Search Results (410)

Background/Objectives: Osteoporosis remains a leading cause of morbidity in postmenopausal women, yet many high-risk individuals remain undiagnosed or untreated. This study aimed to assess the prevalence of osteoporosis and osteopenia, treatment patterns, and skeletal fragility indicators in a large cohort of postmenopausal women undergoing DXA screening. Methods: We analyzed data from 1669 postmenopausal women aged 40–89 years who underwent DXA evaluation. BMD status was categorized as normal, osteopenia, or osteoporosis. Treatment status was classified based on active antiosteoporotic therapy, calcium/vitamin D supplementation, hormonal therapy (historical use), or no treatment. Logistic regression models were used to explore independent predictors of osteoporosis and treatment uptake. Results: A total of 45.0% of women had osteoporosis and 43.5% had osteopenia. Despite this, 58.5% of the population, over half of women with osteoporosis, were not receiving any active pharmacologic treatment. Bisphosphonates were the most prescribed therapy (17.9%), followed by calcium/vitamin D supplements (20.6%). A prior history of fragility fractures and radiological bone lesions were significantly associated with lower BMD (p < 0.05). Historical hormone replacement therapy (HRT) use was not associated with current BMD (p = 0.699), but women with HRT use reported significantly fewer fractures (p < 0.001). In multivariate analysis, later menopause age and low BMD status predicted higher odds of receiving active treatment. Conclusions: Our findings highlight a substantial care gap in osteoporosis management, with treatment primarily initiated reactively in more severe cases. Improved screening and earlier intervention strategies are urgently needed to prevent fractures and reduce the long-term burden of osteoporosis. Full article

Background/Objectives: Platelets play a role in bone metabolism and fracture healing. This study aimed to investigate the association between platelet indices and the derived systemic immune inflammation index (SII) with fracture risk in postmenopausal women. Methods: Platelet count, mean platelet volume, platelet distribution width (PDW), platelet crit, percentage of large platelets (P-LCR), platelet–lymphocyte ratio, and the SII, calculated as (NxP)/L, where N, P, and L represented neutrophils, platelets and lymphocytes counts, respectively, were evaluated. Bone mineral density (BMD) was measured using dual-energy X-ray absorptiometry. Results: A total of 124 women (mean age 68.4 ± 9 years) were stratified into two groups based on the median platelet count; the “lower platelet count group” (n = 58) had a count of 200,000 (174,000 to 226,000), while the “higher platelet count group” (n = 66) had a count of 281,500 (256,500 to 308,500). The higher platelet count group showed a higher hip fracture risk (7.4 vs. 4.5%, p = 0.08) and lower lumbar spine BMD (0.773 vs. 0.83 gr/cm², p = 0.03). By dividing the participants into two groups with higher SSI (950,848.6 ± 746,097.99) (n = 61) and lower SII (355,751.2 ± 88,662.6) (n = 63), the group with the higher SII showed the higher hip fracture risk (7.4 vs. 3.6%, p = 0.01). Univariate regression analysis revealed correlations between chronological age and PDW (r = 0.188, p = 0.047), and P-LCR (r = 0.208, p = 0.03), as well as associations between vitamin D status and P-LCR (r = −0.301, p = 0.034), and between SII and hip fracture risk (r = 0.12, p = 0.007). Conclusions: Platelet count and SII were associated with fracture risk in postmenopausal women undergoing osteoporosis assessment. Given their reproducibility and cost-effectiveness, these markers warrant further investigation in future prospective studies focused on bone fragility. Full article

Postmenopausal osteoporosis is estrogen-dependent and results in an imbalance between bone formation and resorption. The approved therapy is intended to reduce the risk and consequences of fractures, but still has a number of contraindications and associated adverse effects. Recently, oxytocin has been shown to have an anabolic effect on bone tissue, increasing the production of osteoblasts and inhibiting the activity of osteoclasts. Thus, this study aimed to examine the potential of oxytocin as a biomarker and therapeutic agent for postmenopausal osteoporosis. A PubMed search yielded 16 articles upon analysis of the inclusion and exclusion criteria. The results showed that, compared to women in the same age group without bone loss, those diagnosed with osteoporosis exhibited lower blood oxytocin levels, possibly related to a greater tendency towards fractures. The administration of oxytocin could be a promising strategy to enhance bone quality and, consequently, to reduce the incidence of fragility fractures; however, no human studies have been conducted regarding its use as a possible treatment. Thus, it is essential to increase the number of clinical trials in women with ovarian dysfunction and bone loss, in which oxytocin could become a viable therapeutic alternative. Full article

Background/Objectives: Vertebral fractures (VFs) are a global health issue caused by traumatic or pathological factors that compromise spinal integrity. The burden of VFs is increasing, particularly in older adults. Methods: Data from the Global Burden of Disease 2021 were analyzed to estimate the prevalence, mortality, and years lived with disability due to VFs from 1990 to 2021. Estimates were stratified according to age, sex, and region. Bayesian meta-regression models were used to generate age-standardized rates, and projections for 2050 were calculated using demographic trends and the sociodemographic index. Das Gupta’s decomposition assessed the relative contributions of population growth, aging, and prevalence changes to future case numbers. Results: In 2021, approximately 5.37 million people (95% Uncertainty Interval [UI]: 4.70–6.20 million) experienced VFs globally, with an age-standardized prevalence of 65 per 100,000. Although the rates have declined slightly since 1990, the absolute burden has increased owing to population aging. VF prevalence was the highest in Eastern and Western Europe and in high-income regions. Males had higher VF rates until 70 years of age, after which females surpassed them, reflecting postmenopausal osteoporosis. Falls and road injuries were the leading causes of VF. By 2050, the number of VF cases is expected to increase to 8.01 million (95% UI: 6.57–8.64 million). Conclusions: While the age-standardized VF rates have decreased slightly, the global burden continues to increase. Targeted strategies for the early diagnosis, osteoporosis management, and fall prevention are necessary to reduce the impact of VFs. Full article

Osteoporosis is a chronic disease associated with significant morbidity and mortality and requires long-term therapy. Efficacious and well-tolerated treatments are available, but their effect is either short-lived or lost following their discontinuation. The exception is bisphosphonates that reduce bone resorption and turnover, can be administered in regimens ranging from once-daily to once-yearly, and have been shown in randomized clinical trials to reduce the incidence of all osteoporotic fractures, but their effect persists following their discontinuation. This is due to their property of being taken-up selectively by the skeleton and being slowly released following treatment arrest. This property allows the discontinuation of bisphosphonate treatment for different periods of time, the so-called drug holiday, which reduces the risk of rare adverse events while maintaining the effect; an action particularly important for patients at very high risk of fractures for whom sequential therapy with different agents is currently advised. Thus, bisphosphonates, apart from being the treatment of choice for certain groups of patients, are also indispensable for the consolidation and maintenance of the gains of all other treatments, providing, in addition, the opportunity of temporary treatment arrest. Most patients with postmenopausal osteoporosis will, therefore, receive bisphosphonate at some stage during therapy of their disease, regardless of their initial fracture risk. Full article

The assessment of bone mineral density (BMD) is essential for osteoporosis diagnosis. Dual-energy X-ray Absorptiometry (DXA) is the current gold standard, but it has limitations in evaluating trabecular bone and is susceptible to different artifacts. In this study we evaluate whether Dual-Energy Computed Tomography (DECT) can be defined as an alternative method for the assessment of BMD in a sample of postmenopausal patients undergoing oncological follow-up. In this study a retrospective analysis was conducted on 41 patients who had both DECT and DXA within six months. BMD values were extracted from DECT using five different base material pairs (BMPs) and compared with DXA measurements at the femoral neck. The calcium–fat pairing showed the strongest correlation with DXA-derived BMD (Spearman’s ρ = 0.797) and excellent reproducibility (ICC = 0.983). There was a strong and significant association between the DXA results and the various BPM measurements. These findings support the possibility of DECT in the precise and opportunistic evaluation of BMD changes when employing particular BMPs. This study showed how this technique can be a useful and effective substitute for conventional DXA, particularly when patients are in oncological follow-up using DECT, minimizing additional radiation exposure. 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: Studies have reported an increased risk of type 2 diabetes among people with higher protein intake. Moreover, branched-chain amino acids (BCAA) are reported to be positively associated with insulin resistance (IR). However, it is not understood whether elevated levels of BCAA are causal to IR development, or if higher BCAA are a marker of IR. The objective of this study was to examine the effects of long-term protein and carbohydrate supplementation on plasma BCAA levels, and the relationship between plasma BCAA and IR in postmenopausal women. Methods: Stored samples and data from 84 postmenopausal women who participated in a protein supplementation trial (SPOON) were included. Exclusion criteria consisted of protein intakes less than 0.6 g/kg or greater than 1.0 g/kg, a body mass index (BMI) greater than 32 kg/m² or less than 19 kg/m² diseases, and conditions and medications known to impact musculoskeletal health. Subjects were randomized to a whey protein (PRO: n = 38) or maltodextrin supplement (CHO: n = 46) for 18 months. Plasma BCAA, homeostatic model assessment of insulin resistance (HOMA-IR) and body composition were analyzed at baseline and 18 months. Results: At baseline, there were no significant associations between plasma BCAA and IR. There were also no significant changes in plasma BCAA or IR by study arm. However, there was a significant positive association between plasma BCAA and IR in both groups at 18 months (CHO: r = 0.35, p = 0.02; PRO: r = 0.35, p = 0.03). Conclusions: Findings from this study warrant future research to examine other diet and lifestyle factors that may mediate the relationship between circulating BCAA and IR in postmenopausal women. Full article

Objectives: The aim of this study was to develop AI-based predictive models to assess the risk of osteoporosis in postmenopausal women using panoramic radiographs (OPTs). Methods: A total of 301 panoramic radiographs (OPTs) from postmenopausal women were collected and labeled based on DXA-assessed bone mineral density. Of these, 245 OPTs from the Hospital of San Giovanni Rotondo were used for model training and internal testing, while 56 OPTs from the University of Parma served as an external validation set. A mandibular region of interest (ROI) was defined on each image. Predictive models were developed using classical radiomics, deep radiomics, and convolutional neural networks (CNNs), evaluated based on AUC, accuracy, sensitivity, and specificity. Results: Among the tested approaches, classical radiomics showed limited predictive ability (AUC = 0.514), whereas deep radiomics using DenseNet-121 features combined with logistic regression achieved the best performance in this group (AUC = 0.722). For end-to-end CNNs, ResNet-50 using a hybrid feature extraction strategy achieved the highest AUC in external validation (AUC = 0.786), with a sensitivity of 90.5%. While internal testing yielded high performance metrics, external validation revealed reduced generalizability, highlighting the challenges of translating AI models into clinical practice. Conclusions: AI-based models show potential for opportunistic osteoporosis screening from OPT images. Although the results are promising, particularly those obtained with deep radiomics and transfer learning strategies, further refinement and validation in larger and more diverse populations are essential before clinical application. These models could support the early, non-invasive identification of at-risk patients, complementing current diagnostic pathways. Full article

Osteoporosis is a major public health concern, particularly among postmenopausal women. Environmental exposure to metals has been proposed as a potential contributor to osteoporosis, but human data remain limited and inconsistent. This study investigated changes in urinary concentrations of 20 metal(loid)s in patients with osteoporosis, as well as the association of these elements with bone mineral density (BMD), in a cohort of 380 postmenopausal women aged 50–70 years from Cascavel, Paraná, Brazil. Demographic, lifestyle, and clinical data were collected, and urinary concentrations of aluminum (Al), barium (Ba), cadmium (Cd), cobalt (Co), cesium (Cs), copper (Cu), mercury (Hg), lithium (Li), manganese (Mn), molybdenum (Mo), nickel (Ni), lead (Pb), rubidium (Rb), antimony (Sb), selenium (Se), tin (Sn), strontium (Sr), thallium (Tl), uranium (U), and zinc (Zn) were measured by inductively coupled plasma mass spectrometry. BMD was assessed at the lumbar spine, femoral neck, and total hip using dual-energy X-ray absorptiometry. Osteoporosis was diagnosed in 73 participants (19.2%). Osteoporotic women had significantly higher urinary concentrations of Cd, Mn, Pb, Sb, Sn, and Zn (p < 0.05). Statistically significant negative correlations were observed between BMD and urinary concentrations of Al, Cd, Hg, Mn, Sb, and U. After adjustment for confounders, elevated urinary concentrations of Cd, Mn, Pb, and Sb remained independently and significantly associated with higher odds of osteoporosis, with Cd (aOR = 1.495; p = 0.026) and Sb (aOR = 2.059; p = 0.030) showing the strongest associations. In addition, women with urinary concentrations above the 90th percentile for both Cd and Sb had a significantly higher prevalence of osteoporosis compared to those with lower levels (44.4% vs. 18.0%; p = 0.011). Longitudinal studies are needed to confirm causality and inform prevention strategies. Full article

Background/Objectives: Estrogen deficiency is strongly related to osteoporosis, but its role in the development of atherosclerotic cardiovascular disease (CVD), particularly in postmenopausal women, is unclear. The aim of this study was to assess the relationship between osteopenia and subclinical atherosclerosis in asymptomatic non-diabetic postmenopausal women. Methods: This prospective study included 117 consecutive postmenopausal women (mean age 59 ± 7 years) referred from the outpatient Rheumatology Clinic of the University Clinical Centre of Kosovo, recruited between September 2021 and December 2022. Clinical, biochemical, bone mineral density (BMD), carotid ultrasound and coronary CT angiography data were analyzed. Subclinical atherosclerosis was diagnosed as the presence of carotid plaques and/or increased intima-media thickness (CIMT) > 1.0 mm. Results: Of the 117 studied women, 83 (71%) had osteopenia or osteoporosis (T-score < −1 SD), who had higher prevalence of carotid artery plaques (27.7 vs. 8.8%, p = 0.019), compared to those with normal BMD. They were, also, older (p < 0.001), had a longer duration of menopause (p = 0.004) and higher CAC scores (p < 0.019), compared to those without plaques. In multivariate analysis [odds ratio 95% confidence interval], age [1.244 (1.052–1.470), p = 0.001], osteoporosis [0.197 (0.048–0.806), p = 0.024] and CAC score > 10 HU [0.174 (0.058–0.806), p = 0.006] were independently associated with the presence of carotid plaques. Conclusions: Reduced BMD is highly prevalent in asymptomatic non-diabetic postmenopausal women and is associated with a high prevalence of subclinical carotid atherosclerosis. Age, osteoporosis and CAC score > 10 HU were independently associated with atherosclerotic carotid plaque formation. These findings highlight the potential pathophysiological link between osteoporosis and subclinical atherosclerosis. Full article

Background: Osteoporosis is a chronic metabolic condition characterized by progressive loss of bone mass and disruption of the bone spatial architecture. Pathological changes are influenced by multiple factors, including genetic predispositions. Identifying risk factors for osteoporosis is crucial for recognizing at-risk populations, implementing preventive strategies, and supporting diagnostics. Type I collagen, composed of two chains—α1(I) and α2(I), encoded by the COL1A1 and COL1A2 genes, respectively—plays a key role in the mechanical strength of tissues, including bones. The aim of this study was to assess the effect of the rs17166249 and rs412777 polymorphisms in the COL1A2 gene on bone mineral density (BMD) in postmenopausal women. Methods: The study included 570 unrelated women: 119 diagnosed with osteoporosis, 96 with osteopenia, and 355 healthy controls. Polymorphisms in the COL1A2 gene were analyzed using real-time PCR with specific primers and TaqMan probes. Results: The results showed no significant differences in the distribution of genotypes and alleles of rs412777 between the groups. However, the rs17166249 T allele was found to be more prevalent in the osteoporosis group, although the association was not statistically significant after adjusting for confounders. Furthermore, no significant correlations were observed between the genotypes of either SNP and BMD parameters such as T-score, Z-score, and BMD measurements. Conclusion: These findings suggest that while the COL1A2 gene may have a modest influence on bone health, its role in osteoporosis risk remains inconclusive, highlighting the need for further studies to explore additional genetic and environmental factors. Full article

Breast cancer is the leading cause of death among women, and its treatment often involves chemotherapy and hormone therapy, which can compromise bone mineral density (BMD). Tamoxifen, a selective estrogen receptor modulator, has different effects depending on the patient’s hormonal status. On the one hand, in postmenopausal women, it has a protective effect on BMD; on the other hand, in premenopausal women, it can accelerate bone loss, increasing the risk of osteoporosis and fractures. The reduction in estrogen levels during treatment is a key factor in this bone loss. This review underscores the importance of early risk assessment and regular monitoring of bone mineral density, along with the adoption of individualized pharmacological and non-pharmacological strategies, such as calcium and vitamin D supplementation and physical exercise, to preserve bone health in premenopausal women with breast cancer undergoing endocrine therapy. Full article

Genetic variations in the COL1A1 and COL1A2 genes have been linked to bone mineral density (BMD) and metabolic disorders. This study analyzed the associations of COL1A1 (rs1107946, rs1800012) and COL1A2 (rs42524) polymorphisms with BMD, obesity, and type 2 diabetes (T2D) in 554 postmenopausal women. Dual-energy X-ray absorptiometry assessed BMD, and genotyping was performed alongside an evaluation of metabolic and lifestyle factors. The COL1A1 rs1107946 AA genotype was associated with higher femoral neck BMD (p < 0.05), an over 10-fold increased obesity prevalence (p = 0.038), and a 3.5-fold higher T2D risk (p = 0.011)—a novel finding. The rs1800012 polymorphism showed age-dependent BMD effects: A allele carriers had lower femoral neck BMD in the 60–69 age group but higher total hip BMD in the 70–79 age group. Additionally, COL1A2 rs42524 GG homozygotes had a significantly higher incidence of maternal fractures (p < 0.05). These results highlight COL1A1 rs1107946 as a potential marker for both skeletal and metabolic risk, demonstrate the age-specific effects of rs1800012 on BMD, and identify rs42524 as a possible genetic indicator of familial fracture risk. These insights may inform personalized approaches to osteoporosis and metabolic disease prevention. Full article

Estrogen levels are the core factor influencing postmenopausal osteoporosis (PMOP). Estrogen can affect the progression of PMOP by regulating bone metabolism, influencing major signaling pathways related to bone metabolism, and modulating immune responses. When estrogen levels decline, the activity of Sirtuins (SIRTs) is reduced. SIRTs are enzymes that function as NAD+-dependent deacetylases. SIRTs can modulate osteocyte function, sustain mitochondrial homeostasis, and modulate relevant signaling pathways, thereby improving bone metabolic imbalances, reducing bone resorption, and promoting bone formation. In PMOP, SIRT1, SIRT3, and SIRT6 are primarily affected. Oxidative stress (OS) is a crucial factor in PMOP, as it generates excessive reactive oxygen species (ROS) that exacerbate PMOP. There is a certain interplay between SIRTs and OS. The reduced activity of SIRTs leads to intensified OS and the excessive accumulation of ROS. In return, ROS suppresses the AMPK signaling pathway and the synthesis of NAD+, which consequently diminishes the function of SIRTs. Natural SIRT activators and natural antioxidants, which are characterized by high safety, convenience, and minimal side effects, represent a potential therapeutic strategy for PMOP. This study aims to investigate the mechanisms of SIRTs and OS in PMOP and summarize potential therapeutic strategies to assist in the improvement of PMOP. Full article