{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T13:30:41Z","timestamp":1791898241262,"version":"4.3.4"},"reference-count":57,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2025,9,19]],"date-time":"2025-09-19T00:00:00Z","timestamp":1758240000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Inflammaging has been implicated in age-related bone loss and fragility fractures through immune-mediated effects on bone turnover. We aimed to explore the relationship between systemic inflammatory markers and bone health in older adults, focusing on the differences between patients with osteoporotic fractures and non-fractured controls. We retrospectively analyzed 40 older patients (20 with hip fractures and 20 with osteoarthritis without prior fragility fractures). We compared routine inflammatory markers, including red cell distribution width (RDW), C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), and the composite CRP\u2013albumin\u2013lymphocyte index (CALLY), between groups. Bone mineral density (BMD) at the hip, lumbar spine, and wrist, as well as the FRAX score, were assessed. Correlations between inflammatory markers, BMD, and FRAX scores were evaluated using Spearman\u2019s coefficient. Patients with fractures exhibited significantly elevated CRP (66.2 \u00b1 70.3 vs. 3.8 \u00b1 4.0 mg\/L, p = 0.0008) and SII (1399.7 \u00b1 1143.4 vs. 751.4 \u00b1 400.8, p = 0.025) compared to controls. RDW, NLR, and CALLY scores did not differ significantly between the groups. Higher CRP levels were associated with lower BMD at all sites (hip: r \u2248 \u22120.63, p = 0.002; spine: r \u2248 \u22120.60, p = 0.005; wrist: r \u2248 \u22120.60, p = 0.005). No significant correlations were observed between the SII and BMD or FRAX values. Elevated systemic inflammation, particularly indicated by CRP and SII, was associated with osteoporotic fracture status and low bone density in our cohort. These findings support the concept that inflammatory pathways may contribute to osteoporosis and fracture risk and suggest that inflammatory markers could serve as adjunctive tools in fracture risk assessment. Further studies are required to clarify the causality and evaluate whether targeting chronic inflammation can improve bone health in older adults.<\/jats:p>","DOI":"10.3390\/ijms26189138","type":"journal-article","created":{"date-parts":[[2025,9,19]],"date-time":"2025-09-19T10:08:58Z","timestamp":1758276538000},"page":"9138","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Systemic Inflammation in Hip Fracture and Osteoarthritis: Insights into Pathways of Immunoporosis"],"prefix":"10.3390","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0190-4402","authenticated-orcid":false,"given":"Bernardo Abel","family":"Cedeno-Veloz","sequence":"first","affiliation":[{"name":"Navarre University Hospital (HUN), Navarrabiomed, Institute for Health Research of Navarra (IdiSNA), 31008 Pamplona, Spain"},{"name":"Heath Sciences Department, Public University of Navarre, 31006 Pamplona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alba Mar\u00eda","family":"Rodriguez-Garcia","sequence":"additional","affiliation":[{"name":"Navarre University Hospital (HUN), Navarrabiomed, Institute for Health Research of Navarra (IdiSNA), 31008 Pamplona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8377-9827","authenticated-orcid":false,"given":"Fabricio","family":"Zambom-Ferraresi","sequence":"additional","affiliation":[{"name":"Navarre University Hospital (HUN), Navarrabiomed, Institute for Health Research of Navarra (IdiSNA), 31008 Pamplona, Spain"},{"name":"Heath Sciences Department, Public University of Navarre, 31006 Pamplona, Spain"},{"name":"CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Av Monforte de Lemos, 3-5, Pabell\u00f3n 11, Planta 0, 28029 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soledad","family":"Dom\u00ednguez-Mendoza","sequence":"additional","affiliation":[{"name":"Navarre University Hospital (HUN), Navarrabiomed, Institute for Health Research of Navarra (IdiSNA), 31008 Pamplona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Guruceaga-Eguillor","sequence":"additional","affiliation":[{"name":"Navarre University Hospital (HUN), Navarrabiomed, Institute for Health Research of Navarra (IdiSNA), 31008 Pamplona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Virginia","family":"Ruiz-Izquieta","sequence":"additional","affiliation":[{"name":"Navarre University Hospital (HUN), Navarrabiomed, Institute for Health Research of Navarra (IdiSNA), 31008 Pamplona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1641-3881","authenticated-orcid":false,"given":"Juan Jose","family":"Lasarte","sequence":"additional","affiliation":[{"name":"Immunology and Immunotherapy Program, Centre for Applied Medical Research (CIMA), University of Navarra, IdiSNA, 31008 Pamplona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9576-9960","authenticated-orcid":false,"given":"Nicol\u00e1s","family":"Martinez-Velilla","sequence":"additional","affiliation":[{"name":"Navarre University Hospital (HUN), Navarrabiomed, Institute for Health Research of Navarra (IdiSNA), 31008 Pamplona, Spain"},{"name":"Heath Sciences Department, Public University of Navarre, 31006 Pamplona, Spain"},{"name":"CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Av Monforte de Lemos, 3-5, Pabell\u00f3n 11, Planta 0, 28029 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1007\/s00198-018-4704-5","article-title":"European Guidance for the Diagnosis and Management of Osteoporosis in Postmenopausal Women","volume":"30","author":"Kanis","year":"2019","journal-title":"Osteoporos. Int."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1007\/s11657-020-0706-y","article-title":"Fragility Fractures in Europe: Burden, Management and Opportunities","volume":"15","author":"Karlsson","year":"2020","journal-title":"Arch. Osteoporos."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e018898","DOI":"10.1136\/bmjopen-2017-018898","article-title":"Does Bone Mineral Density Improve the Predictive Accuracy of Fracture Risk Assessment? A Prospective Cohort Study in Northern Denmark","volume":"8","author":"Dhiman","year":"2018","journal-title":"BMJ Open"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1215","DOI":"10.14336\/AD.2021.1206","article-title":"Prediction Models for Osteoporotic Fractures Risk: A Systematic Review and Critical Appraisal","volume":"13","author":"Sun","year":"2022","journal-title":"Aging Dis."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"103169","DOI":"10.1016\/j.jaut.2024.103169","article-title":"Age-Related Bone Diseases: Role of Inflammaging","volume":"143","author":"Bi","year":"2024","journal-title":"J. Autoimmun."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"102822","DOI":"10.1016\/j.arr.2025.102822","article-title":"Osteoimmunology and Aging: Mechanisms, Implications, and Therapeutic Perspectives","volume":"111","author":"Wang","year":"2025","journal-title":"Ageing Res. Rev."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"116540","DOI":"10.1016\/j.bone.2022.116540","article-title":"Cytokine-Mediated Immunomodulation of Osteoclastogenesis","volume":"164","author":"Zhou","year":"2022","journal-title":"Bone"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Zhang, W., Gao, R., Rong, X., Zhu, S., Cui, Y., Liu, H., and Li, M. (2022). Immunoporosis: Role of Immune System in the Pathophysiology of Different Types of Osteoporosis. Front. Endocrinol., 13.","DOI":"10.3389\/fendo.2022.965258"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1186\/s40001-025-02893-w","article-title":"Association between Immune-Inflammatory Index and Osteoporosis: A Systematic Review and Meta-Analysis","volume":"30","author":"Bai","year":"2025","journal-title":"Eur. J. Med. Res."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Little-Letsinger, S.E. (2023). Serum High Sensitivity C-Reactive Protein Poorly Predicts Bone Mineral Density: A NHANES 2017\u20132020 Analysis. PLoS ONE, 18.","DOI":"10.1101\/2023.06.22.23291785"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e081250","DOI":"10.1136\/bmj-2024-081250","article-title":"Advances in the Management of Osteoporosis","volume":"390","author":"Hoong","year":"2025","journal-title":"BMJ"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Salimi, M., Khanzadeh, M., Nabipoorashrafi, S.A., Seyedi, S.A., Yaghoobpoor, S., Brism\u00e9e, J.-M., Lucke-Wold, B., Ebadi, M., Ghaedi, A., and Kumar, V.S. (2024). Association of Neutrophil to Lymphocyte Ratio with Bone Mineral Density in Post-Menopausal Women: A Systematic Review and Meta-Analysis. BMC Women\u2019s Health, 24.","DOI":"10.1186\/s12905-024-03006-1"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Panebianco, P., Testa, G., Barbagallo, G., Costarella, L., Caldaci, A., Condorelli, S., Sapienza, M., and Pavone, V. (2025). The Correlations of the Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio with Bone Mineral Density in Postmenopausal Women: A Cross-Sectional Study. Osteology, 5.","DOI":"10.20944\/preprints202503.1285.v1"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e992","DOI":"10.1002\/iid3.992","article-title":"High Systemic Immune-inflammation Index Is Relevant to Osteoporosis among Middle-aged and Older People: A Cross-sectional Study","volume":"11","author":"Zhang","year":"2023","journal-title":"Immun. Inflam. Dis."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"869","DOI":"10.1002\/jbmr.3963","article-title":"Red Cell Distribution Width Is a Risk Factor for Hip Fracture in Elderly Men Without Anemia","volume":"35","author":"Kim","year":"2020","journal-title":"J. Bone Miner. Res."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Zhang, J., Lin, Y., Zeng, J., Luo, G., Liao, P., Chen, Q., Zhong, H., Liang, S., Zhou, C., and Yang, B. (2025). The C-Reactive Protein (CRP)-Albumin-Lymphocyte (CALLY) Index Exhibits an L-Shaped Association with All-Cause Mortality in Rheumatoid Arthritis Patients: A Retrospective Cohort Study. BMC Rheumatol., 9.","DOI":"10.1186\/s41927-025-00499-7"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1007\/s40265-024-02138-w","article-title":"Treatment of Osteoporosis and Osteoarthritis in the Oldest Old","volume":"85","author":"Fuggle","year":"2025","journal-title":"Drugs"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1007\/s11926-013-0328-0","article-title":"Osteoarthritis and Osteoporosis: What Is the Overlap?","volume":"15","author":"Bultink","year":"2013","journal-title":"Curr. Rheumatol. Rep."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1591","DOI":"10.1007\/s00198-019-05015-5","article-title":"Correlation between Hip Osteoarthritis and Proximal Femoral Fracture Site: Could It Be Protective for Intracapsular Neck Fractures? A Retrospective Study on 320 Cases","volume":"30","author":"Maluta","year":"2019","journal-title":"Osteoporos. Int."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.job.2019.01.001","article-title":"RANKL-Independent Modulation of Osteoclastogenesis","volume":"61","author":"Feng","year":"2019","journal-title":"J. Oral Biosci."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Tylutka, A., Walas, \u0141., and Zembron-Lacny, A. (2024). Level of IL-6, TNF, and IL-1\u03b2 and Age-Related Diseases: A Systematic Review and Meta-Analysis. Front. Immunol., 15.","DOI":"10.3389\/fimmu.2024.1330386"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"703","DOI":"10.1136\/annrheumdis-2013-204494","article-title":"Circulating C Reactive Protein in Osteoarthritis: A Systematic Review and Meta-Analysis","volume":"74","author":"Jin","year":"2015","journal-title":"Ann. Rheum. Dis."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1111\/1440-1681.12758","article-title":"C-reactive Protein and Ageing","volume":"44","author":"Tang","year":"2017","journal-title":"Clin. Exp. Pharmacol. Physiol."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Perri, G., French, C., Agostinis-Sobrinho, C., Anand, A., Antarianto, R.D., Arai, Y., Baur, J.A., Cauli, O., Clivaz-Duc, M., and Colloca, G. (2025). An Expert Consensus Statement on Biomarkers of Aging for Use in Intervention Studies. J. Gerontol. Ser. A Biol. Sci. Med. Sci., 80.","DOI":"10.1093\/gerona\/glae297"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1186\/s12979-023-00379-z","article-title":"Effect of Immunology Biomarkers Associated with Hip Fracture and Fracture Risk in Older Adults","volume":"20","year":"2023","journal-title":"Immun. Ageing I A"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Yin, W., Li, X., Zheng, S., Lai, W., Chen, C., He, X., Gong, K., He, K., Hu, S., and Zheng, J. (2025). Association of Novel Inflammatory Markers with Osteoporosis Index in Older Spine Osteoporosis Patients: NHANES 1999\u20132018 Cross-Sectional Study. Sci. Rep., 15.","DOI":"10.1038\/s41598-025-93378-7"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1038\/s41423-021-00832-3","article-title":"Neutrophils in Chronic Inflammatory Diseases","volume":"19","author":"Soehnlein","year":"2022","journal-title":"Cell. Mol. Immunol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1160\/TH14-12-1067","article-title":"The Role of Platelets in Inflammation","volume":"114","author":"Thomas","year":"2015","journal-title":"Thromb. Haemost."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1038\/nrrheum.2014.164","article-title":"Fracture Healing: Mechanisms and Interventions","volume":"11","author":"Einhorn","year":"2015","journal-title":"Nat. Rev. Rheumatol."},{"key":"ref_30","first-page":"138","article-title":"Oxidative Stress as a Possible Therapeutic Target for Osteoporosis Associated with Aging","volume":"8","author":"Esbrit","year":"2016","journal-title":"Rev. Osteoporos. Y Metab. Miner."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"815","DOI":"10.2217\/imt-2021-0282","article-title":"Immunology of Osteoporosis: Relevance of Inflammatory Targets for the Development of Novel Interventions","volume":"14","author":"Ahmad","year":"2022","journal-title":"Immunotherapy"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"113156","DOI":"10.1016\/j.intimp.2024.113156","article-title":"Causal Associations between Circulating Immune Cells and Osteoarthritis: A Bidirectional Mendelian Randomization Study","volume":"142","author":"Xu","year":"2024","journal-title":"Int. Immunopharmacol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1038\/nrrheum.2016.136","article-title":"Low-Grade Inflammation as a Key Mediator of the Pathogenesis of Osteoarthritis","volume":"12","author":"Robinson","year":"2016","journal-title":"Nat. Rev. Rheumatol."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Liu, Y.-C., Yang, T.-I., Huang, S.-W., Kuo, Y.-J., and Chen, Y.-P. (2022). Associations of the Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio with Osteoporosis: A Meta-Analysis. Diagnostics, 12.","DOI":"10.3390\/diagnostics12122968"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"960","DOI":"10.12688\/f1000research.123245.1","article-title":"The Mechanistic Role of Neutrophil Lymphocyte Ratio Perturbations in the Leading Non Communicable Lifestyle Diseases","volume":"11","author":"Biswas","year":"2022","journal-title":"F1000Res"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1016\/j.joca.2021.12.003","article-title":"Association between Knee Inflammation and Knee Pain in Patients with Knee Osteoarthritis: A Systematic Review","volume":"30","author":"Dainese","year":"2022","journal-title":"Osteoarthr. Cartil."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"106145","DOI":"10.5312\/wjo.v16.i5.106145","article-title":"Role of Neutrophil to Lymphocyte Ratio in Osteoarthritis: A Systematic Review and Meta-Analysis","volume":"16","author":"Salimi","year":"2025","journal-title":"World J. Orthop."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Buonacera, A., Stancanelli, B., Colaci, M., and Malatino, L. (2022). Neutrophil to Lymphocyte Ratio: An Emerging Marker of the Relationships between the Immune System and Diseases. IJMS, 23.","DOI":"10.3390\/ijms23073636"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"101283","DOI":"10.1016\/j.beha.2021.101283","article-title":"Marrow Failure and Aging: The Role of \u201cInflammaging\u201d","volume":"34","author":"Zhao","year":"2021","journal-title":"Best Pract. Res. Clin. Haematol."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Li, W., Zhang, C., Wang, P., Dai, P., Xue, H., Zhang, L., Xu, J., and Gao, K. (2025). Association of the Red Blood Cell Distribution Width with Osteoarthritis Risk: A Cross-Sectional Study from NHANES 2009\u20132018. Res. Sq.","DOI":"10.21203\/rs.3.rs-6541651\/v1"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Demir Cendek, B., Bayraktar, B., Sapmaz, M.A., Y\u0131ld\u0131r\u0131m, A.E., Can Ibanoglu, M., and Engin Ustun, Y. (2024). The Role of Inflammatory and Nutritional Indices in Postmenopausal Osteoporosis: A Retrospective Study. JCM, 13.","DOI":"10.3390\/jcm13247741"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1016\/j.jamda.2014.10.018","article-title":"Phenotype of Osteosarcopenia in Older Individuals With a History of Falling","volume":"16","author":"Huo","year":"2015","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1186\/s13075-025-03530-x","article-title":"CRP-Albumin-Lymphocyte Index (CALLYI) as a Risk-Predicting Biomarker in Association with Osteoarthritis","volume":"27","author":"Geng","year":"2025","journal-title":"Arthritis Res. Ther."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Epsley, S., Tadros, S., Farid, A., Kargilis, D., Mehta, S., and Rajapakse, C.S. (2021). The Effect of Inflammation on Bone. Front. Physiol., 11.","DOI":"10.3389\/fphys.2020.511799"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Cataltepe, E., Ceker, E., Fadiloglu, A., Gungor, F., Karakurt, N., Ulger, Z., and Varan, H.D. (2025). Association between the Systemic Immune-Inflammation Index and Sarcopenia in Older Adults: A Cross-Sectional Study. BMC Geriatr., 25.","DOI":"10.1186\/s12877-025-05686-2"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"971","DOI":"10.1007\/s40520-021-02022-7","article-title":"Inflammatory Biomarkers in Older Adults with Frailty: A Systematic Review and Meta-Analysis of Cross-Sectional Studies","volume":"34","author":"Xu","year":"2022","journal-title":"Aging Clin. Exp. Res."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1186\/s40001-024-02211-w","article-title":"Impact of Hematologic Inflammatory Markers on the Prognosis of Geriatric Hip Fracture: A Systematic Review and Meta-Analysis","volume":"29","author":"Pan","year":"2024","journal-title":"Eur. J. Med. Res."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"32","DOI":"10.4321\/S1889-836X2021000100006","article-title":"Fisiopatolog\u00eda de La Osteoporosis En Las Enfermedades Articulares Inflamatorias Cr\u00f3nicas","volume":"13","year":"2021","journal-title":"Rev. Osteoporos. Metab. Min."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1002\/jcsm.13447","article-title":"Frailty Phenotype as Mediator between Systemic Inflammation and Osteoporosis and Fracture Risks: A Prospective Study","volume":"15","author":"Di","year":"2024","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_50","first-page":"101390","article-title":"Importance of Biomarkers in Osteoporosis: Advances in the Geroscience of the Older Adult","volume":"58","year":"2023","journal-title":"Rev. Esp. Geriatr. Y Gerontol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1097\/BOR.0000000000000256","article-title":"Osteoporosis and Osteoarthritis: Shared Mechanisms and Epidemiology","volume":"28","author":"Geusens","year":"2016","journal-title":"Curr. Opin. Rheumatol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"120847","DOI":"10.1016\/j.lfs.2022.120847","article-title":"Targeting Chronic Inflammation as a Potential Adjuvant Therapy for Osteoporosis","volume":"306","author":"Livshits","year":"2022","journal-title":"Life Sci."},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Amani, F., Amanzadeh, M., Hamedan, M., and Amani, P. (2024). Diagnostic Accuracy of Deep Learning in Prediction of Osteoporosis: A Systematic Review and Meta-Analysis. BMC Musculoskelet. Disord., 25.","DOI":"10.1186\/s12891-024-08120-7"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1002\/art.1780340502","article-title":"The American College of Rheumatology Criteria for the Classification and Reporting of Osteoarthritis of the Hip","volume":"34","author":"Altman","year":"1991","journal-title":"Arthritis Rheum."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1016\/j.ecl.2015.05.002","article-title":"Bone Health and Osteoporosis","volume":"44","author":"Lupsa","year":"2015","journal-title":"Endocrinol. Metab. Clin. N. Am."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1007\/s11657-018-0510-0","article-title":"A Brief History of FRAX","volume":"13","author":"Kanis","year":"2018","journal-title":"Arch. Osteoporos."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"W566","DOI":"10.1093\/nar\/gkv468","article-title":"ClustVis: A Web Tool for Visualizing Clustering of Multivariate Data Using Principal Component Analysis and Heatmap","volume":"43","author":"Metsalu","year":"2015","journal-title":"Nucleic Acids Res."}],"container-title":["International Journal of Molecular Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1422-0067\/26\/18\/9138\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:48:46Z","timestamp":1760035726000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1422-0067\/26\/18\/9138"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,19]]},"references-count":57,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["ijms26189138"],"URL":"https:\/\/doi.org\/10.3390\/ijms26189138","relation":{},"ISSN":["1422-0067"],"issn-type":[{"value":"1422-0067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,19]]}}}