Background: Orthopaedic surgery remains one of the most competitive residency matches for both senior allopathic (MD) and senior osteopathic (DO) medical students. Despite the completion of a transition to single accreditation of residency programs accredited by the American Osteopathic Association and the Accreditation Council for Graduate Medical Education in 2020, little is known about the subsequent impact of this new environment for DO and MD orthopaedic applicants. The purpose of this study was to evaluate the differences between MD and DO match rates using both Electronic Residency Application Service (ERAS) and National Residency Matching Program (NRMP) data. Methods: ERAS applicant data from 2020 to 2023 specific to orthopaedic surgery were obtained from the Association of American Medical Colleges. NRMP data were queried for the same years. Both NRMP (unadjusted) and ERAS (adjusted) match rates were calculated and compared for each year and cumulatively. In addition, the proportion of ERAS applicants that failed to rank orthopaedic surgery in the NRMP was calculated and compared between senior MD and senior DO applicant groups. Results: From 2020 to 2023, the unadjusted match rate dropped for MDs (79% vs 73%, p = 0.002) and DOs (63% vs 50%, p = 0.009). Adjusted match rates over this time were not different for MDs (59% vs 57%, p = 0.22) or DOs (39% vs 37%, p = 0.67). Overall, the unadjusted and adjusted match rate for DO applicants was lower than MD across all years (p < 0.05). For every year except 2023 (p = 0.15), a larger proportion of US DO senior students with ERAS applications did not submit a final NRMP rank list for orthopaedics (p < 0.05). Conclusions: Aspiring DO orthopaedic surgeons have lower match rates and higher rates of abandoning plans to apply for orthopaedic surgery between ERAS application and NRMP compared with their US MD peers despite single accreditation. Active identification of bias, orthopaedic mentorship, and focused advising may help prepare qualified applicants for competitive specialty matches. Level of Evidence: Level III. See Instructions for Authors for a complete description of levels of evidence.

Bone homeostasis is a dynamic process governed by the balanced activity of osteoblasts and osteoclasts, tightly regulated through complex signaling networks. Emerging evidence highlights sphingolipid metabolism as a critical modulator of skeletal integrity, influencing bone remodeling in both health and disease. Each individual step, however, appears to have a unique role in these processes, with some overlap in function that is not well understood yet. This review explores the interplay between sphingolipid metabolism and bone homeostasis. It provides a comprehensive overview of the diverse roles of the various sphingolipid metabolic enzymes in bone remodeling and the maintenance of bone health. Special focus is given to the key enzymes from the de novo and turnover pathways that have been shown to play a pivotal role in modulating osteoblast and osteoclast differentiation, survival, and function, thereby impacting bone formation and resorption. Emerging data also suggest that alterations in sphingolipid metabolism may serve as biomarkers or therapeutic targets in metabolic bone diseases. Understanding these sphingolipid-mediated mechanisms opens new avenues for targeted interventions in bone disorders. It also highlights the need for further research into the therapeutic potential of modulating the sphingolipid metabolic pathway.