Osteoporotic fractures are characterized by reduced bone mass and microstructural abnormalities, leading to differences in the healing process compared to traumatic fractures. The fracture healing process is generally divided into the inflammatory phase, the repair phase and the remodeling phase. In patients with osteoporotic fractures, due to factors such as decreased bone density, reduced bone quality and aging, there are partial alterations in inflammatory cells and osteoimmunity associated with those three healing phases, ultimately affecting fracture healing. This article focuses on the differences in fracture healing between non-osteoporotic fractures and osteoporotic fractures, reviewing relevant research literature and consensus. It analyzes and discusses changes in bone marrow mesenchymal stem cells and bone metabolism during osteoporosis, the effects of inflammatory aging, underlying diseases, and anti-osteoporosis medications on fracture healing, as well as the changes observed after pharmacological intervention. The aim is to emphasize personalized treatment approaches that account for individual and bone-specific factors in managing osteoporotic fractures, striving to promote better fracture healing outcomes and improving patients' quality of life.

Global population aging has exacerbated the clinical management challenges of osteoporotic fractures, especially during the high-risk period of re-fracture within 2 years after fracture. Although significant progress has been made in the comprehensive management of osteoporotic fractures in China, which has improved patient prognosis. There are still many challenges in clinical practice, including the mismatch between traditional implants and osteoporotic bone structure, the clinical management bottlenecks from treatment to rehabilitation of osteoporotic fractures (such as low implementation rates of drug treatment, poor drug compliance, and inadequate rehabilitation awareness), as well as the underdevelopment and regional disparities of fracture liaison services in China. To address these challenges, we propose three strategic improvements: transitioning from a purely mechanical fixation to a combined "mechanical-biological" synergistic treatment model, optimizing a full-cycle management pathway for osteoporotic fractures based on the enhanced recovery after surgery, and developing a systematic and intelligent approach for re-fracture prevention (such as establishing exclusive management teams, constructing specialized databases, and developing intelligent data platforms). These strategies are expected to enable efficient screening, precise monitoring, and full lifecycle management of patients with osteoporotic fractures, thereby enhancing the effectiveness and precision of clinical management and offering new insights and practical pathways for improving the treatment and care of osteoporotic fractures in China.

Vertebral refracture following percutaneous vertebral augmentation (PVA) is commonly seen in elderly patients with osteoporotic thoracolumbar compression fractures (OTLCF). It can lead to recurrent pain, loss of vertebral height, progression of kyphosis, and even neurological dysfunction, significantly impairing patients′ quality of life. Current diagnosis and treatment face multiple challenges, including high misdiagnosis rate, difficulty in choosing between surgical and non-surgical treatment options, lack of standardized surgical protocols, interference from intralesional bone cement during procedures, inadequate stability of internal fixation in osteoporotic bone, and suboptimal compliance of anti-osteoporotic therapy. Establishing a standardized diagnostic and therapeutic framework is urgently needed. To standardize the management process and improve outcomes for vertebral refractures after PVA in elderly OTLCF patients, Spinal Trauma Group of the Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field to develop Guideline for the diagnosis and treatment of vertebral refracture after percutaneous vertebral augmentation in elderly patients with osteoporotic thoracolumbar compression fractures ( version 2025), based on current literature and clinical experience, and adhering to principles of scientific rigor and clinical applicability. A total of 11 recommendations were proposed, encompassing diagnosis, treatment, and rehabilitation of vertebral refracture after PVA in elderly patients with OTLCF, aiming to provide a foundation for a standardized management.

Nonunion of osteoporotic vertebral fractures (OVF), predominantly affecting the elderly, can lead to intractable pain, vertebral collapse, progressive kyphotic deformity, and neurological impairment, significantly compromising patients′ quality of life. There exists considerable debate on diagnosis and management of OVF, encompassing key issues such as clinical diagnosis and staging criteria for nonunion, surgical indications and procedure selection, and postoperative rehabilitation planning. Currently, there lacks standardized clinical guideline and expert consensus on the diagnosis and management of OVF nonunion in China. To address this gap, Minimally Invasive Surgery Group of Chinese Orthopedic Association, Osteoporosis Committee of Chinese Association of Orthopedic Surgeons, Prevention and Rehabilitation Committee for Osteoporosis of Chinese Association of Rehabilitation Medicine and Minimally Invasive Orthopedic Surgery Branch of China Association for Geriatric Care jointly organized domestic experts in spinal surgery, endocrinology, and rehabilitation to formulate the Clinical guideline for the diagnosis and treatment for nonunion of osteoporotic vertebral fractures ( version 2025), based on existing literature and clinical experience and adhering to principles of scientific rigor and practicality. The guideline provided 13 evidence-based recommendations encompassing diagnosis and treatment of OVF nonunion, aiming to standardize its clinical management.

Allergic comorbidity is a common allergic-related disease in the department of pediatrics,which is called atopic triad in modern medicine.Professor Xu Youjia believes that the children with allergic comorbidity have a more distinctive constitution of insufficiency of immature yang.Children with allergic comorbidity initially have the spleen-qi deficiency pathogenesis,and then the kidney yang will be further involved if the children fail in timely regulation and supplementation,which will result in kidney yang deficiency.In the view of spleen-kidney deficiency-cold pathogenesis of children with allergic comorbidity,Professor Xu Youjia suggested that,during the treatment,attention should be paid to the protection of the spleen(earth)of the middle energizer,thus to ensure the postnatal fire warm congenital kidney yang,and then the efficacy of raising qi and reinforcing yang can be achieved.The core medicines used for the treatment of deficiency-cold snineling nose include seven herbs,and they were Glycyrrhizae Radix et Rhizoma,Atractylodis Macrocephalae Rhizoma,Angelicae Dahuricae Radix,Saposhnikoviae Radix,Xanthii Fructus,Magnoliae Flos,and Schisandrae Chinensis Fructus.For children with severe deficiency-cold,the treatment needs to start from supplementing kidney-qi and protecting the root of yang,and the medicinals such as Psoraleae Fructus,Cimicifugae Rhizoma,Eucommiae Cortex,and Cinnamomi Cortex can be used.Professor Xu stressed the importance of adjusting the children's dietary structure and habits for protecting the spleen and stomach.The application of therapy of mediating the middle earth,raising qi and strengthening yang should accord with the growth and development of children,and the therapy is suitable for guiding the clinical treatment of diseases related to deficiency-cold syndrome.The selection of prescriptions should be based on the identification of the pathogenesis of deficiency-cold and its severity.

Osteoporotic fractures are characterized by reduced bone mass and microstructural abnormalities, leading to differences in the healing process compared to traumatic fractures. The fracture healing process is generally divided into the inflammatory phase, the repair phase and the remodeling phase. In patients with osteoporotic fractures, due to factors such as decreased bone density, reduced bone quality and aging, there are partial alterations in inflammatory cells and osteoimmunity associated with those three healing phases, ultimately affecting fracture healing. This article focuses on the differences in fracture healing between non-osteoporotic fractures and osteoporotic fractures, reviewing relevant research literature and consensus. It analyzes and discusses changes in bone marrow mesenchymal stem cells and bone metabolism during osteoporosis, the effects of inflammatory aging, underlying diseases, and anti-osteoporosis medications on fracture healing, as well as the changes observed after pharmacological intervention. The aim is to emphasize personalized treatment approaches that account for individual and bone-specific factors in managing osteoporotic fractures, striving to promote better fracture healing outcomes and improving patients' quality of life.

Global population aging has exacerbated the clinical management challenges of osteoporotic fractures, especially during the high-risk period of re-fracture within 2 years after fracture. Although significant progress has been made in the comprehensive management of osteoporotic fractures in China, which has improved patient prognosis. There are still many challenges in clinical practice, including the mismatch between traditional implants and osteoporotic bone structure, the clinical management bottlenecks from treatment to rehabilitation of osteoporotic fractures (such as low implementation rates of drug treatment, poor drug compliance, and inadequate rehabilitation awareness), as well as the underdevelopment and regional disparities of fracture liaison services in China. To address these challenges, we propose three strategic improvements: transitioning from a purely mechanical fixation to a combined "mechanical-biological" synergistic treatment model, optimizing a full-cycle management pathway for osteoporotic fractures based on the enhanced recovery after surgery, and developing a systematic and intelligent approach for re-fracture prevention (such as establishing exclusive management teams, constructing specialized databases, and developing intelligent data platforms). These strategies are expected to enable efficient screening, precise monitoring, and full lifecycle management of patients with osteoporotic fractures, thereby enhancing the effectiveness and precision of clinical management and offering new insights and practical pathways for improving the treatment and care of osteoporotic fractures in China.

Vertebral refracture following percutaneous vertebral augmentation (PVA) is commonly seen in elderly patients with osteoporotic thoracolumbar compression fractures (OTLCF). It can lead to recurrent pain, loss of vertebral height, progression of kyphosis, and even neurological dysfunction, significantly impairing patients′ quality of life. Current diagnosis and treatment face multiple challenges, including high misdiagnosis rate, difficulty in choosing between surgical and non-surgical treatment options, lack of standardized surgical protocols, interference from intralesional bone cement during procedures, inadequate stability of internal fixation in osteoporotic bone, and suboptimal compliance of anti-osteoporotic therapy. Establishing a standardized diagnostic and therapeutic framework is urgently needed. To standardize the management process and improve outcomes for vertebral refractures after PVA in elderly OTLCF patients, Spinal Trauma Group of the Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field to develop Guideline for the diagnosis and treatment of vertebral refracture after percutaneous vertebral augmentation in elderly patients with osteoporotic thoracolumbar compression fractures ( version 2025), based on current literature and clinical experience, and adhering to principles of scientific rigor and clinical applicability. A total of 11 recommendations were proposed, encompassing diagnosis, treatment, and rehabilitation of vertebral refracture after PVA in elderly patients with OTLCF, aiming to provide a foundation for a standardized management.

Nonunion of osteoporotic vertebral fractures (OVF), predominantly affecting the elderly, can lead to intractable pain, vertebral collapse, progressive kyphotic deformity, and neurological impairment, significantly compromising patients′ quality of life. There exists considerable debate on diagnosis and management of OVF, encompassing key issues such as clinical diagnosis and staging criteria for nonunion, surgical indications and procedure selection, and postoperative rehabilitation planning. Currently, there lacks standardized clinical guideline and expert consensus on the diagnosis and management of OVF nonunion in China. To address this gap, Minimally Invasive Surgery Group of Chinese Orthopedic Association, Osteoporosis Committee of Chinese Association of Orthopedic Surgeons, Prevention and Rehabilitation Committee for Osteoporosis of Chinese Association of Rehabilitation Medicine and Minimally Invasive Orthopedic Surgery Branch of China Association for Geriatric Care jointly organized domestic experts in spinal surgery, endocrinology, and rehabilitation to formulate the Clinical guideline for the diagnosis and treatment for nonunion of osteoporotic vertebral fractures ( version 2025), based on existing literature and clinical experience and adhering to principles of scientific rigor and practicality. The guideline provided 13 evidence-based recommendations encompassing diagnosis and treatment of OVF nonunion, aiming to standardize its clinical management.

Objective:To identify the risk factors for poor prognosis following interventional treatment in the patients with postherpetic neuralgia (PHN) and construct a predictive model.Methods:The medical records from patients with PHN undergoing interventional therapy at the First Affiliated Hospital of Soochow University from March 2020 to August 2023 were retrospectively collected, including basic characteristics, past medical and surgical history, symptoms, medication therapy, clinical pain score, neutrophil/lymphocyte ratio (NLR) before interventional treatment and interventional treatment methods. Logistic regression analysis was used to identify the risk factors associated with poor prognosis following interventional treatment in PHN patients, and a nomogram predictive model for poor prognosis was constructed. The discrimination and calibration of the nomogram predictive model were evaluated using the C-index and Hosmer-Lemeshow test. Calibration curves and clinical decision curves were drawn to further verify the accuracy of the predictive model.Results:The results of the multivariate logistic regression analysis show that increasing age, prolonged disease duration, elevated NLR, use of immunosuppressants and use of pulsed radiofrequency were independent risk factors for poor prognosis following intervention treatment in PHN patients ( P<0.05). The nomogram predictive model for poor prognosis following PHN interventional treatment constructed based on these factors had a C-index of 0.844. Calibration curves showed good consistency between predicted probability of poor prognosis and actual incidence of poor prognosis. Clinical decision curves indicated that the predictive model provided good accuracy and net benefit. Conclusions:Increasing age, prolonged disease course, elevated NLR, use of immunosuppressants and use of pulsed radiofrequency are independent risk factors for poor prognosis following interventional treatment in the patients with PHN. The nomogram predictive model based on these factors can effectively predict the occurrence of poor prognosis in PHN patients undergoing interventional treatment.