Patients › General-Health
Salud ósea y osteoporosis
How bone strength affects fractures, fixation and recovery — bone density, fragility fractures, and what helps keep bones strong (lifestyle, supplements and medications).
¿Qué es?¶
La osteoporosis significa que los huesos han perdido densidad; por eso son más delgados y frágiles de lo normal. Imagine el hueso sano como un panal de abejas con paredes gruesas. En la osteoporosis, esas paredes se vuelven delgadas y presentan numerosos huecos. El hueso sigue estando allí, pero se rompe con mayor facilidad; a veces basta una pequeña caída o incluso un simple golpe. Esta clase de fractura se denomina fractura por fragilidad.
Esta afección es frecuente después de la menopausia y su probabilidad aumenta con la edad. Algunas personas solo se enteran de que padecen osteoporosis tras sufrir una fractura, ya que suele haber un intervalo entre el momento en que ocurre la fractura y el diagnóstico y tratamiento correspondientes [1]. Ese intervalo es importante. Diversos ensayos han demostrado que tratar la osteoporosis tras una fractura por fragilidad puede reducir el riesgo de sufrir otra fractura hasta en un 50 %, además de disminuir la mortalidad hasta en un 30 % [2].
Mecanismo de acción: el cuerpo remodela constantemente los huesos, descomponiendo el hueso viejo y formando uno nuevo. La osteoporosis se desarrolla cuando la descomposición supera a la formación. Algunos tratamientos frenan dicha descomposición; otros, llamados tratamientos anabólicos, estimulan la formación ósea. Existe un enfoque que consiste en aplicar primero un tratamiento anabólico y luego cambiar a uno que ralentice la descomposición [3]. Es posible medir la densidad ósea, y ciertos modelos basados en marcadores de análisis de sangre rutinarios ayudan a predecir el riesgo de fractura [4].
Hay otros aspectos relevantes que vale la pena conocer. En nueve estudios, cada aumento de 1 unidad en el índice de masa corporal se asoció con una reducción del 9 % en el riesgo de osteoporosis [5]. El ejercicio también resulta beneficioso: el ejercicio de resistencia y de impacto fortalece los huesos; los ejercicios de equilibrio previenen las caídas; y los ejercicios de extensión espinal mejoran la postura [6]. Si padece osteoporosis y necesita cirugía de hombro, esto no supone un impedimento. Las tasas de complicaciones generales tras la reparación artroscópica del manguito rotador fueron bajas; por ello, la osteoporosis no debe considerarse motivo para evitar dicha intervención [7].
¿Funciona?¶
Sí, pero depende de lo que entienda por “funcionar”. No existe una única cura para la osteoporosis. El objetivo es fortalecer los huesos y reducir el riesgo de fracturas. Algunos tratamientos logran esto eficazmente; otros todavía se encuentran en fase de prueba.
La evidencia más sólida apoya a los medicamentos que frenan la pérdida ósea o estimulan la formación de nuevo hueso. Un estudio amplio demostró que una inyección de una hormona osteoinductora acelera la curación de fracturas: 7,8 semanas frente a 12,6 semanas sin el tratamiento [1]. Otros fármacos, llamados bifosfonatos, protegen los huesos mejor que los antiguos aerosoles nasales [2]. El ejercicio también es fundamental: el entrenamiento de resistencia y los ejercicios de impacto fortalecen los huesos; los ejercicios de equilibrio previenen caídas; y los ejercicios de extensión espinal mejoran la postura y podrían disminuir el riesgo de fractura vertebral [3].
Existen otros tratamientos con evidencia menos contundente. Algunos estudios pequeños indican que la acupuntura podría aliviar los síntomas [4]. Una cápsula herbal tradicional parece beneficiar tanto el dolor como la densidad ósea [5]. La terapia con células madre muestra resultados prometedores en estudios con animales, pero aún no está lista para uso humano [6]. Los investigadores también estudian si el momento de aplicar la inyección diaria influye en su eficacia, así como si nuevas herramientas como radiografías de mano y calculadoras en línea permiten detectar la pérdida ósea antes [7, 8, 9].
Existen ciertas carencias evidentes: muchas personas que sufren una fractura de cadera no reciben medicación ósea posteriormente, a pesar de que las guías clínicas lo recomiendan [10]. Además, no existe un método perfecto para estudiar esta enfermedad en laboratorio, por lo que aún quedan interrogantes sin resolver [11].
¿Qué significa esto para usted? Si padece osteoporosis, existen tratamientos comprobados que reducen el riesgo de nuevas fracturas. Su médico le explicará qué opciones son adecuadas para usted y le informará con sinceridad sobre aquellos tratamientos con evidencia limitada.
¿Cuáles son los riesgos?¶
El principal riesgo de la osteoporosis en sí es la fractura. Los huesos de la cadera, la columna vertebral y la muñeca se rompen con mayor facilidad cuando son frágiles. Si se produce una fractura y posteriormente no se trata la osteoporosis, es muy probable que se produzca otra fractura. Los estudios demuestran que muchas personas que sufren una fractura de cadera no reciben tratamiento óseo, a pesar de que las guías clínicas lo recomiendan [1]. En un estudio realizado con mujeres ingresadas en el hospital por fracturas, el 76,9 % padecía osteoporosis [2]. En dicho estudio, la menopausia prolongada, las fracturas vertebrales y las fracturas recientes identificaron a las mujeres con mayor riesgo [2].
Los riesgos del tratamiento dependen del tipo de terapia empleada. Los comprimidos de bisfosfonatos son más eficaces que los antiguos aerosoles nasales para proteger el hueso; por ello, los aerosoles nasales se reservan generalmente para personas que no pueden tomar los medicamentos de primera línea [3]. Algunas opciones más recientes todavía se están investigando. Actualmente se lleva a cabo un ensayo para determinar el momento óptimo para aplicar una inyección diaria que fortalezca el hueso [4]. La acupuntura y las cápsulas a base de hierbas cuentan con cierta evidencia de eficacia, aunque ésta es menor que la que respalda los medicamentos convencionales [5, 6]. La terapia con células madre, por ahora, solo se ha probado en animales; por lo tanto, sus efectos en humanos son desconocidos [7].
Si necesita cirugía, hay algunos aspectos específicos a considerar. Las mediciones de densidad ósea realizadas antes de la operación no permiten predecir si una fractura no sanará; por eso, dicha prueba carece de valor clínico para ese fin [8]. En pacientes con huesos frágiles sometidos a prótesis articulares, las tasas de complicaciones a los 2 y 5 años fueron bajas y similares, independientemente de si tomaron o no comprimidos reductores de ácido en el período perioperatorio [9]. En procedimientos de columna en los que se inyecta cemento en una vértebra fracturada, el uso continuo de cemento junto con el tratamiento estándar contra la osteoporosis se asoció con buenos resultados [10].
Un último riesgo que merece mención: la información disponible en internet sobre la osteoporosis a menudo no cumple con los estándares básicos de calidad [11]. Verifique siempre el origen de la información y consulte sus dudas con su médico.
¿Es adecuado para usted?¶
Vale la pena considerar el tratamiento si le han diagnosticado osteoporosis, especialmente después de una fractura. Las mujeres posmenopáusicas son el grupo más afectado. En un estudio realizado con mujeres ingresadas en el hospital por fracturas, la mayoría padecía osteoporosis; los signos de alerta más importantes fueron una menopausia prolongada, una fractura vertebral o una fractura reciente [1]. Si alguno de estos casos se aplica a usted, es lógico preguntar sobre la salud de sus huesos.
El tratamiento también podría ser adecuado si desea mantenerse activa y reducir el riesgo de caídas. Además de la medicación, las recomendaciones clave son ejercicios de resistencia e impacto para fortalecer los huesos, ejercicios de equilibrio para prevenir caídas, y ejercicios de extensión espinal para mejorar la postura [2]. Puede empezar a hablar de estos temas con su médico hoy mismo.
Probablemente el tratamiento no sea necesario si sus huesos están sanos, no tiene antecedentes de fracturas ni factores de riesgo importantes. Asimismo, si ya toma medicamentos para los huesos, esta página trata sobre si debe continuar con ellos, no sobre si debe empezar a tomarlos.
En comparación con no hacer nada, el tratamiento es la opción más recomendable tras una fractura. Entre los distintos tratamientos disponibles, cada uno actúa de forma diferente: algunos ralentizan la pérdida ósea, otros favorecen la formación de nuevo hueso, y algunos hacen ambas cosas de forma secuencial [3]. Su médico podrá explicarle cuál se adapta mejor a usted.
Esta debe ser una decisión conjunta. Lleve consigo sus preguntas, su historial de fracturas y la lista de medicamentos que toma. Pregunte qué indica su densidad ósea y qué significa para usted. La respuesta correcta depende de sus huesos, su salud y sus objetivos, no de un único resultado de prueba.
Conclusión¶
Si le han diagnosticado osteoporosis o si se ha fracturado un hueso tras una simple caída, merece la pena tomar medidas. Tratar la fragilidad ósea después de una fractura reduce la probabilidad de sufrir otra fractura, y también puede disminuir el riesgo de muerte prematura [1]. Lo que se puede esperar realistamente es tener huesos más fuertes y menos fracturas, no una curación total. La advertencia más importante: a muchas personas que se fracturan la cadera nunca se les prescribe medicación para los huesos posteriormente, por lo que quizás deba usted mismo plantear el tema [2].
Referencias¶
[1] La brecha en el tratamiento de la osteoporosis en Canadá. BMC Musculoskeletal Disorders. 2004. DOI: 10.1186/1471-2474-5-11
[2] Tratamiento médico de la osteoporosis y el papel del médico. Injury. 2016. DOI: 10.1016/s0020-1383(16)30014-6
[3] Eficacia de los agentes anabólicos y antirresortivos para prevenir fracturas por osteoporosis posmenopáusica: revisión sistemática y metanálisis de red. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-06040-3
[4] Enfoque SuperLearner para predecir el riesgo inminente de fractura en pacientes chinos mayores con diagnóstico reciente de osteoporosis, basado en marcadores de análisis de sangre rutinarios. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-026-09768-z
[5] Asociación entre el índice de masa corporal y la osteoporosis, considerando las diferencias de género: revisión sistemática y metanálisis dosis-respuesta. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-026-09675-3
[6] Fuerte, estable y recto: declaración de consenso del Reino Unido sobre actividad física y ejercicio en la osteoporosis. British Journal of Sports Medicine. 2022. DOI: 10.1136/bjsports-2021-104634
[7] La osteoporosis es un factor de riesgo para complicaciones y reoperaciones a 1 y 3 años tras la reparación artroscópica del manguito rotador. JSES International. 2026. DOI: 10.1016/j.jseint.2026.101678
[8] Uso de teriparatida en pacientes con fracturas osteoporóticas. Injury. 2016. DOI: 10.1016/s0020-1383(16)30009-2
[9] Revisión del calcitonín salmón intranasal: evidencia histórica sobre la osteoporosis y su posible rol en el manejo del dolor ortopédico agudo. JBJS Reviews. 2026. DOI: 10.2106/jbjs.rvw.26.00021
[10] Eficacia de la acupuntura para la osteoporosis primaria: revisión sistemática y metanálisis de ensayos controlados aleatorizados. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-05513-9
[11] Efecto de las cápsulas Jintiange sobre el dolor en pacientes con osteoporosis primaria: revisión sistemática y metanálisis. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08694-w
[12] Células madre modificadas genéticamente para la osteoporosis: revisión sistemática y metanálisis de estudios preclínicos. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08507-0
[13] Aplicación del aprendizaje automático en el cribado de osteoporosis y osteopenia mediante radiografías de mano. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2024.09.008
[14] Nomograma con calculadora dinámica en línea para predecir la osteoporosis: desarrollo y validación basados en NHANES. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-026-09920-9
[15] Optimización del momento de administración de teriparatida en la osteoporosis posmenopáusica: ensayo controlado aleatorizado. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-06083-6
[16] ¿Una oportunidad perdida? Tratamiento de la osteoporosis tras fracturas de cuello femoral: reducción del riesgo de fracturas de cadera secundarias. The Journal of Arthroplasty. 2026. DOI: 10.1016/j.arth.2025.07.028
[17] ¿Podemos inducir osteoporosis en animales de forma comparable a la situación humana?. Injury. 2016. DOI: 10.1016/s0020-1383(16)30002-x
[18] ¿Qué prevalencia tiene la osteoporosis en un subgrupo de alto riesgo? Estudio multicéntrico en mujeres posmenopáusicas hospitalizadas por fracturas en China. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-026-09517-2
[19] A89 La osteoporosis no es un factor de riesgo para el desarrollo de no unión ósea: estudio de casos y controles anidado. Injury. 2011. DOI: 10.1016/s0020-1383(11)70106-1
[20] Efectos del uso perioperatorio de inhibidores de la bomba de protones en los resultados de pacientes con osteoporosis y osteopenia sometidos a artroplastia total. The Journal of Arthroplasty. 2026. DOI: 10.1016/j.arth.2025.07.067
[21] La continuidad y el volumen de cemento óseo, así como el tratamiento antiosteoporótico, garantizan buenos resultados clínicos en la vertebroplastia percutánea: estudio multicéntrico. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-024-08153-y
[22] Evaluación de la calidad de la información sobre la osteoporosis: un análisis transversal de la información sanitaria en línea. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-026-09711-2
Evidence & references
This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.
Overview¶
- A bone density-based aging model approach may facilitate and support the development of precision medicine strategies in osteoporosis prevention and management [1].
- Investigators must select an osteoporotic fracture model that best reflects the clinical problem being studied and the underlying pathophysiology of the osteoporosis in the target patient group [2].
- Current online health information on osteoporosis often fails to meet basic standards of evidence-based health information, highlighting the urgent need to improve quality to support informed decision-making [3].
- Each 1-unit increase in body mass index was associated with a 9% reduction in osteoporosis risk based on a dose-response analysis of nine studies [4].
- Sequential anabolic-to-anti-resorptive therapy may inform treatment guidelines for high-risk postmenopausal populations [5].
- There is no perfect model for osteoporosis, but a variety of models are appropriate for answering specific questions [6].
- There is evidence of a care gap between the occurrence of a fragility fracture and the diagnosis and treatment of osteoporosis in Canada [7].
- A nomogram with an online dynamic calculator could facilitate the early prediction, diagnosis, and treatment of osteoporosis, contributing to the bone health of the elderly population and promoting the development of public health [10].
- Patients with osteoporosis may experience a higher incidence of medical complications within the 90-day global period than nonosteoporotic patients following rotator cuff repair [12].
- Overall rates of complication were low and osteoporosis should not be considered a contraindication to arthroscopic rotator cuff repair [18].
How It Works¶
- A randomized controlled trial on the timing optimization of teriparatide dosing is expected to provide insights into optimizing administration timing, potentially guiding personalized dosing strategies to enhance bone formation and reduce fracture risk in osteoporosis [8].
- The book "Radiology of Osteoporosis" summarises the thoroughly researched topic of osteoporosis in a scientific approach [9].
- Data showed no relationship between decreased bone mineral density and 2-year clinical outcomes following arthroscopic rotator cuff repair, despite previous literature showing the negative effect of osteoporosis on rotator cuff healing [11].
- Recent research progress on natural traditional Chinese medicine products provides a theoretical and experimental basis for the development of new drugs and the improvement of osteoporosis management [13].
- Current evidence suggests that the efficacy of acupuncture in improving the symptoms of primary osteoporosis is encouraging for its use in clinical practice as a physical intervention [14].
- Macrophage polarization-related genes with potential causal roles in osteoporosis identified via multi-omics Mendelian randomization are exploratory and hypothesis-generating findings that require validation in bone marrow-specific and functional studies [21].
- The gut microbiota–metabolite–bone network may be involved in the skeletal effects of leptin, providing novel mechanistic insights and potential therapeutic strategies for osteoporosis management [22].
- MiR-137 promotes TLR4/NF-κB pathway activity through targeting KDM4A, which inhibits osteogenic differentiation of human bone marrow mesenchymal stem cells and aggravates osteoporosis [23].
- There is some promising experimental and clinical evidence for possible enhancement of the bone repair process via administration of systemic agents [24].
- In humans, de novo use of bisphosphonate therapy after fracture does not appear to have a significant effect on fracture healing [25].
- Although bone quality may be diminished in the elderly, this does not influence the occurrence of nonunion [26].
What the Evidence Shows¶
Risk Factors and Prediction¶
- Each 1-unit increase in BMI was associated with a 9% reduction in osteoporosis risk based on a dose–response analysis of nine studies [4].
- A nomogram with an online dynamic calculator developed based on NHANES data could facilitate the early prediction, diagnosis, and treatment of osteoporosis [10].
- A SuperLearner approach was successfully developed and validated as a fracture risk prediction model for patients newly diagnosed with osteoporosis based on routine blood test markers [29].
- Mendelian randomization results show varying associations between diabetes and BMD across different sites and methods, with significant associations found for T2D on femoral neck and total body BMD, and HbA1c on heel BMD [30].
- Machine learning application to hand radiographs represents a possible step toward more accessible, cost-effective, automated diagnosis and earlier treatment of osteoporosis/osteopenia [17].
Diagnosis and Information Quality¶
Treatment and Management¶
- Randomized controlled trials have demonstrated that treatment of osteoporosis in patients with fragility fractures can reduce the risk of subsequent fractures by up to 50% and mortality rates by up to 30% [16].
- A randomized controlled trial on teriparatide dosing timing is expected to provide insights into optimizing administration to enhance bone formation and reduce fracture risk in osteoporosis [8].
- Intranasal salmon calcitonin is less effective than bisphosphonates and modern anabolic agents for increasing BMD and reducing fracture risk, and its use is best reserved for patients who cannot take first-line therapies due to contraindications, intolerance, or personal preference [19].
- The current evidence suggests that the efficacy of acupuncture in improving the symptoms of primary osteoporosis is encouraging for its use in clinical practice as a physical intervention [14].
- Natural traditional Chinese medicine products provide a theoretical and experimental basis for the development of new drugs and the improvement of osteoporosis management [13].
- Key recommendations for people with osteoporosis include undertaking resistance and impact exercise to maximise bone strength, activities to improve strength and balance to reduce falls, and spinal extension exercise to improve posture and potentially reduce risk of falls and vertebral fractures [20].
- Findings from a retrospective cross-sectional study on long-term hospitalized patients with muscular dystrophy may help inform strategies for osteoporotic treatment and nutritional care in this patient population [15].
Surgical Outcomes and Complications¶
- Continuous bone cement and standardized treatment for osteoporosis were guarantees of good clinical outcomes for percutaneous vertebroplasty, and injected bone cement >5.5 ml might be a guarantee [28].
- Patients who received PTH (1–84) injections accelerated radiographic and clinical fracture healing (7.8 weeks) when compared to patients who received no treatment (12.6 weeks) [27].
Research Models¶
Practical Considerations¶
Risk Factors and Screening¶
- A bone density-based aging model approach may facilitate the development of precision medicine strategies in osteoporosis prevention and management [1].
- Each 1-unit increase in body mass index is associated with a 9% reduction in osteoporosis risk [4].
- Machine learning application to hand radiographs represents a possible step toward more accessible, cost-effective, automated diagnosis and earlier treatment of osteoporosis and osteopenia [17].
Treatment and Management¶
- Treatment of osteoporosis in patients with fragility fractures can reduce the risk of subsequent fractures by up to 50% and mortality rates by up to 30% [16].
- Intranasal salmon calcitonin is less effective than bisphosphonates and modern anabolic agents for increasing bone mineral density and reducing fracture risk [19].
- The use of intranasal salmon calcitonin is best reserved for patients who cannot take first-line therapies due to contraindications, intolerance, or personal preference [19].
- Optimizing teriparatide administration timing may guide personalized dosing strategies to enhance bone formation and reduce fracture risk in osteoporosis [8].
- People with osteoporosis should undertake resistance and impact exercise to maximise bone strength [20].
- People with osteoporosis should undertake activities to improve strength and balance to reduce falls [20].
- People with osteoporosis should undertake spinal extension exercise to improve posture and potentially reduce risk of falls and vertebral fractures [20].
Surgical Outcomes and Complications¶
- There is no relationship between decreased bone mineral density and 2-year clinical outcomes following arthroscopic rotator cuff repair [11].
- Patients with osteoporosis may experience a higher incidence of medical complications within the 90-day global period than nonosteoporotic patients [12].
- Osteoporosis should not be considered a contraindication to arthroscopic rotator cuff repair [18].
Research and Information Quality¶
- Current online health information on osteoporosis often fails to meet basic standards of evidence-based health information [3].
Key Evidence¶
- [L3] This approach may facilitate and support the development of precision medicine strategies in osteoporosis prevention and management. [1] (10.1186/s12891-025-09298-0)
- [L5] Investigators must select a model that best reflects the clinical problem being studied, and the underlying pathophysiology of the osteoporosis in the target patient group. [2] (10.1016/s0020-1383(16)30004-3)
- [Paper] Current OHI on osteoporosis often fails to meet basic standards of EBHI, highlighting the urgent need to improve the quality to support informed decision-making. [3] (10.1186/s12891-026-09711-2)
- [L1] Based on our dose–response analysis of nine studies, each 1-unit increase in BMI was associated with a 9% reduction in osteoporosis risk. [4] (10.1186/s12891-026-09675-3)
- [L1] This sequential anabolic-to-anti-resorptive therapy may inform treatment guidelines for high-risk postmenopausal populations. [5] (10.1186/s13018-025-06040-3)
- [Paper] However, there is no perfect model for osteoporosis, but a variety of models appropriate for answering specific questions. [6] (10.1016/s0020-1383(16)30002-x)
- [L4] There is evidence of a care gap between the occurrence of a fragility fracture and the diagnosis and treatment of osteoporosis in Canada. [7] (10.1186/1471-2474-5-11)
- [L2] This trial is expected to provide crucial insights into optimizing teriparatide administration timing, potentially guiding personalized dosing strategies to enhance bone formation and reduce fracture risk in osteoporosis. [8] (10.1186/s13018-025-06083-6)
- [Paper] The book summarises the thoroughly researched topic of osteoporosis in a scientific approach. [9] (10.1016/s0020-1383(03)00201-8)
- [L3] Ultimately, this tool could facilitate the early prediction, diagnosis, and treatment of osteoporosis, thus contributing to the bone health of the elderly population and promoting the development of public health. [10] (10.1186/s12891-026-09920-9)
- [L3] Despite previous literature showing the negative effect of osteoporosis on rotator cuff healing, our data showed no relationship between decreased bone mineral density and 2-year clinical outcomes following RCR. [11] (10.1016/j.jse.2025.02.011)
- [L3] In addition, patients with osteoporosis may experience a higher incidence of medical complications within the 90-day global period than nonosteoporotic patient. [12] (10.1016/j.xrrt.2026.100723)
- [L4] This paper summarises recent research progress on natural TCM products in preventing and treating osteoporosis and provides a theoretical and experimental basis for the development of new drugs and the improvement of osteoporosis management. [13] (10.1186/s13018-025-05879-w)
- [L1] The current evidence suggests that the efficacy of acupuncture in improving the symptoms of primary osteoporosis is encouraging for its use in clinical practice as a physical intervention. [14] (10.1186/s13018-025-05513-9)
- [L4] These findings may help inform strategies for osteoporotic treatment and nutritional care in this patient population. [15] (10.1186/s12891-026-10045-2)
- [Paper] Randomized controlled trials have demonstrated that treatment of osteoporosis in patients with fragility fractures can reduce the risk of subsequent fractures by up to 50% and mortality rates by up to 30%. [16] (10.1016/s0020-1383(16)30014-6)
- [L2] The findings represent a possible step toward more accessible, cost-effective, automated diagnosis and therefore earlier treatment of osteoporosis/osteopenia. [17] (10.1016/j.jhsa.2024.09.008)
- [L3] Overall rates of complication were low and osteoporosis should not be considered a contraindication to arthroscopic RCR. [18] (10.1016/j.jseint.2026.101678)
- [Paper] IN-CAL is less effective than bisphosphonates and modern anabolic agents for increasing BMD and reducing fracture risk; accordingly, its use is best reserved for patients who cannot take first-line therapies due to contraindications, intolerance, or personal preference. [19] (10.2106/jbjs.rvw.26.00021)
- [L5] Key recommendations are that people with osteoporosis should undertake (1) resistance and impact exercise to maximise bone strength; (2) activities to improve strength and balance to reduce falls; (3) spinal extension exercise to improve posture and potentially reduce risk of falls and vertebral fractures. [20] (10.1136/bjsports-2021-104634)
- [Paper] These findings are exploratory and hypothesis-generating and require validation in bone marrow-specific and functional studies. [21] (10.1186/s13018-026-06905-1)
- [Paper] These findings suggest that the gut microbiota–metabolite–bone network may be involved in the skeletal effects of leptin, providing novel mechanistic insights and potential therapeutic strategies for osteoporosis management. [22] (10.1186/s12891-026-09950-3)
- [Paper] This mechanism inhibits osteogenic differentiation of human bone marrow mesenchymal stem cells and aggravates osteoporosis. [23] (10.1186/s13018-023-03918-y)
- [Paper] There is some promising experimental and clinical evidence for possible enhancement of the bone repair process via administration of systemic agents. [24] (10.1016/s0020-1383(16)30003-1)
- [L4] In humans, de novo use of bisphosphonate therapy after fracture does not appear to have a significant effect on fracture healing. [25] (10.1016/s0020-1383(16)30015-8)
- [L3] Although bone quality may be diminished in the elderly, this does not influence the occurrence of nonunion. [26] (10.1016/s0020-1383(11)70106-1)
- [Paper] Patients who received the PTH (1–84) injections accelerated radiographic and clinical fracture healing (7.8 weeks) when compared to patients who received no treatment (12.6 weeks). [27] (10.1016/s0020-1383(16)30009-2)
- [L3] Continuous bone cement and standardized treatment for osteoporosis were guarantees of good clinical outcomes for PVP, and injected bone cement >5.5 ml might be a guarantee. [28] (10.1186/s12891-024-08153-y)
- [L3] We successfully developed and validated a fracture risk prediction model for patients newly diagnosed with osteoporosis. [29] (10.1186/s12891-026-09768-z)
- [Paper] The results show varying associations across different BMD sites (femoral neck, lumbar spine, heel, total body) and methods (IVW, MR-Egger, Weighted median), with some significant associations found for T2D on femoral neck and total body BMD, and HbA1c on heel BMD. [30] (10.1186/s12891-024-07430-0)
References¶
[1] Unveiling risk factors and predicting osteoporosis through bone density based aging model: a community-based cohort in Guangdong, China. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-09298-0
[2] Main differences in osteoporotic fracture models: which should I use?. Injury. 2016. DOI: 10.1016/s0020-1383(16)30004-3
[3] Mapping the quality of information on osteoporosis: a cross-sectional analysis of online health information. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-026-09711-2
[4] The association between body mass index and osteoporosis, with consideration of sex differences: a systematic review and dose-response meta-analysis. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-026-09675-3
[5] Effectiveness of anabolic and anti-resorptive agents for preventing postmenopausal osteoporosis fractures: a systematic review and network meta-analysis. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-06040-3
[6] Can we induce osteoporosis in animals comparable to the human situation?. Injury. 2016. DOI: 10.1016/s0020-1383(16)30002-x
[7] The osteoporosis care gap in Canada. BMC Musculoskeletal Disorders. 2004. DOI: 10.1186/1471-2474-5-11
[8] Timing optimization of teriparatide dosing for postmenopausal osteoporosis: a randomized controlled trial. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-06083-6
[9] Radiology of Osteoporosis. Injury. 2004. DOI: 10.1016/s0020-1383(03)00201-8
[10] A nomogram with online dynamic calculator for predicting osteoporosis: development and validation based on NHANES. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-026-09920-9
[11] No difference in 2-year outcomes of arthroscopic rotator cuff repair in patients with osteoporosis. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2025.02.011
[12] Impact of osteoporosis on post-operative outcomes following rotator cuff repair. JSES Reviews, Reports, and Techniques. 2026. DOI: 10.1016/j.xrrt.2026.100723
[13] Natural traditional Chinese medicine products: emerging therapeutic targets for the treatment of osteoporosis. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-05879-w
[14] Efficacy of acupuncture for primary osteoporosis: a systematic review and meta-analysis of randomized controlled trials. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-05513-9
[15] Osteoporosis in long-term hospitalized patients with muscular dystrophy: a retrospective cross-sectional study. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-026-10045-2
[16] Medical management of osteoporosis and the surgeons' role. Injury. 2016. DOI: 10.1016/s0020-1383(16)30014-6
[17] Application of Machine Learning to Osteoporosis and Osteopenia Screening Using Hand Radiographs. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2024.09.008
[18] Osteoporosis is a risk factor for complications and reoperations at 1 and 3 years after arthroscopic rotator cuff repair. JSES International. 2026. DOI: 10.1016/j.jseint.2026.101678
[19] Revisiting Intranasal Salmon Calcitonin: Historical Osteoporosis Evidence and a Potential Role in Acute Orthopaedic Pain Management. JBJS Reviews. 2026. DOI: 10.2106/jbjs.rvw.26.00021
[20] Strong, steady and straight: UK consensus statement on physical activity and exercise for osteoporosis. British Journal of Sports Medicine. 2022. DOI: 10.1136/bjsports-2021-104634
[21] Macrophage polarization-related genes with potential causal roles in osteoporosis: a multi-omics Mendelian randomization study. Journal of Orthopaedic Surgery and Research. 2026. DOI: 10.1186/s13018-026-06905-1
[22] Role and mechanism of leptin in improving osteoporosis via the “gut–bone axis”. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-026-09950-3
[23] MiR-137 promotes TLR4/NF-κB pathway activity through targeting KDM4A, inhibits osteogenic differentiation of human bone marrow mesenchymal stem cells and aggravates osteoporosis. Journal of Orthopaedic Surgery and Research. 2023. DOI: 10.1186/s13018-023-03918-y
[24] Fracture repair: general aspects and influence of osteoporosis and anti-osteoporosis treatment. Injury. 2016. DOI: 10.1016/s0020-1383(16)30003-1
[25] How do bisphosphonates affect fracture healing?. Injury. 2016. DOI: 10.1016/s0020-1383(16)30015-8
[26] A89 Osteoporosis is not a risk factor for the development of nonunion: a cohort nested case-control study. Injury. 2011. DOI: 10.1016/s0020-1383(11)70106-1
[27] Use of teriparatide in osteoporotic fracture patients. Injury. 2016. DOI: 10.1016/s0020-1383(16)30009-2
[28] Continuity and volume of bone cement and anti osteoporosis treatment were guarantee of good clinical outcomes for percutaneous vertebroplasty: a multicenter study. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-024-08153-y
[29] SuperLearner approach for predicting imminent risk of fracture in older Chinese patients with newly diagnosed osteoporosis based on their routine blood test markers. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-026-09768-z
[30] Diabetes and osteoporosis: a two-sample mendelian randomization study. BMC Musculoskeletal Disorders. 2024. DOI: 10.1186/s12891-024-07430-0