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Bone Health and Osteoporosis

How bone strength affects fractures, fixation and recovery — bone density, fragility fractures, and what helps keep bones strong (lifestyle, supplements and medications).

Overview

Osteoporosis is a systemic skeletal disorder characterized by decreased bone mineral density, serving as a significant risk factor for complications and reoperations at 1 and 3 years after arthroscopic rotator cuff repair [11]. Despite this risk, osteoporosis should not be considered a contraindication to arthroscopic rotator cuff repair given overall low complication rates [11]. Patients with decreased bone mineral density can still achieve excellent 2-year outcomes after the procedure [9]. However, patients with osteoporosis may experience a higher incidence of medical complications within the 90-day global period than nonosteoporotic patients following rotator cuff repair [8].

In the context of vertebral interventions, continuous bone cement and standardized treatment for osteoporosis are guarantees of good clinical outcomes for percutaneous vertebroplasty [12]. Injected bone cement volume greater than 5.5 ml might be a guarantee of good clinical outcomes for percutaneous vertebroplasty [12].

Diagnostic and management strategies are evolving to address these challenges. A bone density-based aging model may facilitate and support the development of precision medicine strategies in osteoporosis prevention and management [1]. Machine learning application to hand radiographs represents a possible step toward more accessible, cost-effective, automated diagnosis and earlier treatment of osteoporosis/osteopenia [6]. Optimizing teriparatide administration timing may guide personalized dosing strategies to enhance bone formation and reduce fracture risk in osteoporosis [2]. Sequential anabolic-to-anti-resorptive therapy may inform treatment guidelines for high-risk postmenopausal populations [4]. Natural traditional Chinese medicine products provide a theoretical and experimental basis for the development of new drugs and the improvement of osteoporosis management [3]. Acupuncture shows encouraging efficacy in improving symptoms of primary osteoporosis as a physical intervention in clinical practice [5]. Despite established guidelines, low rates of osteoporotic pharmacotherapy were observed in patients who had femoral neck fractures [7].

How It Works

Diagnostic and Risk Stratification: Machine learning applied to hand radiographs represents a step toward more accessible, cost-effective, automated diagnosis and earlier treatment of osteoporosis/osteopenia [6]. Current machine learning-based prediction models for postmenopausal osteoporosis without fractures demonstrate good discriminative ability but are characterized by a high risk of bias, a notable lack of calibration performance evaluation, and insufficient validation of clinical utility [10]. A bone density-based aging model may facilitate precision medicine strategies in osteoporosis prevention and management [1]. In postmenopausal women hospitalized for fractures in China, the prevalence of osteoporosis is 76.9%, with prolonged menopause, vertebral fractures, and recent fracture history identified as key risk profiles [14].

Pharmacologic and Biological Mechanisms: Optimizing teriparatide administration timing may guide personalized dosing strategies to enhance bone formation and reduce fracture risk in osteoporosis [2]. Natural traditional Chinese medicine products provide a theoretical and experimental basis for the development of new drugs and the improvement of osteoporosis management [3]. Genetically modified stem cell therapy is a safe and effective method that can significantly improve bone mineral density and bone volume/total volume in animal models of osteoporosis [13]. Obesity-associated dyslipidemia drives bone mineral density loss partly through inflammation-mediated pathways, with key inflammatory cytokines significantly mediating lipid metabolism's impact on bone health [16].

Therapeutic Interventions and Outcomes: Sequential anabolic-to-anti-resorptive therapy may inform treatment guidelines for high-risk postmenopausal populations [4]. Acupuncture shows encouraging efficacy in improving symptoms of primary osteoporosis as a physical intervention in clinical practice [5]. Patients with decreased bone mineral density can achieve excellent 2-year outcomes after arthroscopic rotator cuff repair [9]. However, patients with osteoporosis may experience a higher incidence of medical complications within the 90-day global period following rotator cuff repair than nonosteoporotic patients [8]. Bone mineral density alone cannot predict early migration of tibial baseplates in cementless total knee arthroplasty [17].

Clinical Practice Gaps: Low rates of osteoporotic pharmacotherapy were observed in patients who had femoral neck fractures despite established guidelines [7].

What the Evidence Shows

Diagnosis and Screening

Bone Density-Based Aging Models: A bone density-based aging model may facilitate precision medicine strategies in osteoporosis prevention and management [1].

Machine Learning Applications: Machine learning applied to hand radiographs represents a possible step toward more accessible, cost-effective, automated diagnosis and earlier treatment of osteoporosis/osteopenia [6]. Current machine learning-based prediction models for postmenopausal osteoporosis without fractures demonstrate good discriminative ability but are generally characterized by a high risk of bias, a notable lack of calibration performance evaluation, and insufficient validation of clinical utility [10].

Pharmacologic and Non-Pharmacologic Treatment

Sequential Anabolic Therapy: Sequential anabolic-to-anti-resorptive therapy may inform treatment guidelines for high-risk postmenopausal populations [4].

Acupuncture: The efficacy of acupuncture in improving the symptoms of primary osteoporosis is encouraging for its use in clinical practice as a physical intervention [5].

Traditional Chinese Medicine: Natural traditional Chinese medicine products provide a theoretical and experimental basis for the development of new drugs and the improvement of osteoporosis management [3]. Jintiange capsules are a good choice for patients with osteoporosis in terms of relieving pain, improving bone mineral density (BMD), improving activity function, improving gait, and preventing fracture [18].

Stem Cell Therapy: Genetically modified stem cell therapy is a safe and effective method that can significantly improve BMD and bone volume/total volume (BV/TV) in animal models of osteoporosis [13].

Perioperative Management and Outcomes

Femoral Neck Fracture Care: Despite established guidelines, low rates of osteoporotic pharmacotherapy were seen in patients who had femoral neck fractures [7].

Rotator Cuff Repair: Osteoporosis is a risk factor for complications and reoperations at 1 and 3 years after 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 following rotator cuff repair [8]. However, patients with decreased bone mineral density can still achieve excellent 2-year outcomes after arthroscopic rotator cuff repair [9]. Osteoporosis should not be considered a contraindication to arthroscopic rotator cuff repair, as overall rates of complication were low [11].

Total Joint Arthroplasty (TJA): In osteopenic and osteoporotic patients undergoing total joint arthroplasty (TJA), rates of 2- and 5-year postoperative complications were low and similar among patients who used proton pump inhibitors (PPIs) perioperatively and those who did not [15]. Bisphosphonate use in patients with osteoporosis did not decrease the risk of periprosthetic fracture following total knee arthroplasty, but it significantly lowered the incidence of all-cause revision at 2 years [20].

Vertebroplasty: Continuous bone cement and standardized treatment for osteoporosis were guarantees of good clinical outcomes for percutaneous vertebroplasty (PVP), and injected bone cement >5.5 ml might be a guarantee [12].

Timing and Optimization

Teriparatide Administration: Optimizing teriparatide administration timing may guide personalized dosing strategies to enhance bone formation and reduce fracture risk in osteoporosis [2].

Practical Considerations

Diagnostic and Screening Strategies: Machine learning applied to hand radiographs offers a potential pathway toward more accessible, cost-effective, automated diagnosis and earlier treatment of osteoporosis/osteopenia [6]. Current machine learning-based prediction models for postmenopausal osteoporosis without fractures demonstrate good discriminative ability but are generally characterized by a high risk of bias, a notable lack of calibration performance evaluation, and insufficient validation of clinical utility [10]. A bone density based aging model may facilitate and support the development of precision medicine strategies in osteoporosis prevention and management [1].

Pharmacologic and Therapeutic Management: Optimizing teriparatide administration timing may guide personalized dosing strategies to enhance bone formation and reduce fracture risk in osteoporosis [2]. Sequential anabolic-to-anti-resorptive therapy may inform treatment guidelines for high-risk postmenopausal populations [4]. Natural traditional Chinese medicine products provide a theoretical and experimental basis for the development of new drugs and the improvement of osteoporosis management [3]. Acupuncture shows encouraging efficacy in improving symptoms of primary osteoporosis as a physical intervention in clinical practice [5].

Perioperative Risk and Outcomes: Osteoporosis is a risk factor for complications and reoperations at 1 and 3 years after 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 following rotator cuff repair [8]. Despite these risks, osteoporosis should not be considered a contraindication to arthroscopic rotator cuff repair [11]. Patients with decreased bone mineral density can still achieve excellent 2-year outcomes after arthroscopic rotator cuff repair [9]. In osteopenic and osteoporotic patients undergoing total joint arthroplasty, rates of 2- and 5-year postoperative complications were low and similar among patients who used proton pump inhibitors perioperatively and those who did not [15].

Vertebroplasty Technical Considerations: Continuous bone cement and standardized treatment for osteoporosis were guarantees of good clinical outcomes for percutaneous vertebroplasty [12]. Injected bone cement >5.5 ml might be a guarantee of good clinical outcomes for percutaneous vertebroplasty [12].

Epidemiology and Guideline Adherence: The prevalence of osteoporosis among postmenopausal women hospitalized for fractures in China is 76.9% [14]. Prolonged menopause, vertebral fractures, and recent fracture history are key risk profiles for osteoporosis in postmenopausal women hospitalized for fractures [14]. Low rates of osteoporotic pharmacotherapy were seen in patients who had femoral neck fractures despite established guidelines [7].

Key Evidence

  • [L3] This approach may facilitate and support the development of precision medicine strategies in osteoporosis prevention and management. (10.1186/s12891-025-09298-0)
  • [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. (10.1186/s13018-025-06083-6)
  • [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. (10.1186/s13018-025-05879-w)
  • [L1] This sequential anabolic-to-anti-resorptive therapy may inform treatment guidelines for high-risk postmenopausal populations. (10.1186/s13018-025-06040-3)
  • [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. (10.1186/s13018-025-05513-9)
  • [L2] The findings represent a possible step toward more accessible, cost-effective, automated diagnosis and therefore earlier treatment of osteoporosis/osteopenia. (10.1016/j.jhsa.2024.09.008)
  • [L3] Despite established guidelines, low rates of osteoporotic pharmacotherapy were seen in patients who had femoral neck fractures. (10.1016/j.arth.2025.07.028)
  • [L3] In addition, patients with osteoporosis may experience a higher incidence of medical complications within the 90-day global period than nonosteoporotic patient. (10.1016/j.xrrt.2026.100723)
  • [L3] Patients with decreased bone mineral density can still achieve excellent 2-year outcomes. (10.1016/j.jse.2025.02.011)
  • [L1] Current machine learning-based prediction models for postmenopausal osteoporosis without fractures demonstrate good discriminative ability but are generally characterized by a high risk of bias, a notable lack of calibration performance evaluation, and insufficient validation of clinical utility. (10.1186/s12891-025-09385-2)
  • [L3] Overall rates of complication were low and osteoporosis should not be considered a contraindication to arthroscopic RCR. (10.1016/j.jseint.2026.101678)
  • [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. (10.1186/s12891-024-08153-y)
  • [L1] Genetically modified stem cell therapy is a safe and effective method that can significantly improve the BMD and BV/TV in animal models of osteoporosis. (10.1186/s12891-025-08507-0)
  • [L4] This study reveals an alarmingly high prevalence (76.9%) of osteoporosis among postmenopausal women hospitalized for fractures in China, identifying prolonged menopause, vertebral fractures, and recent fracture history as key risk profiles. (10.1186/s12891-026-09517-2)
  • [L3] In osteopenic and osteoporotic patients undergoing TJA, rates of 2- and 5-year postoperative complications were low and similar among patients who used PPIs perioperatively and those who did not. (10.1016/j.arth.2025.07.067)
  • [L4] Obesity-associated dyslipidemia drives BMD loss partly through inflammation-mediated pathways, with key inflammatory cytokines significantly mediating lipid metabolism's impact on bone health. (10.1186/s12891-026-09576-5)
  • [L4] Our results suggest that BMD alone cannot predict early migration of tibial baseplates. (10.1016/j.arth.2026.03.014)
  • [L1] In terms of relieving pain, improving BMD, improving activity function, and improving gait and preventing fracture, JTG is a good choice for patients with osteoporosis (OP). (10.1186/s12891-025-08694-w)
  • [L3] While bisphosphonate use in patients who have osteoporosis did not decrease the risk of periprosthetic fracture, it did significantly lower the incidence of all-cause revision at 2 years. (10.1016/j.arth.2024.11.004)

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] 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

[3] 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

[4] 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

[5] 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

[6] 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

[7] A Missed Opportunity? Osteoporosis Treatment Following Femoral Neck Fractures: Reducing the Risk of Secondary Hip Fracture. The Journal of Arthroplasty. 2026. DOI: 10.1016/j.arth.2025.07.028

[8] Impact of osteoporosis on post-operative outcomes following rotator cuff repair. JSES Reviews, Reports, and Techniques. 2026. DOI: 10.1016/j.xrrt.2026.100723

[9] 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

[10] Risk prediction models for postmenopausal osteoporosis: a systematic review and meta-analysis study. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-025-09385-2

[11] 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

[12] 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

[13] Genetically modified stem cells for osteoporosis: a systematic review and meta-analysis of preclinical studies. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08507-0

[14] How prevalent is osteoporosis in a high-risk subgroup? A multicenter study of postmenopausal women hospitalized for fractures in China. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-026-09517-2

[15] Effects of Perioperative Proton Pump Inhibitor Use on Outcomes of Total Joint Arthroplasty Patients Who Have Osteoporosis and Osteopenia. The Journal of Arthroplasty. 2026. DOI: 10.1016/j.arth.2025.07.067

[16] Perioperative inflammatory cytokines nursing screening test indicate the link between dysregulated lipid metabolism and reduced bone mineral density in obese osteoporosis patients: a retrospective study. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-026-09576-5

[17] Stable Fixation in Cementless Total Knee Arthroplasty Even for Low Local Bone Mineral Density. The Journal of Arthroplasty. 2026. DOI: 10.1016/j.arth.2026.03.014

[18] The effect of Jintiange capsules on pain in patients with primary osteoporosis: a systematic review and meta-analysis. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08694-w

[20] Bisphosphonate Use in Patients Who Have Osteoporosis Does Not Increase the Risk of Periprosthetic Fracture Following Total Knee Arthroplasty. The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2024.11.004

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