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Bone Density & Osteoporosis

Systemic bone fragility and microarchitectural decay — T-score diagnostics, vertebral compression fracture risk, and implications for spinal stability.

Overview

Osteoporosis is a systemic skeletal disorder characterized by decreased bone mineral density, significantly increasing the risk of fragility fractures. Fracture prevention remains the primary efficacy endpoint in medical management [4]. While national guidelines recommend densitometry for diagnosis [2], a substantial proportion of patients with subsequent contralateral proximal femoral fractures were neither screened nor formally treated [5]. Consequently, identifying high-risk individuals is critical to effectively deploy the expanding array of osteoporosis therapies [3].

Screening strategies extend beyond traditional densitometry. Circulating markers of bone turnover may identify patients at risk for low bone mineral density long before standard screening thresholds, though prospective validation is required before widespread clinical adoption [6]. Adult children of patients with proximal femur fractures constitute a high-risk demographic, with nearly half meeting treatment thresholds [56]. In pediatric populations, the effectiveness of regular screening for low bone mineral density risk factors in children with idiopathic scoliosis requires further investigation to prevent osteoporosis [12].

Bone health directly influences surgical outcomes and perioperative risk. Osteoporosis exacerbates complications in total knee arthroplasty, advocating for routine screening, preoperative optimization, and enhanced postoperative surveillance to mitigate risks and improve implant durability [29]. Management in spine surgery is challenging but can yield pain relief, deformity correction, and improved function through appropriate patient selection, medical optimization, and surgical technique [30]. Conversely, patients with decreased bone mineral density can still achieve excellent 2-year outcomes following arthroscopic rotator cuff repair [9]. Therapeutic interventions such as denosumab result in higher spine bone mineral density in selected postmenopausal women [27]. Clinical practice regarding bisphosphonate prescribing and treatment decision-making varies significantly among providers [57].

Anatomy & Pathophysiology

Osseous

Bone density and its relation to the development of acromial stress fracture following reverse total shoulder arthroplasty do not predictably decrease with age or osteoporosis diagnosis [23]. Mechanical bone properties of vertebral cancellous bone can be modelled with high accuracy in the investigated bone density range based on quantitative computed tomography [39]. Data from individual spinal segments measured using Hounsfield units of computed tomography may be helpful to comprehensively evaluate the status of the spine and to design a better preoperative plan before instrumentation [69].

The L2‒L4 lumbar spine segment may substantially increase in bone mineral density with whole-body vibration training, whereas the L1‒L4 lumbar spine segment and total hip region have a negligible effect [63]. Participation in one or more high-impact sports in adulthood is associated with larger vertebral size, and thus increased vertebral strength, among middle-aged women [74]. Due to the unique microarchitecture of the cervical vertebrae, fractures occur much later in this region than in the thoracic or lumbar spine [44]. Acute multiple osteoporotic vertebral compression fractures are an accelerated form of osteoporotic vertebral compression fracture cascades, showing similar anatomical distribution and distribution pattern of osteoporotic vertebral compression fractures in the spine [70].

Ligamentous & Disc

Endplate thickness and bone density significantly influence biomechanical stability after anterior cervical discectomy and fusion, highlighting the importance of preserving endplate integrity and evaluating bone quality to mitigate the risk of postoperative subsidence [79]. Osteoporosis leads to the deterioration of biomechanical characteristics in the adjacent segment disc after percutaneous transforaminal endoscopic discectomy, which may result in an increase in the incidence of adjacent segment disease [52]. The co-morbidity of intervertebral disc degeneration and osteoporosis is driven by a synergistic network of biomechanical coupling and molecular pathways, including inflammatory factors, senescence signaling, and immunometabolic reprogramming [72].

Classification

Osteoporosis is a common bone disorder with increasing incidence [1]. It is a condition of bone mass loss often associated with cellular activity alterations rather than obvious biochemical defects [7]. Current clinical management focuses excessively on the diagnosis of osteoporosis, neglecting previous stages of low bone mineral density such as osteopenia, bone quality, and bone tissue structure [8]. The identification of high-risk patients is important to effectively use the growing number of available osteoporosis therapies [3]. Proper recognition of the etiology of osteoporosis is an essential step in improving bone health and preventing further bone loss [18].

Trabecular Pattern Analysis: Femoral trabecular patterns are of little help in establishing the diagnosis or severity of osteoporosis [10]. The femoral trabecular scoring system as described by Singh and associates is of little or no help in establishing the diagnosis or the severity of osteoporosis [58]. Conversely, trabecular patterns can be utilized as a roentgenographic scale for the diagnosis and grading of osteoporosis [11].

Bone Density Indices: Trabecular bone density of the peripheral skeleton is a reliable index of postmenopausal osteoporosis [43]. Osteoporotic patients can be distinguished from those with age-related bone loss based on the magnitude of the decrease in trabecular bone density [43]. Distal radius bone mineral density has the potential to be integrated into future osteoporosis classification systems [17].

Advanced Imaging Models: A three-classification predictive model combining deep learning-based automatic segmentation of the proximal femur and radiomics-based bone status classification on low-dose abdominal CT images can be used for the opportunistic detection of osteoporosis [61]. Specific characteristics of vertebral fractures in elderly men, including the number of fractures, fracture type, and degree of compression, are associated with low bone mineral density and osteoporosis [64].

Other Considerations: The evidence highlights a tension between traditional radiographic scoring systems and emerging quantitative or AI-driven classification methods. While Singh’s system and general femoral trabecular patterns are deemed of little diagnostic help, other trabecular pattern analyses and peripheral density metrics remain clinically relevant.

Clinical Presentation

Osteoporosis is a common bone disorder with increasing incidence [1]. It is a condition of bone mass loss often associated with cellular activity alterations rather than obvious biochemical defects [7]. The condition is prevalent among specific demographics, including Palestinian people above 50 years old [22]. However, disparities in incidence, awareness, diagnosis, treatment, and outcomes exist across racial and ethnic lines, with minority women often underdiagnosed and undertreated [35].

Clinical management currently focuses excessively on the diagnosis of osteoporosis, neglecting previous stages of low bone mineral density, such as osteopenia, bone quality, and bone tissue structure [8]. A high proportion of women diagnosed with osteoporosis had been evaluated by densitometry, in agreement with national guidelines [2]. Conversely, most patients with subsequent contralateral proximal femoral fracture were not screened or formally treated for osteoporosis [5]. Proper recognition of the etiology of osteoporosis is an essential step in improving bone health and preventing further bone loss [18].

Imaging and Screening Modalities

Trabecular Patterns: These are of little help in establishing the diagnosis or severity of osteoporosis [10]. Alternatively, trabecular patterns can be utilized as a roentgenographic scale for the diagnosis and grading of osteoporosis [11].

CT-Based Opportunistic Screening: Vertebral HU value and the pectoral muscle index based on chest CT can be used to opportunistically screen for osteoporosis [13]. This opportunistic screening approach allows early prevention of osteoporotic fractures via timely screening of individuals at high risk without requiring additional radiation [13]. Hounsfield unit measurements on CT scans are useful for identifying osteoporosis and predicting complications in patients undergoing spinal surgery [20]. Based on CT at the third lumbar spine level, the skeletal muscle index and psoas muscle index can predict osteoporosis [21].

Lumbar Degenerative Disease Parameters: Combinations of two imaging parameters can improve bone mineral density assessment in patients with lumbar degenerative diseases [19]. Parameters at the single-segment level are recommended to assist in the diagnosis of osteoporosis due to easier measurement and same diagnostic performance [19]. Specific metrics such as VFI, SFI, and VSR do not help clinicians to diagnose osteoporosis well [21].

Pediatric Considerations: Regular screening for low bone mineral density risk factors in children with idiopathic scoliosis needs to be investigated to prevent osteoporosis [12].

Physical and Laboratory Assessment

Mechanical Characteristics: Mechanical characteristics do not predictably decrease with age or osteoporosis diagnosis [23].

Muscle Metrics: Findings regarding the association between muscle strength and mass and bone mineral density may have profound implications for public health regarding osteopenia and osteoporosis prevention, early diagnosis, and treatment [36].

Biomarkers: Prospective validation is necessary before recommending widespread clinical use of circulating markers of bone turnover to identify patients at risk for developing low bone mineral density long before traditional screening [6].

Investigations

Plain radiography: Osteoporosis is characterized by bone mass loss and cellular activity alterations rather than obvious biochemical defects [7]. While trabecular patterns of the upper end of the femur can serve as a roentgenographic scale for diagnosis and grading [11], general trabecular patterns are of little help in establishing the diagnosis or severity of osteoporosis [10]. Vertebral fracture indices (VFI), subchondral fracture index (SFI), and vertebral shape ratio (VSR) do not help clinicians diagnose osteoporosis effectively [21].

MRI: Average cortical bone thickness measurements obtained from shoulder MRI correlate with DXA and appear effective in differentiating patients with normal and abnormal BMD [73]. Radionucleotide bone scanning and MRI are helpful in diagnosing regional migratory osteoporosis [60].

CT: Hounsfield unit (HU) measurements on CT scans are useful for identifying osteoporosis and predicting complications in patients undergoing spinal surgery [20]. Vertebral HU value and the pectoral muscle index based on chest CT can be used to opportunistically screen for osteoporosis without requiring additional radiation [13]. Known 2D radiographic and novel 3D measurements of bone density can be reproducibly measured from CT scans and show moderately strong correlation [66]. For patients with lumbar degenerative diseases, parameters at the single-segment level are recommended to assist in diagnosis, offering the same diagnostic performance with easier measurement [19]. Diffusion tensor imaging (DTI) with a cutoff of 1.6 may help prompt clinicians to initiate workup and manage underlying osteoporosis [82].

Other Considerations: A high proportion of women diagnosed with osteoporosis had been evaluated by densitometry, aligning with national guidelines [2]. However, most patients who sustained subsequent contralateral proximal femoral fractures were not screened or formally treated for osteoporosis [5]. Current clinical management focuses excessively on osteoporosis diagnosis, neglecting previous stages such as osteopenia, bone quality, and bone tissue structure [8]. Improved osteoporosis workup and intervention are needed among patients who have sustained low-energy vertebral compression fractures [16]. Distal radius bone mineral density has the potential to be integrated into future osteoporosis classification systems for patients with a history of fragility fracture [17]. Patients with decreased bone mineral density can still achieve excellent 2-year outcomes after arthroscopic rotator cuff repair [9]. In AS patients not using antiosteoporotic therapy, spine trabecular bone density evaluated by QCT decreased over 10-year follow-up and was not related to baseline radiological severity of spine involvement [77]. Denosumab results in higher spine BMD in selected women with postmenopausal osteoporosis [27].

Treatment

Non-Operative

Osteoporosis management rests on early recognition, medical therapy, and fracture prevention [1]. Fracture prevention serves as the primary efficacy endpoint in medical management [4]. Identifying high-risk patients is critical to effectively deploying the expanding array of osteoporosis therapies [3]. More than one in two patients with clinical vertebral or non-vertebral fractures and BMD-osteoporosis have correctable secondary contributors [32]. Circulating bone turnover markers may identify patients at risk for low BMD long before traditional screening, though prospective validation is needed before widespread clinical adoption [6]. For children with idiopathic scoliosis, the effectiveness of regular screening for low BMD risk factors to prevent osteoporosis requires further investigation [12]. Non-NOF fragility fractures receive less attention for assessment and treatment than NOF fractures [65]. Bisphosphonate therapy reduces fracture risk but does not reduce overall mortality risk [42].

Operative

Indications: Management of osteoporosis in spine surgery is challenging but can yield pain relief, deformity correction, and improved function through appropriate patient selection, medical optimization, and surgical techniques [30]. Active treatment for lumbar spinal stenosis (LSS) with potent osteoporosis therapy is indicated to increase BMD in patients with both conditions [45]. Conventional instrumentation combined with complete osteoporosis treatment improves surgical outcomes in LSS patients with osteoporosis [71]. Lower limb deformity correction techniques are likely contraindicated in osteogenesis imperfecta patients with significant bone fragility or ongoing fractures [54].

Surgical Approach / Technique: Good immediate stability can be achieved after surgery regardless of the cage type used in osteoporotic patients [83]. Short-term anabolic agent administration followed by sequential therapy may effectively enhance bone health and reduce subsequent fracture risk in osteoporotic hip fractures [80].

Implant Selection: Patient-reported and clinical outcomes for osteoporotic patients on teriparatide are comparable to those with normal BMD undergoing long spinal fusion [46].

Adjuncts: Teriparatide treatment combined with denosumab alone effectively improves spine BMD [15]. The combination of calcitriol and bisphosphonates demonstrates superior clinical efficacy and safety in postmenopausal osteoporosis, reducing pain and disability while enhancing bone metabolism, immune function, BMD, and daily living ability [37]. Both denosumab and alendronate effectively improve BMD in postmenopausal breast cancer patients with aromatase inhibitor-associated osteoporosis [40]. Twelve months of alendronate treatment increases BMD at axial and appendicular skeletons in postmenopausal women with established osteoporosis [41]. Bisphosphonate treatment improves health-related quality of life (HRQoL) in men with osteopenia/osteoporosis [47]. Denosumab shows promising efficacy in maintaining bone health and preventing joint damage in rheumatoid arthritis patients with coexisting osteoporosis [48]. Traditional Chinese Exercise (TCE) significantly affects postmenopausal osteoporosis and serves as a non-pharmacological treatment option [75]. The efficacy of risedronate against bone resorption remains disputed in medium- or long-term follow-up due to declining trends and safety challenges, necessitating larger, longer clinical trials focusing on clinically relevant endpoints [14].

Complications

Osteoporosis: Osteoporosis is a common bone disorder with increasing incidence [1]. It is a condition of bone mass loss often associated with cellular activity alterations rather than obvious biochemical defects [7]. Osteopenia and osteoporosis are conditions often associated with cellular activity alterations rather than obvious biochemical defects [7]. Osteoporosis is common among Palestinian people above 50 years old [22]. A negative calcium balance of as little as fifty milligrams a day over twenty years may produce significant osteoporosis [33]. More than one in two patients presenting with a clinical vertebral or non-vertebral fracture and BMD-osteoporosis have secondary contributors to osteoporosis, most of which were correctable [32].

Screening and Diagnosis: The identification of high-risk patients is important to effectively use the growing number of available osteoporosis therapies [3]. Vertebral HU value and the pectoral muscle index based on chest CT can be used to opportunistically screen for osteoporosis without requiring additional radiation [13]. Prospective validation is necessary before recommending widespread clinical use of circulating markers of bone turnover to identify patients at risk for developing low bone mineral density long before traditional screening would ostensibly take place [6]. Current clinical management focuses excessively on the diagnosis of osteoporosis, neglecting previous stages of low bone mineral density, such as osteopenia, bone quality, and bone tissue structure [8].

Treatment Gaps and Outcomes: Most patients with subsequent contralateral proximal femoral fracture were not screened or formally treated for osteoporosis [5]. Osteoporosis is undertreated after low-energy vertebral compression fractures [16]. Health Related Quality of Life was low in osteoporosis and unaffected by bone specific treatment [25].

Pharmacologic Management: The efficacy of risedronate against bone resorption remains disputed in medium or long-term follow-up due to declining trends and potential safety challenges, necessitating future larger clinical trials with longer duration focusing on clinically relevant endpoints [14]. Short-term teriparatide administration followed by denosumab alone was effective only in improving spine BMD [15]. Long term treatment with pamidronate iv has a comparable effect on BMD as oral bisphosphates [24]. BMD is preserved at the lumbar spine and total hip following discontinuation of bisphosphonate for a short period following long-term treatment, although a gradual loss occurs at the femoral neck [26]. Medication history and age-specific gender differences must be considered in bone turnover and metabolic clinical research [28].

Fracture Healing and Natural History: The study clarified the natural history of the progression pattern of vertebral deformities in radiographic prevalent vertebral fractures in elderly individuals [31]. The current evidence indicates that the beneficial effects of anti-osteoporosis treatment exceed any concerns about possible adverse consequences on fracture healing in most circumstances [49].

Recovery

Light activity (weeks): Evidence does not provide specific week ranges for light activity or desk work return in the context of osteoporosis management or fracture recovery.

Full activity (months): Evidence does not provide specific month ranges for full activity, manual work, or strength return.

Complete recovery / outcome plateau (months): Patients with decreased bone mineral density can achieve excellent 2-year outcomes after arthroscopic rotator cuff repair [9]. Health-related quality of life was low in osteoporosis and unaffected by bone-specific treatment in a 10-year follow-up study [25].

Rehabilitation protocol: Evidence does not specify PT phasing, immobilisation duration, or weight-bearing progression for osteoporosis-related conditions.

Functional milestones: Evidence does not provide validated PROM trajectories or outcome-measure benchmarks.

Other Considerations: Osteoporosis is a common bone disorder with increasing incidence [1]. Early recognition, medical management, and fracture prevention are main pillars of osteoporosis treatment [1]. Fracture prevention is the key efficacy end point in the medical management of osteoporosis [4]. Circulating markers of bone turnover may identify patients at risk for developing low bone mineral density long before traditional screening [6], although prospective validation is necessary before recommending widespread clinical use of these markers for early risk identification [6].

The efficacy of risedronate against bone resorption remains disputed in medium or long-term follow-up due to declining trends and potential safety challenges [14], necessitating future clinical trials to evaluate risedronate efficacy with longer duration and clinically relevant endpoints [14]. Short-term teriparatide administration followed by denosumab alone was effective only in improving spine BMD in patients with osteoporotic hip fracture [15]. Osteoporosis is undertreated after low-energy vertebral compression fractures, indicating a need for improved workup and intervention [16]. Intravenous pamidronate is a good alternative for patients with gastrointestinal side effects or contraindications for oral bisphosphonates [24], and long-term treatment with intravenous pamidronate has a comparable effect on BMD as oral bisphosphonates [24].

BMD is preserved at the lumbar spine and total hip following short-term discontinuation of bisphosphonates after long-term treatment [26], whereas a gradual loss of BMD occurs at the femoral neck following discontinuation of bisphosphonates after long-term treatment [26]. Medication history and age-specific gender differences must be considered in bone turnover and metabolic clinical research [28]. Osteoporosis exacerbates perioperative complications in total knee arthroplasty [29], and routine osteoporosis screening, preoperative optimization of bone health, and enhanced postoperative surveillance are advocated to mitigate risks and improve long-term implant durability in total knee arthroplasty [29]. Preoperative screening and management of osteoporosis may be important for optimizing long-term outcomes in patients requiring multilevel cervical fusion [62].

The study clarified the natural history of the progression pattern of vertebral deformities in radiographic prevalent vertebral fractures in elderly individuals [31]. A negative calcium balance of as little as fifty milligrams a day over twenty years may produce significant osteoporosis [33]. Some osteoporotic patients retain calcium on high intake, but retention may disappear over time [33]. Low trabecular bone density at the site of the hip was associated with the duration of disease progression and degree of hip involvement in ankylosing spondylitis patients [84]. In chronically treated osteoporotic patients, 95% have a bone turnover in the premenopausal range [85]. The burden of screening for markers of bone health and subsequent treatment in at-risk elderly patients with proximal femur fractures has increased over time [86]. Bone metabolism factors were associated with poor prognosis of osteoporosis in the elderly [88]. Reductions in bone mineral density were observed in some postmenopausal women previously tolerant of brand alendronate who switched to generic alendronate [89].

Key Evidence

  • [L3] A high proportion of women diagnosed with osteoporosis had been evaluated by densitometry, in agreement with national guidelines. (10.1186/1471-2474-12-7)
  • [L4] The identification of high-risk patients is important to effectively use the growing number of available osteoporosis therapies. (10.1186/1471-2474-3-22)
  • [L4] Most of these patients were not screened or formally treated for osteoporosis. (10.1186/s13018-023-03621-y)
  • [L2] Although prospective validation is necessary before recommending widespread clinical use, this information may be used to identify patients at risk for developing low bone mineral density long before traditional screening would ostensibly take place. (10.1016/j.jhsa.2021.02.019)
  • [L5] This article defines osteopenia and osteoporosis, discusses their pathophysiology, clinical manifestations, diagnostic modalities, and current therapeutic modes, emphasizing that osteoporosis is a condition of bone mass loss often associated with cellular activity alterations rather than obvious biochemical defects. (10.2106/jbjs.l.01168)
  • [L5] The study concludes that current clinical management focuses excessively on the diagnosis of osteoporosis, neglecting previous stages of low bone mineral density, such as osteopenia, bone quality, and bone tissue structure. (10.1186/s12891-025-08997-y)
  • [L3] Patients with decreased bone mineral density can still achieve excellent 2-year outcomes. (10.1016/j.jse.2025.02.011)
  • [L3] Thus, these trabecular patterns are of little help in establishing the diagnosis or severity of osteoporosis. (10.2106/00004623-197254070-00011)
  • [L4] These patterns can be utilized as a roentgenographic scale for the diagnosis and grading of osteoporosis. (10.2106/00004623-197052030-00005)
  • [L4] To prevent osteoporosis, the effectiveness of regular screening for low BMD risk factors in children with IS needs to be investigated. (10.1186/s12891-023-06157-8)
  • [L3] This approach allows the early prevention of osteoporotic fractures via the timely screening of individuals at high risk of osteoporosis without requiring additional radiation. (10.1186/s13018-024-04825-6)
  • [Letter] The efficacy of risedronate against bone resorption remains disputed in medium or long-term follow-up due to declining trends and potential safety challenges, necessitating future larger clinical trials with longer duration focusing on clinically relevant endpoints. (10.1186/s13018-022-03118-0)
  • [L3] Short-term teriparatide administration followed by denosumab alone was effective only in improving spine BMD. (10.1186/s12891-020-03771-8)
  • [L4] Our study demonstrates the additional need for improved osteoporosis workup and intervention among patients who have sustained VCFs. (10.5435/jaaos-d-20-01132)
  • [L3] Consequently, it has the potential to be integrated into future osteoporosis classification systems. (10.1186/s12891-025-09431-z)
  • [L4] Proper recognition of the etiology of osteoporosis is an essential step in improving bone health and preventing further bone loss. (10.3390/jcm11092382)
  • [L3] Considering the same diagnostic performance but easier measurement, parameters at the single-segment level were recommended to assist in the diagnosis of osteoporosis. (10.1186/s12891-023-06888-8)
  • [L5] This review serves as an update to diagnosis, management, and treatment of patients with osteoporosis undergoing spinal surgery, highlighting new anabolic pharmacologic options and the utility of Hounsfield unit measurements on CT scans for identifying osteoporosis and predicting complications. (10.5435/jaaos-d-24-00311)
  • [L3] In addition, VFI, SFI, and VSR do not help clinicians to diagnose osteoporosis well. (10.1186/s12891-022-05887-5)
  • [L4] Osteoporosis is common among Palestinian people above 50 years old. (10.1186/1471-2474-14-284)
  • [L3] These mechanical characteristics also do not predictably decrease with age or osteoporosis diagnosis. (10.1177/1758573220949992)
  • [L3] Long term treatment with pamidronate iv has a comparable effect on BMD as oral bisphosphonates. (10.1186/1471-2474-10-86)
  • [L3] Health Related Quality of Life was low in osteoporosis and unaffected by bone specific treatment. (10.1186/s12891-022-05987-2)
  • [L3] BMD is preserved at the lumbar spine and total hip following discontinuation of bisphosphonate for a short period following long-term treatment, although a gradual loss occurs at the femoral neck. (10.1186/1471-2474-8-3)
  • [L1] Denosumab results in higher spine BMD in selected women with postmenopausal osteoporosis. (10.1186/s13018-021-02678-x)
  • [L4] Medication history and age-specific gender differences must be considered in bone turnover and metabolic clinical research. (10.1186/s12891-020-03610-w)
  • [L3] These findings advocate for routine osteoporosis screening, optimization of bone health preoperatively, and enhanced postoperative surveillance to mitigate risks and improve long-term implant durability. (10.1186/s13018-025-06340-8)
  • [L5] Management of osteoporosis in patients undergoing spine surgery is challenging, but with appropriate patient selection, medical optimization, and surgical techniques, these patients can experience pain relief, deformity correction, and improved function. (10.5435/jaaos-d-14-00042)
  • [L2] This study clarified the natural history of the progression pattern of vertebral deformities in radiographic prevalent vertebral fractures in elderly individuals. (10.1186/s12891-024-07254-y)
  • [L3] More than one in two patients presenting with a clinical vertebral or non-vertebral fracture and BMD-osteoporosis have secondary contributors to osteoporosis, most of which were correctable. (10.1186/1471-2474-9-109)
  • [L4] Disparities in incidence, awareness, diagnosis, treatment, and outcomes of osteoporosis exist across racial and ethnic lines, with minority women often underdiagnosed and undertreated. (10.5435/00124635-200700001-00008)
  • [L4] These findings may have profound implications for public health regarding osteopenia and osteoporosis prevention, early diagnosis, and treatment. (10.1186/s13018-023-03877-4)
  • [L3] The combination of calcitriol and bisphosphonates demonstrates superior clinical efficacy and safety in treating postmenopausal osteoporosis, effectively reducing pain and disability, enhancing bone metabolism and immune function, and improving bone mineral density and daily living ability. (10.1186/s13018-025-05714-2)
  • [L5] The mechanical bone properties of vertebral cancellous bone could be modelled with high accuracy in the investigated bone density range. (10.1186/s12891-021-04571-4)
  • [L3] Both therapeutic regimens effectively improved BMD in the study population. (10.1186/s12891-025-09280-w)
  • [L2] 12 months Alendronate treatment was effective to increase BMD at both axial and appendicular skeletons in postmenopausal women with established osteoporosis. (10.1186/1749-799x-2-9)
  • [L1] Based on our comprehensive meta-analysis, there is high-quality evidence suggesting that bisphosphonate therapy for patients with osteoporosis does not reduce the overall risk of mortality despite its effectiveness in reducing the risk of fractures. (10.1097/corr.0000000000003204)
  • [L3] Trabecular bone density of the peripheral skeleton is a reliable index of postmenopausal osteoporosis, and osteoporotic patients can be distinguished from those with age-related bone loss based on the magnitude of the decrease in trabecular bone density. (10.2106/00004623-198466070-00007)
  • [L5] Due to the unique microarchitecture of the cervical vertebrae, fractures occur much later in this region than they do in the thoracic or lumbar spine. (10.1186/s13018-022-03105-5)
  • [L3] Active treatment for LSS with more potent treatment for osteoporosis should be taken to increase BMD for patients with osteoporosis and LSS. (10.1186/s12891-021-04273-x)
  • [L3] Moreover, patient-reported and clinical outcomes for osteoporotic patients on teriparatide were not different from those for patients with normal BMD. (10.2106/jbjs.23.00272)
  • [L2] Bisphosphonates treatment is beneficial to improve HRQoL of osteopenia/osteoporosis men. (10.1186/s12891-023-06397-8)
  • [L1] Denosumab demonstrates promising efficacy in maintaining bone health and preventing joint damage in rheumatoid arthritis patients with coexisting osteoporosis. (10.1186/s12891-025-08688-8)
  • [L5] The current evidence indicates that the beneficial effects of anti-osteoporosis treatment exceed any concerns about possible adverse consequences on fracture healing in most circumstances. (10.1016/j.injury.2018.04.016)
  • [L5] Osteoporosis leads to the deterioration of biomechanical characteristics in the adjacent segment disc after PTED; this variation may also result in an increase in the incidence of ASD. (10.1186/s13018-019-1166-1)
  • [L4] The technique is probably contraindicated in patients who have a greater degree of fragility of the bones and in those who continue to sustain fractures. (10.2106/00004623-199602000-00008)
  • [L4] Adult children of patients with proximal femur fractures represent a high-risk group for osteoporosis, with nearly half meeting treatment thresholds. (10.1186/s12891-025-09378-1)
  • [L4] Approaches to making treatment decisions and supporting patients when prescribing bisphosphonates for osteoporosis vary in practice. (10.1186/s12891-023-06865-1)
  • [L5] Radionucleotide bone scanning and MRI were helpful in the diagnosis of regional migratory osteoporosis, and all patients recovered with conservative treatment. (10.1007/s00402-003-0557-1)
  • [L4] A three-classification predictive model combining a deep learning-based automatic segmentation of the proximal femur and a radiomics-based bone status classification on LDCT images can be used for the opportunistic detection of osteoporosis. (10.1186/s12891-025-08631-x)
  • [L3] These data indicate that preoperative screening and management of osteoporosis may be important for optimizing long-term outcomes in patients who require multilevel CF. (10.5435/jaaos-d-22-00361)
  • [L1] The L2‒L4 lumbar spine segment may substantially increase, whereas the L1‒L4 lumbar spine segment and total hip region have negligible effect. (10.1186/s12891-026-09504-7)
  • [L3] Specific characteristics of vertebral fractures in elderly men, including the number of fractures, fracture type, and degree of compression, are associated with low bone mineral density and osteoporosis. (10.1302/0301-620x.97b8.35032)
  • [L4] Non-NOF fragility fractures received less attention for osteoporosis assessment and treatment compared to NOF fractures. (10.1186/s13018-023-04266-7)
  • [L2] This study has demonstrated that known 2D radiographic and novel 3D measurements of bone density can reproducibly be measured from CT scans and have moderately strong correlation. (10.1016/j.jseint.2021.07.015)
  • [L4] These data from the individual spinal segments may be helpful to comprehensively evaluate the status of the spine and to design a better preoperative plan before instrumentation. (10.1186/s12891-024-07324-1)
  • [L3] amOVCF are an accelerated form of OVCFcs showing similar anatomical distribution and distribution pattern of OVCF in the spine. (10.1186/s13018-024-05337-z)
  • [L3] The use of conventional instrumentation along with complete treatment of osteoporosis can help improve the clinical outcome of surgery in these patients. (10.1186/s13018-023-03935-x)
  • [L5] The co-morbidity of intervertebral disc degeneration and osteoporosis is driven by a synergistic network of biomechanical coupling and molecular pathways, including inflammatory factors, senescence signaling, and immunometabolic reprogramming. (10.1186/s13018-025-06075-6)
  • [L3] Average cortical bone thickness measurements obtained from shoulder MRI are correlated with DXA and appear effective in differentiating patients with normal and abnormal BMD, potentially guiding further diagnostic assessments. (10.1177/17585732241279090)
  • [L2] Participation in one or more high-impact sports in adulthood is associated with larger vertebral size, and thus increased vertebral strength, among middle-aged women. (10.1186/s12891-017-1794-8)
  • [L1] TCE has a significant effect on postmenopausal patients with osteoporosis and can be used as a non-pharmacological treatment. (10.1186/s13018-024-05288-5)
  • [L3] In AS patients who were not using antiosteoporotic therapy spine trabecular bone density evaluated by QCT decreased over 10-year follow-up and was not related to baseline radiological severity of spine involvement. (10.1186/1471-2474-12-121)
  • [L5] Endplate thickness and bone density significantly influence biomechanical stability after ACDF, highlighting the importance of preserving endplate integrity and evaluating bone quality to mitigate the risk of postoperative subsidence. (10.1186/s12891-025-09255-x)
  • [L3] This treatment approach may be an effective strategy to enhance bone health and potentially reduce subsequent fracture risk in this high-risk population. (10.1186/s13018-025-06084-5)
  • [L3] DTI with a cutoff of 1.6 may help prompt clinicians to initiate workup and thus manage underlying osteoporosis. (10.1016/j.jse.2024.05.018)
  • [L5] For people with osteoporosis, no matter what type of cage is used, good immediate stability can be achieved after surgery. (10.1186/s12891-024-07221-7)
  • [L3] The low trabecular bone density at the site of the hip was associated with the duration of disease progression and degree of hip involvement. (10.1186/s12891-021-04912-3)
  • [L3] In chronically treated patients, 95% have a bone turnover in the premenopausal range. (10.1186/1471-2474-12-167)
  • [L3] The burden of screening for markers of bone health and subsequent treatment in at-risk patients has increased over time. (10.1186/s13018-025-06202-3)
  • [L3] Bone metabolism factors were associated with poor prognosis of osteoporosis in the elderly. (10.1186/s12891-024-07560-5)
  • [L3] In addition, reductions in bone mineral density were observed in some patients who had stable BMDs before January 2006. (10.1186/1471-2474-11-68)

See Also

References

[1] Chapter 6 Osteoporosis and Pathologic Bone. 2021.

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