of osteoporosis and vitamin D deficiency, as well as the rates of related treatments, in patients with hip osteoarthritis scheduled for THA. Methods: This single-center, retrospective study was conducted at Policlinico Universitario di TorVergata, Italy, involving 66 hip OA patients (35 men, 31 women; mean age 67.5 years). BMD was assessed at the femoral neck, total femur, and lumbar spine via DEXA, alongside vitamin D and PTH levels. Demographic data, ongoing anti-osteoporotic therapies, Harris Hip Score (HHS), and handgrip strength were recorded. Statistical analysis included t-tests and Pearson’s correlation. Osteoporosis was defined per WHO criteria, with significance set at p < 0.05. Results: In this study of 66 patients with hip osteoarthritis (35 men, 31 women; mean age 67.5 years), women exhibited significantly lower bone mineral density (BMD) at the total femur (−0.98 ± 1.42 vs. −0.08 ± 1.04; p < 0.05) and lumbar spine (−0.66 ± 1.74 vs. 0.67 ± 1.59; p < 0.05) compared to men. Handgrip strength was also significantly reduced in females (17.1 ± 8.2 kg) versus males (27.3 ± 10.3 kg; p < 0.05). Vitamin D levels were below 30 ng/mL in 89.4% of patients, and 63.6% had levels below 20 ng/mL; PTH levels were elevated (>65 pg/mL) in 54.5% of cases, indicating frequent secondary hyperparathyroidism. Only 9 patients were receiving vitamin D supplementation and none were on anti-osteoporotic treatment. Conclusions: These findings highlight the frequent coexistence of low BMD, vitamin D deficiency, and reduced muscle strength in THA candidates, suggesting a pattern of musculoskeletal vulnerability that warrants clinical attention. Full article

Alkaline phosphatase (ALP) deficiency has been linked to reduced physical performance, as seen in hypophosphatasia (HPP). However, its potential role in muscle function has not been fully explored. This was a cross-sectional study in 34 HPP adults and 34 matched healthy controls. Muscle strength was assessed using handgrip strength (HGS), considering values below the 10th percentile of the Spanish population as low strength. Muscle mass was evaluated using dual-energy X-ray absorptiometry and morphometric ultrasound. Bone mineral density (BMD) was measured at the lumbar spine, femoral neck, and total hip. The prevalence of low muscle strength was significantly higher in the HPP group compared to controls (30% vs. 6%; p = 0.009), with decreased HGS in the HPP group (p = 0.039). Positive associations were observed between ALP and femoral neck BMD, leg circumference, and fat-free mass and an inverse association with tricipital skinfold. Subjects with serum ALP activity below the sex-adjusted median had a significantly higher risk of low muscle strength independently of HPP diagnosis. ALP remained independently associated with HGS (p = 0.005), and a predictive model using ALP values showed strong capability to predict low-muscle-strength risk. Based on these results, we conclude circulating ALP levels are independently associated with muscle strength and may represent a useful biomarker for the early detection of muscle dysfunction. Future longitudinal or interventional studies are needed to assess whether ALP plays a causal role in muscle strength. Full article

Bone metabolism is a dynamic process involving continuous bone formation and resorption, orchestrated by the interplay between osteoblasts and osteoclasts. Osteoporosis (Op), the most prevalent osteo-metabolic disorder globally, results from an imbalance in this remodeling cycle. Hashimoto’s thyroiditis (HT), a chronic autoimmune thyroid disorder, has been increasingly recognized as a contributor to bone loss, even in euthyroid individuals. HT is marked by immune dysregulation, autoantibody production, and chronic inflammation, factors that can alter bone remodeling. Furthermore, both thyroid-stimulating hormone (TSH) and thyroid hormones (THs) independently influence bone health. Low TSH and elevated TH levels, including in subclinical states, have been linked to reduced bone mineral density (BMD) and increased fracture risk. Nutritional factors, particularly selenium and iodine intake, modulate both thyroid and bone function, and can be considered as a link between HT and Op. In particular, antioxidant-rich diets such as the Mediterranean diet may confer protective effects. This review integrates current clinical and experimental evidence linking HT with bone metabolism disorders, emphasizing the multifactorial nature of bone fragility in autoimmune thyroid disease and the potential role of diet in mitigating its impact. Full article

Elite female tennis players are among those at high risk for developing the Female Athlete Triad (Triad), characterized by three interrelated conditions: energy deficiency/low energy availability, menstrual dysfunction, and low bone mineral density. From 1996 to 2022, the Women’s Tennis Association (WTA) developed and implemented prevention, education, and management plans for female athletes at risk for, or exhibiting symptoms of, the Triad. This article reviews the WTA Triad protocol, developed in 2018 and utilized through 2022, in collaboration with subject matter experts in the Women’s Health and Exercise Laboratory at The Pennsylvania State University. The WTA Triad protocol (1996–2022) includes prevention and management programs implemented by a multidisciplinary Performance Health Team to include screening for “red flags” during annual physicals or upon clinical presentation of a menstrual problem, bone disorder, or nutritional concern; targeted education for players, coaches, and other support team members with handouts and lectures on nutrition and body image to prevent energy deficiency; and a multidisciplinary protocol to guide treatment and return-to-play decisions. Other sport governing bodies can adopt similar multi-layered programs and practices for their athletes, coaches, and support teams to educate, screen, manage, and help to prevent the development of the Triad. Full article

Osteogenesis imperfecta (OI) is a rare bone dysplasia that occurs with a frequency of 1/15,000–20,000 live births. It is characterized by increased susceptibility of bone fractures, skeletal deformities, low stature, and low bone mass. It results in impaired production of type I collagen. About 90% of people with OI have heterozygous mutations in the COL1A1 and COL1A2 genes. Fibroblast growth factor 23 (FGF23) is a protein involved in the regulation of phosphate and 1,25-dihydroxyvitamin D₃ metabolism on a negative feedback basis. FGF23 is secreted by osteocytes in response to increased serum calcitriol and phosphorus. The purpose of this study was to evaluate the concentration of FGF23 among children with osteogenesis imperfecta and the differences in reference values in a healthy population of children and adolescents. Then, this study sought to evaluate how the course of osteogenesis imperfecta, including type of disease, number of bone fractures, and bone mineral density, are related to FGF23 concentration. The study included 47 children aged 3 to 17 years with a diagnosis of osteogenesis imperfecta, confirmed by genetic tests. The patients were hospitalized at the Department from August 2019 to September 2020 and were treated with intravenous infusions of sodium pamidronate. The course of the disease was analyzed, including the number of bone fractures, clinical symptoms, and anthropometric parameters, and bone densitometry was performed by dual X-ray absorptiometry (DXA) in Total Body Less Head (TBLH) and Spine options with Z-score evaluation. FGF23 concentration was determined by the ELISA method. The study was prospective in nature. Results: The mean level of FGF23 in the study group of patients was 645.09 pg/mL and was within the reference values for the developmental age population. There was no significant correlation between FGF23 concentration and anthropometric measurements: body weight (p = 0.267), height (p = 0.429), gender (p = 0.291), or pubertal stage (p = 0.223) in the study group of patients. FGF23 levels were not related to the number of fractures (p = 0.749), the number of sodium pamidronate cycles administered (p = 0.580), bone mineral density parameters (Z-score), the form of osteogenesis imperfecta (p = 0.156), or the genetic test result (p = 0.573). FGF23 levels decrease with age (r = −0.32, p = 0.030) and BMI (r = −0.34, p = 0.020). The level of FGF23 in patients with osteogenesis imperfecta is lower among older children and those having a higher BMI. This index cannot be a diagnostic tool in this group of patients, for no differences were found between the concentrations in patients with osteogenesis imperfecta and the developmental age population. Full article

Background: Calcium is the most abundant mineral in the human body and is essential not only for bone health but also for many other physiological functions. In fact, dietary calcium intake is important not only for bone health but also for fat mass and overall body composition. This study aimed to evaluate the potential effects of dietary calcium intake on bone mineral density (BMD), body composition, and fragility fractures. Methods: In a cohort of 173 consecutive elderly men and 939 women aged 55 and over, living in Siena, Italy, daily dietary calcium intake was evaluated using a food frequency questionnaire (FFQ) specifically validated for the Italian population. Bone mineral density at various skeletal sites and body composition were measured in all participants using a Lunar Prodigy densitometer. Additionally, the serum levels of vitamin D and bone turnover markers were assessed, and the presence of prevalent atraumatic fractures was documented. Results: Across all age groups, calcium intake was consistently higher in males (898.40 ± 312.87 mg/day) than in females (821.95 ± 351.3 mg/day); the prevalence of subjects in the lowest tertile of calcium intake was significantly higher among females than males (31.4% vs. 14.5% p < 0.05). Moreover, dietary calcium intake showed an inverse relationship with body fat mass in women (p < 0.05) and a positive association with lean mass in men (p < 0.05). Two hundred twenty-eight (24.3%) women and forty-eight (27.8%) men had a history of one or more fractures, and in both sexes, subjects with prevalent fractures had significantly lower dietary calcium intake values than those without fractures. Conclusions: This study indicates that inadequate calcium intake remains widespread in the Italian population, especially among subjects with low BMD and a history of fractures. Furthermore, this study confirms that dietary calcium intake significantly affects body composition. Full article

Approximately 95% of skeletal size, bone, and muscle mass is achieved by the age of 18, with a rapid acceleration in bone mineral accumulation and muscle growth during the adolescent growth spurt. Bone mineral status in children and adolescents in Kazakhstan is a relevant subject for both clinical and fundamental research. The aim of this study was to investigate the prevalence of low bone mineral density (BMD) and the factors associated with it in children and adolescents living in the Abay region of Kazakhstan. The target group consisted of children and adolescents aged 5 to 17 years (n = 509) who had been residing in the Abay region of Kazakhstan since birth. Based on physiological age, participants were divided into two groups: 5–10 years (preschool and early school age) and 11–17 years (adolescence). All participants completed a questionnaire and underwent bone mineral density assessment using dual-energy X-ray absorptiometry (DXA). Comparisons were made between two age groups (5–10 and 11–17 years) and based on the presence or absence of reduced bone mineralization. Regression analysis identified four factors independently associated with reduced bone mineralization: ionized calcium (AOR 2099.9; p = 0.007), age (AOR 1.21; p = 0.013), body weight (AOR 0.97; p = 0.047), and green vegetables (AOR 0.46; p = 0.017). Conclusions: Our study demonstrated that 50.5% of children aged 5–10 years and 57.4% of adolescents aged 11–17 years had BMD below the age-specific norm. The study identified several risk factors that are associated with a decrease in BMD. These include blood ionized calcium, age, inadequate consumption of fruits and vegetables and dairy products, low physical activity, and insufficient sun exposure. These findings highlight the importance of early prevention of osteopenic conditions beginning in childhood and adolescence. Full article

Background/Objectives: This study aims to assess dietary quality among Chinese pregnant women across three gestational trimesters using different assessment indices while investigating the relationship between dietary patterns and longitudinal alterations in maternal body composition parameters and bone mineral density (BMD) during pregnancy. Methods: A total of 556 healthy pregnant women were recruited. Dietary intake was assessed utilizing a semi-quantitative food frequency questionnaire (FFQ). Diet quality was evaluated through three indices: the Dietary Balance Index for Pregnant Women (DBI-P), the Dietary Inflammatory Index (DII), and the Eastern Health Diet Index (EHDI). Multiple linear regression models and mediation analyses were constructed to elucidate the relationships between dietary indices, body composition parameters, and BMD. Results: In the first trimester, excessive dietary intake was associated with increased maternal fat mass but reduced BMD, while insufficient intake correlated with declines in muscle mass, water compartments, and inorganic salt levels. Pro-inflammatory diets further exacerbated reductions in non-fat body composition, including protein and muscle mass. By the second trimester, low-quality diets continued to negatively affect muscle mass and water balance, whereas no significant dietary effects on body composition or BMD were observed in the third trimester. Mediation analyses revealed that body composition partially mediated the relationship between dietary imbalance and reduced BMD. Conclusions: Unbalanced, pro-inflammatory, and low-quality diets during early-to-mid pregnancy contribute to adverse changes in maternal body composition and bone health, especially in the first and second trimesters, with the DBI-P index demonstrating superior applicability for assessing dietary impacts in Chinese pregnant women. Full article

Pathogenic variants in the phenylalanine hydroxylase gene can result in phenylalanine (Phe) accumulation leading to phenylketonuria (PKU; OMIM #261600), a metabolic disease diagnosed in newborn screening. Early treatment with a Phe-restricted diet prevents severe mental retardation. Next to several other health complaints, patients with PKU present with low bone mineral density (BMD) more often than the general population. The etiology of the phenotype is not yet fully understood, and current research focuses on improving special medical foods and changes in osteoclasts (OC) and osteoblasts. Analysis of osteoclastic and oxidative stress control gene expression next to the simple number of OC developing from peripheral blood mononucleated cells (PBMCs) in association with dietary compliance and BMD was therefore part of our analysis. PBMCs were obtained from 17 adults with PKU and 17 age- and sex-matched controls on the same day. PBMCs were differentiated into osteoclasts (OC, Trap-positive multi-nucleated cells (≥3 nuclei)) for 14 days by adding human macrophage colony-stimulating factor (MCSF) and receptor activator of NF-κB Ligand (RANKL). Subsequently, quantitative real-time PCR was performed on OC function and oxidative stress control. Data on dietary compliance during the previous 12 months and 5 years and BMD were collected. PBMCs from adults with PKU and controls were differentiated into comparable numbers of OC (PKU: 53 [17–87] vs. controls: 39 [19–52], p = 0.381) without differences in mRNA expression of genes related to OC function and oxidative stress control. Dietary compliance in short-term and mid-term was not associated with OC number or mRNA expression, but CTSK negatively correlated with BMD T-Score in the hips of adults with PKU (Spearman r = −0.518, p = 0.040). Osteoclastogenesis was not changed in adult patients with PKU, nor were most mRNA expressions of OC marker genes or those of oxidative stress control. However, 44% of patients presented with BMD below −1 in their hips, and the OC of these tended to express higher CTSK (above −1: 0.2 [0.2–0.8] vs. below −1: 0.9 [0.6–3.4], p = 0.055). Thus, alternative regulatory mechanisms of OC activity may play a role in the development of low BMD in patients with PKU. Full article

Background: Considering the increasing interest in strategies to prevent osteoporosis and other bone-related conditions, it is relevant to critically assess the existing evidence on the potential benefits of phenolic compounds in wine on bone metabolism. Objectives: This integrative review aims to evaluate clinical and animal studies investigating the influence of wine consumption on bone mineral density (BMD). Methods: The search was conducted in PubMed, Scopus, and Embase databases until April 2025. The key question was: “Does wine consumption influence BMD?”. Results: After searching the identified databases, 108 studies were screened, and 7 were included in the final analysis. Conclusions: This review suggests a possible association between light to moderate wine consumption and favorable effects on BMD, particularly in the spine and femoral neck. However, these findings should be interpreted cautiously due to the predominance of observational studies. Future RCTs and systematic reviews must clarify wine’s potential role in bone health and explore non-alcoholic or low-alcohol wine alternatives with similar polyphenol content. Full article