Abstract: Background/Objectives: Proximal junctional kyphosis (PJK) is one of the most frequently dis-cussed complications following corrective surgery in patients with neuromuscular scoliosis (NMS). Despite its clinical relevance, the etiology of PJK remains incompletely understood and appears to be multifactorial. Biomechanical and limited clinical studies have suggested that pre-operative hyperkyphosis, resection of the spinous processes with consequent disruption of poste-rior ligamentous structures, and rod contouring parameters may contribute as risk factors. Meth-ods: To validate these findings, we retrospectively analyzed 99 NMS patients who underwent posterior spinal fusion using a standardized screw-rod system between 2009 and 2017. Radio-graphic parameters were assessed preoperatively (preOP), postoperatively (postOP), and at an average follow-up (FU) of 29 months. Clinical data included age, weight, height, gender, and Risser sign. Radiological measurements comprised Cobb angles, thoracic kyphosis (TK), lumbar lordosis, levels of the upper (UIV) and lower (LIV) instrumented vertebrae, the number of fused levels, sagittal alignment parameters, the rod contour angle (RCA), and the mismatch between RCA and the proximal junctional angle (PJA). Patients were stratified into a PJK group and a non-PJK group. Results: The overall incidence of PJK was 23.2%. In line with previous biome-chanical findings, spinous process resection was significantly associated with PJK development. Furthermore, the PJK group demonstrated significantly higher preoperative TK (59.3° ± 29.04° vs. 34.5° ± 26.76°, p < 0.001), greater RCA (10.2° ± 4.01° vs. 7.7° ± 4.34°, p = 0.021), and a larger postop-erative mismatch between PJA and RCA (PJA−RCA: 3.8° ± 6.76° vs. −1.8° ± 6.55°, p < 0.001) com-pared to the non-PJK group. Conclusions: Spinous process resection, a pronounced mismatch between postoperative PJA and RCA (odds ratio [OR] = 1.19, p = 0.002), excessive rod bending (i.e., high RCA), and severe preoperative thoracic hyperkyphosis are significant risk factors for PJK. These variables should be carefully considered during the surgical planning and execution of de-formity correction in NMS patients.

Abstract: Background: Carpal Tunnel Syndrome (CTS) is a prevalent neuropathy often requiring invasive diagnostic methods. This study explores the use of the New Energy Vision (NEV) camera, a non-invasive imaging tool, to detect CTS by analyzing visible light images of the hand. Objectives: To evaluate the diagnostic accuracy of the NEV camera in distinguishing CTS patients from controls and to identify image features associated with nerve damage. Methods: In a two-part study, Part 1 involved 103 participants (50 controls, 53 CTS patients) imaged with the NEV camera. Features extracted from these images were used to train a Support Vector Machine (SVM) classifier. Part 2 included 32 CTS patients with images from median nerve-damaged (MED) and ulnar nerve-normal (ULN) palm areas compared. Clinical validations included nerve conduction tests and questionnaires. Results: The SVM classifier achieved 93.33% accuracy with a confusion matrix of [[14, 1], [1, 14]] at a decision threshold of 0.7. Cross-validation showed a mean accuracy of 81.79%. In Part 2, significant differences (p < 0.05) were found in color proportions and Haralick texture features between MED and ULN areas. Conclusions: The NEV camera, combined with machine learning, demonstrates high accuracy in diagnosing CTS and reveals distinct image features linked to nerve damage, suggesting its potential as a non-invasive diagnostic tool.

Abstract: Background: Forearm fractures are common presentations to the emergency department (ED), frequently requiring reduction and immobilization. In the pediatric population, procedural sedation is the gold standard to allow for appropriate analgesia, patient compliance, and ultimate successful reduction. Hematoma block is another means of analgesia prior to reduction. Hematoma block, however, is often associated with less pain control, limiting quality of reduction. Procedural sedation increases length of stay, resource allocation, and can be associated with complications. A possible alternative for analgesia to facilitate reduction of forearm fractures in the ED, are ultrasound-guided nerve blocks. This is especially significant for the pediatric population, as non-surgical treatment is frequently the standard of care. Methods: Illustrative case series of three pediatric patients who underwent supraclavicular nerve block for management of distal forearm fracture at a tertiary hospital. Results: The indication for supraclavicular nerve block was unique in all patients; avoiding procedural sedation to monitor Glasgow Coma Scale, avoidance of numerous doses of opioids for analgesia, and parental preference to avoid risks of complications associated with procedural sedation. Each reduction was successful on the first attempt. There was no surgical intervention or adverse events in our patients. Conclusions: Supraclavicular nerve block provided a successful alternative to procedural sedation for reduction, analgesia, without adverse events. It holds exceptional potential as an alternative to procedural sedation in a variety of clinical scenarios.

Abstract: Background: Tendons, along with joints, are among the most affected structures in musculoskeletal disorders. This multicenter, single-cohort, retrospective clinical study evaluated the clinical benefits of Polynucleotides (PNs) injections in reducing pain and improving functionality in patients with tendinopathies. Methods: This retrospective study included 68 patients with different tendinopathies, all diagnosed with persistent pain lasting at least six weeks, accompanied by functional impairment and swelling. Three periarticular/peritendinous injections of a PNs-based medical device were administered at T0 (baseline), FU-1 (two weeks post-T0), and FU-2 (four weeks post-T0), with efficacy and safety assessments at FU-1, FU-2, FU-3 (eight weeks post-FU-2), and FU-4 (24 weeks post-FU-2) groups. The primary outcome measure was pain reduction, assessed using a numerical rating scale (NRS). Secondary outcomes were the Clinical Global Impression–Improvement scale (CGI-I), and patient satisfaction using a 5-point Likert scale. Results: Longitudinal analysis showed an average NRS score reduction of -1.76±0.08 at each follow-up, with statistically significant reductions observed between each follow-up and the final one (FU-4). Based on the CGI-I scale, 78% of the clinicians rated the clinical condition of tendinopathies at FU-4 as "very much improved" or "much improved." Additionally, 88% of patients reported being "satisfied" or "very satisfied" with treatment at the final follow-up (FU-4). No adverse events were reported. Conclusions: As demonstrated by the positive outcomes reported in this study, PNs injections may offer a promising therapeutic option for the treatment of tendinopathies. This study may open up new frontiers for the implementation of conservative approaches in patients affected by tendinopathies.

Abstract: Background/Objectives: Symptomatic intravertebral vacuum cleft (SIVC) is a complication of vertebral compression fractures (VCFs) that leads to persistent pain and deformity. Its prediction remains challenging due to multifactorial causes. Paraspinal muscle fat infiltration has been associated with spinal fracture outcomes but has not been extensively explored in SIVC prediction. To develop machine learning (ML) models for predicting SIVC and to evaluate the role of muscle-related variables in improving predictive performance. Methods: Demographic, radiological, and muscle-related variables were collected. ML models—including Logistic Regression, Random Forest, XGBoost, and Multi-Layer Perceptron—were trained and tested under two input conditions: baseline variables (SETTING_1) and baseline plus muscle-related variables (SETTING_2). Model performance was evaluated using accuracy, area under the receiver operating characteristic curve (AUC), and feature importance analysis. Results: The Random Forest model in SETTING_2, which incorporated muscle-related variables, achieved the highest accuracy (96.6%) and AUC (0.956). Multifidus fatty infiltration (MFfi), erector spinae fatty infiltration (ESfi), and endplate CSA were identified as the most significant predictors. The inclusion of muscle-related variables significantly improved the predictive performance of all ML models. Conclusions: ML models, particularly Random Forest, demonstrated high accuracy in predicting SIVC when muscle-related variables were included. Paraspinal muscle fat infiltration is a critical predictor of SIVC and should be integrated into risk assessment strategies to improve early diagnosis and management.

Abstract: Background Many middle-aged and older individuals experience shoulder pain, often due to partial-thickness rotator cuff tears (PTRCTs). If conservative treatment fails to relieve symptoms in a patient, surgical intervention may be necessary. In such cases, using a bioinductive collagen implant may offer a viable alternative to conventional rotator cuff repair. Most notably, it offers potential advantages, particularly in reducing postoperative pain and promoting faster recovery. Accordingly, this study aims to evaluate the clinical outcomes of treating bursal-sided partial-thickness rotator cuff tears using bioinductive collagen implants alone, without concurrent rotator cuff repair. Methods We followed 32 patients who had bursal-sided partial-thickness rotator cuff tears (Ellman grade I or II) and received conservative care for more than six months but continued to experience symptoms. These patients received surgery using Bioinductive collagen implant without rotator cuff repair, we followed up their postoperative prognosis for at least one year after surgery. For a more accurate contrast, we performed clinical evaluation preoperatively and at 2 weeks, 6 weeks, 3 months, 6 months, and 12 months postoperatively. As the assessment tools, Visual Analog Scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE), and Western Ontario Rotator Cuff (WORC) score were used in this study. As for radiological outcomes, Magnetic Resonance Imaging (MRI) and ultrasonography was helpful. This supported us to assess graft integration and failure. Results These 32 patients constisted of 13 with Ellman grade I tear and 19 with grade II tear. In both cases, they took surgery only using Bioinductive collagen implant, and any anchor-based cuff repair was completely excluded. As for VAS, it was found a certain statistically significant improvements since 2 weeks postoperatively. On the other hand, the scores of ASES, SANE, and WORC began to be observed a significant improvement from 6 weeks postoperatively, showing continuous progress. At each final step, we confirmed that there were no cases of graft failure by radiological evaluation, and found successful healing such as much less pain in all patients. Conclusion The findings of this study provide the clinical evidence that surgery using Bioinductive collagen implant for bursal-sided partial-thickness rotator cuff tears is highly effective treatment option in patients unresponsive to conservative therapy. Particulary, its practical clinical effectivess includes facilitating rapid recovery without a significant risk of complications.

Abstract: Transcutaneous Randomized Pulsed Radiofrequency (PRF-STP) is a non-invasive therapeutic approach increasingly explored for managing spine-related pain, particularly in cases involving disc herniations and degenerative spine conditions. This case series examines the outcomes of four patients treated with PRF-STP for varying spine pathologies, including lumbar and cervical disc herniations, lumbar stenosis, and radiculopathy. All patients had previously undergone conventional conservative therapies without satisfactory improvement and were unwilling or unable to undergo invasive procedures. Treatment involved the application of electromagnetic fields through adhesive skin patches at targeted sites, providing pain relief and functional improvement. Patients underwent three sessions of PRF-STP, with follow-up assessments showing significant reductions in pain (VAS 0 in most cases), improvement in movement, and restoration of normal daily activities. Follow-up MRI scans demonstrated positive structural changes in the treated discs. Although long-term recurrence occurred in one case, the patient remained active without functional limitations. PRF-STP offers a promising, minimally invasive alternative for patients seeking to avoid surgery, though further studies with larger cohorts and longer follow-up periods are necessary to establish more robust evidence of its efficacy. This technique could become an important adjunct in managing chronic spinal pain conditions, offering patients an option with minimal risk and hospital demands.

Abstract: MAI Motion is a motion capture system designed to assess lower-limb biomechanics during functional movements like the sit-to-stand (STS) test. Determining how many repetitions are needed to obtain reliable measurements is critical for balancing data quality and participant burden. This study evaluates whether three repetitions (3x) of STS provide sufficiently reliable data compared to five repetitions (5x). 3D videos of participants (n=10) performing 5x STS movements were captured using MAI Motion. Primary measurements were the mean values of each joint angle and the coefficient of variation (CV). Statistical comparisons (paired t-tests or non-parametric equivalents) determined differences in mean values or CV existed between 3x and 5x. Analysis revealed minimal differences in mean angles between 3x and 5x. Variability, assessed via CV, showed no clinically meaningful differences. Although ankle angle, knee and hip abduction had higher CV values than other metrics, 3x and 5x performed similarly. Participants reported that 3x required less effort than 5x, implying practical advantage for clinical or research settings. These findings validate that a 3x STS captures biomechanical data comparable to a 5x protocol using the MAI Motion system. Reducing repetitions can lessen participant fatigue while preserving measurement reliability, making 3x a pragmatic standard for most populations.

Abstract: Artificial Intelligence (AI) is revolutionizing the field of orthopedic bioengineering by increasing diagnostic accuracy and surgical precision and improving patient outcomes. This review high-lights using AI for orthopedics in preoperative planning, intra-operative robotics, smart implants, and bone regeneration. AI-powered imaging, automated 3D anatomical modeling, and robot-ic-assisted surgery have dramatically changed orthopedic practices. AI has improved surgical planning by enhancing complex image interpretation and providing augmented reality guidance to create highly accurate surgical strategies. Intraoperatively, robotic-assisted surgeries enhance accuracy and reduce human error while minimizing invasiveness. AI-powered smart implant sensors allow for in vivo monitoring, early complication detection, and individualized rehabilitation. It also has advanced bone regeneration devices and neuroprosthetics, highlighting its innovation capabilities. While AI advancements in orthopedics are exciting, challenges remain, like the need for standardized surgical system validation protocols, assessing ethical consequences of AI-derived decision-making, and using AI with bioprinting for tissue engineering. Future research should focus on proving the reliability and predictability of the performance of AI-pivoted systems and their adoption within clinical practice. This review synthesizes recent developments and highlights the increasing impact of AI in orthopedic bioengineering and its potential future effectiveness in bone care and beyond.

Abstract: Background: Diabetic foot osteomyelitis is a complex condition to manage with substantial risk of treatment failure which could necessitate major amputations. Limb preservation is a critical goal as amputations are associated with poor outcomes, including high mortality rates and reduced quality of life. Surgical debridement and prolonged systemic antibiotic therapy have been the mainstay of treatment, but recurrence rates remain high. The use of adjuvant local antibiotic therapy has been proposed as a potential adjunct to improve outcomes. Methods: This retrospective study involved 113 patients with diabetic foot osteomyelitis who underwent debridement and application of antibiotic loaded calcium sulphate ceramic from the year 2018 to 2023. Clinical outcomes of interest were eradication of infection, ulcer healing, recurrence of infection, prevention of major amputation and mortality rate. Patient associated factors were identified and analysed. Results: Eradication of infection was achieved in 96%, healing of ulcer in 93% and limb salvage in 95% of patients. The mortality rate for 1 year is 5.4% and 5 years is 25.6%. Peripheral arterial disease was adversely associated with eradication of infection, ulcer healing, recurrence of ulcer and limb salvage. Higher levels of HbA1c were substantially related to poor ulcer healing with longer duration and increased recurrence of infection rate. Higher CRP levels are significantly associated with increased recurrence of infection and mortality rate. Gender, BMI, smoking status, part of foot, charcot arthropathy, duration of antibiotics and microorganism factors had no impact on treatment success. Conclusions: This is the largest single centre study involving Cerament G and V in the management of diabetic foot osteomyelitis and the first investigating the specific factors associated with outcome goals. The use of these antibiotic loaded carrier demonstrated excellent eradication of infection, healing of ulcer and limb salvage and prevention of recurrence of infection.

Abstract: Background: Complex hindfoot pathologies involving critical sized bone defects of talus are difficult to manage. The current management involves arthrodesis and bone grafting with the defective talus which have limitations in restoring structural integrity and functional goals. The advancement of 3D printed scaffolds have opened new avenues to address such complex hindfoot pathologies which may potentially improve treatment outcomes. The addition of Platelet-rich fibrin further enhances healing potential. Method: This is a retrospective study involving 6 patients with severe hindfoot bone loss where 3D printed scaffolds coated with PRF were performed as a salvage surgery from 2023 to 2024. We intend to to investigate the clinical outcomes in terms of healing time and union rate. Additionally we would evaluate the degree of deformity corrections and patient clinical outcomes. Results: This report includes 6 complex reconstructions where all the patients (100%) achieved CT confirmed union with mean duration of 20.2 weeks. All patients were able to ambulate in full weight bearing after an average duration of 23.3 weeks. There were significant improvement in all radiological parameters. Patients demonstrated improved VAS from 7.5 ± 1.4 points to 2.3 ± 1.2 and functional scores in all domains utilizing AOFAS score, FFI and SF-36. Conclusion: This demonstrated the potential of PRF coated 3D printed scaffold in managing complex hindfoot cases especially in the presence of significant bony defects. This modality demonstrated excellent union rate of 100%, near anatomical correction and good functional outcomes with low complication rate.

Abstract: A case report about a female patient has been presented here, who was suffering from various symptoms associated with Prolapsed Intervertebral Disc (PIVD) and Polyarthritis, as well as some other ailments. Based on the principles of Ayurveda, an integrative approach including Panchakarma and Marma Therapy, was administered to the patient, in a Spiritual Environment, over a period of 11 days (wherein no therapy was administered on the 7th day). The patient experienced notable relief in various symptoms associated with PIVD and Polyarthritis, such as lower back pain which radiated to the left leg (~80% relief); pain in B/L calf muscles with excess stiffness with swelling (almost complete relief); pain in left elbow with stiffness (~90% relief); pain in B/L wrist joints (almost complete relief). There was no body pain, and there was notable relief in the pain in B/L soles. Overall, the patient was feeling light and relaxed. Thus, integrative approach including Panchakarma and Marma Therapy, administered in a Spiritual Environment, showed encouraging results in the management of symptoms associated with Prolapsed Intervertebral Disc (PIVD) and Polyarthritis, as well as some other ailments, in a short duration of time.

Abstract: The osseus skeleton is the 3rd commonest site of metastasis due to malignancy, behind lung and liver.1 Metastatic bone disease (MBD), also known as secondary bone cancer, is a common event which signals increased morbidity and early mortality2. Recently, the duration of survival for patients with MBD has increased3, 4 likely due to advancements in medical and surgical techniques. MBD is therefore an increasingly common issue that orthopaedic surgeons are required to manage and investigate, and improvements in care have led to improved survival of this patient population. The British Orthopaedic Association have issued guidelines on Management of MBD in 20155 A recent audit of these guidelines demonstrated that current practice in the UK does not comply with national guidelines set out by BOOS/BOA1. This article will outline presentation, investigation and current recommended treatment of MBD, as well as prognosis, and future possibilities in managing MBD. This article aims to improve awareness and details appropriate management for patients presenting with MBD for UK based clinicians and surgeons.

Abstract: Proximal femoral fractures (PFFs) are the most frequent bone fractures in elderly people. In Italy, from 2007 to 2017, there were 906,111 hospitalizations for hip fractures. These fractures are expected to reach up to 21.3 million globally by 2050 because of aging. Femoral neck fractures in elderly people are usually treated with protheses. Hemiarthroplasty has been the treatment of choice. However, high-demand patients require total hip replacement. A dual mobility cup is more powerful than total hip arthroplasty or hemiarthroplasty and has less complications. We did a search of the literature about the best choice between a dual mobility cup and hemiarthroplasty in treatment of femur neck fracture. In this literature review, we found many works that show better results in patients treated with dual mobility total hip arthroplasty, compared to hemiarthroplasty. In elderly people femoral neck fractures, dual mobility total hemiarthroplasty should be the solution of choice except for cases with internal or anesthetic problems, which should have a less invasive intervention.

Abstract: Background: Thumb carpo-metacarpal arthritis, a form of arthritis at the base of the thumb, causes pain, swelling, and limited mobility, significantly affecting patients' quality of life. This study aimed to evaluate the efficacy of an exercise protocol, comparing standard treatment with an app-assisted approach. Methods: Two groups of 10 patients each were randomly assigned standard treatment or standard treatment plus a Hand Rehab App. Both groups received physiotherapy sessions over three phases spanning three months. Results: Both groups showed improvement, with Group 0 showing more significant improvements in several variables. However, the clinical significance of these improvements differed between groups. Discussion: Group 0 had significant improvements in FLEX IF, FLEX MF TT, and VAS AT NIGHT, while Group 1 had significant improvements in FLEX MF and TT. Group 1 showed greater improvement in JAMAR and TT, while both groups showed similar improvements in other variables. Overall, Group 1 showed more improvement in key measurements. Conclusion: This study suggests that adding a specific app to exercise therapy may enhance outcomes for trapeziometacarpal osteoarthritis patients, particularly in terms of pain relief and functionality.

Abstract: Although cemented total knee arthroplasty (TKA) is considered the standard fixation technique, the emerging trend toward cementless fixation has created the need for a detailed comparison. In a previous study, we reported the 5-year results comparing cementless and hybrid cemented TKAs using the same implant design. The purpose of this study was to assess the long-term follow-up at a minimum of 10 years. Methods: A retrospective analysis was performed on 120 TKAs (60 cementless, 60 hybrid cemented) conducted between 2003 and 2007. Demographic and clinical data were collected, ra-diographic follow-up was performed with attention to signs of loosening, while compli-cations and revision surgery were assessed using competing risk analysis. Operative time was recorded as an indicator of surgical efficiency. Results: At 10 years, 59 TKAs (54 patients) were available for long‐term follow‐up. Both fixation groups demonstrated significant improvement in Knee Society Scores (KSS) compared to preoperative values (p < 0.001). However, there was no significant difference in KSS between the two groups at 10 years follow-up (p = 0.480). The 10-year cumulative incidence of revision was 8.4% in both groups (p = 0.721), and that of aseptic loosening was identical at 3.4% (p = 0.967). Although radiolucent lines were noted in three tibial components of the cementless group, the difference was not statistically significant (p = 0.075). Notably, the cementless group demonstrated a significantly shorter operative time with a mean difference of 10 minutes (p = 0.017). Conclusions: At a minimum follow-up of 10 years, there were no significant differences between the hybrid cemented and cementless groups in revision rates, cu-mulative incidences, clinical scores, or radiological signs of loosening, confirming the long-term effectiveness of both fixation methods in clinical practice.

Abstract: This study aimed to determine the physical conditions of university students by evaluating their cardiorespiratory capacity and dynamometry. Materials and Methods: The research employed a quantitative approach with a cross-sectional, descriptive scope. It was non-experimental and observational, focusing on determining correlations between the proposed variables. Additionally, a machine learning model, specifically a random forest algorithm, was employed to analyze the importance of variables such as age, BMI, and handgrip strength in predicting cardiorespiratory capacity. The study involved 12,466 enrolled students, of whom 624 were tested and selected using cluster random sampling. This sample comprised 295 men and 329 women aged 15–44 years. Results: Regarding cardiorespiratory capacity, the highest mean was observed in tenth-semester students, at approximately 60%, followed by eighth-semester (49.48%) and seventh-semester (46.733%) students. The lowest levels were found in third-semester students (42.87%), followed by fourth-semester (43.03%) and sixth-semester (44.21%) students. The mean dynamometry value was highest among tenth-semester students (39.41%), followed by second-semester students (38.12%). The lowest values were recorded for fifth-semester students (30.57%), followed by fourth-semester students (31.12%). Conclusions: Homogeneous values were observed among fifth-semester students. The university students in this study exhibited adequate levels of cardiorespiratory capacity and handgrip strength, which may help reduce risk factors for potential non-communicable diseases (NCDs) in the future.

Abstract: Background: In hallux rigidus (HR), elastic resistance during hallux dorsiflexion persisted even after cheilectomy, which is attributed to plantar tissue contracture. The Cochrane procedure published in 1927 involves releasing the flexor hallucis brevis (FHB) tendon, plantar capsule, and plantar portion of the lateral ligament at the first metatarsophalangeal (MTP) joint through a plantar skin incision. This novel approach directly addressed and treated the underlying cause of HR, resulting in high satisfaction and complete pain resolution in 12 patients. However, to our knowledge, no further case reports or case series on the Cochrane procedure have been published since this initial report. This report presents a case treated with arthroscopic Cochrane procedure with long-term follow-up. Case Presentation: A 73-year-old male with HR presented with limited dorsiflexion, a painful bony prominence, and pain during walking at the first MTP joint, treated with the arthroscopic Cochrane procedure. During surgery, hallux dorsiflexion did not improve after resecting all spurs in the MTP joint, but the dorsiflexion angle immediately improved from 55° to 85°after releasing the FHB tendon, plantar capsule, and plantar portion of the lateral ligament. Improvements in both visual analog scale scores (70–0) and Japanese Society for Surgery of the Foot scores (57–88) were noted from preoperatively to 9 years and 6 months postoperatively. No postoperative cockup deformity was observed. Conclusions: The arthroscopic Cochrane procedure can yield favorable long-term outcomes without postoperative cockup deformity.

Abstract: The study aims to evaluate adherence to Romosozumab treatment in osteoporotic patients after surgical fracture fixation and compare side effects with non-fractured controls on the same therapy. This retrospective case–control study was conducted at the Orthopaedic Department of Policlinico Universitario di Roma “Tor Vergata,” following the principles of the Declaration of Helsinki. It included postmenopausal women aged over 60, with the case group receiving Romosozumab after fracture fixation, and the control group consisting of women on Romosozumab therapy without fracture fixation. Exclusion criteria included psychiatric conditions, contraindications to Romosozumab, high-energy trauma, or other bone metabolism disorders. Data on fractures, surgeries, FRAX scores, MOC values, and follow-up details were collected. Side effects, including nasopharyngitis and severe events like hypocalcemia, stroke, and myocardial infarction, were recorded. Adherence was assessed via pharmacy records and patient interviews. Statistical analysis was performed using descriptive statistics, t-tests, and chi-square tests. The study included 25 patients, with 12 in the surgical group and 13 in the conservative treatment group. The surgical group had a mean age of 67.3 years and a follow-up of 374 days, while the conservative group had a mean age of 76.4 years and a follow-up of 287 days. The surgical group underwent various fracture treatments, including femoral, humeral, and distal radius fractures, while the conservative group was treated with immobilization. There were no significant differences in FRAX scores or MOC values between the two groups. Vitamin D levels increased significantly in both groups after supplementation, but parathyroid hormone levels showed no difference. No new fractures occurred, and surgical patients had no delayed union or nonunion, though two had superficial wound infections. Both groups adhered well to Romosozumab therapy, with no severe side effects; minor side effects included myalgia in the surgical group and shoulder arthralgia in the conservative group. Romosozumab is well-tolerated and adherent in osteoporotic patients after osteosynthesis surgery, with adverse events similar to non-fractured individuals. While the study design is appropriate, multicenter trials would improve sample size and allow for subgroup analysis based on fracture type and demographics.

Abstract: Background/Objectives: Osteoporosis is a skeletal disorder characterized by reduced bone mineral density (BMD) and increased fracture risk. Chronic inflammation is implicated in osteoporosis pathogenesis, with inflammatory mediators promoting bone resorption. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are markers of systemic inflammation and have emerged as potential indicators of bone health. This study’s aim was to highlight the potential role of NLR and PLR as markers of bone health in postmenopausal women affected by osteoporosis or osteopenia and to evaluate the possible influence of autoimmune disease in this context. Methods: This cross-sectional study included 124 postmenopausal women diagnosed with osteopenia or osteoporosis at the Orthopedic Unit of the Policlinico G. Rodolico in Catania, Italy. Demographic, clinical, laboratory, and diagnostic imaging data were collected. NLR and PLR were calculated from complete blood counts, and BMD was measured using dual-energy X-ray absorptiometry (DEXA). Statistical analyses included correlations, group comparisons, and multiple and logistic regressions. Results: NLR and PLR did not directly correlate with BMD or fracture incidence. However, PLR weakly correlated with vitamin D levels. Notably, women without Hashimoto's thyroiditis exhibited higher NLR values than those with the condition. Hypertensive women had lower PLR than non-hypertensive women, while euthyroid women had higher PLR than hyperthyroid or hypothyroid women. Multiple regression analysis revealed that age, BMI, CKD stage, vitamin D levels, NLR, PLR, diabetes, and autoimmune diseases significantly predicted BMD at the femur neck, with PLR contributing significantly. Logistic regression confirmed these predictors for osteoporosis or osteopenia, with increased PLR being associated with a higher likelihood of osteoporosis. Conclusion: While NLR and PLR may not independently predict bone health, their inclusion in a multifactorial assessment considering age, BMI, vitamin D, and comorbidities could enhance osteoporosis management.