Bone and mineral metabolism in the human body undergoes significant adaptations during pregnancy and lactation to meet the physiological demands of both the mother and fetus. The growing fetus requires approx imately 30 g of calcium, with 80% of this transferred from the mother during the third trimester. These adap tations involve complex hormonal changes, such as increased parathyroid hormone-related peptide (PTHrP) and 1,25-dihydroxyvitamin D, ensuring the mother maintains calcium balance despite fetal demands. However, these changes can also exacerbate pre-existing metabolic bone disorders, presenting unique challenges during preg nancy. This narrative review, framed around illustrative case examples, focuses on the management of metabolic bone disorders in pregnancy. Relevant case studies of hypercalcemia, hypocalcemia, hypophosphatemia, and osteoporosis and chronic kidney disease mineral bone disorder are reviewed to illustrate the biochemical changes, clinical implications, and therapeutic strategies available during pregnancy and lactation. We analyze literature from case reports and existing guidelines to provide practical clinical recommendations. The review highlights critical pregnancy-related metabolic adaptations, such as increased intestinal calcium absorption and skeletal resorption. Disorders like primary hyperparathyroidism (PHPT) and familial hypocalciuric hypercalce mia present significant maternal and fetal risks, including miscarriage, growth restriction, and neonatal com plications. Early identification and tailored treatment, including hydration, parathyroidectomy, and vitamin D supplementation, mitigate these risks, with surgical interventions in PHPT improving pregnancy outcomes compared to conservative management. Management of metabolic bone disorders during pregnancy and lacta tion requires a nuanced approach to meet the dual needs of the mother and fetus.

Bone and mineral metabolism in the human body undergoes significant adaptations during pregnancy and lactation to meet the physiological demands of both the mother and fetus. The growing fetus requires approx imately 30 g of calcium, with 80% of this transferred from the mother during the third trimester. These adap tations involve complex hormonal changes, such as increased parathyroid hormone-related peptide (PTHrP) and 1,25-dihydroxyvitamin D, ensuring the mother maintains calcium balance despite fetal demands. However, these changes can also exacerbate pre-existing metabolic bone disorders, presenting unique challenges during preg nancy. This narrative review, framed around illustrative case examples, focuses on the management of metabolic bone disorders in pregnancy. Relevant case studies of hypercalcemia, hypocalcemia, hypophosphatemia, and osteoporosis and chronic kidney disease mineral bone disorder are reviewed to illustrate the biochemical changes, clinical implications, and therapeutic strategies available during pregnancy and lactation. We analyze literature from case reports and existing guidelines to provide practical clinical recommendations. The review highlights critical pregnancy-related metabolic adaptations, such as increased intestinal calcium absorption and skeletal resorption. Disorders like primary hyperparathyroidism (PHPT) and familial hypocalciuric hypercalce mia present significant maternal and fetal risks, including miscarriage, growth restriction, and neonatal com plications. Early identification and tailored treatment, including hydration, parathyroidectomy, and vitamin D supplementation, mitigate these risks, with surgical interventions in PHPT improving pregnancy outcomes compared to conservative management. Management of metabolic bone disorders during pregnancy and lacta tion requires a nuanced approach to meet the dual needs of the mother and fetus.

Bone and mineral metabolism in the human body undergoes significant adaptations during pregnancy and lactation to meet the physiological demands of both the mother and fetus. The growing fetus requires approx imately 30 g of calcium, with 80% of this transferred from the mother during the third trimester. These adap tations involve complex hormonal changes, such as increased parathyroid hormone-related peptide (PTHrP) and 1,25-dihydroxyvitamin D, ensuring the mother maintains calcium balance despite fetal demands. However, these changes can also exacerbate pre-existing metabolic bone disorders, presenting unique challenges during preg nancy. This narrative review, framed around illustrative case examples, focuses on the management of metabolic bone disorders in pregnancy. Relevant case studies of hypercalcemia, hypocalcemia, hypophosphatemia, and osteoporosis and chronic kidney disease mineral bone disorder are reviewed to illustrate the biochemical changes, clinical implications, and therapeutic strategies available during pregnancy and lactation. We analyze literature from case reports and existing guidelines to provide practical clinical recommendations. The review highlights critical pregnancy-related metabolic adaptations, such as increased intestinal calcium absorption and skeletal resorption. Disorders like primary hyperparathyroidism (PHPT) and familial hypocalciuric hypercalce mia present significant maternal and fetal risks, including miscarriage, growth restriction, and neonatal com plications. Early identification and tailored treatment, including hydration, parathyroidectomy, and vitamin D supplementation, mitigate these risks, with surgical interventions in PHPT improving pregnancy outcomes compared to conservative management. Management of metabolic bone disorders during pregnancy and lacta tion requires a nuanced approach to meet the dual needs of the mother and fetus.

Bone and mineral metabolism in the human body undergoes significant adaptations during pregnancy and lactation to meet the physiological demands of both the mother and fetus. The growing fetus requires approx imately 30 g of calcium, with 80% of this transferred from the mother during the third trimester. These adap tations involve complex hormonal changes, such as increased parathyroid hormone-related peptide (PTHrP) and 1,25-dihydroxyvitamin D, ensuring the mother maintains calcium balance despite fetal demands. However, these changes can also exacerbate pre-existing metabolic bone disorders, presenting unique challenges during preg nancy. This narrative review, framed around illustrative case examples, focuses on the management of metabolic bone disorders in pregnancy. Relevant case studies of hypercalcemia, hypocalcemia, hypophosphatemia, and osteoporosis and chronic kidney disease mineral bone disorder are reviewed to illustrate the biochemical changes, clinical implications, and therapeutic strategies available during pregnancy and lactation. We analyze literature from case reports and existing guidelines to provide practical clinical recommendations. The review highlights critical pregnancy-related metabolic adaptations, such as increased intestinal calcium absorption and skeletal resorption. Disorders like primary hyperparathyroidism (PHPT) and familial hypocalciuric hypercalce mia present significant maternal and fetal risks, including miscarriage, growth restriction, and neonatal com plications. Early identification and tailored treatment, including hydration, parathyroidectomy, and vitamin D supplementation, mitigate these risks, with surgical interventions in PHPT improving pregnancy outcomes compared to conservative management. Management of metabolic bone disorders during pregnancy and lacta tion requires a nuanced approach to meet the dual needs of the mother and fetus.

Bone and mineral metabolism in the human body undergoes significant adaptations during pregnancy and lactation to meet the physiological demands of both the mother and fetus. The growing fetus requires approx imately 30 g of calcium, with 80% of this transferred from the mother during the third trimester. These adap tations involve complex hormonal changes, such as increased parathyroid hormone-related peptide (PTHrP) and 1,25-dihydroxyvitamin D, ensuring the mother maintains calcium balance despite fetal demands. However, these changes can also exacerbate pre-existing metabolic bone disorders, presenting unique challenges during preg nancy. This narrative review, framed around illustrative case examples, focuses on the management of metabolic bone disorders in pregnancy. Relevant case studies of hypercalcemia, hypocalcemia, hypophosphatemia, and osteoporosis and chronic kidney disease mineral bone disorder are reviewed to illustrate the biochemical changes, clinical implications, and therapeutic strategies available during pregnancy and lactation. We analyze literature from case reports and existing guidelines to provide practical clinical recommendations. The review highlights critical pregnancy-related metabolic adaptations, such as increased intestinal calcium absorption and skeletal resorption. Disorders like primary hyperparathyroidism (PHPT) and familial hypocalciuric hypercalce mia present significant maternal and fetal risks, including miscarriage, growth restriction, and neonatal com plications. Early identification and tailored treatment, including hydration, parathyroidectomy, and vitamin D supplementation, mitigate these risks, with surgical interventions in PHPT improving pregnancy outcomes compared to conservative management. Management of metabolic bone disorders during pregnancy and lacta tion requires a nuanced approach to meet the dual needs of the mother and fetus.

Osteoporosis in men remains a significantly underrecognized condition, with notable differences in bone mineral density (BMD) and fracture risk between Asian and Western populations. Despite 30% of hip fractures globally occurring in men, they are less likely to be diagnosed or treated for osteoporosis, especially in resource-limited settings. Given these disparities, a deeper understanding of osteoporosis epidemiology and treatment efficacy in men is essential, particularly in Asian populations.This review synthesizes the latest evidence on the epidemiology, screening, and treatment of osteoporosis in men, with a focus on genetic, environmental, and epidemiological disparities between Eastern and Western populations. Additionally, the review examines existing controversies surrounding fracture risk screening in men and evaluates the efficacy and cost-effectiveness of pharmacological treatments such as bisphosphonates, denosumab, and anabolic agents.Asian men exhibit lower peak BMD compared to their Caucasian counterparts, leading to potential misdiagnoses when using Caucasian-based BMD reference ranges. Screening tools like the Fracture Risk Assessment Tool (FRAX)® show variability in performance across populations. Data on pharmacological treatment in men remain limited, although studies suggest comparable benefits to those observed in women. Larger studies, particularly in male and Asian populations, are urgently needed to refine diagnostic and therapeutic guidelines.Osteoporosis in men is underdiagnosed and undertreated globally, with pronounced disparities between populations. Current diagnostic tools and treatment protocols are not fully tailored to male and Asian populations. There is an urgent need for longitudinal studies focusing on male-specific osteoporosis management to reduce fracture risk and improve outcomes.

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.

Osteoporosis in men remains a significantly underrecognized condition, with notable differences in bone mineral density (BMD) and fracture risk between Asian and Western populations. Despite 30% of hip fractures globally occurring in men, they are less likely to be diagnosed or treated for osteoporosis, especially in resource-limited settings. Given these disparities, a deeper understanding of osteoporosis epidemiology and treatment efficacy in men is essential, particularly in Asian populations.This review synthesizes the latest evidence on the epidemiology, screening, and treatment of osteoporosis in men, with a focus on genetic, environmental, and epidemiological disparities between Eastern and Western populations. Additionally, the review examines existing controversies surrounding fracture risk screening in men and evaluates the efficacy and cost-effectiveness of pharmacological treatments such as bisphosphonates, denosumab, and anabolic agents.Asian men exhibit lower peak BMD compared to their Caucasian counterparts, leading to potential misdiagnoses when using Caucasian-based BMD reference ranges. Screening tools like the Fracture Risk Assessment Tool (FRAX)® show variability in performance across populations. Data on pharmacological treatment in men remain limited, although studies suggest comparable benefits to those observed in women. Larger studies, particularly in male and Asian populations, are urgently needed to refine diagnostic and therapeutic guidelines.Osteoporosis in men is underdiagnosed and undertreated globally, with pronounced disparities between populations. Current diagnostic tools and treatment protocols are not fully tailored to male and Asian populations. There is an urgent need for longitudinal studies focusing on male-specific osteoporosis management to reduce fracture risk and improve outcomes.

Osteoporosis in men remains a significantly underrecognized condition, with notable differences in bone mineral density (BMD) and fracture risk between Asian and Western populations. Despite 30% of hip fractures globally occurring in men, they are less likely to be diagnosed or treated for osteoporosis, especially in resource-limited settings. Given these disparities, a deeper understanding of osteoporosis epidemiology and treatment efficacy in men is essential, particularly in Asian populations.This review synthesizes the latest evidence on the epidemiology, screening, and treatment of osteoporosis in men, with a focus on genetic, environmental, and epidemiological disparities between Eastern and Western populations. Additionally, the review examines existing controversies surrounding fracture risk screening in men and evaluates the efficacy and cost-effectiveness of pharmacological treatments such as bisphosphonates, denosumab, and anabolic agents.Asian men exhibit lower peak BMD compared to their Caucasian counterparts, leading to potential misdiagnoses when using Caucasian-based BMD reference ranges. Screening tools like the Fracture Risk Assessment Tool (FRAX)® show variability in performance across populations. Data on pharmacological treatment in men remain limited, although studies suggest comparable benefits to those observed in women. Larger studies, particularly in male and Asian populations, are urgently needed to refine diagnostic and therapeutic guidelines.Osteoporosis in men is underdiagnosed and undertreated globally, with pronounced disparities between populations. Current diagnostic tools and treatment protocols are not fully tailored to male and Asian populations. There is an urgent need for longitudinal studies focusing on male-specific osteoporosis management to reduce fracture risk and improve outcomes.

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.