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Background: The evidence supporting the use of antiresorptive and anabolic agents for fracture prevention in elderly patients is still inconclusive. Whether it is too late to alter the course of the disease in this age-group has remained uncertain. Objectives: The objective of this study was to determine the efficacy and safety of antiresorptive and anabolic agents in elderly patients. Methods: PubMed, Web of Science, MEDLINE, and the Cochrane Central Register of Controlled Trials were searched for randomized controlled trials (RCTs) and post hoc analyses of RCTs reporting efficacy outcomes or adverse events of antiresorptive and anabolic agents in elderly patients. Statistical heterogeneity was assessed with the Cochran Q χ2 test and I2 statistic. All results were expressed as relative risk (RR) with 95% confidence intervals (CIs). Results: The meta-analysis included 1 RCT and 11 post hoc analyses of data from 10 double-blind placebo-controlled RCTs. Antiresorptive therapy significantly reduced the pooled incidence of vertebral fractures (RR = 0.43; 95% CI = 0.35–0.53; and p < 0.001). It was also associated with lower risk of nonvertebral and hip fractures (RR = 0.84; 95% CI = 0.74–0.96; and p = 0.009 and RR = 0.75; 95% CI = 0.58–0.97; and p = 0.028, respectively). For any adverse events, no difference was observed between antiresorptive agents and placebo groups (RR = 1.01; 95% CI = 1.00–1.02; and p = 0.23). Conclusions: Both antiresorptive and anabolic agents represented potentially important osteoporosis treatments, showing significant effects on reducing vertebral, nonvertebral, or hip fracture risk, and were well-tolerated by elderly patients. Even in the elderly, maybe it is not too late to alter the course of the disease.

Purpose: This study aimed to investigate the relationship of triglyceride glucose-body mass index (TyG-BMI) with bone mineral density, femoral neck geometry, and risk of fracture in middle-aged and elderly Chinese individuals. Methods: A total of 832 nondiabetic individuals (474 men aged ≥50 years and 358 postmenopausal women) were selected from the prospective population-based HOPE cohort. All individuals underwent dual-energy X-ray absorptiometry for assessment of bone mineral density (BMD) at the lumbar spine, femoral neck, and total hip, as well as femoral neck geometry. The 10-year probabilities of major osteoporotic fractures (MOFs) and hip fractures (HFs) were calculated. Correlations of TyG-BMI with BMD at different sites, femoral neck geometry, and risk of fractures were examined in men and women. Results: Cortical thickness (CT), compression strength index (CSI), cross-sectional moment of inertia (CSMI), cross-sectional area (CSA), section modulus (SM), and 25(OH)D levels were significantly lower in women (all P < 0.001). The presence of osteoporosis was related to age, BMI, BMD and femoral neck geometry, TyG-BMI index and TyG index, MOF and HF in both sex. TyG-BMI was positively correlated with BMD at femoral neck, lumber spine, and total hip and with femoral neck geometry parameters in men, Similar significant association was also present in women. In men, TyG-BMI showed significant negative correlation with HF but not with MOF. In women, TyG-BMI showed significant negative correlation with both factors only after adjusting for other variable. The various geometric indices of the femoral neck were 3 significantly impaired in individuals with low TyG-BMI. the TyG-BMI index was found to be significantly associated with osteoporosis after adjusting for confounders. Conclusion: TyG-BMI is positively associated with BMD and femoral neck geometry, and negatively associated with risk of fracture in nondiabetic middle-aged and elderly Chinese men and women.

This study evaluated the predictive power of adjusted FRAX and standard FRAX models based on the actual prevalence of osteoporosis in type 2 diabetic (T2DM) postmenopausal women, and to explore the optimal strategy to better predicted fracture risk in postmenopausal women with diabetes in China. We recruited 434 patients from community-medical centers, 217 with T2DM and 217 without T2DM (non-T2DM). All participants completed self-reported questionnaires detailing their characteristics and risk factors. Bone mineral density (BMD) and spinal radiographs were evaluated. The China FRAX model calculated all scores. The area under the receiver operator characteristic curve (ROC-AUC) evaluated the sensitivity, specificity, and accuracy for predicting 10-year risk for major (MOF) and hip (OHF) osteoporotic fractures in T2DM patients. T2DM patients had higher BMD but lower average FRAX values than non-T2DM patients. The unadjusted FRAX ROC-AUC was 0.774, significantly smaller than that for 0.5-unit femoral neck T-score-adjusted FRAX (0.800; p = 0.004). Rheumatoid arthritis (RA; AUC = 0.810, p = 0.033) and T-score (AUC = 0.816, p = 0.002) adjustments significantly improved fracture prediction in T2DM patients. Femoral neck T-score adjustment might be the preferred method for predicting MOF and OHF in Chinese diabetic postmenopausal women, while RA adjustment only effectively predicted HF risk.

Paget's disease of bone (PDB) is a metabolic bone disease with distinct geographical and ethnic differences in its pathogenesis. In this study, we aimed to retrospectively analyze the clinical features and the status of diagnosis and treatment of PDB in mainland China to improve the clinician's understanding of this disease. For this purpose, we conducted a systematic review of 118 articles, including a total of 332 patients with PDB. The results showed that the onset age of PDB in mainland China was 46-60 years. The number of male patients in most age groups was slightly higher than that of female patients, but there was no statistical difference (p 0.05). The gender ratio (male to female) of PDB in mainland China was significantly different from that in Japan (p 0.05), but not from that in the USA (p 0.05). The clinical manifestations of PDB patients in mainland China mainly included ostealgia, bone malformation, hearing loss, and fracture, and bisphosphonate was used as the main treatment drug. These findings were similar to those in Japan, UK, and USA. Total alkaline phosphatase (TALP) level was elevated in about 89.7% of patients, and no correlation between TALP level and ostealgia was observed (p 0.05). In addition, no difference in TALP level between males and females in each group was observed (p 0.05).