BACKGROUND: Osteoporosis is the fourth most common chronic disease worldwide. The adoption of preventative measures and effective self-management interventions can help improve bone health. Mobile health (mHealth) technologies can play a key role in the care and self-management of patients with osteoporosis. OBJECTIVE: This study presents a systematic review and meta-analysis of the currently available mHealth apps targeting osteoporosis self-management, aiming to determine the current status, gaps, and challenges that future research could address, as well as propose appropriate recommendations. METHODS: A systematic review of all English articles was conducted, in addition to a survey of all apps available in iOS and Android app stores as of May 2021. A comprehensive literature search (2010 to May 2021) of PubMed, Scopus, EBSCO, Web of Science, and IEEE Xplore was conducted. Articles were included if they described apps dedicated to or useful for osteoporosis (targeting self-management, nutrition, physical activity, and risk assessment) delivered on smartphone devices for adults aged 18 years. Of the 32 articles, a random effects meta-analysis was performed on 13 (41%) studies of randomized controlled trials, whereas the 19 (59%) remaining studies were only included in the narrative synthesis as they did not provide enough data. RESULTS: In total, 3906 unique articles were identified. Of these 3906 articles, 32 (0.81%) articles met the inclusion criteria and were reviewed in depth. The 32 studies comprised 14,235 participants, of whom, on average, 69.5% (n=9893) were female, with a mean age of 49.8 (SD 17.8) years. The app search identified 23 relevant apps for osteoporosis self-management. The meta-analysis revealed that mHealth-supported interventions resulted in a significant reduction in pain (Hedges g -1.09, 95% CI -1.68 to -0.45) and disability (Hedges g -0.77, 95% CI -1.59 to 0.05). The posttreatment effect of the digital intervention was significant for physical function (Hedges g 2.54, 95% CI -4.08 to 4.08) but nonsignificant for well-being (Hedges g 0.17, 95% CI -1.84 to 2.17), physical activity (Hedges g 0.09, 95% CI -0.59 to 0.50), anxiety (Hedges g -0.29, 95% CI -6.11 to 5.53), fatigue (Hedges g -0.34, 95% CI -5.84 to 5.16), calcium (Hedges g -0.05, 95% CI -0.59 to 0.50), vitamin D intake (Hedges g 0.10, 95% CI -4.05 to 4.26), and trabecular score (Hedges g 0.06, 95% CI -1.00 to 1.12). CONCLUSIONS: Osteoporosis apps have the potential to support and improve the management of the disease and its symptoms; they also appear to be valuable tools for patients and health professionals. However, most of the apps that are currently available lack clinically validated evidence of their efficacy and focus on a limited number of symptoms. A more holistic and personalized approach within a cocreation design ecosystem is needed.

Introduction: Osteoporosis is a disease having adverse effects on bone health and causing fragility fractures. Osteoporosis affects approximately 200 million people worldwide, and nearly 9 million fractures occur annually. Evidence exists that, in addition to traditional risk factors, certain environmental substances may increase the risk of osteoporosis. Methods: The European Human Biomonitoring Initiative (HBM4EU) is a joint program coordinating and advancing human biomonitoring in Europe. HBM4EU investigates citizens' exposure to several environmental substances and their plausible health effects aiming to contribute to policymaking. In HBM4EU, 18 priority substances or substance groups were selected. For each, a scoping document was prepared summarizing existing knowledge and health effects. This scoping review is based on these chemical-specific scoping documents and complementary literature review. Results: A possible link between osteoporosis and the body burden of heavy metals, such as cadmium (Cd) and lead (Pb), and industrial chemicals such as phthalates and per- and poly-fluoroalkyl substances (PFASs) was identified. Conclusions: Evidence shows that environmental substances may be related to osteoporosis as an adverse health effect. Nevertheless, more epidemiological research on the relationship between health effects and exposure to these chemicals is needed. Study results are incoherent, and pervasive epidemiological studies regarding the chemical exposure are lacking.

Background: The potential association between hepatitis B virus (HBV) infection and development of osteoporosis has drawn significant attention from clinicians and researchers in recent years due to the increasing prevalence of HBV infection. This study aims to perform a systematic review and meta-analysis of the literature to show whether HBV infection is associated with an increased risk of osteoporosis. Methods: Case-control, cohort, and cross-sectional studies that report the incidence of osteoporosis, osteoporotic fracture, osteopenia, and bone mineral density level in populations with HBV infection will be selected. Four databases from their inception to October 2019 will be searched. All data were assessed and extracted by 2 authors independently. The Newcastle-Ottawa scale and (Agency for Healthcare Research and Quality) Agency for Healthcare Research and Quality checklist will be used to assess the quality of the selected studies. Stata 15.1 (Stata Corp, College Station, TX) will be used to conduct meta-analysis. Result: The results of this systemic review and meta-analysis will be submitted to a recognized journal for publication. Conclusion: This systemic review and meta-analysis will determine whether HBV infection is associated with an increased risk of osteoporosis. We hope this review can provide a reliable evidence. Registration: PROSPERO (registration number CRD42020140522).

Background: Acupoint injection has currently received increasing attention as a treatment for primary osteoporosis (POP), This study aimed to evaluate the efficacy and safety of acupoint injection as a clinical treatment for POP. Methods: Randomized controlled trials (RCTs) of acupoint injection compared with conventional non-acupoint injection for POP were identified in searches of seven databases from their inception to March 2019. All data were assessed and extracted by two authors independently. The risk of bias assessment recommended by the Cochrane Collaboration was used to assess the quality of the selected studies. RevMan 5.3 was used to conduct meta-analysis for the efficacy and safety of acupoint injection. Results: Five trials with 337 patients (aged 45–86 years) with bone mineral density (BMD) ≤2 SD were included in our meta-analysis. The results showed that, compared with conventional intramuscular injection, acupoint injection significantly increased the BMD [mean difference (MD) =0.02; 95% CI, 0.01 to 0.03, P0.05). Individuals results showed that acupoint injection improved biochemical indicators, such as NBAP, IGF-I and reduced CTX and leptin levels. While the risk of bias was high in all five trials. Conclusions: This meta-analysis and systematic review suggests that acupoint injection improves BMD and some biochemical indicators in POP patients compared with the effects of conventional intramuscular injection. However, due to the high risk of bias in all the trials reviewed, the evidence remains inconclusive and future research will be required with improved methodological quality.

BACKGROUND: Although vitamin K antagonists (VKA) lower serum values of bone deposition markers, the link with osteoporosis and fractures remains controversial. OBJECTIVES: To assess whether the use of VKA is associated with an increased prevalence and/or incidence of osteoporosis, fractures, or lower bone mineral density (BMD) values METHODS: A systematic PubMed and EMBASE literature search until 08/31/2014 and meta-analysis of cross-sectional and longitudinal studies investigating and BMD, comparing patients treated with VKA and healthy controls (HCs) or with patients with medical illness (MCs). Standardized mean differences (SMDs)+/-95% and confidence intervals (CIs) were calculated for BMD; risk ratios (RRs) for prevalent and incident fractures. RESULTS: Of 4,597 initial hits, 21 studies were eligible, including 79,663 treated with VKA vs. 597,348 controls. Compared to HCs, VKA-treated individuals showed significantly higher fracture risk in cross-sectional (studies=3; RR=1.24; 95%CI:1.12-1.39, p<0.0001) and longitudinal studies (studies=7; RR=1.09; 95%CI:1.01-1.18, p=0.03), and more incident hip fractures (studies=4; RR=1.17; 95%CI:1.05-1.31, p=0.003). Analysing studies that matched VKA participants with HCs (studies=4), both these findings in longitudinal studies became non-significant. Notably, the VKA and MC group had similar BMD at all investigated sites. Compared to HCs, one single study showed significantly lower spine T-scores in the VKA-treated group (SMD=-0.45; 95%CI: -0.75, -0.14, p=0.004). CONCLUSION: VKAs neither increased prospectively-assessed fracture risk compared to MCs when matching eliminated confounding factors nor reduced BMD beyond effects of medical illness. Future studies, using careful matching and/or adequate MC groups are needed to further clarify the short- and long-term effects of VKA on bone health. This article is protected by copyright. All rights reserved