teriparatide (Movymia)

Preventing Hip (Proximal Femoral) Fractures: An Evidence-Based Review for Clinicians.

Kawai Toshiyuki T, Okuzu Yaichiro Y, Takaoka Yusuke Y, Natsume Daichi D et al.

Hip fractures are among the most devastating fragility fractures, associated with excess mortality, disability, loss of independence, and substantial healthcare costs. Although age-standardized incidence has declined in several high-income countries, absolute case numbers continue to rise because of population aging. This review summarizes contemporary PubMed-indexed evidence on the epidemiology, risk stratification, and prevention of proximal femoral fractures, with emphasis on hip-fracture outcomes rather than vertebral or composite endpoints alone. We discuss secular trends, FRAX-based case findings and screening, non-pharmacologic strategies, pharmacologic therapy, and health-system interventions relevant to both primary and secondary prevention. Among non-pharmacologic measures, long-term balance-challenging and resistance-based exercise has the most consistent evidence for reducing falls and likely contributes to fracture prevention, whereas multifactorial interventions, home hazard modification, calcium/vitamin D supplementation, and hip protectors are best targeted to selected high-risk populations and care settings. Among medications, bisphosphonates, denosumab, and romosozumab-based sequential strategies show the strongest evidence for reducing hip-fracture risk, while teriparatide and abaloparatide have important roles in very-high-risk patients despite less direct hip-fracture evidence. Menopausal hormone therapy reduces hip fractures in younger postmenopausal women but is limited by extra-skeletal risk, and selective estrogen receptor modulators are primarily vertebral-fracture agents. A major message of this review is that effective prevention depends not only on drug efficacy but also on implementation. Fracture liaison services, orthogeriatric co-management, prompt treatment after fragility fracture, and sustained adherence support are essential to close persistent care gaps. Preventing hip fractures therefore requires an integrated, risk-stratified approach that combines skeletal protection, falls prevention, and reliable health-system delivery.

Pharmacologic Adjuncts for Bone Stress Injuries in Athletes: A Narrative Review of Current Evidence and Clinical Practice.

Porter Richard R, Rees Jon J

Bone stress injuries (BSIs) are common in athletes, carry substantial time-loss and recurrence risk, and are increasingly managed with bone-active drugs despite a limited evidence base. This narrative review appraises the evidence for pharmacologic adjuncts in BSI, distinguishes the separate clinical indications for which they are proposed, and defines where current evidence does and does not support their use. This is a narrative review; therefore ethical approval was not required. PubMed/MEDLINE, Embase, and the Cochrane Library were searched from inception to June 2026 combining terms for BSI, stress fracture and athletes. Evidence is summarized in an evidence table that states whether each source is directly applicable to BSI in athletes or extrapolated from osteoporosis, traumatic fracture, spinal surgery, military, or animal studies. Greatest weight is given to controlled studies conducted in patients with BSI. Contemporary practice is illustrated by a previously published survey of 126 clinicians working in professional football and by the 2025 international Delphi consensus. The evidence base for treatment options in BSI varies substantially based on the clinical context. Correction of a documented abnormality of energy availability, calcium or protein intake, vitamin D status is a key initial step, but there is no clear evidence that supplementation of replete athletes accelerates healing of an established injury. Evidence for bisphosphonates in BSI is limited to small uncontrolled case series and may even impair bone healing or risk reinjury. Teriparatide data derive predominantly from osteoporotic, fragility fracture, and spinal fusion populations, with a single randomized controlled trial in stress fracture in progress. Newer agents, abaloparatide and romosozumab have no direct evidence in BSI, likely because of their novelty. Across all agents, apparent benefit may represent analgesia and earlier controlled loading rather than accelerated biological healing, given that return-to-play timing is determined by numerous clinical, occupational, and organizational factors. There is currently insufficient evidence to recommend routine use of bisphosphonates or osteoanabolic agents as treatment for an uncomplicated acute BSI in an otherwise healthy athlete. Assessment and correction of nutritional, and metabolic abnormalities, together with load management and rehabilitation, remain the foundation of care. Off-label treatment adjuncts discussed should be considered in recurrent, high-risk or delayed-healing BSI, with shared decision-making focus. Prospective outcome collection is likely to be the most pragmatic way to advance available evidence.

Letter of response to "letter of response to 'postpartum timing of teriparatide initiation and BMD response in pregnancy- and lactation-associated osteoporosis: an observational study'".

Lynch Lauren K LK, Shane Elizabeth E, Cohen Adi A

Sequential stress fractures of the ulna and radius in a patient with neurofibromatosis type 1: A case report.

Kang Hyun Tak HT, Jin Woong Geun WG, Kang Hong Je HJ

Stress fractures of the forearm are uncommon, and to our knowledge, sequential involvement of both the ulna and radius has not been well characterized. Neurofibromatosis type 1 is associated with increased bone fragility and delayed fracture healing due to impaired osteoblastic differentiation, reduced mineralization capacity, and increased osteoclastic activity. We report the case of a woman in her early 60s with neurofibromatosis type 1 and lower-extremity weakness who relied on upper-extremity weight-bearing ambulation. She initially developed a nondisplaced transverse stress fracture of the proximal ulnar shaft with delayed union, which subsequently achieved union following conservative treatment, including teriparatide. Approximately 24 months after the initial ulnar fracture, she developed a new nondisplaced stress fracture of the radial shaft, suggestive of a possible stress-transfer phenomenon related to altered load distribution across the forearm. Repeated conservative treatment with strict weight-bearing restriction resulted in radiographic union with restoration of functional forearm motion. This case highlights the importance of recognizing altered forearm load distribution to reduce the risk of secondary stress injury.