{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T14:12:45Z","timestamp":1789827165264,"version":"4.0.1"},"reference-count":57,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2025,8,8]],"date-time":"2025-08-08T00:00:00Z","timestamp":1754611200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>At Stavanger University Hospital (SUH), patients aged 50 years and above with a fracture after a fall are included in our Fracture Liaison Service (FLS) at the orthopaedic department, due to their high imminent fracture risk. The FLS at SUH keeps a quality registry, including index fractures, fall from standing\/walking, preventive factors, Dual Absorptiometry X-ray (DXA) results and treatment status, in addition to risk factors such as chronic diseases. As in many other hospitals and countries, the capacity of the DXA scanner at SUH does not meet the needs of the ageing population. As such, FLS patients should be prioritised for DXA scanning according to their need for anti-osteoporotic treatment. The aims of this study were (1) to identify whether any risk factors are more strongly associated with osteoporosis than others, and (2) to use this information as a tool to prioritise patients for which the decision to initiate anti-osteoporotic treatment should be assessed by a DXA scan. Method: We used software from CheckWare to keep a structured health record, submitting journal text to the health record and data to our fracture quality registry from 1 June 2022 to 31 December 2024. The fracture coverage of the registry, as part of the medical record, was 100%. Both men and women aged over 50 years with fragility-related fractures were included in the analysis, with index fracture having been reported within 24 months prior to FLS assessment. Exclusion criteria: short life expectancy (&lt;3 years), already started on anti-osteoporotic treatment, living in nursing home, age &gt;97 years, or multi-trauma patients. Statistics were calculated using SPSS and logistic regression. The results are presented as odds ratio (OR) and 95% confidence interval (95% CI). Significant differences were considered at a p-value of &lt;0.05. Results: A total of 6974 patients were included, 81% of which were female. After the DXA scan, 5307 of the patients were started on anti-osteoporotic treatment (76%). Patients aged 50\u201370 years were the largest group. Female patients or those aged 80 years or older had an increased odds ratio (OR) of starting treatment after a fracture. The index fractures included in the logistic regression analysis and were most likely to initiate anti-osteoporotic treatment in the FLS, were vertebral fracture (p &lt; 0.000, OR 3.1, 95% CI: 2.4\u20134.0), hip fracture (p &lt; 0.000, OR 2.60, 95% CI: 1.9\u20133.5), costa fracture (p-value = 0.028, OR:1.3, 95% CI:1.0\u20131.5), pelvic fracture (p-value &lt; 0.000, OR 3.1, 95% CI: 1.8\u20135.1). Patients with lack of sufficient vitamin D had increased odds with OR of 1.7 (p-value &lt; 0.00, 95% CI: 1.3\u20132.2) for having osteoporosis compared to the other FLS patients. Fall from standing, walking or sitting increased the odds for osteoporosis treatment (p-value &lt; 0.000, OR 2.8, 95% CI: 2.3\u20133.3). Conclusions: The listed risk factors for needing treatment were high for most fractures, especially vertebral, hip, and pelvic fractures. Patients aged 80+ years and with a fracture from standing\/walking could also start treatment directly, without waiting for a DXA scan. Thus, these patients should be shifted rapidly to FLS and started on treatment without delay. In this way, DXA scanning can be prioritised for patients for whom supporting information is needed regarding the decision to initiate anti-osteoporotic treatment, such as those with proximal humerus, wrist, or ankle fractures. Time to DXA scan could be shortened for these patients and 12 weeks may be achievable.<\/jats:p>","DOI":"10.3390\/jcm14165619","type":"journal-article","created":{"date-parts":[[2025,8,8]],"date-time":"2025-08-08T13:20:09Z","timestamp":1754659209000},"page":"5619","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Which Patients in the FLS Should Be Prioritised for a DXA Scan Within 12 Weeks?"],"prefix":"10.3390","volume":"14","author":[{"given":"Hege","family":"Nysted","sequence":"first","affiliation":[{"name":"Orthopaedic Department, Stavanger University Hospital, 4020 Stavanger, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oda","family":"Horpestad","sequence":"additional","affiliation":[{"name":"Orthopaedic Department, Stavanger University Hospital, 4020 Stavanger, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ane","family":"Djuv","sequence":"additional","affiliation":[{"name":"Orthopaedic Department, Stavanger University Hospital, 4020 Stavanger, Norway"},{"name":"Clinical Institute 1, University of Bergen, 5007 Bergen, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1393","DOI":"10.1093\/jbmr\/zjae119","article-title":"Goal-directed osteoporosis treatment: ASBMR\/BHOF task force position statement 2024","volume":"39","author":"Cosman","year":"2024","journal-title":"J. Bone Min. Res."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1007\/s11657-020-00871-9","article-title":"SCOPE 2021: A new scorecard for osteoporosis in Europe","volume":"16","author":"Kanis","year":"2021","journal-title":"Arch. Osteoporos."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2135","DOI":"10.1007\/s00198-013-2348-z","article-title":"Capture the Fracture: A Best Practice Framework and global campaign to break the fragility fracture cycle","volume":"24","author":"Akesson","year":"2013","journal-title":"Osteoporos. Int."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2183","DOI":"10.1007\/s00198-024-07251-w","article-title":"Cost-effectiveness intervention thresholds for romosozumab and teriparatide in the treatment of osteoporosis in the UK","volume":"35","author":"Borgstrom","year":"2024","journal-title":"Osteoporos. Int."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.1007\/s00198-019-05274-2","article-title":"Fracture risk following high-trauma versus low-trauma fracture: A registry-based cohort study","volume":"31","author":"Leslie","year":"2020","journal-title":"Osteoporos. Int."},{"key":"ref_6","first-page":"e10736","article-title":"Fracture Risk in Men and Women with Vertebral Fractures Identified Opportunistically on Routine Computed Tomography Scans and Not Treated for Osteoporosis: An Observational Cohort Study","volume":"7","author":"Skjodt","year":"2023","journal-title":"J. Bone Miner. Res. Plus"},{"key":"ref_7","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":"Borgstrom","year":"2020","journal-title":"Arch. Osteoporos."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1007\/s11657-013-0136-1","article-title":"Osteoporosis in the European Union: Medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA)","volume":"8","author":"Hernlund","year":"2013","journal-title":"Arch. Osteoporos."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1281","DOI":"10.1007\/s00198-015-3440-3","article-title":"The National Osteoporosis Foundation\u2019s position statement on peak bone mass development and lifestyle factors: A systematic review and implementation recommendations","volume":"27","author":"Weaver","year":"2016","journal-title":"Osteoporos. Int."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"S139","DOI":"10.3177\/jnsv.61.S139","article-title":"Osteoporosis and Lifestyle","volume":"61","author":"Ishimi","year":"2015","journal-title":"J. Nutr. Sci. Vitaminol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"45","DOI":"10.4103\/jehp.jehp_450_20","article-title":"Health-promoting lifestyle and quality of life in affected and unaffected menopausal women by primary osteoporosis","volume":"10","author":"Abdolalipour","year":"2021","journal-title":"J. Educ. Health Promot."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1007\/s00223-006-0060-0","article-title":"Methotrexate, azathioprine, cyclosporine, and risk of fracture","volume":"79","author":"Vestergaard","year":"2006","journal-title":"Calcif. Tissue Int."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1016\/j.ecl.2024.08.008","article-title":"Postmenopausal Osteoporosis: A Review of Latest Guidelines","volume":"53","author":"Subarajan","year":"2024","journal-title":"Endocrinol. Metab. Clin. N. Am."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"545","DOI":"10.3899\/jrheum.170202","article-title":"Is Fragility Fracture a Strong Risk Factor for a Cardiovascular Event in Rheumatoid Arthritis? The Challenge of Dealing with Multiple Comorbidities","volume":"44","author":"Lems","year":"2017","journal-title":"J. Rheumatol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1016\/j.jagp.2023.10.004","article-title":"Prospective Association Between the Dispensing of Antidepressants and of Medications to Treat Osteoporosis in Older Age","volume":"32","author":"Almeida","year":"2024","journal-title":"Am. J. Geriatr. Psychiatry"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1007\/s11914-020-00644-w","article-title":"Closing the Osteoporosis Care Gap","volume":"19","author":"Akesson","year":"2021","journal-title":"Curr. Osteoporos. Rep."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2381","DOI":"10.1001\/jama.298.20.2381","article-title":"High-trauma fractures and low bone mineral density in older women and men","volume":"298","author":"Mackey","year":"2007","journal-title":"JAMA"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1002\/jbmr.3953","article-title":"History of Previous Fracture and Imminent Fracture Risk in Swedish Women Aged 55 to 90 Years Presenting with a Fragility Fracture","volume":"35","author":"Toth","year":"2020","journal-title":"J. Bone Miner. Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2573","DOI":"10.1007\/s00198-015-3192-0","article-title":"Effective secondary fracture prevention: Implementation of a global benchmarking of clinical quality using the IOF Capture the Fracture(R) Best Practice Framework tool","volume":"26","author":"Javaid","year":"2015","journal-title":"Osteoporos. Int."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1007\/s00198-024-07376-y","article-title":"Fracture liaison service (FLS) is associated with lower subsequent fragility fracture risk and mortality: NoFRACT (the Norwegian capture the fracture initiative)","volume":"36","author":"Andreasen","year":"2025","journal-title":"Osteoporos. Int."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2083","DOI":"10.1007\/s00198-011-1534-0","article-title":"Fracture liaison services for the evaluation and management of patients with osteoporotic fracture: A cost-effectiveness evaluation based on data collected over 8 years of service provision","volume":"22","author":"McLellan","year":"2011","journal-title":"Osteoporos. Int."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e198","DOI":"10.1097\/OI9.0000000000000198","article-title":"Overview of fracture liaison services in the UK and Europe: Standards, model of care, funding, and challenges","volume":"5","author":"Chesser","year":"2022","journal-title":"OTA Int."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1007\/s00198-011-1712-0","article-title":"Fracture prevention in Kaiser Permanente Southern California","volume":"22","author":"Dell","year":"2011","journal-title":"Osteoporos. Int."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"3139","DOI":"10.1016\/j.injury.2022.08.021","article-title":"Epidemiological characteristics of fractures of spine, hip, proximal humerus and forearm during the haze epidemic period","volume":"53","author":"Lv","year":"2022","journal-title":"Injury"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2027","DOI":"10.1007\/s00198-023-06870-z","article-title":"Previous fracture and subsequent fracture risk: A meta-analysis to update FRAX","volume":"34","author":"Kanis","year":"2023","journal-title":"Osteoporos. Int."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"afad172","DOI":"10.1093\/ageing\/afad172","article-title":"Call to action: A five nations consensus on the use of intravenous zoledronate after hip fracture","volume":"52","author":"Johansen","year":"2023","journal-title":"Age Ageing"},{"key":"ref_27","unstructured":"NICE (2017). Osteoporosis: Assessing the Risk of Fragility Fracture. Clinical Guideline, National Institute for Health and Care Excellence (NICE)."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"426","DOI":"10.5312\/wjo.v11.i10.426","article-title":"Mortality following combined fractures of the hip and proximal humerus","volume":"11","author":"Haque","year":"2020","journal-title":"World J. Orthop."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2116","DOI":"10.1016\/j.jse.2022.03.006","article-title":"Morbidity and mortality of fragility proximal humerus fractures: A retrospective cohort study of patients presenting to a level one trauma center","volume":"31","author":"Curtin","year":"2022","journal-title":"J. Shoulder Elb. Surg."},{"key":"ref_30","unstructured":"Frihagen, F., Djuv, A., Nordb\u00f8, J.V., and Solberg, L.B. (2024, May 21). Treatment Guide for Fragility Fractures in Norway (Behandlingsveileder ved Lavenergibrudd). Available online: https:\/\/www.legeforeningen.no\/foreningsledd\/fagmed\/norsk-ortopedisk-forening\/faggrupper\/faggruppe-for-osteoporose-og-benhelse\/behandlingsveileder-ved-lavenergibrudd\/."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1007\/s00198-004-1811-2","article-title":"Requirements for DXA for the management of osteoporosis in Europe","volume":"16","author":"Kanis","year":"2005","journal-title":"Osteoporos. Int."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1193","DOI":"10.1007\/s00198-020-05377-1","article-title":"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","volume":"31","author":"Javaid","year":"2020","journal-title":"Osteoporos. Int."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1007\/s11657-022-01174-x","article-title":"Spanish National Registry of Major Osteoporotic Fractures (REFRA) seen at Fracture Liaison Services (FLS): Objectives and quality standards","volume":"17","author":"Nogues","year":"2022","journal-title":"Arch. Osteoporos."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Djuv, A., Harboe, K., Nysted, H., Kirkhus, T.K., Horpestad, O., Birkeland, F.H., Mehl, B.W., Johnsen, E., and Paulsen, A. (2023). Improving the quality of the fracture liaison service through the implementation of a structured health record. BMJ Open Qual., 12.","DOI":"10.1136\/bmjoq-2023-002275"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1038\/s41514-024-00153-5","article-title":"Author Correction: Healthcare on the brink: Navigating the challenges of an aging society in the United States","volume":"10","author":"Jones","year":"2024","journal-title":"npj Aging"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1002\/jbmr.2995","article-title":"Cost-Effectiveness of Orthogeriatric and Fracture Liaison Service Models of Care for Hip Fracture Patients: A Population-Based Study","volume":"32","author":"Leal","year":"2017","journal-title":"J. Bone Miner. Res."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1007\/s00198-011-1592-3","article-title":"High fracture probability with FRAX usually indicates densitometric osteoporosis: Implications for clinical practice","volume":"23","author":"Leslie","year":"2012","journal-title":"Osteoporos. Int."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s00223-011-9544-7","article-title":"FRAX((R)) with and without bone mineral density","volume":"90","author":"Kanis","year":"2012","journal-title":"Calcif. Tissue Int."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1007\/s00198-020-05804-3","article-title":"International Osteoporosis Foundation Fracture Working, Vertebral fracture: Epidemiology, impact and use of DXA vertebral fracture assessment in fracture liaison services","volume":"32","author":"Lems","year":"2021","journal-title":"Osteoporos. Int."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1007\/s001980070112","article-title":"Epidemiology of osteoporotic pelvic fractures in elderly people in Finland: Sharp increase in 1970\u20131997 and alarming projections for the new millennium","volume":"11","author":"Kannus","year":"2000","journal-title":"Osteoporos. Int."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"171","DOI":"10.5312\/wjo.v7.i3.171","article-title":"Major osteoporotic fragility fractures: Risk factor updates and societal impact","volume":"7","author":"Pisani","year":"2016","journal-title":"World J. Orthop."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1337","DOI":"10.1007\/s00198-024-07059-8","article-title":"Impact of osteoporosis and osteoporosis medications on fracture healing: A narrative review","volume":"35","author":"Chandran","year":"2024","journal-title":"Osteoporos. Int."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Tang, Y., Hong, W., Xu, X., Li, M., and Jin, L. (2023). Traumatic rib fracture patterns associated with bone mineral density statuses derived from CT images. Front. Endocrinol., 14.","DOI":"10.3389\/fendo.2023.1304219"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Reid, I.R., and Bolland, M.J. (2020). Calcium and\/or Vitamin D Supplementation for the Prevention of Fragility Fractures: Who Needs It?. Nutrients, 12.","DOI":"10.3390\/nu12041011"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"248","DOI":"10.3389\/fphys.2014.00248","article-title":"Vitamin D: A critical and essential micronutrient for human health","volume":"5","author":"Bendik","year":"2014","journal-title":"Front. Physiol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1007\/s11914-016-0330-3","article-title":"Osteoporosis and Periodontitis","volume":"14","author":"Wang","year":"2016","journal-title":"Curr. Osteoporos. Rep."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1421","DOI":"10.1007\/s10067-024-06932-5","article-title":"The interplay of rheumatoid arthritis and osteoporosis: Exploring the pathogenesis and pharmacological approaches","volume":"43","author":"Gupta","year":"2024","journal-title":"Clin. Rheumatol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"6519","DOI":"10.62347\/GXEB5902","article-title":"Zoledronic acid improves periodontal health, reduces serum inflammation, and enhances bone metabolism in postmenopausal osteoporosis complicated by periodontitis","volume":"16","author":"Xu","year":"2024","journal-title":"Am. J. Transl. Res."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Miyamoto, T. (2025). Osteoporosis and Rheumatoid Arthritis: Mechanisms Underlying Osteoclast Differentiation and Activation or Factors Associated with Hip Fractures. J. Clin. Med., 14.","DOI":"10.3390\/jcm14041138"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1092","DOI":"10.1016\/j.chest.2019.06.036","article-title":"Prevalence and Risk Factors for Osteoporosis in Individuals with COPD: A Systematic Review and Meta-analysis","volume":"156","author":"Chen","year":"2019","journal-title":"Chest"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1007\/s00198-025-07443-y","article-title":"Prevalence and risk factors for osteoporosis in type 1 diabetes-results from an observational study","volume":"36","author":"Stoy","year":"2025","journal-title":"Osteoporos. Int."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"e248491","DOI":"10.1001\/jamanetworkopen.2024.8491","article-title":"Health Perceptions, Multimorbidity, and New Fractures and Mortality Among Patients with a Fracture","volume":"7","author":"Alarkawi","year":"2024","journal-title":"JAMA Netw. Open"},{"key":"ref_53","unstructured":"Gebrelibanos, M.B. (2023). The Association Between Alcohol Consumption and Self-Rated Health Among Adult Norwegian Women 2023. [Master\u2019s Thesis, UiT The Arctic University of Norway]."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1093\/eurpub\/ckv190","article-title":"Social disparities in hazardous alcohol use: Self-report bias may lead to incorrect estimates","volume":"26","author":"Devaux","year":"2016","journal-title":"Eur. J. Public Health"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1595","DOI":"10.1210\/jc.2019-00221","article-title":"Pharmacological Management of Osteoporosis in Postmenopausal Women: An Endocrine Society* Clinical Practice Guideline","volume":"104","author":"Eastell","year":"2019","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1779","DOI":"10.1007\/s00198-020-05435-8","article-title":"Bone densitometry worldwide: A global survey by the ISCD and IOF","volume":"31","author":"Clynes","year":"2020","journal-title":"Osteoporos. Int."},{"key":"ref_57","unstructured":"Australian and New Zealand Fragility Fracture Registry (2025, July 28). 2025 ANZFFR Annual Report. Available online: https:\/\/fragilityfracture.co.nz\/2025-annual-report\/."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/16\/5619\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:26:39Z","timestamp":1760034399000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/16\/5619"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,8]]},"references-count":57,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2025,8]]}},"alternative-id":["jcm14165619"],"URL":"https:\/\/doi.org\/10.3390\/jcm14165619","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,8]]}}}