Saúde óssea e osteoporose Folheto

O que você está sentindo

Osteoporose significa que seus ossos perderam parte da sua resistência. Muitas vezes ela não causa nenhum sintoma até que um osso se quebre. Quando essa fratura acontece após um pequeno tropeço ou uma pancada leve, ela é chamada de fratura por fragilidade. Os locais mais comuns são o punho, o quadril e os ossos da coluna.

Se um osso da coluna enfraqueceu, você pode sentir dor nessa região. Ela costuma piorar quando você se levanta de uma cadeira, levanta algum objeto ou gira o tronco. O repouso e ficar deitado podem aliviá-la. Algumas pessoas percebem que a dor é pior logo ao acordar ou depois de passar algum tempo em pé. Uma fratura no punho dificulta servir água da chaleira, segurar uma panela pesada ou carregar as compras. Uma fratura na coluna pode tornar desconfortável curvar-se para calçar os sapatos ou sair da cama.

Há outra coisa que vale a pena saber. Muitas pessoas que quebram um osso dessa forma nunca são informadas de que têm osteoporose. A fratura é tratada, mas a fragilidade óssea subjacente não é diagnosticada nem tratada. Essa lacuna é importante, porque tratar a fragilidade óssea pode reduzir em até 50% a probabilidade de uma nova fratura e diminuir as taxas de mortalidade em até 30%.

Ter peso corporal mais elevado está associado a um risco menor. Cada aumento de 1 unidade no índice de massa corporal esteve associado a uma redução de 9% no risco de osteoporose. O índice de massa corporal, ou IMC, é uma medida do peso em relação à altura.

Se você tem osteoporose e também precisa de uma cirurgia no ombro, as evidências trazem alguma tranquilidade. Pessoas com densidade óssea reduzida ainda obtêm bons resultados após o reparo artroscópico do manguito rotador, em que o cirurgião repara um tendão rompido do ombro por meio de pequenas incisões. As taxas gerais de complicações foram baixas, e a osteoporose não é motivo para descartar essa cirurgia.

Seu cirurgião pode solicitar uma densitometria óssea e conversar com você sobre o tratamento.

O que está realmente acontecendo

O osso é um tecido vivo. Seu corpo está constantemente desfazendo osso antigo e formando osso novo para substituí-lo. A partir da meia-idade, aproximadamente, a formação fica mais lenta. Mais osso é removido do que reposto, e o osso que resta torna-se mais fino e menos denso.

Pense no osso como a estrutura de madeira dentro de uma parede. O osso saudável tem vigas grossas e bem próximas umas das outras. Na osteoporose, essas vigas ficam finas e algumas desaparecem por completo. A estrutura ainda sustenta a parede, mas tem menos reserva. É por isso que um pequeno tropeço ou uma pancada leve podem bastar para quebrar um punho, um quadril ou um osso da coluna, e é por isso que a dor que você sente após uma fratura na coluna piora quando você fica em pé, levanta peso ou gira o tronco.

Há uma segunda parte que vale a pena entender. A fratura em si é tratada, mas a fragilidade óssea subjacente muitas vezes não é diagnosticada nem tratada.

O que esperar

A osteoporose, por si só, é silenciosa. Ela não dói nem lateja, e não vai e volta. A maioria das pessoas não sente nada até que um osso se quebre. É por isso que uma fratura por fragilidade costuma ser o primeiro sinal, e por isso a fragilidade óssea subjacente passa despercebida com tanta frequência.

O prognóstico depende do que acontece a seguir. Se a fratura for tratada mas a fragilidade óssea for deixada de lado, você continua em risco de sofrer outra fratura, muitas vezes no punho, no quadril ou na coluna. Esse é o quadro honesto: tratar o problema de base muda o que acontece com você nos próximos anos.

Tudo começa com um diagnóstico. A densitometria óssea mede a resistência dos seus ossos. Seu cirurgião pode solicitá-la e conversar com você sobre o tratamento. Os medicamentos para fortalecer os ossos agem de formas diferentes. Alguns primeiro formam osso novo e depois o mantêm. Outros retardam a destruição do osso. Usados nessa ordem, eles constituem uma abordagem reconhecida para pessoas com risco mais elevado. Também existem opções mais antigas, mas são menos eficazes do que os medicamentos modernos e geralmente ficam reservadas para quem não pode usar os tratamentos de primeira linha.

A recuperação após uma fratura é um processo à parte. Uma fratura no punho ou na coluna melhora ao longo de semanas a meses, e não de dias, e seu fisioterapeuta pode orientá-lo à medida que o movimento e a força retornam. Se você vier a fazer uma cirurgia no ombro por causa de um tendão rompido, a densidade óssea reduzida não muda muito o quadro. Pessoas com ossos mais fracos ainda obtêm bons resultados dois anos após o reparo artroscópico do manguito rotador, em que o cirurgião repara o tendão por meio de pequenas incisões. As taxas de complicações nos primeiros três meses foram baixas no geral, embora as pessoas com osteoporose tenham tido um pouco mais de problemas clínicos nesse período do que as pessoas sem a doença.

A mensagem realista é esta. A osteoporose não se resolve sozinha, mas pode ser identificada, medida e tratada. Bem controlada, ela reduz sua probabilidade de sofrer outra fratura.

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

A bone density-based aging model approach may facilitate and support the development of precision medicine strategies in osteoporosis prevention and management [1].
There is evidence of a care gap between the occurrence of a fragility fracture and the diagnosis and treatment of osteoporosis in Canada [2].
Investigators must select an osteoporotic fracture model that best reflects the clinical problem being studied and the underlying pathophysiology of the osteoporosis in the target patient group [3].
Current online health information on osteoporosis often fails to meet basic standards of evidence-based health information, highlighting the urgent need to improve quality to support informed decision-making [4].
Each 1-unit increase in body mass index was associated with a 9% reduction in osteoporosis risk based on a dose-response analysis of nine studies [5].
Sequential anabolic-to-anti-resorptive therapy may inform treatment guidelines for high-risk postmenopausal populations [6].
The book "Radiology of Osteoporosis" summarises the thoroughly researched topic of osteoporosis in a scientific approach [7].
Current evidence suggests that the efficacy of acupuncture in improving the symptoms of primary osteoporosis is encouraging for its use in clinical practice as a physical intervention [8].
Findings regarding osteoporosis in long-term hospitalized patients with muscular dystrophy may help inform strategies for osteoporotic treatment and nutritional care in this patient population [9].
There is no perfect model for osteoporosis, but a variety of models are appropriate for answering specific questions [10].
Randomized controlled trials have demonstrated that treatment of osteoporosis in patients with fragility fractures can reduce the risk of subsequent fractures by up to 50% and mortality rates by up to 30% [11].
Machine learning application to hand radiographs represents a possible step toward more accessible, cost-effective, automated diagnosis and therefore earlier treatment of osteoporosis/osteopenia [12].
Intranasal salmon calcitonin is less effective than bisphosphonates and modern anabolic agents for increasing bone mineral density and reducing fracture risk [13].
Intranasal salmon calcitonin use is best reserved for patients who cannot take first-line therapies due to contraindications, intolerance, or personal preference [13].
A fracture risk prediction model was successfully developed and validated for patients newly diagnosed with osteoporosis based on routine blood test markers [14].
A nomogram with an online dynamic calculator could facilitate the early prediction, diagnosis, and treatment of osteoporosis, contributing to the bone health of the elderly population and promoting the development of public health [15].
Patients with decreased bone mineral density can still achieve excellent 2-year outcomes following arthroscopic rotator cuff repair [16].
Low rates of osteoporotic pharmacotherapy were seen in patients who had femoral neck fractures despite established guidelines [19].
Patients with osteoporosis may experience a higher incidence of medical complications within the 90-day global period than nonosteoporotic patients following rotator cuff repair [21].
Overall rates of complication were low and osteoporosis should not be considered a contraindication to arthroscopic rotator cuff repair [22].
The standard Fragility Index is advocated for dichotomous data and the Continuous Fragility Index for continuous outcomes, recognizing the distinct valuable insights each metric offers [37].

How It Works

Risk Prediction and Screening

A bone density-based aging model approach may facilitate the development of precision medicine strategies in osteoporosis prevention and management [1].
Each 1-unit increase in BMI is associated with a 9% reduction in osteoporosis risk based on a dose-response analysis of nine studies [5].
A fracture risk prediction model for patients newly diagnosed with osteoporosis was successfully developed and validated using routine blood test markers [14].
A nomogram with an online dynamic calculator could facilitate the early prediction, diagnosis, and treatment of osteoporosis [15].
Current machine learning-based prediction models for postmenopausal osteoporosis without fractures demonstrate good discriminative ability but are characterized by a high risk of bias, a lack of calibration performance evaluation, and insufficient validation of clinical utility [18].
Machine learning application to hand radiographs represents a possible step toward more accessible, cost-effective, automated diagnosis and earlier treatment of osteoporosis or osteopenia [12].

Pathophysiology and Mechanisms

The gut microbiota–metabolite–bone network may be involved in the skeletal effects of leptin, providing mechanistic insights and potential therapeutic strategies for osteoporosis management [23].
Macrophage polarization-related genes with potential causal roles in osteoporosis were identified in a multi-omics Mendelian randomization study, though findings are exploratory and require validation in bone marrow-specific and functional studies [30].
MiR-137 promotes TLR4/NF-κB pathway activity through targeting KDM4A, which inhibits osteogenic differentiation of human bone marrow mesenchymal stem cells and aggravates osteoporosis [31].
Obesity-associated dyslipidemia drives bone mineral density loss partly through inflammation-mediated pathways, with key inflammatory cytokines significantly mediating lipid metabolism's impact on bone health [32].

Treatment and Management

Intranasal salmon calcitonin is less effective than bisphosphonates and modern anabolic agents for increasing bone mineral density and reducing fracture risk, and its use is best reserved for patients who cannot take first-line therapies due to contraindications, intolerance, or personal preference [13].
The efficacy of acupuncture in improving the symptoms of primary osteoporosis is encouraging for its use in clinical practice as a physical intervention [8].
Natural traditional Chinese medicine products provide a theoretical and experimental basis for the development of new drugs and the improvement of osteoporosis management [24].
A randomized controlled trial on the timing optimization of teriparatide dosing is expected to provide insights into optimizing administration timing to enhance bone formation and reduce fracture risk [17].
Key recommendations for people with osteoporosis include undertaking resistance and impact exercise to maximise bone strength, activities to improve strength and balance to reduce falls, and spinal extension exercise to improve posture and potentially reduce risk of falls and vertebral fractures [20].

Fracture Healing and Surgical Outcomes

There is promising experimental and clinical evidence for possible enhancement of the bone repair process via administration of systemic agents [25].
The use of bone mineral density measurements preoperatively to identify osteoporosis as a possible risk factor of nonunion has no clinical value [26].
In humans, de novo use of bisphosphonate therapy after fracture does not appear to have a significant effect on fracture healing [27].
Patients who received PTH (1–84) injections accelerated radiographic and clinical fracture healing to 7.8 weeks when compared to patients who received no treatment at 12.6 weeks [28].

Care Gaps and Information Quality

What the Evidence Shows

Risk Factors and Prediction

Each 1-unit increase in BMI is associated with a 9% reduction in osteoporosis risk [5].
A nomogram with an online dynamic calculator for predicting osteoporosis could facilitate early prediction, diagnosis, and treatment of the condition [15].
Mendelian randomization results show significant associations for Type 2 Diabetes on femoral neck and total body BMD, and HbA1c on heel BMD [38].

Diagnosis and Screening

Current online health information on osteoporosis often fails to meet basic standards of evidence-based health information [4].

Treatment and Management

Intranasal salmon calcitonin is less effective than bisphosphonates and modern anabolic agents for increasing BMD and reducing fracture risk, and its use is best reserved for patients who cannot take first-line therapies due to contraindications, intolerance, or personal preference [13].
Acupuncture efficacy in improving the symptoms of primary osteoporosis is encouraging for its use in clinical practice as a physical intervention [8].
Jintiange capsules are a good choice for patients with osteoporosis in terms of relieving pain, improving BMD, improving activity function, improving gait, and preventing fracture [34].
Genetically modified stem cell therapy is a safe and effective method that can significantly improve BMD and BV/TV in animal models of osteoporosis [36].
The gut microbiota–metabolite–bone network may be involved in the skeletal effects of leptin, providing novel mechanistic insights and potential therapeutic strategies for osteoporosis management [23].
A randomized controlled trial on teriparatide dosing timing is expected to provide insights into optimizing administration to enhance bone formation and reduce fracture risk in osteoporosis [17].

Fracture Healing and Surgical Outcomes

Patients who received PTH (1–84) injections accelerated radiographic and clinical fracture healing to 7.8 weeks compared to 12.6 weeks in patients who received no treatment [28].
There is some promising experimental and clinical evidence for possible enhancement of the bone repair process via administration of systemic agents [25].
Osteoporosis should not be considered a contraindication to arthroscopic rotator cuff repair, as overall rates of complication were low [22].
In osteopenic and osteoporotic patients undergoing total joint arthroplasty, rates of 2- and 5-year postoperative complications were low and similar among patients who used perioperative proton pump inhibitors and those who did not [29].
Continuous bone cement and standardized treatment for osteoporosis were guarantees of good clinical outcomes for percutaneous vertebroplasty, with injected bone cement >5.5 ml potentially being a guarantee [33].

Care Gaps and Guidelines

Despite established guidelines, low rates of osteoporotic pharmacotherapy were seen in patients who had femoral neck fractures [19].

Research Models

Practical Considerations

Risk Prediction and Screening

Each 1-unit increase in body mass index is associated with a 9% reduction in osteoporosis risk [5].
The prevalence of osteoporosis among postmenopausal women hospitalized for fractures in China is 76.9% [35].
Prolonged menopause, vertebral fractures, and recent fracture history are key risk profiles for osteoporosis in postmenopausal women hospitalized for fractures [35].

Diagnostic and Information Quality

There is a care gap between the occurrence of a fragility fracture and the diagnosis and treatment of osteoporosis in Canada [2].
Despite established guidelines, low rates of osteoporotic pharmacotherapy are observed in patients who have femoral neck fractures [19].

Pharmacological Management

The use of intranasal salmon calcitonin is best reserved for patients who cannot take first-line therapies due to contraindications, intolerance, or personal preference [13].
A randomized controlled trial is expected to provide insights into optimizing teriparatide administration timing to enhance bone formation and reduce fracture risk [17].

Non-Pharmacological and Adjunctive Interventions

People with osteoporosis should undertake resistance and impact exercise to maximize bone strength [20].
People with osteoporosis should undertake activities to improve strength and balance to reduce falls [20].
People with osteoporosis should undertake spinal extension exercise to improve posture and potentially reduce the risk of falls and vertebral fractures [20].

Surgical Considerations

Patients with decreased bone mineral density can achieve excellent 2-year outcomes following arthroscopic rotator cuff repair [16].
Overall rates of complication are low and osteoporosis should not be considered a contraindication to arthroscopic rotator cuff repair [22].
The use of preoperative bone mineral density measurements to identify osteoporosis as a possible risk factor for nonunion has no clinical value [26].
In osteopenic and osteoporotic patients undergoing total joint arthroplasty, rates of 2- and 5-year postoperative complications are low and similar among patients who used proton pump inhibitors perioperatively and those who did not [29].

Research Methodology

Key Evidence

[L3] This approach may facilitate and support the development of precision medicine strategies in osteoporosis prevention and management. [1] (10.1186/s12891-025-09298-0)
[L4] There is evidence of a care gap between the occurrence of a fragility fracture and the diagnosis and treatment of osteoporosis in Canada. [2] (10.1186/1471-2474-5-11)
[L5] Investigators must select a model that best reflects the clinical problem being studied, and the underlying pathophysiology of the osteoporosis in the target patient group. [3] (10.1016/s0020-1383(16)30004-3)
[Paper] Current OHI on osteoporosis often fails to meet basic standards of EBHI, highlighting the urgent need to improve the quality to support informed decision-making. [4] (10.1186/s12891-026-09711-2)
[L1] Based on our dose–response analysis of nine studies, each 1-unit increase in BMI was associated with a 9% reduction in osteoporosis risk. [5] (10.1186/s12891-026-09675-3)
[L1] This sequential anabolic-to-anti-resorptive therapy may inform treatment guidelines for high-risk postmenopausal populations. [6] (10.1186/s13018-025-06040-3)
[Paper] The book summarises the thoroughly researched topic of osteoporosis in a scientific approach. [7] (10.1016/s0020-1383(03)00201-8)
[L1] The current evidence suggests that the efficacy of acupuncture in improving the symptoms of primary osteoporosis is encouraging for its use in clinical practice as a physical intervention. [8] (10.1186/s13018-025-05513-9)
[L4] These findings may help inform strategies for osteoporotic treatment and nutritional care in this patient population. [9] (10.1186/s12891-026-10045-2)
[Paper] However, there is no perfect model for osteoporosis, but a variety of models appropriate for answering specific questions. [10] (10.1016/s0020-1383(16)30002-x)
[Paper] Randomized controlled trials have demonstrated that treatment of osteoporosis in patients with fragility fractures can reduce the risk of subsequent fractures by up to 50% and mortality rates by up to 30%. [11] (10.1016/s0020-1383(16)30014-6)
[L2] The findings represent a possible step toward more accessible, cost-effective, automated diagnosis and therefore earlier treatment of osteoporosis/osteopenia. [12] (10.1016/j.jhsa.2024.09.008)
[Paper] IN-CAL is less effective than bisphosphonates and modern anabolic agents for increasing BMD and reducing fracture risk; accordingly, its use is best reserved for patients who cannot take first-line therapies due to contraindications, intolerance, or personal preference. [13] (10.2106/jbjs.rvw.26.00021)
[L3] We successfully developed and validated a fracture risk prediction model for patients newly diagnosed with osteoporosis. [14] (10.1186/s12891-026-09768-z)
[L3] Ultimately, this tool could facilitate the early prediction, diagnosis, and treatment of osteoporosis, thus contributing to the bone health of the elderly population and promoting the development of public health. [15] (10.1186/s12891-026-09920-9)
[L3] Patients with decreased bone mineral density can still achieve excellent 2-year outcomes. [16] (10.1016/j.jse.2025.02.011)
[L2] This trial is expected to provide crucial insights into optimizing teriparatide administration timing, potentially guiding personalized dosing strategies to enhance bone formation and reduce fracture risk in osteoporosis. [17] (10.1186/s13018-025-06083-6)
[L1] Current machine learning-based prediction models for postmenopausal osteoporosis without fractures demonstrate good discriminative ability but are generally characterized by a high risk of bias, a notable lack of calibration performance evaluation, and insufficient validation of clinical utility. [18] (10.1186/s12891-025-09385-2)
[L3] Despite established guidelines, low rates of osteoporotic pharmacotherapy were seen in patients who had femoral neck fractures. [19] (10.1016/j.arth.2025.07.028)
[L5] Key recommendations are that people with osteoporosis should undertake (1) resistance and impact exercise to maximise bone strength; (2) activities to improve strength and balance to reduce falls; (3) spinal extension exercise to improve posture and potentially reduce risk of falls and vertebral fractures. [20] (10.1136/bjsports-2021-104634)
[L3] In addition, patients with osteoporosis may experience a higher incidence of medical complications within the 90-day global period than nonosteoporotic patient. [21] (10.1016/j.xrrt.2026.100723)
[L3] Overall rates of complication were low and osteoporosis should not be considered a contraindication to arthroscopic RCR. [22] (10.1016/j.jseint.2026.101678)
[Paper] These findings suggest that the gut microbiota–metabolite–bone network may be involved in the skeletal effects of leptin, providing novel mechanistic insights and potential therapeutic strategies for osteoporosis management. [23] (10.1186/s12891-026-09950-3)
[L4] This paper summarises recent research progress on natural TCM products in preventing and treating osteoporosis and provides a theoretical and experimental basis for the development of new drugs and the improvement of osteoporosis management. [24] (10.1186/s13018-025-05879-w)
[Paper] There is some promising experimental and clinical evidence for possible enhancement of the bone repair process via administration of systemic agents. [25] (10.1016/s0020-1383(16)30003-1)
[L3] These results indicate that the use of BMD measurements preoperatively to identify osteoporosis as a possible risk factor of nonunion has no clinical value. [26] (10.1016/s0020-1383(11)70106-1)
[L4] In humans, de novo use of bisphosphonate therapy after fracture does not appear to have a significant effect on fracture healing. [27] (10.1016/s0020-1383(16)30015-8)
[Paper] Patients who received the PTH (1–84) injections accelerated radiographic and clinical fracture healing (7.8 weeks) when compared to patients who received no treatment (12.6 weeks). [28] (10.1016/s0020-1383(16)30009-2)
[L3] In osteopenic and osteoporotic patients undergoing TJA, rates of 2- and 5-year postoperative complications were low and similar among patients who used PPIs perioperatively and those who did not. [29] (10.1016/j.arth.2025.07.067)
[Paper] These findings are exploratory and hypothesis-generating and require validation in bone marrow-specific and functional studies. [30] (10.1186/s13018-026-06905-1)
[Paper] This mechanism inhibits osteogenic differentiation of human bone marrow mesenchymal stem cells and aggravates osteoporosis. [31] (10.1186/s13018-023-03918-y)
[L4] Obesity-associated dyslipidemia drives BMD loss partly through inflammation-mediated pathways, with key inflammatory cytokines significantly mediating lipid metabolism's impact on bone health. [32] (10.1186/s12891-026-09576-5)
[L3] Continuous bone cement and standardized treatment for osteoporosis were guarantees of good clinical outcomes for PVP, and injected bone cement >5.5 ml might be a guarantee. [33] (10.1186/s12891-024-08153-y)
[L1] In terms of relieving pain, improving BMD, improving activity function, and improving gait and preventing fracture, JTG is a good choice for patients with osteoporosis (OP). [34] (10.1186/s12891-025-08694-w)
[L4] This study reveals an alarmingly high prevalence (76.9%) of osteoporosis among postmenopausal women hospitalized for fractures in China, identifying prolonged menopause, vertebral fractures, and recent fracture history as key risk profiles. [35] (10.1186/s12891-026-09517-2)
[L1] Genetically modified stem cell therapy is a safe and effective method that can significantly improve the BMD and BV/TV in animal models of osteoporosis. [36] (10.1186/s12891-025-08507-0)
[Paper] We advocate for the complementary use of both the standard Fragility Index (FI) for dichotomous data and the Continuous Fragility Index (CFI) for continuous outcomes, recognizing the distinct valuable insights each metric offers. [37] (10.1177/23259671251409149)
[Paper] The results show varying associations across different BMD sites (femoral neck, lumbar spine, heel, total body) and methods (IVW, MR-Egger, Weighted median), with some significant associations found for T2D on femoral neck and total body BMD, and HbA1c on heel BMD. [38] (10.1186/s12891-024-07430-0)

References

[1] Unveiling risk factors and predicting osteoporosis through bone density based aging model: a community-based cohort in Guangdong, China. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-09298-0

[2] The osteoporosis care gap in Canada. BMC Musculoskeletal Disorders. 2004. DOI: 10.1186/1471-2474-5-11

[3] Main differences in osteoporotic fracture models: which should I use?. Injury. 2016. DOI: 10.1016/s0020-1383(16)30004-3

[4] Mapping the quality of information on osteoporosis: a cross-sectional analysis of online health information. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-026-09711-2

[5] The association between body mass index and osteoporosis, with consideration of sex differences: a systematic review and dose-response meta-analysis. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-026-09675-3

[6] Effectiveness of anabolic and anti-resorptive agents for preventing postmenopausal osteoporosis fractures: a systematic review and network meta-analysis. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-06040-3

[7] Radiology of Osteoporosis. Injury. 2004. DOI: 10.1016/s0020-1383(03)00201-8

[8] Efficacy of acupuncture for primary osteoporosis: a systematic review and meta-analysis of randomized controlled trials. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-05513-9

[9] Osteoporosis in long-term hospitalized patients with muscular dystrophy: a retrospective cross-sectional study. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-026-10045-2

[10] Can we induce osteoporosis in animals comparable to the human situation?. Injury. 2016. DOI: 10.1016/s0020-1383(16)30002-x

[11] Medical management of osteoporosis and the surgeons' role. Injury. 2016. DOI: 10.1016/s0020-1383(16)30014-6

[12] Application of Machine Learning to Osteoporosis and Osteopenia Screening Using Hand Radiographs. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2024.09.008

[13] Revisiting Intranasal Salmon Calcitonin: Historical Osteoporosis Evidence and a Potential Role in Acute Orthopaedic Pain Management. JBJS Reviews. 2026. DOI: 10.2106/jbjs.rvw.26.00021

[14] SuperLearner approach for predicting imminent risk of fracture in older Chinese patients with newly diagnosed osteoporosis based on their routine blood test markers. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-026-09768-z

[15] A nomogram with online dynamic calculator for predicting osteoporosis: development and validation based on NHANES. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-026-09920-9

[16] No difference in 2-year outcomes of arthroscopic rotator cuff repair in patients with osteoporosis. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2025.02.011

[17] Timing optimization of teriparatide dosing for postmenopausal osteoporosis: a randomized controlled trial. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-06083-6

[18] Risk prediction models for postmenopausal osteoporosis: a systematic review and meta-analysis study. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-025-09385-2

[19] A Missed Opportunity? Osteoporosis Treatment Following Femoral Neck Fractures: Reducing the Risk of Secondary Hip Fracture. The Journal of Arthroplasty. 2026. DOI: 10.1016/j.arth.2025.07.028

[20] Strong, steady and straight: UK consensus statement on physical activity and exercise for osteoporosis. British Journal of Sports Medicine. 2022. DOI: 10.1136/bjsports-2021-104634

[21] Impact of osteoporosis on post-operative outcomes following rotator cuff repair. JSES Reviews, Reports, and Techniques. 2026. DOI: 10.1016/j.xrrt.2026.100723

[22] Osteoporosis is a risk factor for complications and reoperations at 1 and 3 years after arthroscopic rotator cuff repair. JSES International. 2026. DOI: 10.1016/j.jseint.2026.101678

[23] Role and mechanism of leptin in improving osteoporosis via the “gut–bone axis”. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-026-09950-3

[24] Natural traditional Chinese medicine products: emerging therapeutic targets for the treatment of osteoporosis. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-05879-w

[25] Fracture repair: general aspects and influence of osteoporosis and anti-osteoporosis treatment. Injury. 2016. DOI: 10.1016/s0020-1383(16)30003-1

[26] A89 Osteoporosis is not a risk factor for the development of nonunion: a cohort nested case-control study. Injury. 2011. DOI: 10.1016/s0020-1383(11)70106-1

[27] How do bisphosphonates affect fracture healing?. Injury. 2016. DOI: 10.1016/s0020-1383(16)30015-8

[28] Use of teriparatide in osteoporotic fracture patients. Injury. 2016. DOI: 10.1016/s0020-1383(16)30009-2

[29] Effects of Perioperative Proton Pump Inhibitor Use on Outcomes of Total Joint Arthroplasty Patients Who Have Osteoporosis and Osteopenia. The Journal of Arthroplasty. 2026. DOI: 10.1016/j.arth.2025.07.067

[30] Macrophage polarization-related genes with potential causal roles in osteoporosis: a multi-omics Mendelian randomization study. Journal of Orthopaedic Surgery and Research. 2026. DOI: 10.1186/s13018-026-06905-1

[31] MiR-137 promotes TLR4/NF-κB pathway activity through targeting KDM4A, inhibits osteogenic differentiation of human bone marrow mesenchymal stem cells and aggravates osteoporosis. Journal of Orthopaedic Surgery and Research. 2023. DOI: 10.1186/s13018-023-03918-y

[32] Perioperative inflammatory cytokines nursing screening test indicate the link between dysregulated lipid metabolism and reduced bone mineral density in obese osteoporosis patients: a retrospective study. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-026-09576-5

[33] Continuity and volume of bone cement and anti osteoporosis treatment were guarantee of good clinical outcomes for percutaneous vertebroplasty: a multicenter study. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-024-08153-y

[34] The effect of Jintiange capsules on pain in patients with primary osteoporosis: a systematic review and meta-analysis. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08694-w

[35] How prevalent is osteoporosis in a high-risk subgroup? A multicenter study of postmenopausal women hospitalized for fractures in China. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-026-09517-2

[36] Genetically modified stem cells for osteoporosis: a systematic review and meta-analysis of preclinical studies. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08507-0

[37] Fragility of Assumptions: Response. Orthopaedic Journal of Sports Medicine. 2026. DOI: 10.1177/23259671251409149

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