{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T04:53:40Z","timestamp":1791262420233,"version":"4.1.0"},"reference-count":56,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Pregnancy and lactation-associated osteoporosis (PLO) is a rare disorder causing rapid bone loss and severe fragility fractures. While familial clusterings suggest genetic susceptibility, the specific clinical features, genetic landscape, and skeletal recovery trajectory of PLO remain poorly characterized in non-Caucasian populations. This study aimed to evaluate a Taiwanese PLO cohort to optimize diagnostic awareness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Eleven postpartum women with PLO were evaluated using bone densitometry and spinal imaging. Whole-exome sequencing was performed utilizing a targeted 398-gene skeletal disease virtual panel. Patients were followed longitudinally for a median of 25 months during lactation cessation and\/or targeted bone therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Seven women developed symptoms after their first pregnancy and four after their second. Vertebral fractures occurred in 91% (10\/11) of patients, 80% (8\/10) of whom had multi-level involvement predominantly localized to the thoracolumbar spine (T3-L5, peaking at T11-L2). Baseline lumbar bone mineral density (BMD) was significantly lower than hip sites (\n                      <jats:italic>P<\/jats:italic>\n                      =\u00a00.018). Genetic variants were identified in 10 of 11 patients (91%), with six individuals harboring pathogenic variants in\n                      <jats:italic>WNT1<\/jats:italic>\n                      ,\n                      <jats:italic>LRP5<\/jats:italic>\n                      ,\n                      <jats:italic>COL10A1<\/jats:italic>\n                      ,\n                      <jats:italic>LTBP3<\/jats:italic>\n                      , and\n                      <jats:italic>CALCR<\/jats:italic>\n                      . Patients with pathogenic variants exhibited significantly lower lumbar spine BMD than those without (Z-scores: -3.7 vs. -3.0;\n                      <jats:italic>P<\/jats:italic>\n                      =\u00a00.043). Post-treatment, the cohort\u2019s median Z-score improved from -3.5 to -2.3 (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.005), though none achieved a score above -1.0.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our findings suggest a significant genetic burden associated with PLO, potentially revealed by pregnancy and lactation stressors. The predominance of vertebral bone loss highlights acute postpartum back pain as a notable clinical sign warranting further investigation. Optimizing long-term maternal outcomes may require rapid diagnostic evaluation, prompt lactation cessation, and the future integration of genotype-informed management strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1930247","type":"journal-article","created":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T04:25:09Z","timestamp":1791260709000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["High genetic predisposition and vertebral fracture burden in pregnancy and lactation-associated osteoporosis: clinical insights from a Taiwanese cohort"],"prefix":"10.3389","volume":"17","author":[{"given":"Wei-Yih","family":"Chiu","sequence":"first","affiliation":[{"name":"Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine","place":["Taipei, Taiwan"]},{"name":"Department of Laboratory Medicine, National Taiwan University Hospital","place":["Taipei, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu-An","family":"Chen","sequence":"additional","affiliation":[{"name":"Graduate Institute of Medical Genomics and Proteomics, College of Medicine, National Taiwan University College of Medicine","place":["Taipei, Taiwan"]},{"name":"Department of Medical Research, National Taiwan University Hospital Hsin-Chu Branch","place":["Hsinchu, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shyang-Rong","family":"Shih","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine","place":["Taipei, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rong-Sen","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, National Taiwan University Hospital","place":["Taipei, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming-Hsiao","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, National Taiwan University Hospital","place":["Taipei, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen-Ping","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Metabolism and Endocrinology, Taipei City Hospital, Renai Branch","place":["Taipei, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pei-Lung","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine","place":["Taipei, Taiwan"]},{"name":"Graduate Institute of Medical Genomics and Proteomics, College of Medicine, National Taiwan University College of Medicine","place":["Taipei, Taiwan"]},{"name":"Department of Medical Genetics, National Taiwan University Hospital","place":["Taipei, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keh-Sung","family":"Tsai","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine","place":["Taipei, Taiwan"]},{"name":"Department of Laboratory Medicine, National Taiwan University Hospital","place":["Taipei, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei-Shiung","family":"Yang","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine","place":["Taipei, Taiwan"]},{"name":"Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University","place":["Taipei, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,10,6]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2024.1494965","article-title":"Current and future perspectives on pregnancy and lactation-associated osteoporosis","volume":"15","author":"Gak","year":"2024","journal-title":"Front Endocrinol (Lausanne)"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1007\/s00223-021-00815-6","article-title":"Pregnancy and lactation associated osteoporosis","volume":"110","author":"Hardcastle","year":"2022","journal-title":"Calcif Tissue Int"},{"key":"B3","doi-asserted-by":"publisher","first-page":"926","DOI":"10.1186\/s12891-021-04776-7","article-title":"Pregnancy- and lactation-associated osteoporosis with vertebral fractures: a systematic review","volume":"22","author":"Qian","year":"2021","journal-title":"BMC Musculoskelet Disord"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1155\/2014\/287832","article-title":"A rare cause of postpartum low back pain: pregnancy- and lactation-associated osteoporosis","volume":"2014","author":"Terzi","year":"2014","journal-title":"BioMed Res Int"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1007\/s00223-023-01139-3","article-title":"Clinical features, incidence and treatment outcome in pregnancy-associated osteoporosis: a single-centre experience over two decades","volume":"113","author":"Orhadje","year":"2023","journal-title":"Calcif Tissue Int"},{"key":"B6","doi-asserted-by":"publisher","first-page":"301","DOI":"10.1186\/s12884-024-06520-0","article-title":"Pregnancy and lactation-associated osteoporosis as a major type of premenopausal osteoporosis: a retrospective cohort study based on real-world data","volume":"24","author":"Kasahara","year":"2024","journal-title":"BMC Pregnancy Childbirth"},{"key":"B7","first-page":"697","article-title":"Pregnancy associated osteoporosis: the familial effect","volume":"20","author":"Peris","year":"2002","journal-title":"Clin Exp Rheumatol"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1016\/j.bone.2021.115911","article-title":"Relevant genetic variants are common in women with pregnancy and lactation-associated osteoporosis (PLO) and predispose to more severe clinical manifestations","volume":"147","author":"Butscheidt","year":"2021","journal-title":"Bone"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1016\/j.bone.2025.117744","article-title":"Genetic contributors to osteoporosis in pregnancy and lactation associated osteoporosis (PLO)","volume":"204","author":"Lynch","year":"2026","journal-title":"Bone"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocd.2023.101435","article-title":"Executive summary of the 2023 adult position development conference of the International Society for Clinical Densitometry: dxa reporting, follow-up bmd testing and trabecular bone score application and reporting","volume":"27","author":"Shuhart","year":"2024","journal-title":"J Clin Densitom"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1002\/jbmr.5650080915","article-title":"Vertebral fracture assessment using a semiquantitative technique","volume":"8","author":"Genant","year":"1993","journal-title":"J Bone Miner Res"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1038\/s41587-024-02382-1","article-title":"Comprehensive genome analysis and variant detection at scale using dragen","volume":"43","author":"Behera","year":"2025","journal-title":"Nat Biotechnol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"122","DOI":"10.1186\/s13059-016-0974-4","article-title":"The ensembl variant effect predictor","volume":"17","author":"McLaren","year":"2016","journal-title":"Genome Biol"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1038\/ng.2892","article-title":"A general framework for estimating the relative pathogenicity of human genetic variants","volume":"46","author":"Kircher","year":"2014","journal-title":"Nat Genet"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1016\/j.cell.2018.12.015","article-title":"Predicting splicing from primary sequence with deep learning","volume":"176","author":"Jaganathan","year":"2019","journal-title":"Cell"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1038\/gim.2015.30","article-title":"Standards and guidelines for the interpretation of sequence variants: a joint consensus recommendation of the American College of Medical Genetics and Genomics and the Association for Molecular Pathology","volume":"17","author":"Richards","year":"2015","journal-title":"Genet Med"},{"key":"B17","unstructured":"Taiwan Ai Labs, Taigenomics, Gendiseak Platform"},{"key":"B18","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1186\/s40246-025-00778-x","article-title":"Toward streamline variant classification: discrepancies in variant nomenclature and syntax for clinvar pathogenic variants across annotation tools","volume":"19","author":"Chen","year":"2025","journal-title":"Hum Genomics"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1093\/nar\/gkx1153","article-title":"Clinvar: improving access to variant interpretations and supporting evidence","volume":"46","author":"Landrum","year":"2018","journal-title":"Nucleic Acids Res"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1093\/bioinformatics\/bty897","article-title":"Varsome: the human genomic variant search engine","volume":"35","author":"Kopanos","year":"2019","journal-title":"Bioinformatics"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1111\/cge.14516","article-title":"Genebe.Net: implementation and validation of an automatic acmg variant pathogenicity criteria assignment","volume":"106","author":"Stawinski","year":"2024","journal-title":"Clin Genet"},{"key":"B22","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1007\/s00223-025-01381-x","article-title":"Gene variants and bisphosphonates treatment in pregnancy and lactation-associated osteoporosis (PLO): a retrospective study of 22 Chinese patients","volume":"116","author":"Fu","year":"2025","journal-title":"Calcif Tissue Int"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1093\/jbmr\/zjae078","article-title":"Genetic predisposition to bone mineral density and their health conditions in East Asians","volume":"39","author":"Lin","year":"2024","journal-title":"J Bone Miner Res"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1038\/nm.3074","article-title":"Wnt signaling in bone homeostasis and disease: from human mutations to treatments","volume":"19","author":"Baron","year":"2013","journal-title":"Nat Med"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1215458","article-title":"Wnt1 mutations in early-onset osteoporosis and osteogenesis imperfecta","volume":"368","author":"Laine","year":"2013","journal-title":"N Engl J Med"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajhg.2013.02.010","article-title":"Mutations in Wnt1 cause different forms of bone fragility","volume":"92","author":"Keupp","year":"2013","journal-title":"Am J Hum Genet"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1002\/ajmg.a.63987","article-title":"Osteoporosis caused by monoallelic variant of Wnt1 gene in four pediatric patients","volume":"197","author":"Wang","year":"2025","journal-title":"Am J Med Genet A"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1111\/ahg.12399","article-title":"The role of Wnt1 mutant variant (Wnt1 c.677 C>T) in osteogenesis imperfecta","volume":"84","author":"Zhang","year":"2020","journal-title":"Ann Hum Genet"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgac752","article-title":"Genotypic and phenotypic spectrum and pathogenesis of Wnt1 variants in a large cohort of patients with OI\/osteoporosis","volume":"108","author":"Hu","year":"2023","journal-title":"J Clin Endocrinol Metab"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1359\/JBMR.050101","article-title":"Heterozygous mutations in the LDL receptor-related protein 5 (LRP5) gene are associated with primary osteoporosis in children","volume":"20","author":"Hartikka","year":"2005","journal-title":"J Bone Miner Res"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.2009.03680.x","article-title":"Low density lipoprotein receptor-related protein 5 (LRP5) mutations and osteoporosis, impaired glucose metabolism and hypercholesterolaemia","volume":"72","author":"Saarinen","year":"2010","journal-title":"Clin Endocrinol (Oxf)"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1016\/j.bone.2005.06.017","article-title":"LRP5 gene polymorphisms and idiopathic osteoporosis in men","volume":"37","author":"Ferrari","year":"2005","journal-title":"Bone"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-018-4499-4","article-title":"Mutational analysis uncovers monogenic bone disorders in women with pregnancy-associated osteoporosis: three novel mutations in LRP5, COL1A1, and COL1A2","volume":"29","author":"Butscheidt","year":"2018","journal-title":"Osteoporos Int"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2013-3238","article-title":"Osteoporotic vertebral fractures during pregnancy: be aware of a potential underlying genetic cause","volume":"99","author":"Campos-Obando","year":"2014","journal-title":"J Clin Endocrinol Metab"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1007\/s43465-024-01152-0","article-title":"Screening and analysis of core genes for osteoporosis based on bioinformatics analysis and machine learning algorithms","volume":"58","author":"Lu","year":"2024","journal-title":"Indian J Orthop"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1006\/bbrc.1998.8445","article-title":"Allelic variants of human calcitonin receptor: distribution and association with bone mass in postmenopausal Italian women","volume":"245","author":"Masi","year":"1998","journal-title":"Biochem Biophys Res Commun"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1172\/JCI116046","article-title":"Cloning, characterization, and expression of a human calcitonin receptor from an ovarian carcinoma cell line","volume":"90","author":"Gorn","year":"1992","journal-title":"J Clin Invest"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1210\/mend.9.8.7476993","article-title":"Functionally different isoforms of the human calcitonin receptor result from alternative splicing of the gene transcript","volume":"9","author":"Moore","year":"1995","journal-title":"Mol Endocrinol"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pgen.1001372","article-title":"Genome-wide association study using extreme truncate selection identifies novel genes affecting bone mineral density and fracture risk","volume":"7","author":"Duncan","year":"2011","journal-title":"PloS Genet"},{"key":"B40","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1530\/JOE-20-0599","article-title":"The calcitonin receptor regulates osteocyte lacunae acidity during lactation in mice","volume":"249","author":"Davey","year":"2021","journal-title":"J Endocrinol"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2020.00613","article-title":"Calcitonin induces bone formation by increasing expression of Wnt10b in osteoclasts in ovariectomy-induced osteoporotic rats","volume":"11","author":"Hsiao","year":"2020","journal-title":"Front Endocrinol (Lausanne)"},{"key":"B42","doi-asserted-by":"publisher","first-page":"449","DOI":"10.1152\/physrev.00027.2015","article-title":"Maternal mineral and bone metabolism during pregnancy, lactation, and post-weaning recovery","volume":"96","author":"Kovacs","year":"2016","journal-title":"Physiol Rev"},{"key":"B43","doi-asserted-by":"publisher","DOI":"10.3389\/fphys.2023.1121579","article-title":"Crosstalk within a brain-breast-bone axis regulates mineral and skeletal metabolism during lactation","volume":"14","author":"Athonvarangkul","year":"2023","journal-title":"Front Physiol"},{"key":"B44","doi-asserted-by":"publisher","DOI":"10.1016\/j.bone.2013.01.025","article-title":"Osteocytes remove and replace perilacunar mineral during reproductive cycles","volume":"54","author":"Wysolmerski","year":"2013","journal-title":"Bone"},{"key":"B45","doi-asserted-by":"publisher","DOI":"10.1016\/j.ecl.2024.05.003","article-title":"Bone metabolism, bone mass, and bone structure during pregnancy and lactation: normal physiology and pregnancy and lactation-associated osteoporosis","volume":"53","author":"Cohen","year":"2024","journal-title":"Endocrinol Metab Clin North Am"},{"key":"B46","doi-asserted-by":"publisher","DOI":"10.1038\/s41586-024-07634-3","article-title":"A maternal brain hormone that builds bone","volume":"632","author":"Babey","year":"2024","journal-title":"Nature"},{"key":"B47","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.1993.tb02398.x","article-title":"Pregnancy associated osteoporosis","volume":"39","author":"Dunne","year":"1993","journal-title":"Clin Endocrinol (Oxf)"},{"key":"B48","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-006-0112-3","article-title":"Bisphosphonates in pregnancy and lactation-associated osteoporosis","volume":"17","author":"O'Sullivan","year":"2006","journal-title":"Osteoporos Int"},{"key":"B49","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-016-3897-8","article-title":"Pregnancy-associated osteoporosis: a case-control study","volume":"28","author":"Hadji","year":"2017","journal-title":"Osteoporos Int"},{"key":"B50","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2025.1612188","article-title":"Identifying risk factors for pregnancy and lactation-associated osteoporosis: insights from an Italian survey in PLAO patients and controls","volume":"16","author":"Grassi","year":"2025","journal-title":"Front Endocrinol (Lausanne)"},{"key":"B51","doi-asserted-by":"publisher","DOI":"10.1002\/ijgo.71203","article-title":"Pregnancy- and lactation-associated osteoporosis: A position statement of the IAPM, IOF, ECTS, ESCEO, IMS, and EMAS","author":"Hadji","year":"2026","journal-title":"Int J Gynaecol Obstet"},{"key":"B52","doi-asserted-by":"publisher","first-page":"879","DOI":"10.1210\/clinem\/dgad548","article-title":"Comparative effectiveness of therapeutic interventions in pregnancy and lactation-associated osteoporosis: A systematic review and meta-analysis","volume":"109","author":"Anagnostis","year":"2024","journal-title":"J Clin Endocrinol Metab"},{"key":"B53","doi-asserted-by":"publisher","DOI":"10.1007\/s00774-008-0028-4","article-title":"Bone mineral density measurement in puerperal women as a predictor of persistent osteopenia","volume":"27","author":"Kurabayashi","year":"2009","journal-title":"J Bone Miner Metab"},{"key":"B54","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-017-4239-1","article-title":"Subsequent fracture risk of women with pregnancy and lactation-associated osteoporosis after a median of 6 years of follow-up","volume":"29","author":"Kyvernitakis","year":"2018","journal-title":"Osteoporos Int"},{"key":"B55","doi-asserted-by":"publisher","DOI":"10.1002\/jbmr.3018","article-title":"Irreversible deterioration of cortical and trabecular microstructure associated with breastfeeding","volume":"32","author":"Bjornerem","year":"2017","journal-title":"J Bone Miner Res"},{"key":"B56","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2014-2825","article-title":"Changes in cortical volumetric bone mineral density and thickness, and trabecular thickness in lactating women postpartum","volume":"100","author":"Brembeck","year":"2015","journal-title":"J Clin Endocrinol Metab"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1930247\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T04:25:11Z","timestamp":1791260711000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1930247\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,6]]},"references-count":56,"alternative-id":["10.3389\/fendo.2026.1930247"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2026.1930247","relation":{},"ISSN":["1664-2392"],"issn-type":[{"value":"1664-2392","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,6]]},"article-number":"1930247"}}