What’s New in Osteoporosis 2024

New insights regarding osteoporosis treatment and fracture prevention are highlighted in the recent JBJS Guest Editorial What’s New in Osteoporosis: Emphasis on the Aging Athlete. Here, we summarize the 5 most compelling studies, as selected by co-author Ting Cong, MD. 

Antiosteoporosis Medications

Researchers investigated whether denosumab use was associated with a decreased risk of developing diabetes in a cohort of 68,510 patients with osteoporosis (mean age, 77.7 years; 84.3% female). The study utilized data from the Taiwan National Health Insurance Research Database. Compared with a propensity-matched control group, the treatment group had a lower cumulative incidence of diabetes. The study authors concluded that these results “may help physicians choose an appropriate antiosteoporosis medication for patients with osteoporosis while also considering the risk of diabetes”¹. 

A separate study utilized the Taiwan National Health Insurance Research Database to investigate the possible cardioprotective effects of antiosteoporosis medications in a cohort of 41,102 patients ≥40 years old with newly diagnosed osteoporosis. Hormone replacement therapy was associated with a higher likelihood (odds ratio, 1.36) of cardiovascular disease. In contrast, denosumab, teriparatide, and bisphosphonate were each associated with lower odds of cardiovascular disease (odds ratios of 0.13, 0.52, and 0.80, respectively) relative to no drug treatment².  

Osteoporosis Among Men

To help address the lack of established guidelines for routine osteoporosis screening in men, researchers conducted a study to identify the age at which men begin to have an increased risk of fragility fractures. Among men without a pre-existing history of osteoporosis, the risk of fragility fracture increased after 70 years of age (p < 0.001), with the highest risk observed for those ≥81 years of age (p < 0.001)³. 

High-Risk Patients on the Fracture Risk Continuum

The relationship between vitamin D level and trabecular bone score, grip strength, and gait speed were investigated in a study of 246 older women with osteoporosis and multiple comorbidities who resided in long-term care centers. After adjusting for covariates, the investigators observed an increase of 0.004 in spinal trabecular bone score (p = 0.0599) and an increase of 0.012 m/s in gait speed (p = 0.0144) for every 5-ng/dL increase in serum 25-OH vitamin D⁴. 

Low-Risk Patients on the Fracture Risk Continuum

The comparative effectiveness of osteoporosis treatments in reducing fracture risk in postmenopausal women was reviewed in a network meta-analysis and meta-regression analysis of 69 randomized controlled trials⁵. The study demonstrated “the profound positive effect of anabolic agents on bone density in the spine compared with other body parts”, write Guest Editorial authors Dr. Cong et al. 

What’s New in Osteoporosis: Emphasis on the Aging Athlete is freely available at JBJS.org. 

What’s New by Subspecialty

Each month, JBJS publishes a review of the most pertinent studies from the orthopaedic literature in a select subspecialty. To read the reports, visit the What’s New by Subspecialty collection at JBJS.org. 

Recent OrthoBuzz posts include: What’s New in Limb Lengthening and Deformity Correction, What’s New in Musculoskeletal Infection, and What’s New in Orthopaedic Trauma. 

References 

1. Huang HK, Chuang AT, Liao TC, Shao SC, Liu PP, Tu Y, Lai EC. Denosumab and the risk of diabetes in patients treated for osteoporosis. JAMA Netw Open. 2024 Feb 5;7(2):e2354734. 
2. Tsai WH, Sung FC, Muo CH, Tsai MC, Wu SI. Antiosteoporosis medications and cardiovascular disease: a population-based nationwide nested case-control study. Front Pharmacol. 2023 Oct 10;14:1220174.  
3. Agarwal AR, Tarawneh O, Cohen JS, Gu A, Moseley KF, DeBritz JN, Golladay GJ, Thakkar SC. The incremental risk of fragility fractures in aging men. Osteoporos Int. 2024 Mar;35(3):495-503. 
4. Haeri NS, Perera S, Greenspan SL. The association of vitamin D with bone microarchitecture, muscle strength, and mobility performance in older women in long-term care. Bone. 2023 Nov;176:116867. 
5. Händel MN, Cardoso I, von Bülow C, Rohde JF, Ussing A, Nielsen SM, Christensen R, Body JJ, Brandi ML, Diez-Perez A, Hadji P, Javaid MK, Lems WF, Nogues X, Roux C, Minisola S, Kurth A, Thomas T, Prieto-Alhambra D, Ferrari SL, Langdahl B, Abrahamsen B. Fracture risk reduction and safety by osteoporosis treatment compared with placebo or active comparator in postmenopausal women: systematic review, network meta-analysis, and meta-regression analysis of randomised clinical trials. BMJ. 2023 May 2;381:e068033.