Journal of Bone Metabolism

"Namki Hong"

Original Articles

Challenges in Evaluation and Management in Tumor-Induced Osteomalacia: A Retrospective Institutional and Literature-Based Scoping Review in Korean Patients: Seyoun Park, Sung Joon Cho, Jin Ah Park, Namki Hong, Yumie Rhee; J Bone Metab 2025;32(4):315-322.
Published online November 30, 2025; DOI: https://doi.org/10.11005/jbm.25.901

Background
Tumor-induced osteomalacia (TIO) is a rare paraneoplastic syndrome characterized by hypophosphatemia and osteomalacia, resulting from excessive production of fibroblast growth factor 23 by mesenchymal tumors. Although various imaging techniques are used to localize the tumor, the rarity of the disease poses significant challenges in tumor detection.
Methods
After retrospectively analyzing 25 TIO patients who visited the Severance bone and mineral clinic between 2004 and 2024, we added all reported TIO cases in Korea by searching PubMed, Embase, and Web of Science. Using the PRISMA method, an additional 14 reports comprising 22 patients were included.
Results
Among the 47 patients, 25 (53.2%) were male, with a median age of 52 years. Tumors were most commonly located in the lower extremities (57.5%), with a median size of 1.9 cm. Surgical resection, including radiofrequency ablation, was performed in 45 patients; reoperation was required in 26.7% (12/45) due to residual tumors. After gallium scans were covered by insurance, 83.3% (25/30) of patients underwent gallium-based imaging for tumor localization with 77.3% of tumors successfully localized in initial scan. Of the five patients with negative initial scans, four (80%) showed positive findings on a second scan conducted 1 to 2 years later.
Conclusions
Although gallium scans are the most commonly employed imaging modality for detecting tumors responsible for TIO, localization remains challenging due to the small tumor size, potential for widespread anatomical distribution, and prolonged diagnostic delay. Repeating gallium imaging can yield positive results in previously negative cases, and additional imaging modalities may be necessary to facilitate accurate localization.

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Discriminatory Accuracy of Fracture Risk Assessment Tool in Asian Populations: A Systematic Review and Meta-Analysis: Dheeraj Jha, Manju Chandran, Namki Hong, Yumie Rhee, Seungjin Baek, Stephen J. Ferguson, Benedikt Helgason, Anitha D. Praveen; J Bone Metab 2024;31(4):296-315.
Published online November 30, 2024; DOI: https://doi.org/10.11005/jbm.24.781

Background
This review explores the discriminative ability of fracture risk assessment tool (FRAX) in major osteoporotic fracture (MOF) and hip fracture (HF) risk prediction and the densitometric diagnosis of osteoporosis in Asian populations.
Methods
We systematically searched the EMBASE, Cochrane, and PubMed databases from the earliest indexing date to January 2024. Studies were included if FRAX was used to identify future osteoporotic fractures or a densitometric diagnosis of osteoporosis in an Asian population and reported the area under the curve (AUC) values. Meta-analyses were conducted after quality assessment for AUC with 95% confidence intervals across the following categories: standard FRAX without/with bone mineral density (BMD), adjusted FRAX, and BMD alone for fracture prediction, as well as standard FRAX for densitometric diagnosis of osteoporosis.
Results
A total of 42 studies were included. The AUC values for predicting fracture risk using FRAX-MOF with BMD (0.73 [0.70–0.77]) was highest compared to FRAX-MOF without BMD (0.72 [0.66–0.77]), and adjusted FRAX-MOF (0.71 [0.65–0.77]). The AUC values for predicting fracture risk using FRAX-HF with BMD (0.77 [0.71–0.83]) was highest compared to FRAX-HF without BMD (0.72 [0.65–0.80]), and adjusted FRAX-HF (0.75 [0.63–0.86]). The AUC values for BMD alone (0.68 [0.62–0.73]) was lowest for fracture prediction. The AUC values for identifying a densitometric diagnosis of osteoporosis was 0.77 [0.70–0.84] and 0.76 [0.67-0.86] using FRAX-MOF and FRAX-HF, respectively.
Conclusions
FRAX with BMD tends to perform more reliably in predicting HF compared to MOF in Asia. However, its accuracy in predicting fracture risk in Asian populations can be improved through region-specific, long-term epidemiological data.

Citations

Citations to this article as recorded by

1. Health outcomes and care needs after osteoporotic fractures in rural Chinese older adults: policy implications
Qian Zhu, Caixia Ran
Frontiers in Public Health.2025;[Epub] CrossRef
2. Relationship between areal BMD, FRAX®, and femoral strength in community-dwelling older Asian adults
Dheeraj Jha, Manju Chandran, Dario Koller, Vee San Cheong, Anitha D. Praveen, Alexander Baker, Preeti Gupta, Ecosse L. Lamoureux, Halldór Pálsson, Stephen J. Ferguson, Benedikt Helgason
Archives of Osteoporosis.2025;[Epub] CrossRef
3. Development of a machine learning-based predictive model for osteoporosis risk and its application in clinical decision support
Zichen Shao, Jianfeng Wu, Qinqin Deng, Ling Cheng, Xin Huang, Weikang Sun, Weidong Liang, Huanan Li
Frontiers in Medicine.2025;[Epub] CrossRef
4. Dual-energy X-ray absorptiometry based biofidelic finite element models for simulating falls to the hip: Impact of trochanteric soft tissue thickness on fracture risk
Dheeraj Jha, Anitha D. Praveen, Alexander Baker, Anita Fung, Vee San Cheong, Preeti Gupta, Ecosse L. Lamoureux, Namki Hong, Yumie Rhee, Vanessa Jean Wen Koh, Halldór Pálsson, William R. Taylor, Angelique Wei-Ming Chan, Stephen J. Ferguson, Benedikt Helgas
Clinical Biomechanics.2025; : 106720. CrossRef
5. Osteoporosis in men—East and West: Can the twain meet? A perspective from Asia
Gerald Gui Ren Sng, Jean-Yves Reginster, Majed S. Alokail, Manju Chandran
Osteoporosis and Sarcopenia.2024; 10(4): 131. CrossRef

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Impact of COVID-19 on the Incidence of Fragility Fracture in South Korea: Seungjin Baek, Ye-Jee Kim, Beom-Jun Kim, Namki Hong; J Bone Metab 2024;31(1):31-39.
Published online February 29, 2024; DOI: https://doi.org/10.11005/jbm.2024.31.1.31

Background
The coronavirus disease 2019 (COVID-19) pandemic and the consequent social distancing period are thought to have influenced the incidence of osteoporotic fracture in various ways, but the exact changes have not yet been well elucidated. The purpose of this study was to investigate the impact of the COVID-19 pandemic on the incidence of osteoporotic fracture using a nationwide cohort.
Methods
The monthly incidence rates of vertebral; hip; and non-vertebral, non-hip fractures were collected from a nationwide database of the Korean National Health Insurance Review and Assessment from July 2016 to June 2021. Segmented regression models were used to assess the change in levels and trends in the monthly incidence of osteoporotic fractures.
Results
There was a step decrease in the incidence of vertebral fractures for both males (6.181 per 100,000, P=0.002) and females (19.299 per 100,000, P=0.006). However, there was a negative trend in the incidence of hip fracture among both males (-0.023 per 100,000 per month, P=0.023) and females (-0.032 per 100,000 per month, P=0.019). No impact of COVID-19-related social distancing was noted.
Conclusions
In conclusion, during the early days of the COVID-19 pandemic, vertebral fracture incidence considerably decreased with the implementation of social distancing measures.

Citations

Citations to this article as recorded by

1. Trends of incidence and 1-year mortality of vertebral fractures in Korea using nationwide claims data
Young-Kyun Lee, Jung-Wee Park, Tae-Young Kim, Jihye Kim, Hoyeon Jang, Jaiyong Kim, Yong-Chan Ha
Archives of Osteoporosis.2025;[Epub] CrossRef
2. Global, regional, and national burden of vertebral fractures among women from 1990 to 2021: a systematic analysis based on the global burden of disease study
Junpeng Liu, Xingchen Yao, Zhiheng Zhao, Xinglin Liu, Sheyang Xu, Bowen Lu, Xianglong Meng
European Spine Journal.2025;[Epub] CrossRef

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Effectiveness and Usefulness of Bone Turnover Marker in Osteoporosis Patients: A Multicenter Study in Korea: Jun-Il Yoo, So Young Park, Deog-Yoon Kim, Jeonghoon Ha, Yumie Rhee, Namki Hong, Jung-Taek Kim, Hyon-Seung Yi, Bu Kyung Kim, Young-Kyun Lee, Yong-Chan Ha, Yun Kyung Jeon, Ha-Young Kim, Seong Hee Ahn, Seongbin Hong, Sang-Yeob Lee; J Bone Metab 2023;30(4):311-317.
Published online November 30, 2023; DOI: https://doi.org/10.11005/jbm.2023.30.4.311

Background
This study aimed to investigate real-world data of C-terminal telopeptide (CTX), propeptide of type I collagen (P1NP), and osteocalcin through present multicenter clinical study, and retrospectively analyze the usefulness of bone turnover markers (BTMs) in Koreans.
Methods
The study focused on pre- and post-menopausal patients diagnosed with osteoporosis and excluded patients without certain test results or with test intervals of over 1 year. The demographic data and 3 BTMs (CTX, P1NP, and osteocalcin) were collected. The patients were classified by demographic characteristics and the BTM concentrations were analyzed by the group.
Results
Among women with no history of fractures, the levels of P1NP (N=2,100) were 43.544±36.902, CTX (N=1,855) were 0.373 ±0.927, and osteocalcin (N=219) were 10.81 ±20.631. Among men with no history of fractures, the levels of P1NP (N=221) were 48.498±52.892, CTX (N=201) were 0.370±0.351, and osteocalcin (N=15) were 7.868 ±10.674. Treatment with teriparatide increased the P1NP levels after 3 months in both men and women, with a 50% increase observed in women. Similarly, treatment with denosumab decreased the CTX levels after 3 months in both men and women, with a reduction of 50% observed in women.
Conclusions
The results of this study can contribute to the accurate assessment of bone replacement status in Koreans. We also provide the P1NP level in the Korean population for future comparative studies with other populations.

Citations

Citations to this article as recorded by

1. Comparative Analysis of Myokines and Bone Metabolism Markers in Prepubertal Vegetarian and Omnivorous Children
Jadwiga Ambroszkiewicz, Joanna Gajewska, Katarzyna Szamotulska, Grażyna Rowicka, Witold Klemarczyk, Małgorzata Strucińska, Magdalena Chełchowska
Nutrients.2024; 16(13): 2009. CrossRef

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Case Report

Retropharyngeal Ectopic Parathyroid Adenoma Localized by ¹⁸F-Fluorocholine Positron Emission Tomography/Computed Tomography: A Case Report: Hyeokjoo Jang, Seunghyun Lee, Dahee Kim, Namki Hong; J Bone Metab 2022;29(3):197-203.
Published online August 31, 2022; DOI: https://doi.org/10.11005/jbm.2022.29.3.197

Ectopic parathyroid adenomas of the retropharyngeal space are relatively rare. Herein, we report a case of primary hyperparathyroidism (PHPT) secondary to a retropharyngeal parathyroid adenoma. A 22-year-old woman presented with elevated serum calcium and parathyroid hormone (PTH) levels, revealed during a medical check-up. The patient had a history of ureteral stones and a confirmed low bone mass. Neck ^99mTechnetium-sestamibi singlephoton emission computed tomography (CT) and ultrasonography did not reveal any suspicious lesions. There was no evidence of hereditary PHPT based on the results of targeted gene sequencing. Surgical exploration was unsuccessful, and the PHPT persisted after the first surgery. Approximately a year after the failed operation, ¹⁸F-fluorocholine (FCH) positron emission tomography/CT (PET-CT) became available, and when performed, it revealed increased uptake in the retropharyngeal space of the right side of the neck. The results of parathyroid venous sampling were concordant with a >2-fold elevation of PTH level in the veins on the right side of the neck compared to the peripheral veins. The 1.8 cm-diameter mass was successfully removed resulting in an 87% reduction in intraoperative PTH level (198.0-26.5 pg/mL). Subsequently, normalizations of calcium and PTH levels were achieved. In summary, ectopic parathyroid adenomas, including retropharyngeal lesions, should also be suspected when investigating an elusive case of PHPT. ¹⁸F-FCH PET-CT can be a useful complementary modality for detecting culprit lesions.

Citations

Citations to this article as recorded by

1. Hypercalcemia episodes caused by ectopic parathyroid adenoma and subsequent gastrointestinal stromal tumor: A case report and literature review
Yi-Ching Lin, Jen-Chieh Lee, Chen-Yu Wen, Wei-Yih Chiu
Frontiers in Oncology.2025;[Epub] CrossRef

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Review Article

Application of the Trabecular Bone Score in Clinical Practice: Sung Hye Kong, Namki Hong, Jin-Woo Kim, Deog Yoon Kim, Jung Hee Kim; J Bone Metab 2021;28(2):101-113.
Published online May 31, 2021; DOI: https://doi.org/10.11005/jbm.2021.28.2.101

The trabecular bone score (TBS) was introduced as an indirect index of trabecular microarchitecture, complementary to bone mineral density (BMD), and is derived using the same dual energy X-ray absorptiometry images. Recently, it has been approved for clinical use in Korea. Therefore, we conducted a comprehensive review to optimize the use of TBS in clinical practice. The TBS is an independent predictor of osteoporotic fractures in postmenopausal women and men aged >50 years. The TBS is potentially useful in monitoring the skeletal effects of anabolic agents but not of antiresorptive agents. In postmenopausal women with type 2 diabetes mellitus, the TBS assesses osteoporotic fracture risk not captured by BMD. However, high body mass index and soft tissue thickness can cause underestimation of the TBS; however, this limitation has been improved in recent versions of the TBS software. However, a high precision error and low reproducibility limit the use of TBS. This review may provide information on the application of the TBS in clinical practice based on reliable evidence.

Citations

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1. Canadian Adult Reference Data for Body Composition, Trabecular Bone Score and Advanced Hip Analysis Using DXA
Lauren A. Burt, Liam T. Pond, Annabel R. Bugbird, David A. Hanley, Steven K. Boyd
Journal of Clinical Densitometry.2025; 28(1): 101535. CrossRef
2. Decoding bone-inspired and cell-instructive cues of scaffolds for bone tissue engineering
Zahid Hussain, Shah Mehmood, Xingzhu Liu, Yuanshan Liu, Guocheng Wang, Renjun Pei
Engineered Regeneration.2024; 5(1): 21. CrossRef
3. Predicting Osteoporotic Fracture in Patients with Early-Stage Diabetic Kidney Disease Using a Radiomic Model: A Longitudinal Cohort Study
Youyuan Gao, Jianya Gao, Yunting Wang, Hua Gan
Endocrine Practice.2024;[Epub] CrossRef
4. Comment on: Bone density and fracture risk factors in ankylosing spondylitis: a meta-analysis
Patrick Mulkerrin, Finbar O’Shea, Gillian Fitzgerald
Osteoporosis International.2024; 35(5): 929. CrossRef
5. A CT-based Deep Learning Model for Predicting Subsequent Fracture Risk in Patients with Hip Fracture
Yisak Kim, Young-Gon Kim, Jung-Wee Park, Byung Woo Kim, Youmin Shin, Sung Hye Kong, Jung Hee Kim, Young-Kyun Lee, Sang Wan Kim, Chan Soo Shin
Radiology.2024;[Epub] CrossRef
6. Update on the utility of trabecular bone score (TBS) in clinical practice for the management of osteoporosis: a systematic review by the Egyptian Academy of Bone and Muscle Health
Yasser El Miedany, Walaa Elwakil, Mohammed Hassan Abu-Zaid, Safaa Mahran
Egyptian Rheumatology and Rehabilitation.2024;[Epub] CrossRef
7. Evaluation of Trabecular Bone Microarchitecture and Bone Mineral Density in Young Women, Including Selected Hormonal Parameters
Elżbieta Sowińska-Przepiera, Mariola Krzyścin, Igor Syrenicz, Adrianna Ćwiertnia, Adrianna Orlińska, Dorota Ćwiek, Dorota Branecka-Woźniak, Aneta Cymbaluk-Płoska, Žana Bumbulienė, Anhelli Syrenicz
Biomedicines.2024; 12(4): 758. CrossRef
8. A Computed Tomography–Based Fracture Prediction Model With Images of Vertebral Bones and Muscles by Employing Deep Learning: Development and Validation Study
Sung Hye Kong, Wonwoo Cho, Sung Bae Park, Jaegul Choo, Jung Hee Kim, Sang Wan Kim, Chan Soo Shin
Journal of Medical Internet Research.2024; 26: e48535. CrossRef
9. Bone Loss in Diabetes Mellitus: Diaporosis
Krisztina Kupai, Hsu Lin Kang, Anikó Pósa, Ákos Csonka, Tamás Várkonyi, Zsuzsanna Valkusz
International Journal of Molecular Sciences.2024; 25(13): 7269. CrossRef
10. Type 2 Diabetes and Fracture Risk in Older Women
Michail Zoulakis, Lisa Johansson, Henrik Litsne, Kristian Axelsson, Mattias Lorentzon
JAMA Network Open.2024; 7(8): e2425106. CrossRef
11. Bone mineral density: Comparison between women under hormone replacement therapy with Turner syndrome or idiopathic premature ovarian insufficiency
Charlotte Nelis, Lisa Belin, Isabelle Tejedor, Jerome Dulon, Anne Bachelot, Zeina Chakhtoura
Annales d'Endocrinologie.2024; 85(6): 574. CrossRef
12. Clinical significance of trabecular bone score of DXA in hip fracture patients-comparative study between trochanteric fractures and neck fractures
Seungcheol Kwon, Jehyun Yoo, Yonghyun Yoon, Minjae Lee, Jihyo Hwang
BMC Musculoskeletal Disorders.2024;[Epub] CrossRef
13. Trabecular Bone Score and Central Quantitative Computed Tomography for the Prediction of Vertebral Fragility Fractures in Postmenopausal Women
Soree Ryang, Yun Kyung Jeon, Tae Sik Goh, In-Joo Kim, Keunyoung Kim
Journal of Bone Metabolism.2023; 30(1): 77. CrossRef
14. Trabecular Bone Score Significantly Influences Treatment Decisions in Secondary Osteoporosis
Leith Al-Hashimi, Jens Klotsche, Sarah Ohrndorf, Timo Gaber, Paula Hoff
Journal of Clinical Medicine.2023; 12(12): 4147. CrossRef
15. The effect of body size and composition on lumbar spine trabecular bone score in morphologically diverse subjects
Jadwiga Malczewska-Lenczowska, Olga Surała, Dariusz Sitkowski, Beata Szczepańska, Maciej Zawadzki, Ewa Tomaszewska
PLOS ONE.2023; 18(7): e0287330. CrossRef
16. Bone Mineral Density, Trabecular Bone Score and Fractures in Patients Hospitalized for Heart Failure
Lucian Batista de Oliveira, Mariana Andrade de Figueiredo Martins Siqueira, Rafael Buarque de Macedo Gadêlha, Beatriz Pontes Barreto, Alice Rodrigues Pimentel Correia, Vinicius Belfort Leão, Jessica Garcia, Francisco Bandeira
Journal of Bone Metabolism.2023; 30(2): 167. CrossRef
17. Trabecular Bone Score in der Rheumatologie
Zhivana Boyadzhieva, Andriko Palmowski, Frank Buttgereit, Paula Hoff
Zeitschrift für Rheumatologie.2023; 82(8): 672. CrossRef
18. Trabecular Bone Score (TBS) in Individuals with Type 2 Diabetes Mellitus: An Updated Review
Alexandra-Ioana Trandafir, Oana-Claudia Sima, Ana-Maria Gheorghe, Adrian Ciuche, Anca-Pati Cucu, Claudiu Nistor, Mara Carsote
Journal of Clinical Medicine.2023; 12(23): 7399. CrossRef
19. Comparison of Trabecular Bone Score–Adjusted Fracture Risk Assessment (TBS-FRAX) and FRAX Tools for Identification of High Fracture Risk among Taiwanese Adults Aged 50 to 90 Years with or without Prediabetes and Diabetes
Tzyy-Ling Chuang, Mei-Hua Chuang, Yuh-Feng Wang, Malcolm Koo
Medicina.2022; 58(12): 1766. CrossRef
20. Changes in Bone Mineral Density and Trabecular Bone Score over Time between Vegetarian and Non-Vegetarian Middle-Aged and Older Women: A Three-Year Retrospective Medical Record Review
Tzyy-Ling Chuang, Malcolm Koo, Mei-Hua Chuang, Chun-Hung Lin, Chin-Huan Huang, Yuh-Feng Wang
International Journal of Environmental Research and Public Health.2022; 19(4): 2445. CrossRef
21. Comparison of Denosumab and Zoledronic Acid in Postmenopausal Women With Osteoporosis: Bone Mineral Density (BMD) and Trabecular Bone Score (TBS)
Taewook Kang, Si Young Park, Soon Hyuck Lee, Jong Hoon Park, Seung Woo Suh
Journal of Korean Medical Science.2022;[Epub] CrossRef
22. Circulating SIRT1 and Sclerostin Correlates with Bone Status in Young Women with Different Degrees of Adiposity
Rossella Tozzi, Davide Masi, Fiammetta Cipriani, Savina Contini, Elena Gangitano, Maria Elena Spoltore, Ilaria Barchetta, Sabrina Basciani, Mikiko Watanabe, Enke Baldini, Salvatore Ulisse, Carla Lubrano, Lucio Gnessi, Stefania Mariani
Nutrients.2022; 14(5): 983. CrossRef
23. Meta-analyses of the quantitative computed tomography data in dialysis patients show differential impacts of renal failure on the trabecular and cortical bones
S. Sharma, P. Mehta, A. Patil, S. K. Gupta, S. Rajender, N. Chattopadhyay
Osteoporosis International.2022; 33(7): 1521. CrossRef
24. The efficacy of denosumab in Korean male patients with osteoporosis
Chaiho Jeong, Jeonghoon Ha, Jinyoung Kim, Yejee Lim, Mee Kyoung Kim, Hyuk-Sang Kwon, Ki-Ho Song, Moo Il Kang, Ki-Hyun Baek
The Korean Journal of Internal Medicine.2022; 37(5): 1011. CrossRef
25. Fracture risk, underlying pathophysiology, and bone quality assessment in patients with Turner syndrome
Kento Ikegawa, Yukihiro Hasegawa
Frontiers in Endocrinology.2022;[Epub] CrossRef
26. Unraveling the effect of collagen damage on bone fracture using in situ synchrotron microtomography with deep learning
Michael Sieverts, Yoshihiro Obata, James L. Rosenberg, William Woolley, Dilworth Y. Parkinson, Harold S. Barnard, Daniël M. Pelt, Claire Acevedo
Communications Materials.2022;[Epub] CrossRef
27. Spine Fragility Fracture Prediction Using TBS and BMD in Postmenopausal Women: A Bayesian Approach
Claudio Ripamonti, Lucia Lisi, Jacopo Ciaffi, Angela Buffa, Renata Caudarella, Francesco Ursini
International Journal of Environmental Research and Public Health.2022; 19(21): 14315. CrossRef
28. Effect of Romosozumab on Trabecular Bone Score Compared to Anti-Resorptive Agents in Postmenopausal Women with Osteoporosis
Chaiho Jeong, Jinyoung Kim, Yejee Lim, Jeonghoon Ha, Moo Il Kang, Ki-Hyun Baek
Journal of Bone Metabolism.2021; 28(4): 317. CrossRef

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Original Article

Association of Insulin Resistance with Lower Bone Volume and Strength Index of the Proximal Femur in Nondiabetic Postmenopausal Women: Jaewon Yang, Namki Hong, Jee-Seon Shim, Yumie Rhee, Hyeon Chang Kim; J Bone Metab 2018;25(2):123-132.
Published online May 31, 2018; DOI: https://doi.org/10.11005/jbm.2018.25.2.123

Background

Type 2 diabetes mellitus is associated with an increased risk of osteoporotic fracture despite relatively preserved bone mineral density (BMD). Although this paradox might be attributed to the influence of insulin resistance (IR) on bone structure and material properties, the association of IR with femur bone geometry and strength indices remains unclear.

Methods

Using data from the Cardiovascular and Metabolic Disease Etiology Research Center cohort study, we conducted a cross-sectional analysis among nondiabetic postmenopausal women. IR was estimated using the homeostasis model assessment of IR (HOMA-IR). Compartment-specific volumetric BMD (vBMD) and bone volume of proximal femur were measured using quantitative computed tomography. The compressive strength index (CSI), section modulus (Z), and buckling ratio of the femoral neck were calculated as bone strength indices.

Results

Among 1,008 subjects (mean age, 57.3 years; body mass index [BMI], 23.6 kg/m²), BMI, waist circumference, and vBMD of the femoral neck and total hip increased in a linear trend from the lowest (<1.37) to highest (≥2.27) HOMA-IR quartile (P<0.05 for all). The HOMA-IR showed an independent negative association with total bone volume (standardized β=−0.12), cortical volume (β=−0.05), CSI (β=−0.013), and Z (β=−0.017; P<0.05 for all) of the femoral neck after adjustment for age, weight, height, physical activity, and vitamin D and high-sensitivity C-reactive protein levels. However, the association between HOMA-IR and vBMD was attenuated in the adjusted model (femoral neck, β=0.94; P=0.548).

Conclusions

Elevated HOMA-IR was associated with lower cortical bone volume and bone strength indices in nondiabetic postmenopausal women, independent of age and body size.

Citations

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1. Association of breastfeeding duration with longitudinal changes in vertebral bone marrow, paraspinal muscle composition, and metabolic parameters in premenopausal women over five years
N. Hesse, Y. Stohldreier, S. Schlaeger, S. Theuerl, O. Dietrich, H. Hermann, I. Kaiser, J. Seissler, E. Pappa, U. Ferrari, A.S. Gersing
European Journal of Radiology.2026; 195: 112514. CrossRef
2. Relationships of Bone Mineral Density and Femur Strength Index with Aerobic Capacity, Body Composition and Carbohydrate Metabolic Indices in Postmenopausal Women
Krystian Wochna, Rafał Stemplewski, Piotr Leszczyński, Katarzyna Domaszewska, Anna Huta-Osiecka, Alicja Nowak
Applied Sciences.2026; 16(5): 2338. CrossRef
3. Relationship between insulin resistance surrogates and bone mineral density in postmenopausal women
Min Li, Lei Gao, Ying Liu, Yongli Zheng, Luyao Chen, Yan Wang, Wei Zhang
Climacteric.2025; 28(2): 154. CrossRef
4. Research Progress on Type 2 Diabetes Mellitus and Osteoporosis
汶彤姜
Advances in Clinical Medicine.2025; 15(06): 1854. CrossRef
5. The triangular relationship of serum uric acid, osteoporosis or osteopenia, and body mass index for men and postmenopausal women
Ziran Xiu, Zhengnan Gao, Lan Luo
Scientific Reports.2025;[Epub] CrossRef
6. A Review of the Relationship Between Insulin and Bone Health
Sivasree Ravindran, Sok Kuan Wong, Nur-Vaizura Mohamad, Kok-Yong Chin
Biomedicines.2025; 13(6): 1504. CrossRef
7. Effect of Drugs Used in Pharmacotherapy of Type 2 Diabetes on Bone Density and Risk of Bone Fractures
Agnieszka Wikarek, Małgorzata Grabarczyk, Katarzyna Klimek, Agata Janoska-Gawrońska, Magdalena Suchodolska, Michał Holecki
Medicina.2024; 60(3): 393. CrossRef
8. A systematic review of the association between insulin resistance surrogate indices and bone mineral density
Amirhossein Shirinezhad, Alireza Azarboo, Amirhossein Ghaseminejad-Raeini, Fatemeh Kanaani Nejad, Negar Zareshahi, Sheyda Mohtasham Amiri, Yasamin Tahmasebi, Amir Human Hoveidaei
Frontiers in Endocrinology.2024;[Epub] CrossRef
9. Association of Insulin Resistance with Bone Mineral Density and Fracture Risk in Non-Diabetic Postmenopausal Women
R. Dimitrova, K. Hristozov
Acta Medica Bulgarica.2023; 50(2): 26. CrossRef
10. Protective Effect of Long-Term Fermented Soybeans with Abundant Bacillus subtilis on Glucose and Bone Metabolism and Memory Function in Ovariectomized Rats: Modulation of the Gut Microbiota
Hee-Jong Yang, Ting Zhang, Yu Yue, Su-Ji Jeong, Myeong-Seon Ryu, Xuangao Wu, Chen Li, Do-Yeon Jeong, Sunmin Park
Foods.2023; 12(15): 2958. CrossRef
11. Predictors of osteoporotic fracture in postmenopausal women: a meta-analysis
Guanghua Long, Chong Liu, Tuo Liang, Zide Zhang, Zhaojie Qin, Xinli Zhan
Journal of Orthopaedic Surgery and Research.2023;[Epub] CrossRef
12. Associations of insulin resistance and insulin secretion with bone mineral density and osteoporosis in a general population
Yi-Hsiu Fu, Wei-Ju Liu, Chia-Lin Lee, Jun-Sing Wang
Frontiers in Endocrinology.2022;[Epub] CrossRef
13. Insulin Resistance and Its Association With Osteoporosis in People Living With HIV
Gabriela Caeran, Luciana L de Almeida, Thales A S H Ilha, José A M de Carvalho, Carolina Stein, Rafael N Moresco, Carlos J P Haygert, Fabio V Comim, Melissa O Premaor
Journal of the Endocrine Society.2022;[Epub] CrossRef
14. Association of Triglyceride-Glucose Index with Bone Mineral Density in Non-diabetic Koreans: KNHANES 2008–2011
Jee Hee Yoon, A Ram Hong, Wonsuk Choi, Ji Yong Park, Hee Kyung Kim, Ho-Cheol Kang
Calcified Tissue International.2021; 108(2): 176. CrossRef
15. Increasing fasting glucose and fasting insulin associated with elevated bone mineral density—evidence from cross-sectional and MR studies
H. Zhou, C. Li, W. Song, M. Wei, Y. Cui, Q. Huang, Q. Wang
Osteoporosis International.2021; 32(6): 1153. CrossRef
16. Lower trabecular bone score in type 2 diabetes mellitus: A role for fat mass and insulin resistance beyond hyperglycaemia
María Hayón-Ponce, Beatriz García-Fontana, María Dolores Avilés-Pérez, Sheila González-Salvatierra, Francisco Andújar-Vera, Enrique Moratalla-Aranda, Manuel Muñoz-Torres
Diabetes & Metabolism.2021; 47(6): 101276. CrossRef
17. Physical Activity Associations with Bone Mineral Density and Modification by Metabolic Traits
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Journal of the Endocrine Society.2020;[Epub] CrossRef
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Diabetes/Metabolism Research and Reviews.2019;[Epub] CrossRef
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21. Bone health in diabetes and prediabetes
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22. Marrow adiposity as an indicator for insulin resistance in postmenopausal women with newly diagnosed type 2 diabetes – an investigation by chemical shift-encoded water-fat MRI
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European Journal of Radiology.2019; 113: 158. CrossRef
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Yonsei Medical Journal.2019; 60(8): 804. CrossRef
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