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Osteonecrosis, characterized by bone cell death leading to impaired bone recovery, causes challenges in bone homeostasis maintenance. Bone homeostasis relies on the delicate balance between osteoclasts and osteoblasts, encompassing a series of complex and strictly regulated biological functions. Current treatments, including conservative therapies and surgeries, often fall short of expected outcomes, necessitating a reorientation towards more effective therapeutic strategies according to the pathogenesis. In this review, we hierarchically outlined risk factors, emerging mechanisms, and last-decade treatment approaches in osteonecrosis. By connecting mechanisms of bone homeostasis, we proposed future research directions should be focused on elucidating risk factors and key molecules, performing high-quality clinical trial, updating practice, and accelerating translational potential., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background: The integration of telehealth-supported programs in chronic disease management has become increasingly common. However, its effectiveness for individuals with knee osteoarthritis (KOA) remains unclear., Objective: This study aimed to assess the effectiveness of telehealth-supported exercise or physical activity programs for individuals with KOA., Methods: A comprehensive literature search encompassing Embase, MEDLINE, CENTRAL, Web of Science, PubMed, Scopus, PEDro, GreyNet, and medRxiv from inception to September 2023 was conducted to identify randomized controlled trials comparing telehealth-supported exercise or physical activity programs to a control condition for KOA. Data were extracted and qualitatively synthesized across eligible studies, and a meta-analysis was performed to evaluate the effects. The study was reported according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020., Results: In total, 23 studies met eligibility criteria, with 20 included in the meta-analysis. Results showed that telehealth-supported exercise or physical activity programs reduced pain (g=-0.39; 95% CI -0.67 to -0.11; P<.001), improved physical activity (g=0.13; 95% CI 0.03-0.23; P=.01), and enhanced physical function (g=-0.51; 95% CI -0.98 to -0.05; P=.03). Moreover, significant improvements in quality of life (g=0.25; 95% CI 0.14-0.36; P<.001), self-efficacy for pain (g=0.72; 95% CI 0.53-0.91; P<.001), and global improvement (odds ratio 2.69, 95% CI 1.41-5.15; P<.001) were observed. However, self-efficacy for physical function (g=0.14; 95% CI -0.26 to 0.53; P=.50) showed insignificant improvements. Subgroup analyses based on the World Health Organization classification of digital health (pain: χ 2 2 =6.5; P=.04 and physical function: χ 2 2 =6.4; P=.04), the type of teletechnology in the intervention group (pain: χ 2 4 =4.8; P=.31 and function: χ 2 4 =13.0; P=.01), and active or inactive controls (pain: χ 2 1 =5.3; P=.02 and physical function: χ 2 1 =3.4; P=.07) showed significant subgroup differences., Conclusions: Telehealth-supported exercise or physical activity programs might reduce knee pain and improve physical activity, physical function, quality of life, self-efficacy, and global improvement in individuals with KOA. Future research should consider longer implementation durations and assess the feasibility of incorporating wearables and standardized components into large-scale interventions to evaluate the effects., Trial Registration: PROSPERO CRD42022359658; https://www.crd.york.ac.uk/prospero/display&#95;record.php?RecordID=359658., (©Xiao-Na Xiang, Ze-Zhang Wang, Jing Hu, Jiang-Yin Zhang, Ke Li, Qi-Xu Chen, Fa-Shu Xu, Yue-Wen Zhang, Hong-Chen He, Cheng-Qi He, Si-Yi Zhu. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 02.08.2024.)