Search Results (466)

Prostate cancer (PCa) is a prevalent malignancy in men worldwide, and both androgen deprivation therapy (ADT) and radiotherapy (RT) are key components of its management. However, these treatments significantly affect bone health by inducing bone mineral density (BMD) loss, osteopenia, osteoporosis and increased fracture risk. ADT promotes a high bone turnover state through hormonal suppression and molecular mechanisms involving increased RANKL expression and osteoclast activation. RT generates direct cytotoxic damage and inflammatory changes that compromise bone microarchitecture. Combined ADT + RT exerts synergistic detrimental effects. This narrative review synthesizes the molecular basis, clinical evidence, preventive strategies and emerging technologies related to bone health in men with PCa undergoing ADT and/or RT. Full article

Osteoporosis is a metabolic disease of the skeleton characterized by a low bone mass and deterioration of bone tissue structure, leading to increased fragility and susceptibility to fractures. It is often referred to as the “silent killer of bones” because it progresses without symptoms until a bone fracture occurs. Osteoporosis is a serious health problem, especially in aging societies, leading to fractures, limited mobility, and a decreased quality of life. Osteoporosis prevention through dietary modification should be the first step in protecting bone health before implementing any form of pharmacotherapy. The composition of the diet and nutritional patterns are considered the most important factors influencing the shaping of gut microbiota and its metabolites, which in turn affect the regulation of bone tissue metabolism. Mushrooms, as a source of vitamin D, can play a significant role in the prevention of osteoporosis. Additionally, the application of UV irradiation can rapidly increase the vitamin D₂ content in mushrooms. A review of currently available studies reveals that many mushroom species contain substances (Ca, P, Se) that support bone formation by promoting remineralization. Mushrooms also induce bone regeneration after osteoporosis by balancing their reconstruction. This review systematically integrates the latest research on the use of mushrooms in the prevention of osteoporosis. The most promising species in the prevention of osteoporosis include: Lentinula edodes, Ganoderma lucidum, Ophiocordyceps sinensis, Pleurotus eryngii, Antrodia camphorata, Auricularia auricula, Agaricus bisporus, and Grifola frondosa. Full article

Introduction: Chronic inflammation in axial spondyloarthritis (axSpA) promotes osteoclast formation and bone resorption, leading to osteoporosis and an increased risk of fragility fractures. Osteoporotic fractures significantly impact the quality of life in patients with axSpA. While the Fracture Risk Assessment Tool (FRAX) is widely used to evaluate fracture risk, data on FRAX-based fracture risk assessment in axSpA, particularly in German patients, are limited. Objective: The primary objective of this study was to assess the prevalence of low bone mineral density (BMD) and fracture risk using FRAX for major osteoporotic fractures (MOF) and hip fractures (HF) in German patients with axSpA. Secondary objectives were to compare FRAX scores and BMD between genders and between patients with and without previous fractures, and to identify which FRAX parameters were most frequently abnormal. Materials and Methods: This retrospective study analyzed demographic and clinical data, along with DXA-measured BMD, T-scores and Z-scores of the lumbar spine and femoral neck in 58 axSpA patients aged 43–81 years from routine clinical practice. Calculations for MOF and HF were performed using the FRAX model for Germany. Low BMD was defined as a T-score < −1 SD or a Z-score < −2 SD. Statistical analyses included independent t-tests and chi-square tests. Results: The mean age of patients was 65 years with a mean BMI of 29.5 kg/m². The prevalence of low BMD was 44.8% at the lumbar spine and 60.4% at the femoral neck. Overall, 10 (17.2%) patients reported previous fractures of the spine, forearm, hip, or shoulder. Female patients had higher FRAX scores for MOF (8.2%) than males (6.8%, p = 0.02), while male patients had higher FRAX scores for HF (2.8% vs. 2%, p = 0.04). There was no significant difference in BMD between patients with or without a history of fracture. However, patients with previous fractures had significantly higher FRAX scores for MOF (10.2%) compared to those without fractures (7.3%, p = 0.030); the difference in HF scores was not statistically significant (3.5% vs. 2%, p = 0.056). Conclusions: This study highlights the elevated fracture risk in axSpA patients assessed with FRAX. In this cohort, BMD alone was not associated with fracture history, suggesting that other factors—such as age, sex, glucocorticoid exposure, and prior fractures—may play a more prominent role. FRAX provides a valuable tool for evaluating fracture risk in axSpA, emphasizing the importance of a comprehensive assessment that incorporates both clinical risk factors and BMD. Full article

Background/Objectives: Systemic sclerosis (SSc) patients frequently develop osteoporosis; however, vertebral fracture risk factors remain poorly characterized. This study identifies general and SSc-specific predictors of vertebral fractures in SSc patients undergoing osteoporosis evaluation. Methods: This multicenter cross-sectional study enrolled consecutive SSc patients meeting ACR/EULAR 2013 criteria with suspected osteoporosis. Data included demographics, disease characteristics, bone density (DXA), and vertebral imaging. Stepwise logistic regression analyzed fracture associations (p ≤ 0.05 significant). Results: The majority of 103 enrolled patients were female and all were post-menopausal. The prevalence of osteoporosis was 52.4%, that of vertebral fractures was 38.8%, and that of osteopenia was 28.1%. General risk factor analysis identified family history of fragility fractures (OR 11.8, p = 0.008) and vertebral T-scores (OR 0.6, p = 0.049) as significant predictors. When adding SSc-specific factors, only family history (OR 13.8, p = 0.03) and gastrointestinal (GI) involvement (OR 4.8, p = 0.05) remained significant. Conclusions: Vertebral fractures in SSc patients are strongly linked to a family history of fractures. The suggestive association with GI involvement may imply a significant role for malabsorption-related metabolic impairment. Prioritizing bone density screening in SSc patients with GI symptoms may enable earlier intervention and reduce fracture risk. Full article

Background/Objectives: Hypermobile Ehlers–Danlos syndrome (hEDS) remains genetically unexplained despite decades of clinical investigation, with the molecular basis undefined for the vast majority of cases. This study employs integrated machine learning approaches with rigorous subject-level statistical methods to decode the genetic architecture underlying hEDS. Methods: We analyzed 35,923 rare genetic variants (gnomAD MAF < 0.2) across 116 subjects from 43 families (86 hEDS patients diagnosed per 2017 international criteria; 30 unaffected intrafamilial controls) using whole-exome sequencing. Machine learning analysis employed Random Forest feature selection, deep neural networks, and ensemble methods with subject-stratified cross-validation to prevent data leakage. Statistical association testing used subject-level Fisher’s exact tests with Bonferroni correction (α = 3.77 × 10⁻⁶ for 13,281 genes). Sensitivity analyses assessed robustness to family structure. Results: Subject-level analysis identified statistically significant enrichment in variants associated with three major biological systems: (1) collagen biosynthesis pathway variants (present in 63% of hEDS subjects vs. 17% of controls, Fisher’s p = 1.06 × 10⁻⁵, OR = 8.4), predominantly affecting COL5A1, COL18A1, COL17A1, and post-translational modification enzymes; (2) HLA/adaptive immune axis variants (74% of hEDS vs. 30% of controls, p = 2.23 × 10⁻⁵, OR = 6.8), involving HLA-B, HLA-A, HLA-C, and TAP transporters; (3) mitochondrial respiratory chain variants (34% of hEDS vs. 7% of controls, p = 2.29 × 10⁻³, OR = 7.1), with striking 4.2-fold enrichment in pediatric fracture cases (52% vs. 21%, p = 0.021, 95% CI: 1.2–14.6). These associations require independent validation and functional studies to determine their mechanistic relevance. Genome-wide analysis identified seven genes achieving Bonferroni significance (p < 3.77 × 10⁻⁶), all encoding structural/cytoskeletal proteins. Machine learning models with proper subject-stratified cross-validation achieved 80% accuracy (95% CI: 73–86%, sensitivity = 82%, specificity = 77%). Conclusions: Our findings suggest that hEDS may involve genetic variation across multiple biological systems beyond classical collagen pathways. These hypothesis-generating associations require validation in independent cohorts and functional studies before mechanistic or clinical conclusions can be drawn. Full article

Trade competitiveness can coexist with structurally fragile value chains. When chain feasibility fractures from trade competitiveness, competitiveness without coherence becomes sustainability’s opposite. This paper proposes revisiting the concept of sustainability in agri-food systems, through the lens of structural coherence, understood as the alignment between trade competitiveness, export-destination diversification, and value chain capacity. The research goal is to design and operationalize a diagnostic instrument for structural coherence testing through the triangulation of constant market share analysis (CMSA), the Herfindahl–Hirschman Index (HHI), and physical structural input–output analysis (I-OA). CMSA measures two elements: demand- and competitiveness-driven export dynamics. Export patterns are further explored to verify if there are any destination-market concentration risks (HHI). I-OA closes the loop by linking trade outcomes to internal value chain capacity and efficiency. With clear upstream–downstream segmentation, the sunflower oilseed value chain of the European Union (EU) represents an empirically fertile ground, relevant in the context of the geopolitical disruptions of Black Sea trade corridors and double-cropping dynamics with food-fuel and land-use trade-offs. Focusing on Bulgaria, France, Hungary, Romania, and Spain, which collectively account for more than 85% of EU sunflower seed production, this paper benchmarks post-2013 Common Agricultural Policy (CAP) programming effects, utilized as a proxy for a period of stability, against the post-2020 window, marked by a sequence of crises. Diagnosis is facilitated through findings triangulation, enabling deriving CAP-relevant policy recommendations, aligned with country-specific binding constraints. Results show heterogeneous structurally incoherent profiles: Bulgaria suffers from growth-induced stress, France’s chain efficiency is eroded, the Hungarian chain lacks competitiveness, Romania is raw-export dependent with value-added leakage, and Spain is structurally constrained by physical limits. Policy recommendations target reorienting market-driven low value-added trade behaviors toward structurally sustainable value chain trajectories. Full article

Background: Type 1 diabetes mellitus (T1DM) is associated with an increased risk of fragility fractures that cannot be fully explained by reduced bone mineral density (BMD), highlighting a potential role for bone quality impairment. The purpose of this study was to evaluate the prevalence of altered bone density and microarchitecture and to identify their main clinical correlates in adults with T1DM and seemingly adequate glycemic control at the time of assessment. Methods: Sixty-eight adults aged 18–69 years with T1DM attending a diabetes technology outpatient clinic were enrolled in this single-center, cross-sectional study. BMD at the lumbar spine, femoral neck, and total hip was assessed by dual-energy X-ray absorptiometry (DXA) and classified as reduced based on age and sex: Z-score < −2.0 SD for premenopausal women and men < 50 years, and T-score ≤ −2.5 SD for postmenopausal women and men ≥ 50 years. Bone microarchitecture was evaluated using trabecular bone score (TBS). Clinical, metabolic, and lifestyle variables were collected, including glycated hemoglobin (HbA1c; good control ≈ 7.0%/53 mmol/mol), diabetes duration, microvascular complications, and physical activity (PA) assessed by the International PA Questionnaire (IPAQ; moderate–high PA defined according to combined high and moderate IPAQ categories). Results: Reduced BMD was observed in 35.3% of patients and was associated with older age (p < 0.001), longer disease duration (p = 0.044), lower body mass index (p = 0.031), poorer glycemic control (p = 0.03), microvascular complications such as diabetic peripheral neuropathy (p = 0.028) and retinopathy (p = 0.045), and low PA (p = 0.012). Altered TBS was present in 45.6% of patients and was associated with older age (p < 0.001), longer diabetes duration (p = 0.011), higher HbA1c levels (p < 0.001), diabetic peripheral neuropathy (p = 0.002), retinopathy (p = 0.007), cardiovascular risk factors (dyslipidemia p = 0.002, hypertension p = 0.002), and low PA (p < 0.001). In multivariable analyses, older age and higher HbA1c were independently associated with reduced TBS, whereas moderate–high PA was associated with a lower likelihood of impaired bone microarchitecture. Conclusions: Impaired bone density and bone quality are highly prevalent in adults with T1DM and are frequently associated with longer disease duration, poorer metabolic control, and chronic complications. Our findings support the potential value of a combined assessment of BMD and TBS in fracture risk evaluation, together with strategies aimed at preventing diabetes-related complications and promoting healthy lifestyle behaviors. Full article

Background: Fragility fractures of the pelvis (FFPs) are increasingly prevalent given ageing populations. Conservative management is often primarily utilised due to its initial minimal displacement and the high risks of surgery in this vulnerable population. However, this can lead to rapid deconditioning, especially with non-weight-bearing protocols. Parathyroid hormone (PTH), as a bone anabolic agent, has the potential to improve clinical and radiological outcomes in FFPs, but the evidence remains limited. Methods: A systematic review and meta-analysis following PRISMA guidelines was undertaken. Database search results were independently screened by two authors, and data were extracted. The primary outcome measure was time to fracture healing as assessed by imaging, with the secondary outcome measure of pain levels (VAS/NRS). Results: There were 1230 articles screened, and 893 unique results identified. Six studies were included in the final analysis. These compared the use of PTH and its analogues with standard care, placebo, or sacroplasty. The findings suggest that PTH may accelerate fracture healing and reduce pain in this patient population, although evidence is limited and at high risk of bias. Conclusions: Treatment with PTH may improve bone healing and visual analogue pain scores, although the evidence is limited. There may be a benefit from adjunctive PTH treatment for patients with FFPs; however, larger methodologically robust studies are required to confirm this. Full article

Background: Osteoporosis is a prevalent metabolic bone disorder characterized by reduced bone mineral density (BMD) and increased fracture risk, particularly among older adults. While individual medications have been implicated in bone loss, the cumulative impact of polypharmacy on skeletal health remains underexplored. Methods: This cross-sectional study included 1155 geriatric inpatients undergoing routine bone mineral density assessment. Medication use, demographic characteristics, and clinical variables were extracted from electronic medical records. BMD at the lumbar spine (L1–L4) and total hip was measured using dual-energy X-ray absorptiometry (DXA). Unadjusted analyses and multivariable linear regression models were used to examine associations between medication use, polypharmacy (defined as the use of ≥5 medications), and BMD, adjusting for age, sex, body mass index, and relevant clinical covariates. Results: The mean age of the study population was 85.0 ± 7.1 years, and 80.1% were female. Polypharmacy was present in 64.5% of patients. In medication-specific analyses, thyroid hormone use was associated with lower lumbar spine BMD (p = 0.032), and concomitant use of diuretics and proton pump inhibitors was associated with lower hip BMD (p = 0.049). Steroid use showed a marginally non-significant correlation with reduced BMD (p = 0.057). Polypharmacy was associated with lower lumbar spine BMD (p = 0.022), whereas no significant association was observed with hip BMD. Increasing age was consistently associated with lower BMD across skeletal sites (p < 0.001). Conclusions: In this geriatric inpatient cohort, polypharmacy and selected medication classes were associated with lower bone mineral density, particularly at the lumbar spine. Given the cross-sectional design, these findings reflect associations rather than causal relationships and may partly capture underlying multimorbidity and clinical complexity. Consideration of medication burden may be relevant when evaluating bone health in older adults. Polypharmacy is increasingly common in older adults and may contribute to bone fragility. In this cohort of 1155 geriatric inpatients, multiple medications and certain drug classes were associated with lower bone mineral density, particularly in the spine. These findings suggest that medication burden should be considered when evaluating osteoporosis risk in aging populations. Full article

Bone resorption and formation are known to change in response to mechanical stress. The mechano-transduction mechanism by which bone tissue senses the stress, altering cellular activity in response via intracellular signaling pathways, ultimately leading to physiological and pathological changes, is beginning to be elucidated. Furthermore, excessive mechanical stress on bone and joints due to aging, obesity, overload, and overuse is thought to cause decreased chondrocyte activity, degeneration and destruction of the cartilage collagen matrix, degeneration of the subchondral bone, and joint dysfunction, contributing to the progression of osteoarthritis (OA). However, much remains unknown about how osteoblasts, responsible for bone formation, and chondrocytes, responsible for cartilage homeostasis, sense and respond to mechanical stress. Furthermore, whether there are mechanisms to protect against pathological and excessive mechanical stress in bone and cartilage tissue, their associated molecular mechanisms, and the relationship between mechanical stress responses and osteochondral degeneration, remain unknown. Understanding these mechanisms is considered essential for the development of new therapeutic strategies for osteochondral diseases. Our research aims to deepen our understanding of the etiology and pathophysiology of bone and cartilage diseases (osteoporosis, fragility fracture, and OA) and to develop new treatments from the perspective of mechanical stress response. In this paper we review the latest findings regarding the roles of cellular energy regulators (glucose transporters and energy sensors) and mechanical stress response factors, and the relationship between these factor-mediated changes in energy metabolism and osteochondral degeneration. This minireview discusses how energy metabolism regulators control the activity of both osteoblasts and chondrocytes in osteochondral tissue in response to mechanical stress. Full article

The Cave of Altamira (Spain), a UNESCO World Heritage site, contains one of the most fragile and inaccessible Paleolithic rock-art environments in Europe, where geomatics documentation is constrained not only by severe spatial, lighting and safety limitations but also by conservation-driven restrictions on time, access and operational procedures. This study applies a confined-space UAV equipped with LiDAR-based SLAM navigation to document and assess the stability of the vertical rock wall leading to “La Hoya” Hall, a structurally sensitive sector of the cave. Twelve autonomous and assisted flights were conducted, generating dense LiDAR point clouds and video sequences processed through videogrammetry to produce high-resolution 3D meshes. A Mask R-CNN deep learning model was trained on manually segmented images to explore automated crack detection under variable illumination and viewing conditions. The results reveal active fractures, overhanging blocks and sediment accumulations located on inaccessible ledges, demonstrating the capacity of UAV-SLAM workflows to overcome the limitations of traditional surveys in confined subterranean environments. All datasets were integrated into the DiGHER digital twin platform, enabling traceable storage, multitemporal comparison, and collaborative annotation. Overall, the study demonstrates the feasibility of combining UAV-based SLAM mapping, videogrammetry and deep learning segmentation as a reproducible baseline workflow to inform preventive conservation and future multitemporal monitoring in Paleolithic caves and similarly constrained cultural heritage contexts. Full article

Background/Objectives: Diabetic osteoporosis (DOP) is a metabolic bone disorder marked by reduced bone mass, impaired microarchitecture and elevated fracture risk arising from type 1 and type 2 diabetes. Understanding its pathophysiology is essential for developing effective interventions. Method: A broad literature search of Scopus and PubMed (2015–2025) using diabetic osteoporosis-related keywords identified relevant English in vivo studies, which were screened, extracted, and narratively summarised for this review. Results: In vivo models, including high-fat-diet (HFD), streptozotocin (STZ) and combined HFD + STZ protocols, are widely used to investigate DOP mechanisms. HFD models mimic obesity-induced insulin resistance, chronic hyperglycaemia and low-grade inflammation, leading to suppressed osteoblast activity, enhanced osteoclastogenesis and accumulation of advanced glycation end products (AGEs). Ultimately, they compromise bone microarchitecture and mechanical strength. STZ models replicate type 1 diabetes by inducing β-cell destruction, insulin deficiency, oxidative stress, osteoblast apoptosis and inflammatory pathways promoting bone resorption. The combined HFD + STZ model integrates insulin resistance and partial β-cell dysfunction, closely reflecting type 2 diabetes pathology, including trabecular bone loss, collagen glycation and disrupted osteoblast–osteoclast signalling. Mechanistically, DOP involves impaired insulin/IGF-I signalling, AGE–RAGE interactions, oxidative stress and inflammation, resulting in diminished bone formation and quality. These models provide robust platforms for exploring molecular mechanisms and evaluating potential therapies, including Wnt pathway modulators, antioxidants and ferroptosis inhibitors. Conclusions: Collectively, preclinical in vivo models are indispensable for understanding DOP pathophysiology and developing strategies to mitigate diabetic bone fragility. Full article

Iron deficiency (ID) is highly prevalent in older adults and remains frequently underdiagnosed despite its relevant prognostic impact. ID may be absolute or functional and is observed across multiple geriatric clinical settings, including heart failure, chronic kidney disease, malnutrition, fragility fractures and long-term care facilities. Beyond anaemia, ID contributes to impaired mitochondrial function, reduced exercise capacity, frailty, cognitive and functional decline, increased hospitalizations and mortality. In heart failure and CKD, ID – irrespective of haemoglobin – worsens clinical outcomes. Systematic assessment of iron status should be integrated into geriatric evaluation. Oral iron therapy is often limited by poor tolerance and hepcidin-mediated malabsorption, whereas intravenous formulations show greater efficacy in selected patients. Early identification and targeted correction of ID may improve symptoms, quality of life and functional recovery in elderly populations, although further large trials in very old and frail subjects are needed. Full article

(1) Background: Fragility fractures of the pelvis (FFP) in elderly patients pose significant clinical challenges due to osteoporosis and associated morbidity. Transiliac–transsacral (TITS) screw fixation offers biomechanical advantages for stabilizing unstable posterior pelvic ring injuries, yet clinical outcomes remain underreported. We aim to report radiographic and clinical outcomes of TITS fixation for posterior pelvic ring injuries in FFP. (2) Methods: We conducted a retrospective review of 22 elderly female patients (mean age 79.0 ± 7.9 years) who underwent TITS screw fixation for unstable posterior pelvic ring fragility fractures between 2019 and 2024. Perioperative, radiographic, and functional outcomes were analyzed. (3) Results: Median operative time was 74 min (IQR 55–90 min), with minimal blood loss (median 5 mL). No intraoperative neurovascular injuries occurred. Median hospital stay was 7 days (IQR 5–10 days). At a mean follow-up of 6 months, 81.8% of patients maintained excellent or good reduction. Screw loosening was observed in 18.2% of cases, with only one (4.5%) requiring revision. Median VAS scores (range 0–10) decreased significantly from 5 preoperatively to 2 at discharge (p < 0.001). By discharge, 59.1% of patients were able to ambulate with assistance. (4) Conclusion: TITS screw fixation is a safe and feasible option for stabilizing unstable FFP in elderly, osteoporotic patients. It provides reliable mechanical stability, promotes early mobilization, and is associated with a short hospital stay and low complication rates. Full article

Background/Objectives: Fragility fractures of the pelvis (FFPs) are a significant concern in the elderly population, often leading to severe morbidity and mortality. This study aims to evaluate the diagnostic challenges, clinical outcomes, and mortality rates associated with FFPs in patients referred to multiple hospitals. Methods: A total of 99 patients with suspected pelvic fragility fractures were enrolled between January 2023 and June 2025. Initial diagnoses were made using plain X-rays, with computed tomography (CT) utilized to assess posterior ring fractures. Data on demographics, fracture types according to the Fragility Fracture of the Pelvis (FFP) Classification, hemoglobin levels, and mortality rates were collected and analyzed. Results: The findings revealed that while plain X-rays identified only anterior pelvic ring fractures, CT scans detected posterior ring fractures in 60.6% of cases. Patients with Nakatani II and III pelvic ramus fractures exhibited the most significant decreases in hemoglobin levels. The overall mortality rate was found to be 13.13%, with the highest rates observed in FFP I (13.5%) and FFP II (11.9%) groups. Conclusions: The findings of this study underscore the importance of CT imaging in the diagnosis of FFPs and highlight the need for close monitoring of hemoglobin levels in affected patients. This study also emphasizes the increased mortality risk associated with more complex fracture types. Future research should focus on evaluating functional independence and treatment outcomes to guide clinical decision-making in managing fragility fractures of the pelvis. Full article