It is unclear whether moderate-to-vigorous physical activity (MVPA) and its proportion by vigorous physical activities (VPA) would decrease the risk of osteoporosis. This study aimed to examine a dose-response association between MVPA, VPA ratio, and incident osteoporosis in a large prospective cohort. We conducted a longitudinal analysis using data on MVPA, VPA, and osteoporosis from the UK Biobank prospective cohort study. A total of 368,553 eligible participants were included at baseline. Cox proportional hazard models were used to explore the association of MVPA and VPA with the incidence of osteoporosis for men and women, and trend tests were applied to assess the dose-response relationship between them. During a median follow-up of 12.56 years, 11,788 incident cases of osteoporosis (2016 in men and 9772 in women) were identified. The multivariate-adjusted HR (95%CI) of osteoporosis in the highest compared with lowest quartile of MVPA was 0.61 (0.54-0.69); P-trend < 0.001 for men and 0.84 (0.79-0.89); P-trend < 0.001 for women. In the analyses of proportions of VPA and the risk of osteoporosis, the highest tertile of VPA proportion was associated with the lowest risk of osteoporosis with a HR (95%CI) of 0.74 (0.63-0.86); P-trend < 0.001 for men and 0.80 (0.75-0.86); P-trend < 0.001 for women. A higher MVPA and VPA proportion were associated with decreasing osteoporosis risk in a dose-response manner, respectively, among British aged between 37 and 73 years.

Animal studies suggest that elevated sympathetic nervous system (SNS) activity can accelerate bone loss. However, this area has not been well researched in humans. High-intensity Resistance and Impact Training (HiRIT) is recognised as an effective treatment for osteoporosis and osteopenia. Alternate forms of exercise such as mind-body exercise may be used to modulate sympathetic activity, which could have an additive benefit for skeletal adaptation when used in conjunction with HiRIT. The aim of this study is to investigate whether the combination of mind-body exercise (Tai Chi) and HiRIT can be used to concurrently modulate SNS activity and improve skeletal health.

The CHILL BONES trial is a semi-randomised controlled trial where consenting adults over 60 years, who have low bone mass (total hip, femoral neck and/or lumbar spine T-score <-1.0) will be randomly allocated to participate in 8 months of twice-weekly Tai Chi, HiRIT or combined (Tai Chi+HiRIT) exercise. If participants are unwilling or unable to undertake exercise, they may opt into a non-exercising control group. The primary outcome will be total hip areal bone mineral density (BMD) measured using dual-energy X-ray absorptiometry. Secondary outcomes include femoral neck BMD, lumbar spine BMD, resting and reflexive skin sympathetic nerve activity and heart rate variability. Outcomes will be measured at baseline and post-intervention (8 months). Both intention-to-treat and per-protocol analyses will be undertaken.

Ethical approval was granted by the Griffith University Human Research Ethics Committee (GUHREC; GU Ref No: 2023/448). Trial findings will be disseminated to participants via a plain-language summary upon completion. Results will be formally reported through peer-reviewed journals and conference presentations.

ACTRN12623001209684; Australian New Zealand Clinical Trials Registry.

This cross-sectional analysis utilized data from the NHANES database and employed multivariable linear regression analyses to examine the relationship between physical activity (PA) patterns and femoral neck bone mineral density (BMD). The results demonstrated that both weekend warrior (WW) and regularly active (RA) patterns were positively associated with femoral neck BMD, particularly among younger adults (< 50 years old), males, and unmarried individuals.

This study aims to explore the association between PA patterns and femoral neck BMD, and to examine the difference between the WW and RA patterns.

Data were obtained from NHANES participants aged ≥ 18 years. PA patterns were self-reported through questionnaires and categorized into four groups: inactive, insufficiently active, weekend warrior, and regularly active. Multivariable linear regression analyses were conducted to evaluate the association between PA patterns and femoral neck BMD. Subgroup analyses and interaction effects were used to examine the potential differences across subgroups. Sensitivity analyses were used to examine the robustness and consistency of the findings.

A total of 16,937 adults (mean age 53.6 ± 17.2 years) were included, comprising 8677 men (51.2%) and 8260 women (48.8%). Based on PA patterns, participants were classified as inactive (n = 9123), insufficiently active (n = 2559), weekend warriors (n = 952), and regularly active (n = 4303). After adjusting for relevant covariates, both the WW and RA groups showed significantly higher femoral neck BMD compared to the inactive group (WW: β = 0.027, 95% CI: 0.020, 0.033, P < 0.001; RA: β = 0.034, 95% CI: 0.025, 0.044, P < 0.001). No statistically significant difference in BMD was found between the WW and RA groups (P = 0.151). These findings were consistent across sensitivity and subgroup analyses. Further subgroup analysis suggested that younger adults (< 50 years old), males, and unmarried individuals may derive greater BMD benefits from the WW and RA patterns.

Among US adults, the WW PA pattern was significantly associated with increased femoral neck BMD, with benefits comparable to those observed in the RA pattern.

Numerous clinical studies indicate that reproductive factors and physical performance levels are significant predictors of bone mineral density (BMD) in postmenopausal women. However, research on the relationship between these factors and body composition remains limited, and the mediating role of body composition in the impact of these factors on BMD remains unclear. This cross-sectional study aims to explore the correlation between reproductive factors, physical performance levels, BMD, and body composition in postmenopausal women, and to further investigate the mediating role of body composition in these relationships. This study enrolled 102 postmenopausal women meeting predetermined criteria from the osteoporosis outpatient clinic of Huzhou Central Hospital, China. Data were collected through surveys, assessments of physical performance function, and dual-energy X-ray absorptiometry (DXA) measurements. Correlation analysis and multiple linear regression analysis were used to determine the relationships among factors. Mediation analysis was conducted to explore the mediating role of body composition, followed by logistic regression analysis to investigate risk factors for osteoporosis. Gynoid Lean Muscle Mass (GLM) emerged as an independent predictive factor for BMD of spine, hip, and total body, and a protective factor against osteoporosis. Hand grip and 6-meter gait speed were positively correlated with BMD at these skeletal sites and GLM, also serving as protective factors against osteoporosis. Conversely, menarche age and Time taken for 5 sit-ups exhibited negative correlations with BMD and GLM, concurrently representing risk factors for osteoporosis. GLM mediated the relationship between menarche age, hand grip, and hip BMD. Prolonged reproductive periods and enhanced physical performance appear beneficial in mitigating Lean Mass loss, particularly GLM, in postmenopausal women, thereby protecting BMD and effectively preventing osteoporosis.

As people age, degenerative bone and joint diseases (DBJDs) become more prevalent. When middle-aged and elderly people are diagnosed with one or more disorders such as osteoporosis (OP), osteoarthritis (OA), and intervertebral disc degeneration (IVDD), it often signals the onset of prolonged pain and reduced functionality. Chronic inflammation has been identified as the underlying cause of various degenerative diseases, including DBJDs. Recently, excessive activation of pyroptosis, a form of programed cell death (PCD) mediated by inflammasomes, has emerged as a primary driver of harmful chronic inflammation. Consequently, pyroptosis has become a potential target for preventing and treating DBJDs.

This review explored the physiological and pathological roles of the pyroptosis pathway in bone and joint development and its relation to DBJDs. Meanwhile, it elaborated the molecular mechanisms of pyroptosis within individual cell types in the bone marrow and joints, as well as the interplay among different cell types in the context of DBJDs. Furthermore, this review presented the latest compelling evidence supporting the idea of regulating the pyroptosis pathway for DBJDs treatment, and discussed the potential, limitations, and challenges of various therapeutic strategies involving pyroptosis regulation.

In summary, an interesting identity for the unregulated pyroptosis pathway in the context of DBJDs was proposed in this review, which was undertaken as a spoiler of peaceful coexistence between cells in a degenerative environment. Over the extended course of DBJDs, pyroptosis pathway perpetuated its activity through crosstalk among pyroptosis cascades in different cell types, thus exacerbating the inflammatory environment throughout the entire bone marrow and joint degeneration environment. Correspondingly, pyroptosis regulation therapy emerged as a promising option for clinical treatment of DBJDs.

Power training has gained attention as a method for enhancing functional performance and mitigating fall risk in older adults, yet its long-term feasibility and safety, particularly in ballistic resistance training, remain underexplored in postmenopausal women. We evaluated the feasibility of 8-month ballistic resistance training compared with conventional resistance training in postmenopausal women.

The Resistance Exercise Programme on Risk of Osteoporosis and Osteoarthritis in Females (REPROOF) study was a three-arm parallel group randomised controlled trial at a university lab in the UK. Healthy postmenopausal women (n = 109) were randomised to 30 weeks (2 sessions/week) of lower-body ballistic resistance training, conventional resistance training, or a non-exercising control group.

The primary outcomes, collected by questionnaire, were process feasibility, acceptability, perceived exercise efficacy, and adverse events.

Eighty-two participants completed the trial (75.2 % retention). Both ballistic resistance training and conventional resistance training were well accepted, with most participants rating the intervention positively. No differences in the perceived improvements in physical function and psychological well-being were found between the resistance training groups. Similarly, there was no significant difference in the rate of muscle-related adverse events between the resistance training groups (ballistic, 2.7 per 100 person-weeks; conventional, 2.3 cases per 100 person-weeks), but the rate was significantly lower in the control group (0.9 cases per 100 person-weeks). No serious adverse events occurred during or within 24 h of exercise sessions.

The absence of serious adverse events and the observed positive outcomes confirm the safety, satisfaction, and perceived effectiveness of ballistic resistance training, suggesting its potential for broader application in healthy postmenopausal women.

gov registry ID NCT05889598.

Older veterans with multimorbidity experience physical and social vulnerabilities that complicate receipt of and adherence to physical rehabilitation services. Thus, traditional physical rehabilitation programs are insufficient to address this population's heterogenous clinical presentation.

To evaluate the feasibility and acceptability of a MultiComponent TeleRehabilitation (MCTR) program for older veterans with multimorbidity.

Randomized controlled cross-over feasibility study.

Telehealth from Veterans Affairs Medical Center to participants' homes.

Fifty U.S. military veterans, age ≥60 years (mean ± SD; 69.2 ± 6.7) with ≥3 comorbidities (6.0 ± 1.9), and impaired physical function were randomized and allocated equally to two groups.

The MCTR program consisted of high-intensity rehabilitation, coaching, social support, and technologies. Physical therapists delivered 12 individual and 20 group telerehabilitation sessions/participant. Participants in the education group started the MCTR program after 12 weeks.

The primary outcome was combined adherence (>75% of participants attending ≥80% sessions). Acceptability was measured by the Acceptability of Intervention Measure. Secondary outcomes included safety, participant surveys, and physical function. Patient-level outcomes were collected at baseline, 12 (primary time point), and 24 weeks.

Of 50 participants, 39 adhered to total session attendance (0.78 [95% confidence interval: 0.64-0.88], p = .76), 45 adhered to individual sessions (0.90 [95% confidence interval: 0.78-0.97], p = .01), and 48 rated the program as acceptable (0.96 [95% confidence interval: 0.85-0.99], p < .001). Thirty-five participants reported 78 safety events, and 12 (15%) had some degree of relatedness to the protocol. Most patient-level outcomes were similar between groups at 12-weeks.

The MCTR program was feasible based on high adherence to individual sessions and high acceptability. Adherence results were consistent with previous exercise studies in older adults. Most in-session safety events were related to underlying medical conditions and consistent with in-person physical rehabilitation safety events. These results can inform use of telerehabilitation for similar populations.

Background/Objective: Sarcopenic obesity (SO), a pathological syndrome characterized by the co-existence of diminished muscle mass and excessive adipose accumulation, significantly compromises the quality of life in older adults. The purpose of this study was to systematically evaluate the efficacy of exercise, nutritional interventions, and neuromuscular electrical stimulation (NMES) in preventing and managing SO in middle-aged and older adults. Methods: A comprehensive search was conducted across PubMed, Web of Science, Embase, Cochrane Library, and CNKI for randomized controlled trials (RCTs) until January 2025. Meta-analyses were performed using the random-effects model and fixed-effects model based on the degree of heterogeneity and calculating the mean differences (MD) with 95% confidence intervals (CI). Subgroup analyses compared the intervention types. Results: Twenty-nine RCTs (1622 participants) were included. Exercise interventions significantly reduced the body fat percentage (MD = -2.79%, 95% CI: -3.94, -1.64, p < 0.001, I2 = 74%), fat mass (MD = -6.77 kg, 95% CI: -11.48, -2.06, p = 0.005, I2 = 98%), waist circumference (MD = -2.05 cm, 95% CI: -3.64, -0.46, p = 0.01, I2 = 0%) and LDL-C (MD: -7.45 mg/dL, 95% CI: -13.82, -1.07, p = 0.02, I2 = 0%), while improving handgrip strength (MD = 2.35 kg, 95% CI: 1.99, 2.70, p < 0.001, I2 = 52%) and gait speed (MD = 0.19 m/s, 95% CI: 0.13, 0.24, p < 0.001, I2 = 89%). Mixed training outperformed resistance-only regimens in reducing the body fat percentage and enhancing functional outcomes. NMES reduced the body fat percentage (MD = -2.01%, 95% CI: -3.54, -0.48, p = 0.01, I2 = 93%) and waist circumference (MD = -1.72 cm, 95% CI: -2.35, -1.09, p < 0.001, I2 = 0%) while increasing the Skeletal Muscle Index (MD = 0.26 kg/m2, 95% CI: 0.22, 0.29, p < 0.001, I2 = 38%). Synergy with nutritional supplementation amplified these effects. Nutritional interventions modestly improved total fat-free mass (MD = 0.77 kg, 95% CI: 0.04, 1.50, p = 0.04, I2 = 0%) and handgrip strength (MD = 1.35 kg, 95% CI: 0.71, 2.00, p < 0.001, I2 = 0%) but showed no significant impact on the metabolic markers (TG, TC, glucose, hemoglobin, and HOMA-IR). Conclusions: Exercise, particularly multimodal regimens combining aerobic and resistance training, is the cornerstone for improving body composition and physical function in SO. NMES serves as an effective adjunct for accelerating fat loss, while nutritional strategies require integration with exercise or prolonged implementation to yield clinically meaningful outcomes. Future research should prioritize standardized diagnostic criteria and long-term efficacy assessments of multimodal interventions.

Body mass index (BMI) and sarcopenia are linked to osteoporosis, but the extent to which BMI influences osteoporosis through sarcopenia remains unclear. This study aims to assess the associations between BMI, sarcopenia, and osteoporosis, and to explore the predictive value of their combined biochemical markers for osteoporosis.

We retrospectively collected clinical data from 813 inpatients in the endocrinology department to explore the relationships between serum markers and skeletal muscle mass or BMI, and to evaluate the predictive value of BMI and sarcopenia for osteoporosis. Mediation analysis was employed to examine the associations among BMI, sarcopenia, and osteoporosis. Participants were randomly divided into training (n = 407) and testing (n = 406) sets (5:5). Independent risk factors were identified using least absolute shrinkage and selection operator and logistic regression, leading to the development of a nomogram model. Model evaluation was conducted through receiver operating characteristic curves, confusion matrices, calibration curves, decision curve analysis (DCA), and clinical impact curves (CIC).

BMI and skeletal muscle mass were negatively correlated with serum 25-hydroxyvitamin D and calcium levels. The "BMI < 28 and Non-Sarcopenia" emerged as a protective factor against osteoporosis. Sarcopenia significantly mediated the association between BMI and osteoporosis (46.88%). Gender, age, high-density lipoprotein, alkaline phosphatase, BMI, and sarcopenia emerged as independent predictors of osteoporosis. The area under the curve (AUC) for the training and testing sets was 0.859 and 0.866, respectively, with calibration curves indicating good consistency. DCA and CIC demonstrated clinical net benefits at risk thresholds of 0.02-0.82 and 0.02-0.67. Sankey diagrams and partial AUCs (1.00-0.75 sensitivity and specificity) illustrate the significant negative predictive value of BMI and sarcopenia.

Lower BMI and non-sarcopenia are negatively associated with the risk of osteoporosis. In addition, the nomogram demonstrates good predictive value, with a greater negative predictive value of the BMI and sarcopenia.

Strength development through physical exercise enhances neuromodulator production, neural connectivity, and motor unit efficiency. Beyond physical benefits, understanding individuals' perceptions, opinions, and knowledge can optimize engagement in exercise. However, existing literature lacks studies examining these factors alongside strength development. This study aimed to investigate whether the effectiveness of strength training protocols is associated with individuals' perceptions, opinions, and knowledge, thereby establishing a link between performance enhancement and awareness of the physiological demands of exercise. The findings seek to highlight the educational potential of physical exercise in promoting psychophysical well-being. A total of 24 participants (14 males, 10 females), aged 35-55 years with varying occupational backgrounds and sedentary levels, were recruited. A strength development protocol was administered, and the participants completed perception-based questionnaires at three time points. Statistical analyses, including repeated-measures ANOVA, Friedman's test, and post hoc comparisons, were conducted. Significant strength improvements were observed, specifically in the Hand Grip Test (p < 0.01). An increase, but non-significant, emerged in the Isometric Mid-Thigh Pull from 1850 ± 210 N to 2270 ± 190 N. The participants also reported a 35% increase in motivation to engage in exercise and a 42% reduction in sedentary behavior. Additionally, 78% of the participants demonstrated greater awareness of exercise benefits, correlating positively with physical improvements. The findings indicate that strength development is associated with increased awareness of the benefits of physical exercise, supporting its use as an educational tool to enhance engagement and adherence to exercise protocols.

This review summarises the latest evidence on effects of exercise on falls prevention, bone mineral density (BMD) and fragility fracture risk in postmenopausal women, explores hypotheses underpinning exercise-mediated effects on BMD and sheds light on innovative concepts to better understand and harness the skeletal benefits of exercise.

Multimodal exercise programs incorporating challenging balance exercises can prevent falls. Emerging clinical trial evidence indicates supervised progressive high-intensity resistance and impact training (HiRIT) is efficacious in increasing lumbar spine BMD and is safe and well-tolerated in postmenopausal women with osteoporosis/osteopenia. There remains uncertainty regarding durability of this load-induced osteogenic response and safety in patients with recent fractures. Muscle-derived myokines and small circulating extracellular vesicles have emerged as potential sources of exercise-induced muscle-bone crosstalk but require validation in postmenopausal women. Exercise has the potential for multi-modal skeletal benefits with i) HiRIT to build bone, and ii) challenging balance exercises to prevent falls, and ultimately fractures. The therapeutic effect of such exercise in combination with osteoporosis pharmacotherapy should be considered in future trials.

Bone injury presents a prevalent challenge in clinical settings, with traditional treatment modalities exhibiting inherent limitations. Recent advancements have highlighted the potential of combining physical exercise intervention and innovative materials to enhance bone repair and recovery. This review explores the synergistic effects of physical exercise and novel materials in promoting bone regeneration, with a particular focus on the role of neurovascular coupling (NVC) mechanisms. Physical exercise not only stimulates bone cell function and blood circulation but also enhances the bioactivity of novel materials, such as nanofiber membranes and smart materials, which provide supportive scaffolds for bone cell attachment, proliferation, and differentiation. NVC, involving the interaction between neural activity and blood flow, is integral to the bone repair process, ensuring the supply of nutrients and oxygen to the injured site. Studies demonstrate that the combination of physical exercise and novel materials can accelerate bone tissue regeneration, with exercise potentially enhancing the bioactivity of materials and materials improving the effectiveness of exercise. However, challenges remain in clinical applications, including patient variability, material biocompatibility, and long-term stability. Optimizing the integration of physical exercise and novel materials for optimal therapeutic outcomes is a key focus for future research. This review examines the collaborative mechanisms between physical exercise, novel materials, and NVC, emphasizing their potential and the ongoing challenges in clinical settings. Further exploration is needed to refine their application and improve bone repair strategies.

Weight loss achieved via energy restriction leads to significant losses in muscle and bone mass, potentially increasing risk for sarcopenia and osteoporosis. High-intensity resistance and impact training (HiRIT) might attenuate weight loss-induced musculoskeletal declines. Our objective was to compare changes in physical function and body composition in older adults with obesity undertaking dietary weight loss combined with HiRIT or aerobic training (AT).

Sixty older adults (aged ≥ 60 years) with obesity (dual-energy x-ray absorptiometry determined body fat percentage ≥ 30% in men and ≥ 40% in women) and a mobility limitation (Short Physical Performance Battery [SPPB] score ≤ 11) were randomly assigned to either 12 weeks of supervised, centre-based HiRIT or self-directed, home-based AT while consuming a hypocaloric diet (750-1000 kcal/day reduction in energy intake). Changes in physical function (primary outcome: gait speed) and body composition were compared between groups.

A total of 49/60 randomised participants (mean age: 69.6 ± 6 years; 58% women; mean BMI: 32.9 ± 4.1 kg/m2) completed the trial. Gait speed increased following HiRIT compared with AT (mean difference: 0.07 m/s [95% CI: 0.01, 0.13]). Chair stand times decreased in both groups (HiRIT: -1.3 s [95% CI: -2.1, -0.4] vs. AT: -0.8 s [95% CI: -1.6, -0.04]) and HiRIT, but not AT, increased handgrip strength (HiRIT: 2.2 kg [95% CI: 0.6, 3.9] vs. AT: 0.7 kg [95% CI: -0.9, 2.3]) and SPPB scores (HiRIT: 0.9 [95% CI: 0.4, 1.3] vs. AT: 0.4 [95% CI: -0.04, 0.8]). Similar decreases in total body mass (HiRIT: -5.1 kg [95% CI: -6.7, -3.4] vs. AT: -4.9 kg [95% CI: -6.5, -3.3]), fat mass (HiRIT: -3.6 kg [95% CI: -5.0, -2.2] vs. AT: -3.3 kg [95% CI: -4.7, -2.0]), visceral fat (HiRIT: -32.1 cm2 [95% CI: -47.4, -16.8] vs. AT: -31.4 cm2 [95% CI: -46.1, -16.8]) and appendicular lean mass (HiRIT: -0.8 kg [95% CI: -1.4, -0.2] vs. AT: -1.2 kg [95% CI: -1.8, -0.6]) were observed. HiRIT was well tolerated with only seven minor adverse events compared with five reported in those who completed AT.

HiRIT appears to be safe and more effective than AT for improving gait speed in older adults with obesity undertaking dietary weight loss. Additional trials with larger sample sizes and longer durations are warranted to explore whether HiRIT can attenuate weight loss-related muscle and bone mass declines.

Australian New Zealand Clinical Trials: ACTRN12618001146280.

Osteoporosis and osteopenia pose substantial public health challenges, particularly among postmenopausal women. Although various anthropometric measures have been proposed for risk assessment, their predictive performance and nonlinear relationships with bone outcomes remain unclear. We analyzed data from six consecutive cycles (2007-2018) of the National Health and Nutrition Examination Survey (NHANES). A total of 4473 postmenopausal women aged ≥ 50 years were included, each classified as having normal bone density, osteopenia, or osteoporosis based on dual-energy X-ray absorptiometry measurements. Ten anthropometric indices-waist-to-height ratio (WTHR), conicity index (CI), a body shape index (ABSI), body roundness index (BRI), lipid accumulation product, visceral adiposity index, cardiometabolic index, atherogenic index of plasma, weight-adjusted-waist index (WWI), and triglyceride-glucose (TyG) index-were examined using multiple logistic regression, restricted cubic spline curves, threshold-effect analyses, and SHAP (SHapley Additive exPlanations) analysis to assess their associations with osteoporosis and osteopenia. In fully adjusted models, individuals with higher WTHR, CI, BRI, WWI, and TyG tended to have a lower likelihood of osteoporosis or osteopenia (p < 0.01), whereas those with elevated ABSI were more likely to be diagnosed with these conditions (p < 0.01). Notably, several indices showed nonlinear effects on bone outcomes. Receiver operating characteristic (ROC) analyses indicated that WTHR and BRI had the highest discriminative capacity for differentiating osteoporosis from osteopenia. SHAP analysis further highlighted WTHR and BRI as the most influential predictors. WTHR and BRI demonstrated strong predictive utility for osteoporosis and osteopenia, suggesting their potential as noninvasive, cost-effective screening metrics for postmenopausal bone health. These findings provide insight into the varying roles of central and general obesity indicators in bone density and underscore the importance of incorporating novel anthropometric indices into early-stage risk assessment.

Regular exercise positively influences bone health, enhances bone density and strength, and reduces the risk of osteoporosis. Silent information regulator of transcription 1 (SIRT1) is a deacetylase that plays a pivotal role in the regulation of various biological processes. In this review, we explore the role of SIRT1 in modulating bone metabolism in response to exercise. SIRT1 regulates crucial cellular processes, including inflammation, aging, autophagy, and oxidative stress, in bone cells such as bone marrow mesenchymal stem cells, osteoblasts, and osteoclasts, in response to exercise-induced stimuli. Notably, exercise influences bone metabolism by modulating muscle metabolism and neurotransmitters, with SIRT1 acting as a key mediator. A comprehensive understanding of SIRT1's regulatory mechanisms will facilitate a deeper exploration of the principles underlying exercise-induced improvements in bone metabolism, ultimately providing novel insights into the treatment of bone metabolic disorders.

Parkinson's disease (PD) is the fastest-growing neurological disorder globally. Defining features include tremor, muscular rigidity, bradykinesia, and postural instability, which in combination with nonmotor symptoms such as cognitive impairment and orthostatic hypotension increase the risk of falls. Along with low bone mineral density, fracture risk is high in PD.

The aims were to identify and appraise clinical practice guidelines, consensus statements, and treatment algorithms containing recommendations for bone health in people with PD (PwP).

We systematically searched 4 electroninc databases (MEDLINE, Embase, Emcare, and Web of Science) (n = 78), in addition to the websites of organizations, societies, and professional bodies focused on PD or osteoporosis (n = 28), up to April 22, 2024.

After duplicate removal, screening, and full-text review, 6 records were included. Included records were appraised using the AGREE II (Appraisal of Guidelines for Research and Evaluation) tool. All records recognized bone health as a concern in PD, yet recommendations for fracture-risk screening were inconsistent. Two of six records grouped PD under the broad category of neurological diseases. The acceptability and tolerance of anti-osteoporosis medications in PwP was discussed only in 1 record, which incorporated national osteoporosis guidelines into a PD-specific treatment algorithm.

This review highlights that despite the documented high fracture rates of PwP, health professionals do not always have adequate resources to support them when considering how to manage osteoporosis. Osteoporosis screening and management needs to be incorporated into PD treatment guidelines, and equally providing specific recommendations for PwP related to bone health in national osteoporosis guidelines should be a priority given the high burden of fracture in the patient population.

To determine the extent to which sex and gender are considered in the design and reporting of distal radius fracture rehabilitation randomized controlled trials (RCTs).

PubMed, Embase, CINAHL, and Pedro databases were searched in March 2022, and an updated search was conducted in July 2023.

All RCTs with a rehabilitation intervention and any comparison were included.

We extracted information on the study characteristics and sex and gender reporting in the articles. We extracted whether the studies complied with the sex and gender equity in research (SAGER) guidelines and a reporting tool for sex and gender.

A total of 77 studies were included in this review. All studies were published between 1987 and 2021. Two were in children, and the rest were in adults. This systematic review found that sex and gender were adequately considered in only 6 of the 77 RCTs investigating rehabilitation interventions after distal radius fracture. Three of those studies were published before the SAGER guidelines were published in 2016, and 3 were published after 2016.

Overall, sex and gender were inadequately defined, and poorly addressed in the study design, conduct, and interpretation. Unfortunately, there was no evidence of improvement after 2016 when the SAGER guidelines became available.

Women lose up to 10% of their bone mass around menopause and the decade following. There is a need for proactive approaches to preserve bone mass and quality around menopause. Existing work has found that high-intensity resistance and impact training (HiRIT) can improve bone and muscle measures in late postmenopausal women. However, this has not been investigated in perimenopausal and early postmenopausal women who are in the midst of the menopausal transition.

This study is a 9-month randomised controlled feasibility trial evaluating a HiRIT programme in perimenopausal and early postmenopausal women. The primary objective of this study is to determine the feasibility of HiRIT in 40 perimenopausal and early postmenopausal women (45-60 years). Participants will be randomised 1:1 into a supervised HiRIT exercise intervention and waitlisted control. The primary outcomes are recruitment, retention and adherence to the exercise intervention. Secondary outcomes include bone (bone mineral density, microarchitecture and strength), muscle (mass, strength and power), physical function (balance and aerobic fitness) and quality of life measures. Feasibility will be assessed based on a priori criterion for success and secondary outcomes will be assessed via multiple linear regressions. The study will be considered feasible if>50% of interested and eligible participants are recruited, if there is>60% adherence to the two times per week, 9-month exercise intervention and if at least 65% of the sample complete the final study visit. Feasibility outcomes will be used to inform a larger, future trial aimed at identifying the efficacy of the exercise intervention for improving various health outcomes, including bone density and muscle mass. Secondary exploratory outcomes will provide insight into the effect of exercise on muscle and bone in perimenopausal and early postmenopausal women.

This study has been approved by the Conjoint Health Research Ethics Board of the University of Calgary REB22-1632. The results of this study will be disseminated at national and international conferences and published in academic journals.

ClinicalTrials.gov: NCT05961371. (Protocol V.1.2, 28 September 2023).

After menopause, there is an imbalance between bone formation and resorption activity, which could lead to postmenopausal osteopenia or osteoporosis. Resistance training (RT) can induce mechanical stress on bone which is necessary for bone remodeling and angiogenic-osteogenic response. This systematic review aims to assess the effects of RT on bone microcirculation and bone turnover markers (BTMs) in postmenopausal women with osteopenia or osteoporosis. We conducted a comprehensive search for related studies published up to April 2023 to identify eligible articles. Out of 316 articles identified, the full texts of 69 articles were screened. There is not any study which consider the effect of resistance exercises on bone microcirculation in PMOP women, but four articles aseess the effect of RT on BTMs and were reviewed. The quality of the articles was assessed by using the Physiotherapy Evidence Database (PEDro) scale. In one study, after 6- and 12 -months RT, bone formation and bone resorption biomarkers decreased not significantly. According to another study, bone formation and resorption biomarkers increased significantly after 3-months RT. Two other studies reported increases in biomarkers of bone formation along with decreases of biomarkers in bone resorption after 6-months of RT, but these were not significant. However, these results suggest that RT had some beneficial effects on BTMs but it is not an effective tool for modifying BTMs in women with osteoporosis or osteopenia. This may be due to the site-specific skeletal stimulation that RT provides. In addition considering the effect of RT on microcirculation of bone are important . So, there is a need for further, high-quality studies in this field.

Engaging in muscle strengthening activities (e.g., resistance training) at least twice/week is promoted by (Inter)national movement guidelines. Cardiovagal baroreflex sensitivity (cvBRS) reflects the ability to modulate R-R interval in response to changes in systolic blood pressure. Given the current conflicting literature, this study posed to explore the relationship between self-report muscle strengthening frequency and spontaneous cvBRS. 114 adults (62 females; age: 33 ± 19 years, 22% >55 years; body mass index: 24.2 ± 3.7 kg/m2) self-reported their weekly muscle strengthening activity frequencies via the Physical Activity and Sedentary Behaviour Questionnaire. Supine beat-by-beat R-R intervals [electrocardiography; 1.00 ± 0.18 s (0.90-1.50 s)] and systolic blood pressure [via finger photoplethysmography; 116 ± 11 mmHg (93-151 mmHg)] were recorded for 10.7 ± 2.0 min (5.3-14.5 min). Spontaneous cvBRS was assessed using the sequence technique. Data were analyzed using multiple regressions adjusted for age, sex, body mass index. Participants completed 2 ± 2 (0-7) days/week of muscle strengthening activities (56% met guidelines), and average overall cvBRS was 14.9 ± 9.1 (3.1-48.4) ms/mmHg. Higher reported frequencies were positively associated with overall cvBRS (Adjusted R2 = 0.40, p < 0.001; β = 2.24, p < 0.001). Meeting muscle strengthening activity guidelines was associated with improved overall cvBRS (Adjusted R2 = 0.29, p < 0.001; β = 7.68, p < 0.001). All results were unchanged if cvBRS for up-sequences or down-sequences only were used (all, p < 0.001). In conclusion, engaging in muscle strengthening exercises and particularly meeting existing guidelines were associated with better beat-by-beat vagally-mediated blood pressure regulation.

Exercise and nutrition interventions can slow ageing-induced decline in physiology. However, effects are heterogeneous and usually studied separately per outcome domain. In the VOILA study, we simultaneously study various health outcomes relevant for older adults and the inter-individual heterogeneity in response to a lifestyle intervention.

VOILA is a 12-week lifestyle intervention in 3 groups of older adults (≥60 years), with compromised mobility (n=50), compromised metabolic health (n=50), or recovering from total knee replacement (TKR, n=70, of which 20 randomized to standard care only). The intervention includes high-intensity resistance exercise training thrice weekly, nutritional counselling, and nutritional supplements every morning and evening (including 20-25 g whey protein and (evening only) 5.5 g Biotis™ GOS). We measure immune-metabolic, gut health, muscle mass and physical functioning at baseline and after completion of the intervention/standard care. An additional reference group of healthy older adults (n=50) will undergo baseline measurements only.

Improvements in various physiological systems are expected, but with differences between groups/individuals. This study will provide insights into how the physiological state of older adults influences the extent of lifestyle-induced health improvements to create better tailored interventions to attenuate biological ageing and improve the health span of subgroups and individuals.

Falls among older adults present a major public health challenge, causing significant physical, psychological, and economic consequences. Exercise interventions are a proven strategy to reduce fall risk by targeting biomechanical, physiological, and psychological factors. This review examines evidence from 155 studies published between 2004 and 2024, including systematic reviews, meta-analyses, randomized controlled trials, and cohort studies. Data were rigorously screened and extracted using predefined criteria, with studies sourced from PubMed, MEDLINE, EBSCO (EDS), and additional gray literature identified via Google Scholar. Key findings show that balance and strength training improves postural control, gait stability, and neuromuscular coordination, while resistance training mitigates sarcopenia and enhances joint mobility. Cognitive exercises enhance attention, spatial awareness, decision-making, and psychological benefits like reduced fear of falling and greater social engagement. Multidisciplinary approaches integrating physical, cognitive, and social components deliver the most significant impact. This review underscores the value of evidence-based exercise programs in promoting active aging and enhancing the quality of life for older adults.

Traditional set (TS), paired-set (PS), and super-set (SS) are used as resistance training methods. However, the effects of these methods on muscle fatigue (muscle strength and training volume) are not clear. The purpose of this study was to compare the effects of TS, PS, and SS on the muscle fatigue of the hamstrings and quadriceps.

Thirteen healthy, untrained men performed three sets of leg curl and leg extension exercises. TS included three successive sets of the leg curl and leg extension exercises with a 60 s rest interval between sets and exercises. In the PS, leg curl exercises were performed alternatingly with the leg extension exercises with a 60 s rest interval between sets and exercises. In the SS, leg curl and leg extension exercises were performed alternatively with each set. During SS, a 60 s rest interval was set between sets but not between exercises. Muscle strength before and immediately after interventions, and training volume during the training, were measured using an isokinetic dynamometer machine. Time efficiency was calculated by dividing the total training volume by the time required for each intervention.

The muscle strength of the hamstrings decreased in PS (p = 0.039) and SS (p = 0.001) but did not change in TS (p = 0.434). Muscle strength of the quadriceps decreased in all interventions (p < 0.05). In all interventions, the training volume of the hamstrings decreased in Set 2 (p < 0.05), and that of the quadriceps decreased in Set 3 (p < 0.05). The total training volume in PS was higher than TS (p < 0.01) and SS (p = 0.03). Time efficiency in SS was higher than TS (p < 0.01) and PS (p < 0.01). These results indicated that PS could be useful for individuals with sufficient time for resistance training because of greater training volume, while SS could be useful for those with limited time due to better time efficiency.

Aim was to demonstrate the influencing factors of infant bone mineral density (BMD) and its correlation with serum 25-hydroxyvitamin D (25-(OH)D) in nursing mothers.

200 children aged 0 č 1 years were rolled into normal group (n=120) and abnormal group (n=80) regarding the results of ultrasound BMD examination. The sunshine duration of infants with different BMD and 25(OH)D, calcium and phosphorus levels of nursing mothers were analyzed, and univariate and multivariate analyses of BMD were implemented.

The results revealed that the sunshine duration and serum 25-(OH)D level of nursing mothers in abnormal group were inferior to those in normal group (P<0.05). Additionally, a notable positive correlation existed between sunshine duration, serum 25-(OH)D level of nursing mothers and BMD (r = 0.911 and 0.503, P<0.05). According to Logistic regression analysis, outdoor activity time 0 č 1 h/d, premature infants, and breastfeeding alone were independent risk factors (RFs) for abnormal BMD in infants, and vitamin D(VD) and calcium supplementation were independent protective factors (P<0.05).

VD and calcium intake, adequate sunshine duration, mixed feeding, and increasing serum 25-(OH)D can reduce the occurrence of abnormal BMD in infants.

Designing appropriate diagnostic and treatment methods to reduce fall risk and improve quality of life, as well as reduce the cost of care in elderlies. Our findings have potential for early diagnosis of those with a high probability of falling based on fairly simple clinical measures of hyperkyphosis, forward head, and lordosis.

Poor balance is an underlying cause of falling in the elderly, for which a change in the natural curvature of the spine plays a major role. Little is known about the relationship between spinal curvatures and fall incidence in this population. We primarily aimed to investigate the relationship between sagittal plane spinal curvatures and fall incidence over 1 year among nursing facility residents. Secondarily, we aim to determine associations of sagittal plane spinal curvatures with participants' perception of fall risk and balance capability.

Participants (100 residents mean age 70.17 ± 6.01 years) underwent standing measures of sagittal plane spinal curvatures (flexible ruler technique) and forward displacement of the head relative to the cervical spine. The Tinetti Performance Oriented Mobility Assessment (POMA) and Fall Efficacy Scale assessed participants' perception of balance and fear of falling. Incident falls were self-reported monthly and tracked across 1 year. Spearman's correlations and logistic regression evaluated associations between fall incidence and spinal curvature. Predictive performance of spinal curvature and fall risk was determined by the corresponding ROC for defining a cut-off for variables of spinal curvature and fall risk indicators.

Predictive performance of spinal curvature and fall risk factors indicated 84% and 77% of participants were correctly classified using models of kyphosis and head angle, respectively.

Our study adds new data on spinal curvatures and incident falls among nursing facility residents. Efforts are needed to intervene to counter progression of spinal curvatures and improve fall prevention practices.

Osteoporosis is a chronic bone metabolic disease that affects millions of people worldwide, particularly the elderly and postmenopausal women. It is characterized by weakened bones, increasing the risk of fractures and leading to significant morbidity and mortality. The goal of the current study is to examine the reported osteo-preservative effects of exercise and/or fasting in the Ramadan fasting model (RFM) in ovariectomized (OVX) rats.

The experimental intervention started 1 month following the ovariectomy procedure and consisted of five 15-min exercise sessions per week at 18-25 m/min and/or an approximately 13-h fast from sunrise to sunset (6:00 AM-19:00 PM). Serum bone metabolism biomarker levels were measured, and mineral concentrations in femoral ashed bones and digested serum were determined. Additionally, serum bone alkaline phosphatase (b-ALP), parathyroid hormone, osteocalcin, calcitonin, and vitamin D3 concentrations were measured using the competitive enzyme immunoassay technique.

Calcium, magnesium, and phosphorus showed a notable decrease in mineral concentration among OVX rat femurs compared with the combination group (OVX + RFM + E) and control groups. In addition, homeostasis of serum concentrations of calcium, magnesium, and phosphorus was observed to increase in the OVX + RFM + E group rather than in the OVX group without intervention when compared with a control group. Furthermore, fasting and exercise, either alone or concurrently with ovariectomy, induced a non-significant elevation in osteocalcin, parathyroid hormone, and vitamin D3, whereas b-ALP and calcitonin increased significantly compared with those in control rats.

The combination of the Ramadan fasting model and moderate intensity exercises among OVX rats manifested advantageous effects in bone biomarkers compared with OVX rats without intervention. This could be recommended as a lifestyle modification that is protective against osteoporosis, especially in the context of depleted estrogen hormone after menopause.

Osteoporosis represents a public health problem that can be prevented and treated early through health education. Over time, screening techniques, diagnosis and treatments even conservative and surgical, have improved. Through this publication we want to highlight the importance of the medical and orthopaedic management of these fractures, describing the benefit of diet and physical exercise as the protagonists of conservative treatment but above all its indications and contraindications, emphasising the limitations of exercise in a vertebral osteoporotic fracture. The different orthoses prescriptions are also highlighted.

Osteoporosis represents a public health problem that can be prevented and treated early through health education. Over time, screening techniques, diagnosis and treatments even conservative and surgical, have improved. Through this publication we want to highlight the importance of the medical and orthopedic management of these fractures, describing the benefit of diet and physical exercise as the protagonists of conservative treatment but above all its indications and contraindications, emphasizing the limitations of exercise in a vertebral osteoporotic fracture. The different orthoses prescriptions are also highlighted.

Approximately 10 million individuals in the United States have osteoporosis and 44 million have low bone mineral density which puts them at risk for bone breaks. This presents a large burden on our health care system since about one-quarter of hip fracture patients never regain full function, need nursing care, and, for those over age 50, 24% die within one year. Oral bisphosphonates are often used as first-line therapy for the treatment of osteoporosis; however, patients frequently experience significant side effects. In addition, bisphosphonates inhibit bone loss by initiating apoptosis in osteoclasts that remove old bone, thus allowing old bone to accumulate and slowing the activity of osteoblasts that create new bone, thereby affecting bone quality. As an alternative, a bone-friendly lifestyle, including calcium and vitamin D consumption, exercise, smoking cessation, and a decrease in alcohol intake, may reduce bone loss. This case report describes lifestyle changes that included diet and exercise that increased bone mineral density in two years in a post-menopausal woman with no negative side effects.

The adult human skeleton is composed of cortical and cancellous bone. The proportions of these two types of bone tissue differ in various parts of the skeleton. The aim of this cross-sectional study was to quantify the determinants of bone mineral density (BMD) and bone mineral content in various regions of interest (ROIs) in smokers and never-smokers.

In this study, 4,332 bone scans of three regions of interest (ROIs) were analyzed: the forearm (distal and proximal), femur, and lumbar spine. Body composition and bone parameters were measured using dual-energy X-ray absorptiometry. Smoking was measured using the Global Adult Tobacco Survey questionnaire. Body mass index (BMI) was calculated, and physical activity (PA) was characterized by the metabolic equivalent of task (MET).

Among women, the interaction between PA (positive β coefficient) and smoking (negative β coefficient) was a significant predictor of BMD in the distal and proximal forearm (adj. R2 = 0.40 and R2 = 0.58; p < 0.001). The interaction of three variables-age, smoking (negative β), and MET (positive β)-was significant for total hip BMD (adj. R2 = 0.54; p < 0.001). The interaction between BMI and MET (positive β) and smoking (negative β) was significant for BMD in the lumbar spine (adj. R2 = 0.62; p < 0.001). In men, the interaction between MET (positive β) and smoking (negative β) was significant for BMD in the forearm and lumbar spine (adj. R2 = 0.44, R2 = 0.46, and R2 = 0.49; p < 0.01). Smoking alone was a significant negative predictor of total hip BMD (adj. R2 = 0.34; p < 0.001).

Among both women and men, never-smokers had significantly better bone parameters than smokers. Smoking was a significant negative predictor for BMD in the various ROIs in both women and men. Physical activity was a significant positive predictor of BMD, with a strong association with bone parameters.

To examine the hypothesis that an increase in response of postmenopausal bone to interval walking training (IWT) depends on baseline bone mineral densities (BMDs).

Two hundred and thirty-four postmenopausal women (64±5 (SD) yr) with no medication for osteoporosis performed 5-month IWT, repeating fast and slow walking at ≥70% and ~40% peak aerobic capacity, respectively, for 3 minutes each per set, ≥5 sets/day, ≥4 days/week. They were recruited from those who had performed IWT ≥6 months before participating in the study so that their physical fitness and lifestyle-related disease symptoms had almost reached a steady state at the time of their participation. We measured BMDs for the lumbar spine (LS), bilateral femoral neck (FN), and bilateral total hip (TH) by dual-energy X-ray absorptiometry (DXA) before and after the intervention. We used a multiple regression analysis to identify significant independent factors for increasing BMDs after the intervention as baseline physical characteristics, exercise intensity, and exercise time during IWT were the candidates. For any bone site where the independent factor identified was singular, we analyzed the relationship between the identified factor vs increases in BMD after the intervention (ΔBMD) by the locally weighted scatterplot smoothing (LOWESS) method.

Almost all subjects completed the designated protocol with minimal adverse events. We found that significant determinants for increasing BMDs were the baseline BMDs for all bone sites, as well as age and body mass index for TH (all, P<0.02). Furthermore, the LOWESS trendline between ΔBMDs vs the baseline BMDs, divided equally into 10 bins for LS and FN, respectively, showed that ΔBMD responses (Y) were attenuated as the baseline BMDs (X) increased in the lower 4 bins and then showed a flat line (Y = ~0) in the remaining higher 6 bins for LS and FN. When the lower 4 bins and the higher 6 bins of the baseline BMD were pooled, respectively, BMDs significantly increased by 1.8% and 1.0% in the lower groups for LS and FN, respectively (both, P<0.001) while not in the higher groups after the intervention (both, P>0.3).

IWT may be of benefit with minimal adverse events to postmenopausal women, although the effects were greater in those with lower baseline BMDs.

UMIN000047428. https://rctportal.niph.go.jp/s/detail/um?trial_id=UMIN000047428#.

Background: To minimize fracture risk, multimodal training regimens are recommended. However, their effectiveness in community settings remains uncertain. This study evaluated the feasibility of 19-weeks of multimodal training in a local community center with emphasis on musculoskeletal health in postmenopausal women. Methods: In a controlled trial, 28 postmenopausal women (53-68-years-old) were assigned to a multimodal training group (MMT, n=15) or a control group (CON, n=13). The training consisted of high- and odd-impact, resistance and balance-coordination training 1-2 hours weekly. The outcomes were attendance rate, regional and total bone mineral density (BMD), bone mineral content (BMC), bone turnover markers (BTM), body composition, functional muscle strength and power, and dynamic balance. All were determined at baseline and after 19 weeks of training. BTM was assessed after three weeks. Results: Overall, 22(79%) participants (MMT, n=9; CON, n=13) completed the study, and the mean attendance rate for MMT was 65.5% of the maximum sessions (2) offered. Only right trochanter BMD increased (p<0.05) by 1.0±1.1% in MMT, which was higher(p<0.05) than CON. While whole-body BMC was not changed at 19 weeks from baseline in MMT, it decreased (p<0.05) in CON resulting in a significant difference (p<0.05) in whole-body BMC delta values between the two groups. Compared to baseline, body fat percentage(%BF), fat mass(FM), and visceral adipose tissue (VAT)-mass and -volume were decreased (p<0.01) in MMT, and were larger (p<0.05) than CON. No significant changes were observed in BTM, muscle strength and power, and dynamic balance after 19 weeks. Conclusions: Nineteen weeks of multimodal training 1-2 hours per week in a local community had a health-enhancing effect on %BF, FM, and VAT, whereas the musculoskeletal health impact was modest. We hypothesize that the reason might be too low training volume and frequency and supposedly too low musculoskeletal training intensity for some participants. Registration: ClinicalTrials.gov NCT05164679 (21/12/2021).

Novel strategies are needed to address the rising burden of osteoporosis and fragility fractures. High-intensity resistance and impact (HiRIT) exercise has shown benefit in improving bone density in postmenopausal women with osteoporosis/osteopenia. Whether HiRIT can enhance the therapeutic effects of osteoporosis pharmacotherapy has not been established. ROLEX-DUO is a randomised controlled trial designed to assess the efficacy of romosozumab on various bone and muscle outcomes in combination with different exercise interventions in women with postmenopausal osteoporosis/osteopenia.

ROLEX-DUO is an 8-month randomised placebo-controlled trial conducted at two tertiary referral centres for patients with osteoporosis/osteopenia in Sydney, New South Wales, Australia. The study is implementing the combination of romosozumab or placebo with different forms of exercise in postmenopausal women with osteoporosis/osteopenia without recent fragility fracture (n=102). Eligible women will be randomised 1:1:1 into one of three groups: (1) romosozumab with supervised HiRIT, (2) romosozumab with unsupervised low-intensity exercise or (3) placebo with unsupervised low-intensity exercise. Co-primary outcomes are the mean percentage change in lumbar spine bone mineral density (BMD), and mean change in five times sit-to-stand test performance (seconds) at 8 months. Secondary/exploratory outcomes include BMD changes at the femoral neck, total hip and distal radius, three-dimensional dual-energy X-ray absorptiometry (DXA) hip outcomes, DXA-derived lean and fat mass, serum markers of bone turnover (procollagen type 1 peptide, C-telopeptide of type 1 collagen) and bone biomarkers (dickkopf-1), serum extracellular vesicle analyses, 36-Item Short Form Survey (SF-36) quality-of-life scores, Menopause-Specific Quality Of Life (MENQOL) Questionnaire menopause symptom burden scores, number of falls and fractures. Mixed-effects models will be performed to compare longitudinal outcome results between groups using intention-to-treat analysis.

The trial was approved by the Northern Sydney Local Health District Human Research Ethics Committee (2022/ETH01794, protocol V.8, dated 03 July 2024). Participants will provide written informed consent prior to inclusion. Findings will be disseminated via peer-reviewed journals, scientific conferences and summary reports to funding bodies.

ACTRN12623000867695.

Osteoporosis and low bone mineral density (BMD) pose significant challenges in adult spinal deformity surgery, increasing the risks of complications such as vertebral compression fractures, hardware failure, proximal junctional kyphosis/failure, and pseudoarthrosis. This narrative review examines the current evidence on bone health optimization strategies for spinal deformity patients. Preoperative screening and medical optimization are crucial, with vitamin D supplementation showing particular benefit. Among the pharmacologic agents, bisphosphonates demonstrate efficacy in improving fusion rates and reducing hardware-related complications, though the effects may be delayed. Teriparatide, a parathyroid hormone analog, shows promise in accelerating fusion and enhancing pedicle screw fixation. Newer anabolic agents like abaloparatide and romosozumab require further study but show potential. Romosozumab, in particular, has demonstrated significant improvements in lumbar spine BMD over a shorter duration compared to other treatments. Surgical techniques like cement augmentation and the use of larger interbody cages can mitigate the risks in osteoporotic patients. Overall, a multifaceted approach incorporating medical optimization, appropriate pharmacologic treatment, and tailored surgical techniques is recommended to improve outcomes in adult spinal deformity patients with compromised bone quality. Future research should focus on optimizing the treatment protocols, assessing the long-term outcomes of newer agents in the spine surgery population, and developing cost-effective strategies to improve access to these promising therapies.

Osteoporosis, a condition defined by low BMD (typically < -2.5 SD), causes a higher fracture risk and leads to significant economic, social, and clinical impacts. Genome-wide studies mainly in Caucasians have found many genetic links to osteoporosis, fractures, and BMD, with limited research in East Asians (EAS). We investigated the genetic aspects of BMD in 86 716 individuals from the Taiwan Biobank and their causal links to health conditions within EAS. A genome-wide association study (GWAS) was conducted, followed by observational studies, polygenic risk score assessments, and genetic correlation analyses to identify associated health conditions linked to BMD. GWAS and gene-based GWAS studies identified 78 significant SNPs and 75 genes related to BMD, highlighting pathways like Hedgehog, WNT-mediated, and TGF-β. Our cross-trait linkage disequilibrium score regression analyses for BMD and osteoporosis consistently validated their genetic correlations with BMI and type 2 diabetes (T2D) in EAS. Higher BMD was linked to lower osteoporosis risk but increased BMI and T2D, whereas osteoporosis linked to lower BMI, waist circumference, hemoglobinA1c, and reduced T2D risk. Bidirectional Mendelian randomization analyses revealed that a higher BMI causally increases BMD in EAS. However, no direct causal relationships were found between BMD and T2D, or between osteoporosis and either BMI or T2D. This study identified key genetic factors for bone health in Taiwan, and revealed significant health conditions in EAS, particularly highlighting the genetic interplay between bone health and metabolic traits like T2D and BMI.

Spinal cord injury is associated with skeletal unloading, sedentary behavior, decreases in skeletal muscle mass, and exercise intolerance, which results in rapid and severe bone loss. To date, monotherapy with physical interventions such as weight-bearing in standing frames, computer-controlled electrically stimulated cycling and ambulation exercise, and low-intensity vibration are unsuccessful in maintaining bone density after SCI. Strategies to maintain bone density with commonly used osteoporosis medications also fail to provide a significant clinical benefit, potentially due to a unique pathology of bone deterioration in SCI. In this review, the available data is discussed on evaluating and monitoring bone loss, fracture, and physical and pharmacological therapeutic approaches to SCI-associated disease of the skeleton. The treatment of SCI-associated disease of the skeleton, the implications for clinical management, and areas of need are considered for future investigation.

The objective of this meta-analysis is to study the effect of different strengths of resistance training programs on the severity and frequency of hot flushes in postmenopausal women with vasomotor symptoms.

Menopause is defined as the state in which the menstrual cycle of a biological female spontaneously comes to a halt for a period of about 1 year. Through a detailed analysis of much of the research, it is found that the resistance training program is beneficial not only for reducing the severity as well as the frequency of hot flushes in postmenopausal women.

Online research was conducted through databases such as PubMed, Cochrane Trial Register, and Google Scholar till the 20th of March 2023. The Review Manager (version 5.4.1) was used to statistically analyze the data from the studies. Studies meeting the inclusion criteria, comparing the vasomotor symptoms in resistance training groups as compared to control were used for this meta-analysis. The primary outcome of interest was the alleviation of hot flushes in the resistance training group. Random-effect model was used to pool the studies and the result was reported in SMD with 95% Confidence Interval (CI).

5 studies were selected for this review. Statistical analysis shows that vasomotor symptoms were more common in the control group and decreased significantly in the resistance training group after the intervention (SMD = -1.31, 95% CI: -1.85 to -0.77, p = 0.002).

Resistance Training significantly affects vasomotor symptoms and can be considered for such symptoms in postmenopausal women.

Musculoskeletal (MSK) injuries in US trail sports are understudied as trail sport popularity grows. This study describes MSK injury patterns among hikers, trail runners, and mountain bikers from 2002 through 2021 and investigates MSK injury trends acquired during mountain sports.

The National Electronic Injury Surveillance System (NEISS) was used to identify US emergency department (ED) patients from 2002-2021 (inclusive) who endured MSK injuries during hiking, trail running, or mountain biking. Injury rates and national estimates were calculated across demographics.

9835 injuries were included (48.4% male, 51.6% female). Injuries increased over time, with 1213 from 2002-2005 versus 2417 from 2018-2021. No sex differences existed before 2010, after which female injury rates exceeded those of males. The following findings were statistically significant, with P<0.05: females endured more fractures and strains/sprains; males endured more lacerations; concussions and head injuries were higher among those <18 y; dislocations and strains/sprains were higher for 18 to 65 y; fractures were higher for >65 y; <18 y had high mountain-biking and low running rates; 18 to 65 y had high running rates; and >65 y had low biking and running rates. Although all diagnoses increased in number over time, no significant differences existed in the proportion of any given diagnosis relative to total injuries.

MSK injuries during trail sports have increased since 2002. Males endured more injuries until 2009, after which females endured more. Significant sex and age differences were found regarding injury diagnosis and body parts. Further studies are needed to confirm these trends and their causes.