Aug 2026· Frontiers in Medicine· Vol 13· 0 citations· 78 references
Medicine
TL;DR
This Perspective proposes a bone–muscle–function framework to complement existing osteoporosis-centered approaches to fragility fracture prevention and organizes bone, muscle, and function into a staged framework for risk identification, recovery planning, and secondary prevention.
Abstract
Fragility fractures are a major clinical and public health challenge in aging societies. Current prevention strategies are commonly organized around skeletal risk assessment and osteoporosis management, yet fracture occurrence and post-fracture outcomes in older adults are also influenced by muscle dysfunction, frailty, fall propensity, physiological reserve, and rehabilitation capacity. This Perspective proposes a bone–muscle–function framework to complement existing osteoporosis-centered approaches to fragility fracture prevention. In this framework, bone represents skeletal strength and structural fragility, muscle represents sarcopenia-related impairment in strength and physical performance, and function represents frailty-related reserve, resilience, fall propensity, and recovery capacity. Osteosarcopenia provides the bone–muscle foundation, whereas the addition of function extends the framework to include broader vulnerability and recovery potential. Rather than simply adding frailty and sarcopenia to osteoporosis assessment, it organizes bone, muscle, and function into a staged framework for risk identification, recovery planning, and secondary prevention.
: Older adults are increasingly offered decompression, fusion, deformity correction, and vertebral fracture procedures, yet chronological age alone is an inadequate measure of operative risk. Frailty, sarcopenia, and osteoporosis represent overlapping but distinct domains of diminished physiologic reserve, impaired muscle function, and compromised bone strength. Each domain is common in spine-surgery candidates and has been associated with adverse perioperative events, prolonged hospitalization, non-home discharge, delayed functional recovery, mechanical complications, and revision surgery. This narrative review summarizes contemporary evidence on frailty, sarcopenia, and osteoporosis in adult spine surgery and proposes a practical perioperative risk-stratification framework for clinical use. Frailty should be considered a multidimensional vulnerability state rather than a synonym for advanced age. Sarcopenia should be screened with functional tools and confirmed with muscle quantity or quality assessment when possible, with attention to Asian diagnostic criteria. Osteoporosis and osteopenia require active preoperative detection because poor bone health increases the risk of screw loosening, cage subsidence, pseudarthrosis, proximal junctional failure, adjacent fracture, and reoperation. Current evidence supports routine screening in at-risk patients, optimization of nutrition and physical function, correction of vitamin D deficiency, and consideration of bone-active therapy before major reconstructive procedures. We propose an Aging Spine Surgical Host framework that integrates frailty, sarcopenia, osteoporosis, nutrition, cognition, mobility, and surgical magnitude into four actionable grades: robust, vulnerable, high-risk, and prohibitive or modifiable high-risk. This framework is intended to improve shared decision-making, trigger prehabilitation and bone-health optimization, and help surgeons select the least morbid durable procedure. Prospective validation is required before formal prognostic use.
Nishant x· International Journal of Sci...· 0 citations
The need to move beyond BMD alone and adopt comprehensive, individualized approaches to fracture risk assessment and management in obesity is highlighted.
Riad Sulimani· Frontiers in Endocrinology· 0 citations
Effective care in cases of male osteoporosis requires an integrated risk-based approach that extends beyond BMD to include clinical risk factors, secondary causes, and functional status, and improved recognition and sex-specific management strategies are essential to reduce the fracture burden and improve long-term outcomes in men.
Selin Tekin, Alper Gürlek· Turkish Journal of Medical S...· 0 citations
FRAX-derived fracture probability in postmenopausal women is associated not only with bone-related parameters but also with muscle structure, muscle quality, and physical performance, which highlights the potential relevance of muscle-related parameters within the broader musculoskeletal profile reflected by FRAX.
Assessment of quantitative MRI and VBQ/modified VBQ into predictive models enables opportunistic, radiation-free screening and more precise fracture risk assessment, bridging the gap between bone quantity and quality for improved prevention and management of fragility fractures.
Sanjith Manian, Arunagiri Gunasekar, Naveen Jeyaraman et al.· World Journal of Methodology· 0 citations
BACKGROUND
Distal radial fractures (DRFs) are common fragility fractures in older adults and often indicate skeletal deterioration. However, whether DRFs reflect underlying systemic frailty or occur predominantly in relatively active individuals with preserved physical function remains unclear.
METHODS
This retrospective cohort study analyzed data from the Shizuoka Kokuho Database, which includes the health and long-term care (LTC) claims of 2.4 million residents. Individuals aged 65 to 89 years who were newly diagnosed with a DRF between 2012 and 2022 were compared with patients with an upper-limb contusion. Propensity score matching was used to balance baseline characteristics between these groups. The primary outcome was all-cause mortality. The secondary outcomes included secondary fragility fractures, hospitalization, LTC deterioration, and osteoporosis treatment initiation. Cox proportional hazards and Poisson regression models were used for the analysis. Causal mediation analysis was conducted to explore the indirect effects of secondary fractures and treatment initiation.
RESULTS
After propensity score matching, the final analysis included 47,178 patients (23,589 matched pairs; mean age, 77.6 ± 6.7 years; 87.8% female) with balanced baseline characteristics. In the matched cohort, patients with a DRF had lower all-cause mortality than controls in the unadjusted analysis (hazard ratio [HR], 0.90; 95% confidence interval [CI], 0.86 to 0.94), but this association was attenuated after multivariable adjustment that included baseline LTC certification (HR, 0.98; 95% CI, 0.93 to 1.02). Subgroup analysis showed that a DRF was associated with lower mortality among individuals with higher LTC needs, particularly women. In the matched cohort, patients with a DRF had higher rates of subsequent hip fractures (2.58 [95% CI, 2.48 to 2.69] versus 2.00 [95% CI, 1.91 to 2.10] fractures per 100 person-years) and more frequent osteoporosis treatment initiation within 1 year after injury (17.6% [95% CI, 17.1% to 18.1%] versus 7.7% [95% CI, 7.4% to 8.0%] of patients). The mediation analysis suggested modest indirect effects of secondary hip fractures and vitamin-D supplementation on mortality.
CONCLUSIONS
DRFs in older adults may reflect preserved function and skeletal fragility rather than advanced frailty. These fractures may represent a critical window for initiating osteoporosis treatment to prevent subsequent fractures and improve long-term outcomes.
LEVEL OF EVIDENCE
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Ryutaro Shibata, Yoko Sato, Yoshihiro Tanaka· Journal of Bone and Joint Su...· 0 citations