BMP signaling drives dorsoventral (DV) axial patterning in vertebrates and invertebrates, with BMP dimers recruiting tetrameric receptor complexes to phosphorylate SMADs that activate ventral target g...

Purpose of Review Osteoporosis is a systemic skeletal disease that presents unique challenges in spine surgery due to decreased bone mass, poor bone quality, and increased risk of fractures. This review aims to synthesize current understanding of osteoporosis in the context of spinal procedures, emphasizing the pathophysiology, diagnostic challenges, perioperative considerations, and evolving management strategies. Recent Findings Despite high prevalence, osteoporosis remains underdiagnosed and undertreated in surgical candidates, with preoperative bone mineral density (BMD) screening often overlooked. Recent evidence underscores the importance of optimizing bone health preoperatively through pharmacologic therapies, which includes bisphosphonates, denosumab, and anabolic agents like teriparatide and romosozumab. Furthermore, surgical innovations such as cement augmentation and biomechanically optimized pedicle screw techniques are thoroughly discussed. New modalities, such as CT-based Hounsfield unit assessments and finite element analysis, offer improved preoperative evaluation of bone quality. Summary Successful spine surgery outcomes in osteoporotic patients require a multidisciplinary approach that integrates early screening, targeted pharmacologic treatment, lifestyle modifications, and advanced surgical planning. Addressing osteoporosis comprehensively improves implant fixation, reduces complications like pseudoarthrosis and junctional failures, and enhances overall patient quality of life.

Introduction These guidelines provide a comprehensive and practical framework for preventing osteoporosis. They are designed for use by healthcare professionals, including orthopaedic surgeons, primary care physicians, specialists, nurses, and allied health providers, as they work with patients at risk of or already diagnosed with osteoporosis. Methodology This iterative process involved multiple questionnaires sent to a panel of 62 osteoporosis and bone health experts. Experts, including clinicians, researchers, and academicians, were selected based on their recognised expertise and contributions to the field of osteoporosis. Observations There were 62 medical personnel with experience. The protocol was to get consensus from experts for each round. The set of questions was divided into six rounds. This structured Delphi methodology ensured that the resulting osteoporosis guidelines were evidence based and reflective of expert consensus, providing a robust clinical practice framework. Results The guidelines were put up in sections with titles as: prevention of osteoporosis, Screening for osteoporosis, diagnosing osteoporosis, calcium and vitamin D in osteoporosis, microbiome, obesity in osteoporosis, postmenopausal osteoporosis, male osteoporosis. Chronic kidney disease and osteoporosis, glucocorticoid-induced osteoporosis (GIOP), therapeutics in osteoporosis, monitoring osteoporosis therapy and osteosarcopenia. Ultimately, all the details obtained in various meetings were analysed, and responses were sought from all the participant members. All such reactions were again grouped back sequentially. Conclusions osteoporosis is a significant problem, and many protocols exist in the literature. These guidelines were created by consensus among experts using the Delphi method. They have been developed until current knowledge is available and may be changed in the next 5–6 years, depending on the new research accumulated by that time.

AbstractContext. The prevalence and severity of low bone mineral density (BMD) in hypogonadotropic hypogonadism (HH), as well as the ability of reproductiv

US withdrawals of funding and pharmaceutical tariffs have left European drug development on a cliff edge, delegates at the European Health Forum in Gastein, Austria, have warned. The concerns come am...

Purpose of Review This systematic review examined the available evidence on fracture risk in people with type 2 diabetes (T2D) using cardiovascular outcome trials with glucagon-like peptide-1 receptor agonist (GLP-1RA). Recent Findings A systematic Literature search identified 797 records, of which 643 remained after duplicate removal. Following screening, 20 studies met the criteria for inclusion. Summary Although GLP-1 RAs have demonstrated well-established benefits in glycaemic control, weight reduction, and cardiovascular protection, their impact on bone health remains incompletely understood. Preclinical studies suggest potential bone-protective effects, including increased bone mass, improved microarchitecture, and reduced bone resorption. However, evidence from human studies has been inconsistent. While some findings indicate a possible reduction in fracture risk with long-term GLP-1 RA therapy, further research is needed to clarify their role in bone metabolism and fracture prevention among people with T2D, particularly within the context of cardiovascular outcome trials.