Osteoporotic vertebral fractures (OVFs) are the most common osteoporotic fracture type and remain substantially underdiagnosed despite their diagnostic, prognostic, and therapeutic importance. This review examines OVFs as sentinel events in osteoporosis, emphasizing their role in diagnosis, fracture-risk stratification, treatment selection, and secondary fracture prevention. This narrative review synthesizes evidence from contemporary clinical practice guidelines, epidemiological studies, randomized controlled trials, systematic reviews, meta-analyses, and selected observational studies addressing imaging and artificial-intelligence-assisted detection. References were selected based on clinical relevance, methodological rigor, and recency, in keeping with the conventions of a focused narrative review rather than a systematic review. OVFs frequently occur without classic osteoporosis-range bone mineral density and often remain clinically silent or incidentally detected. Nevertheless, they independently predict future vertebral, hip, and non-OVFs, particularly during the early post-fracture period. Vertebral fracture assessment on dual-energy X-ray absorptiometry (DXA), opportunistic CT screening, standardized radiology reporting, and AI-assisted detection may improve case finding. Management should combine acute pain control, rehabilitation, appropriate use of vertebral augmentation in selected patients, pharmacological osteoporosis therapy, and structured secondary prevention. Patients with recent or multiple OVFs often meet criteria for high or very-high fracture risk and may benefit from anabolic-first or sequential therapy strategies. Fracture Liaison Services provide a system-level model to close the diagnosis and treatment gap. Recognizing OVFs as actionable markers of skeletal fragility is essential for reducing subsequent fracture burden.

Patient-specific instrumentation (PSI)-assisted high tibial osteotomy (HTO) represents a significant advancement in the surgical management of varus knee deformity and medial compartment osteoarthritis. This chapter provides an in-depth, technique-oriented guide covering the full PSI-HTO workflow – from three-dimensional (3D) computed tomography (CT)-based deformity analysis and virtual surgical planning, through computer-aided design (CAD)/computer-aided manufacturing (CAM) guide fabrication, to intraoperative execution, bone gap management, fixation, and rehabilitation. The historical evolution, evidence-based patient selection, biomechanical rationale, comparative performance of PSI against conventional and navigation-assisted techniques, complication management, bone graft selection, long-term survivorship, return-to-sport outcomes, and future directions, including artificial intelligence (AI) and robotic assistance, are all discussed. More than 20 PubMed-indexed references support the evidence base.