Purpose The International Osteoporosis Foundation (IOF) and the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) have proposed procollagen type I N propeptide (PINP) and β isomerized C-terminal telopeptide of type I collagen (β-CTX-I) as reference bone turnover markers (BTMs) for osteoporosis. This report examines the published literature since the 2011 IOF-IFCC position paper in order to determine the clinical potential of the reference BTMs and newer markers for the prediction of fracture risk and monitoring the treatment of osteoporosis. Methods Evidence for the relationship between BTMs and subsequent fractures was gathered from prospective studies through literature review of the Medline database from years 2011 to May 2024. The impact of treatment on BTMs was also studied by examining publications in that period. Studies of the accuracy of BTMs in the assessment of bone turnover in the setting of advanced chronic kidney disease were also examined. Results Increased BTM concentrations are associated with higher fracture risk in postmenopausal women. PINP and β-CTX-I measured in blood are associated with fracture risk but their interaction with other risk factors has not been sufficiently studied limiting their incorporation into fracture risk algorithms. Treatment-induced changes in PINP and β-CTX-I account for a substantial proportion of fracture risk reduction and are useful for improving adherence; they are recommended for inclusion in studies to examine adherence in individual patients. However, total PINP (tPINP) and β-CTX-I may be elevated in CKD due to renal retention. Bone alkaline phosphatase (BALP), intact PINP (iPINP), and tartrate resistant acid phosphatase 5b (TRACP5b) show the most promise in discriminating high and low turnover bone diseases in patients with advanced CKD and for predicting fracture risk, monitoring treatment response, and assessing the risk of treatment-related complications. Conclusion We re-affirm the use of serum/plasma tPINP and plasma β-CTX-I as reference BTMs with appropriate patient preparation and sample handling and measurement by standardized/harmonized assays in clinical studies to accumulate further data, and for monitoring treatment of osteoporosis in the setting of normal renal function in clinical practice. BALP and TRACP5b, measured by standardized assays, are recommended as reference BTMs for CKD-associated osteoporosis and should be included in observational and intervention studies to ascertain their utility for risk-evaluation, treatment initiation, and assessment of treatment response in CKD-associated osteoporosis.

Osteoporosis care has evolved markedly over the last 50 years, such that there are now an established clinical definition, validated methods of fracture risk assessment and a range of effective pharmacological agents. Currently, bone-forming (anabolic) agents, in many countries, are used in those patients who have continued to lose bone mineral density (BMD), patients with multiple subsequent fractures or those who have fractured despite treatment with antiresorptive agents. However, head-to-head data suggest that anabolic agents have greater rapidity and efficacy for fracture risk reduction than do antiresorptive therapies. The European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) convened an expert working group to discuss the tools available to identify patients at high risk of fracture, review the evidence for the use of anabolic agents as the initial intervention in patients at highest risk of fracture and consider the sequence of therapy following their use. This position paper sets out the findings of the group and the consequent recommendations. The key conclusion is that the current evidence base supports an “anabolic first” approach in patients found to be at very high risk of fracture, followed by maintenance therapy using an antiresorptive agent, and with the subsequent need for antiosteoporosis therapy addressed over a lifetime horizon.

Our ability to optimally manage bone health across the lifecourse, and so minimise the risk of fractures, has advanced substantially in recent decades. Whilst fractures and osteoporosis in older age were historically viewed simply as inherent in normal ageing, they are now recognised as manifestations of age-related disease. Key to advancing the field was the development of conceptual (relating to impaired bone mass and microarchitecture with increased propensity to fracture), and subsequent World Health Organization densitometric definitions of osteoporosis, cementing the role of dual-energy X-ray absorptiometry in bone health management. However, whilst low bone mineral density is a strong risk factor for fracture, many individuals who do fracture have normal or only modestly reduced bone mineral density. Furthermore, the existence of two definitions constituting a condition called “osteoporosis”, one based on a measurement, and the other conceptual, has led to uncertainty in clinical practice. The field is therefore moving towards calculation of an individual’s absolute fracture risk, based on clinical risk factors, with the option to incorporate bone mineral density (if available) as a risk factor rather than as an indication for treatment. Uptake of this new direction has been variable internationally, with many parts of the world, particularly low- and middle-income countries, still predicating treatment (where osteoporosis services exist) on bone mineral density, despite poor availability of densitometry in many such settings. In this Position Paper, on behalf of the International Osteoporosis Foundation, we review the current barriers which prevent equitable access to optimal bone health management worldwide and recommend potential solutions which might be implemented to overcome them.

Mild cognitive impairment, dementia and osteoporosis are common diseases of ageing and, with the increasingly ageing global population, are increasing in prevalence. These conditions are closely associated, with shared risk factors, common underlying biological mechanisms and potential direct causal pathways. In this review, the epidemiological and mechanistic links between mild cognitive impairment, dementia and skeletal health are explored. Discussion will focus on how changes in brain and bone signalling can underly associations between these conditions, and will consider the molecular and cellular drivers in the context of inflammation and the gut microbiome. There is a complex interplay between nutritional changes, which may precede or follow the onset of mild cognitive impairment (MCI) or dementia, and bone health. Polypharmacy is common in patients with MCI or dementia, and there are difficult prescribing decisions to be made due to the elevated risk of falls associated with many drugs used for associated problems, which can consequently increase fracture risk. Some medications prescribed for cognitive impairment may directly impact bone health. In addition, patients may have difficulty remembering medication without assistance, meaning that osteoporosis drugs may be prescribed but not taken. Cognitive impairment may be improved or delayed by physical activity and exercise, and there is evidence for the additional benefits of physical activity on falls and fractures. Research gaps and priorities with the aim of reducing the burden of osteoporosis and fractures in people with MCI or dementia will also be discussed.

Introduction. The primary goal of anterior cruciate ligament reconstruction is to provide stability to the knee and regain full range of motion. Although great improvement has been achieved in surgical techniques and rehabilitation, some patients are not completely satisfied with the results of surgery and a revision anterior cruciate ligament reconstruction is necessary. Material and Methods. Revision arthroscopic anterior cruciate ligament reconstruction was carried out in eleven patients with bone-tendon-bone autografts. The surgery was performed in a standard manner and the graft was taken from the opposite knee. Eight men and three women were evaluated. The mean age of patients was 26 (17-34) years. Repeated instability of the knee was caused by injury in five patients, while six patients were unsatisfied with the position of the graft. Results. The follow up was 4,2 years (2-8) respectively. The mean Lysholm and Gillquist score after operation was 88 (65-90). Preoperative and postoperative tibial shift was 9mm (6-15) and 2mm (0-4), respectively. The preoperative pivot shift test was grade 2 and 3 in all patients. Postoperative pivot shift test was negative in seven patients, in three it was grade 1 and grade 2 in one patient. According to the IKDC scale, preoperative results were abnormal in three patients and in eight they were severely abnormal. Postoperative IKDC score was normal in five patients, in four nearly normal, and in one patient the score was still abnormal. Five patients continued to be active in sports activities, four patients decreased the level of sports activity and two stopped all sports activities. Conclusion. Success of revision anterior cruciate ligament reconstruction requires detailed preoperative evaluation of the repeated instability of the knee. The treatment plan is then decided upon. The patients must be preoperatively informed about the real possibilities of revision surgery. Only a mutual collaboration between the patient, physiatrist and a surgeon is a key for successful treatment and return to previous level of sports activities.

Aim: The aim of this study was to assess whether BMI, severity of knee osteoarthritis, age and gender have any influence on the final clinical results of bone marrow aspirate concentrate injection....