Objectives To examine the association between body mass index (BMI) categories and the fragility fractures in Thai men and to identify the most common anatomical sites of these fractures. We hypothesised that BMI is associated with the risk of fragility fractures in this population. Design Retrospective observational study. Setting A tertiary care centre in eastern Thailand, based on data from Burapha University Hospital. Participants The study included 419 Thai men aged 40 years or older who underwent bone mineral density (BMD) assessment between 2014 and 2022. Participants were classified according to the presence or absence of documented fragility fractures. Exclusion criteria included pathological fractures, high-energy trauma and incomplete BMI or BMD data. Primary and secondary outcomes The primary outcome was the association between BMI categories and the risk of fragility fractures. The secondary outcome was the anatomical distribution of these fractures. Results Among 419 participants, 147 (35.1%) had fragility fractures and 272 (64.9%) did not. Underweight men had significantly increased odds of fragility fractures (OR, 3.44; 95% CI, 1.03 to 11.47; p=0.044) and vertebral fractures (OR, 4.30; 95% CI, 1.36 to 13.58; p=0.013), compared with men of normal BMI. In contrast, overweight men had lower odds of overall fractures (OR, 0.50; 95% CI, 0.31 to 0.80; p=0.004) and vertebral fractures (OR, 0.48; 95% CI, 0.27 to 0.84; p=0.010). Among underweight participants, BMI was moderately positively correlated with BMD at the lumbar spine (r=0.607; p=0.028) and at the one-third radius (r=0.557; p=0.084). Conclusions Lower BMI was significantly associated with increased risk of fragility fractures, particularly vertebral fractures. These findings support prior evidence in Asian populations and reveal a fracture pattern, predominantly vertebral followed by hip fractures, which differs from those observed in predominantly Caucasian populations.

Background: Falls among the elderly present significant physical, psychological, and economic challenges. Fall prevention strategies, such as balance and muscle strengthening exercises, are essential but often require long-term commitment. This study explores the potential of transcranial direct current stimulation (tDCS) as an adjunct to balance training to enhance physical performance in the elderly. Method: A randomized, double-blind, sham-controlled design was employed to compare balance training with active or sham tDCS. Participants underwent baseline assessments, followed by a six-week intervention period. The intervention protocol consisted of 2 mA, 20 min of anodal tDCS over the left primary motor cortex, three times weekly. Post-intervention assessments were conducted a few days after the intervention and follow-up at 4 weeks. Results: Following 18 sessions of anodal tDCS combined with balance exercise training, no significant group differences were observed for the Time Up and Go, One-Leg Standing, lower-limb strength, or the 6 min walk test (6MWT), although both the intervention and control groups demonstrated significant improvements over time. A significant group × time interaction was found only for the 6MWT, with participants in the intervention group exhibiting greater improvements in the 6MWT compared to controls. Conclusions: Anodal tDCS combined with balance exercise training selectively enhanced physical endurance but did not confer additional benefits for balance, gait, or leg strength in healthy older adults. These findings suggest that tDCS may serve as a promising adjunct to exercise for improving endurance-related outcomes in aging populations. Control of various variables for tDCS and exercise is necessary.

Background: Optimal radioactive iodine (RAI) dosing for Graves’ disease remains controversial. Conventional calculated regimens require radioactive iodine uptake (RAIU) testing, whereas empiric fixed-dose strategies risk under- or overtreatment. Although activity per gram of thyroid tissue provides an uptake-independent approach, volume-specific minimum effective doses and functional outcomes remain insufficiently defined. This study aimed to determine the minimum RAI activity per gram required to achieve ≥75% remission across stratified thyroid volumes, to identify the activity associated with the highest euthyroid remission, and to evaluate whether dose escalation increases treatment-related adverse events. Methods: This retrospective study included 236 patients with Graves’ disease who received initial single-dose RAI therapy between August 2022 and August 2024 at a tertiary center in Thailand. Thyroid volume by ultrasonography was categorized as <25 g, 25–49.9 g, 50–74.9 g, and ≥75 g. Administered activity was grouped as <0.30, 0.30–0.39, 0.40–0.49, 0.50–0.59, and ≥0.60 mCi/g. Outcomes and adverse events were assessed at 6 months. Result: The minimum activity required to achieve ≥75% remission increased with thyroid volume: 0.30–0.39 mCi/g for <25 g glands (90%), 0.40–0.49 mCi/g for 25–49.9 g (77%), and 0.50–0.59 mCi/g for 50–74.9 g (100%). No activity achieved ≥75% remission in glands ≥75 g, with a maximum rate of 45%. Across all volumes, the highest euthyroid rates occurred at the lowest effective activity, whereas dose escalation increased hypothyroidism without improving overall remission. Adverse events were infrequent (5.5–7.6%) and mostly mild. Moderate neck pain was more frequent at higher activities, with a strong positive correlation between administered activity and total adverse events (r = 0.82, p = 0.089). Conclusion: This study demonstrates that volume−stratified radioiodine dosing offers an effective and practical alternative to traditional 24−hour RAIU–based dosimetry for Graves’ disease. Adjusting activity according to thyroid volume yields predictable remission while avoiding the logistical burdens of uptake testing. The dose–response relationship also underscores the need to balance efficacy with avoidance of excess toxicity. Overall, this individualized, volume−based strategy provides a scalable and efficient framework for optimizing radioiodine therapy, particularly in resource−limited settings.