{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T19:45:31Z","timestamp":1792266331286,"version":"4.4.0"},"reference-count":32,"publisher":"Springer Science and Business Media LLC","issue":"11","license":[{"start":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T00:00:00Z","timestamp":1792195200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"},{"start":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T00:00:00Z","timestamp":1792195200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Rheumatol Int"],"DOI":"10.1007\/s00296-026-06330-x","type":"journal-article","created":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T05:10:51Z","timestamp":1792213851000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Baseline characteristics and bone mineral density changes associated with lower fracture risk in osteoporosis: a retrospective cohort study"],"prefix":"10.1007","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-9899-7719","authenticated-orcid":false,"given":"Mariya","family":"Nedkova","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7801-2007","authenticated-orcid":false,"given":"Irina","family":"Momcheva","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5089-4925","authenticated-orcid":false,"given":"Tsvetanka","family":"Petranova","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1233-5775","authenticated-orcid":false,"given":"Zguro","family":"Batalov","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,17]]},"reference":[{"key":"6330_CR1","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1007\/s00223-018-0394-4","volume":"103","author":"AW Popp","year":"2018","unstructured":"Popp AW, Varathan N, Buffat H et al (2018) Bone mineral density changes after 1 year of deno sumab discontinuation in postmenopausal women with long-term denosumab treatment for osteoporosis. Calcif Tissue Int 103:50\u201354. https:\/\/doi.org\/10.1007\/s00223-018-0394-4","journal-title":"Calcif Tissue Int"},{"key":"6330_CR2","doi-asserted-by":"publisher","unstructured":"John J, Carey (2022) Paulo Chih-Hsing Wu (\u5433\u81f3\u884c), Diane Bergin Risk assessment tools for osteoporosis and fractures in 2022. Best Practice\u00a7 Research Clinical Rheumatology. https:\/\/doi.org\/10.1016\/j.berh.2022.101775","DOI":"10.1016\/j.berh.2022.101775"},{"issue":"5","key":"6330_CR3","doi-asserted-by":"publisher","first-page":"817e29","DOI":"10.1007\/s00198-020-05756-8","volume":"32","author":"AM Burden","year":"2021","unstructured":"Burden AM, Tanaka Y, Xu L et al (2021) Osteoporosis case ascertainment strategies in European and Asian countries: a comparative review. Osteoporos Int 32(5):817e29. https:\/\/doi.org\/10.1007\/s00198-020-05756-8","journal-title":"Osteoporos Int"},{"issue":"5","key":"6330_CR4","doi-asserted-by":"publisher","first-page":"1507e29","DOI":"10.1007\/s00198-016-3894-y","volume":"28","author":"NC Harvey","year":"2017","unstructured":"Harvey NC, McCloskey EV, Mitchell PJ et al (2017) Mind the (treatment) gap: a global perspective on current and future strategies for prevention of fragility fractures. Osteoporos Int 28(5):1507e29. https:\/\/doi.org\/10.1007\/s00198-016-3894-y","journal-title":"Osteoporos Int"},{"issue":"3","key":"6330_CR5","doi-asserted-by":"publisher","first-page":"397e424","DOI":"10.1016\/j.jocd.2017.06.008","volume":"20","author":"G El-Hajj Fuleihan","year":"2017","unstructured":"El-Hajj Fuleihan G, Chakhtoura M, Cauley JA et al (2017) Worldwide fracture prediction. J Clin Densitom: official J Int Soc Clin Densitometry 20(3):397e424. https:\/\/doi.org\/10.1016\/j.jocd.2017.06.008","journal-title":"J Clin Densitom: official J Int Soc Clin Densitometry"},{"issue":"2","key":"6330_CR6","doi-asserted-by":"publisher","first-page":"251e7","DOI":"10.1007\/s00198-019-05226-w","volume":"31","author":"T Merlijn","year":"2020","unstructured":"Merlijn T, Swart KMA, van der Horst HE et al (2020) Fracture prevention by screening for high fracture risk: a systematic review and meta-analysis. Osteoporos Int 31(2):251e7. https:\/\/doi.org\/10.1007\/s00198-019-05226-w","journal-title":"Osteoporos Int"},{"issue":"7","key":"6330_CR7","doi-asserted-by":"publisher","first-page":"1193e204","DOI":"10.1007\/s00198-020-05377-1","volume":"31","author":"MK Javaid","year":"2020","unstructured":"Javaid MK, Sami A, Lems W et al (2020) A patient-level key performance indicator set to measure the effectiveness of fracture liaison services and guide quality improvement: a position paper of the IOF Capture the Fracture Working Group, National Osteoporosis Foundation and Fragility Fracture Network. Osteoporos Int 31(7):1193e204. https:\/\/doi.org\/10.1007\/s00198-020-05377-1","journal-title":"Osteoporos Int"},{"key":"6330_CR8","doi-asserted-by":"publisher","unstructured":"Aggarwal V, Maslen C, Abel RL et al (2021) Opportunistic diagnosis of osteoporosis, fragile bone strength and vertebral fractures from routine CT scans; a review of approved technology systems and pathways to implementation. Therapeutic Adv Musculoskelet disease 13.https:\/\/doi.org\/10.1177\/1759720X211024029","DOI":"10.1177\/1759720X211024029"},{"issue":"7","key":"6330_CR9","doi-asserted-by":"publisher","first-page":"1233e41","DOI":"10.1002\/jbmr.3429","volume":"33","author":"MJ van Dort","year":"2018","unstructured":"van Dort MJ, Geusens P, Driessen JH et al (2018) High imminent vertebral fracture risk in subjects with COPD with a prevalent or incident vertebral fracture. J Bone Min Res 33(7):1233e41. https:\/\/doi.org\/10.1002\/jbmr.3429","journal-title":"J Bone Min Res"},{"issue":"5","key":"6330_CR10","doi-asserted-by":"publisher","first-page":"859e66","DOI":"10.1002\/jbmr.3672","volume":"34","author":"MJ van Dort","year":"2019","unstructured":"van Dort MJ, Driessen JHM, Romme E et al (2019) Thoracic kyphosis on chest CT scans is associated with incident vertebral fractures in smokers. J Bone Min Res 34(5):859e66. https:\/\/doi.org\/10.1002\/jbmr.3672","journal-title":"J Bone Min Res"},{"issue":"3","key":"6330_CR11","doi-asserted-by":"publisher","first-page":"399e411","DOI":"10.1007\/s00198-020-05804-3","volume":"32","author":"WF Lems","year":"2021","unstructured":"Lems WF, Paccou J, Zhang J et al (2021) Vertebral fracture: epidemiology, impact and use of DXA vertebral fracture assessment in fracture liaison services. Osteoporos Int 32(3):399e411. https:\/\/doi.org\/10.1007\/s00198-020-05804-3","journal-title":"Osteoporos Int"},{"key":"6330_CR12","doi-asserted-by":"publisher","unstructured":"Aubry-Rozier B, Gonzalez-Rodriguez E, Stoll D et al (2016) Severe spontaneous vertebral fractures after denosumab dis continuation: three case reports. Osteoporos. Int 2016;27:1923-5. https:\/\/doi.org\/10.1007\/s00198-015-3380-y","DOI":"10.1007\/s00198-015-3380-y"},{"key":"6330_CR13","doi-asserted-by":"publisher","unstructured":"Blank RD, FRAX\u00ae Position Development Conference Members (2011) Official Positions for FRAX\u00ae Clinical Regarding Prior Fractures: From Joint Official Positions Development Conference of the International Society for Clinical Densitometry and International Osteoporosis Foundation on FRAX\u00ae. J Clin Densitometry 14(3). https:\/\/doi.org\/10.1016\/j.jocd.2011.05.009","DOI":"10.1016\/j.jocd.2011.05.009"},{"key":"6330_CR14","unstructured":"https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/fragility-fractures"},{"key":"6330_CR15","doi-asserted-by":"publisher","first-page":"101437","DOI":"10.1016\/j.jocd.2023.101437","volume":"27","author":"D Krueger","year":"2024","unstructured":"Krueger D, Tanner SB, Szalat A et al (2024) DXA reporting updates: 2023 official positions of the International Society for Clinical Densitometry. J Clin Densitom 27:101437. https:\/\/doi.org\/10.1016\/j.jocd.2023.101437","journal-title":"J Clin Densitom"},{"key":"6330_CR16","doi-asserted-by":"publisher","unstructured":"Park SY, Kwon S, Kim KJ et al (2026) Development of Simple Assessment tool for predict imminent osteoporotic fracture. Korean J Intern Med 1;41(2):277\u2013285. https:\/\/doi.org\/10.3904\/kjim.2025.227","DOI":"10.3904\/kjim.2025.227"},{"key":"6330_CR17","doi-asserted-by":"crossref","unstructured":"Cosman F, Lewiecki EM, Ebeling PR et al (2020) T-score as an indicator of fracture risk during treatment with romosozumab or alendronate in the ARCH trial. J. Bone Miner. Res. 35(7):1333\u20134210.1002\/jbmr.3996","DOI":"10.1002\/jbmr.3996"},{"key":"6330_CR18","doi-asserted-by":"crossref","unstructured":"Ferrari S, Libanati C, Lin CJF et al (2019) Relationship between bone mineral density T-score and nonvertebral fracture risk over 10 years of denosumab treatment. J. Bone Miner. Res 34(6):1033\u20134010.1002\/jbmr.3722","DOI":"10.1002\/jbmr.3722"},{"key":"6330_CR19","doi-asserted-by":"crossref","unstructured":"Black DM, Schwartz AV, Ensrud KE et al (2006) Effects of continuing or stopping alendronate after 5 years of treatment: the Fracture Intervention Trial Long-term Extension (FLEX): a randomized trial. JAMA 296(24):2927\u20133810.1001\/jama.296.24.2927","DOI":"10.1001\/jama.296.24.2927"},{"key":"6330_CR20","doi-asserted-by":"publisher","unstructured":"Carey J, Wu CH, \u5433\u81f3\u884c, Bergin D (2022) Risk assessment tools for osteoporosis and fractures. https:\/\/doi.org\/10.1016\/j.berh.2022.101775","DOI":"10.1016\/j.berh.2022.101775"},{"issue":"3","key":"6330_CR21","doi-asserted-by":"publisher","first-page":"120e6","DOI":"10.1007\/BF01623272","volume":"3","author":"PD Ross","year":"1993","unstructured":"Ross PD, Genant HK, Davis JW et al (1993) Predicting vertebral fracture incidence from prevalent fractures and bone density among non-black, osteoporotic women. Osteoporos Int 3(3):120e6","journal-title":"Osteoporos Int"},{"issue":"6","key":"6330_CR22","doi-asserted-by":"publisher","first-page":"761e70","DOI":"10.1007\/s00198-006-0306-8","volume":"18","author":"ES Siris","year":"2007","unstructured":"Siris ES, Genant HK, Laster AJ et al (2007) Enhanced prediction of fracture risk combining vertebral fracture status and BMD. Osteoporos Int 18(6):761e70","journal-title":"Osteoporos Int"},{"key":"6330_CR23","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-026-07925-7","author":"JA Kanis","year":"2026","unstructured":"Kanis JA, McCloskey EV, Johansson H et al (2026) Predictive value of BMD for hip and other fractures: a meta-analysis to update FRAX. Osteoporos Int https\/\/. https:\/\/doi.org\/10.1007\/s00198-026-07925-7","journal-title":"Osteoporos Int https\/\/"},{"issue":"4","key":"6330_CR24","doi-asserted-by":"publisher","first-page":"57622","DOI":"10.52965\/001c.57622","volume":"14","author":"E Kirilova","year":"2022","unstructured":"Kirilova E, Kirilov N, Bischoff F et al (2022) Prevalence of low bone mineral density at axial sites and fracture risk in Bulgarian population. Orthop Rev 14(4):57622. https:\/\/doi.org\/10.52965\/001c.57622","journal-title":"Orthop Rev"},{"key":"6330_CR25","doi-asserted-by":"publisher","first-page":"39e43","DOI":"10.1016\/j.bone.2016.12.016","volume":"104","author":"HP Dimai","year":"2017","unstructured":"Dimai HP (2017) Use of dual-energy X-ray absorptiometry (DXA) for diagnosis and fracture risk assessment; WHO-criteria, T and Z-score, and reference databases. Bone 104:39e43","journal-title":"Bone"},{"key":"6330_CR26","unstructured":"Vladeva S, Bischoff E, Kirilov N et al (2022) Assessment of the Radiofrequency echographic multi-spectrometry (REMS) based fragility score of the lumbar spine and total fracture risk at 5 years. Rheumatology International Manuscript number: RHEI-D-23-00814, electronic ISSN: 1437-160X, Scopus, IF 4.0"},{"issue":"10","key":"6330_CR27","doi-asserted-by":"publisher","first-page":"1393","DOI":"10.1093\/jbmr\/zjae119","volume":"39","author":"F Cosman","year":"2024","unstructured":"Cosman F, Lewiecki EM, Eastell R et al (2024) Goal-directed osteoporosis treatment: ASBMR\/BHOF task force position statement 2024. J Bone Miner Res 39(10):1393\u20131405. https:\/\/doi.org\/10.1093\/jbmr\/zjae119","journal-title":"J Bone Miner Res"},{"key":"6330_CR28","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1007\/s40520-025-02973-1","volume":"37","author":"C Panait","year":"2025","unstructured":"Panait C, Amelio PD (2025) Advancing care: optimizing osteoporosis treatment in the older and oldest old population. Aging Clin Exp Res 37:123. https:\/\/doi.org\/10.1007\/s40520-025-02973-1","journal-title":"Aging Clin Exp Res"},{"issue":"1","key":"6330_CR29","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1002\/cpt.70270","volume":"120","author":"KH Lu","year":"2026","unstructured":"Lu KH, Wang SI, Yang SF (2026) Denosumab Offers Relatively Lower Initial Protection Against Osteoporotic Vertebral Fractures in Treatment-Naive Patients Compared With Zoledronate. Clin Pharmacol Ther 120(1):139\u2013149. https:\/\/doi.org\/10.1002\/cpt.70270","journal-title":"Clin Pharmacol Ther"},{"key":"6330_CR30","doi-asserted-by":"publisher","unstructured":"Kobayashi T, Morimoto T, Ito K et al (2024) Denosumab vs. bisphosphonates in primary osteoporosis: a meta-analysis of comparative safety in randomized controlled trials. Osteoporos Int 35:1377\u20131393. https:\/\/doi.org\/10.1007\/s00198-024-07118-0 PMID: 38733394","DOI":"10.1007\/s00198-024-07118-0"},{"key":"6330_CR31","doi-asserted-by":"publisher","first-page":"641","DOI":"10.1007\/s00198-022-06626-1","volume":"34","author":"G Yu","year":"2023","unstructured":"Yu G, Tong S, Liu J et al (2023) A systematic review of cost-effectiveness analyses of sequential treatment for osteoporosis. Osteoporos Int 34:641\u2013658","journal-title":"Osteoporos Int"},{"key":"6330_CR32","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1007\/s00296-010-1586-z","volume":"31","author":"P Salari Sharif","year":"2011","unstructured":"Salari Sharif P, Abdollahi M, Larijani B (2011) Current, new and future treatments of osteoporosis. Rheumatol Int 31:289\u2013300 - DOI \u2013 PubMed","journal-title":"Rheumatol Int"}],"container-title":["Rheumatology International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00296-026-06330-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00296-026-06330-x","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00296-026-06330-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T19:03:43Z","timestamp":1792263823000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00296-026-06330-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,17]]},"references-count":32,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2026,11]]}},"alternative-id":["6330"],"URL":"https:\/\/doi.org\/10.1007\/s00296-026-06330-x","relation":{},"ISSN":["1437-160X"],"issn-type":[{"value":"1437-160X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,17]]},"assertion":[{"value":"10 September 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 October 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 October 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare that they have no conflict of interest regarding the authorship and\/or publication of this article.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was designed in accordance with the Declaration of Helsinki. This article contains no studies involving humans conducted by any of the authors. Collection of anonymized patient data was approved by the Professional Ethics Committee for Medical Scientific Research at Prof. Dr. Asen Zlatarov University, Burgas (Protocol No. 4\/23.04.2025). The documented data had not been published previously. Patients were treated in accordance with the recommendations and guidelines set out in \u201cEthical Issues in Patient Safety Research: Interpretation of Existing Guidelines,\u201d approved by WHO.","order":2,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"No part of this article has been copied, published elsewhere, or generated by AI.","order":3,"name":"Ethics","label":"AI use statement","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"290"}}