Background/Objectives: Kienböck disease (idiopathic avascular necrosis of the lunate) is treated almost exclusively surgically; its pharmacological evidence base comprises fewer than five primary publications and ~20 patient-level observations. Femoral-head, jaw, and knee osteonecrosis have decades of evidence, including randomised trials. We ask whether extra-carpal evidence can be translated to Kienböck disease and the wider Carpal Avascular Necrosis Family (lunate, scaphoid/Preiser, capitate, hamate, triquetrum). Methods: We conducted a narrative review reported per SANRA, searching PubMed, CrossRef, Google Scholar and three specialty registries from inception to 2026 across eleven drug classes and eleven skeletal sites. All references were independently verified against primary sources (PubMed/CrossRef). No Kienböck-specific randomised or controlled data exist; all conclusions therefore rest on indirect, extra-carpal evidence. Results: Three pathways (subchondral insufficiency fracture, microvascular ischaemia, hypercoagulability) predict drug-class plausibility differently by site. Iloprost is the candidate most consistently aligned across the translation axes, though no direct lunate data exist; teriparatide provides the only randomised evidence suggesting reversal of established osteonecrosis at any site (medication-related osteonecrosis of the jaw). The lunate sits within a coherent carpal AVN family sharing end-arterial supply, Lichtman-grade trajectories, and a near-identical evidence vacuum. Conclusions: A Four-Axis Translation Framework (mechanistic alignment, anatomic concordance, Lichtman-stage applicability, lunate-specific risk-benefit geometry) is proposed to evaluate which extra-carpal evidence is admissible at the lunate; with the carpal AVN family construct, these are the review's two novel contributions.

Anti-osteoporotic drugs are increasingly discussed as candidate dual bone-muscle therapies in osteosarcopenia, yet clinical claims often conflate biological plausibility, observational signals, and randomized efficacy. We conducted a source-verified scoping evidence map and translational review, updated through 25 July 2026 using PubMed/MEDLINE, Europe PMC, and citation tracking. Evidence was classified as primary randomized evidence, secondary randomized analysis, observational human evidence, mechanistic/preclinical rationale, or review-level context; quantitative pooling was avoided because no drug-outcome pair had a sufficiently homogeneous randomized evidence base. Denosumab has the most coherent translational rationale through RANKL/RANK/NF-kB signaling, but randomized long-term-care data were neutral for muscle mass, strength, and performance despite bone mineral density improvement. Long-term-care context may reduce anabolic reserve, but a drug-by-exercise interaction remains unproven. Early pamidronate data in severe pediatric burns support prevention of resorption-linked muscle catabolism rather than reversal of established age-related sarcopenia. Bisphosphonates and teriparatide have preclinical or secondary signals; romosozumab and abaloparatide lack direct clinical muscle-efficacy evidence. Nandrolone is retained only as a historical positive control. Future trials should distinguish prevention from reversal and use factorial or rigorously standardized exercise designs with prespecified strength, muscle-mass, physical-performance, and pathway endpoints.

Medication-related osteonecrosis of the external auditory canal (MROEAC) is a rare complication of antiresorptive therapy, and guidance for diagnosis and management remains limited. We describe 2 patients with prolonged antiresorptive exposure who developed MROEAC and were treated with teriparatide. An 81-year-old woman developed bilateral external auditory canal erosions after 10 years of denosumab therapy. An 8-week course of teriparatide was associated with clinical improvement and a transient rise in bone formation markers, but computed tomography findings remained unchanged. Denosumab withdrawal led to delayed rebound bone resorption, prompting denosumab reintroduction. A 67-year-old woman developed left-sided MROEAC after 15 years of alendronate followed by a short course of denosumab. Four months of teriparatide was associated with symptomatic and biochemical improvement, but radiologic abnormalities persisted, and definitive surgery was required. These cases highlight the difficulty of differentiating MROEAC from more common otologic disorders, the discordance between clinical, biochemical, and radiologic response, the importance of multidisciplinary management, and therapeutic challenges created by denosumab discontinuation. Teriparatide was well tolerated and was associated with increased bone turnover markers, but radiologic resolution was incomplete. Surgical management may still be necessary.

Palopegteriparatide is a prodrug of teriparatide and should have similar concerns during breastfeeding. One infant with congenital hyperparathyroidism was breastfed during maternal use of teriparatide. The infant appeared to be protected against hypoparathyroidism by breastfeeding. If palopegteriparatide is used in a nursing mother, monitor breastfed infants for signs and symptoms of hypercalcemia or hypocalcemia. Serum calcium monitoring should also be considered. Until more data become available, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.

Hip fractures are among the most devastating fragility fractures, associated with excess mortality, disability, loss of independence, and substantial healthcare costs. Although age-standardized incidence has declined in several high-income countries, absolute case numbers continue to rise because of population aging. This review summarizes contemporary PubMed-indexed evidence on the epidemiology, risk stratification, and prevention of proximal femoral fractures, with emphasis on hip-fracture outcomes rather than vertebral or composite endpoints alone. We discuss secular trends, FRAX-based case findings and screening, non-pharmacologic strategies, pharmacologic therapy, and health-system interventions relevant to both primary and secondary prevention. Among non-pharmacologic measures, long-term balance-challenging and resistance-based exercise has the most consistent evidence for reducing falls and likely contributes to fracture prevention, whereas multifactorial interventions, home hazard modification, calcium/vitamin D supplementation, and hip protectors are best targeted to selected high-risk populations and care settings. Among medications, bisphosphonates, denosumab, and romosozumab-based sequential strategies show the strongest evidence for reducing hip-fracture risk, while teriparatide and abaloparatide have important roles in very-high-risk patients despite less direct hip-fracture evidence. Menopausal hormone therapy reduces hip fractures in younger postmenopausal women but is limited by extra-skeletal risk, and selective estrogen receptor modulators are primarily vertebral-fracture agents. A major message of this review is that effective prevention depends not only on drug efficacy but also on implementation. Fracture liaison services, orthogeriatric co-management, prompt treatment after fragility fracture, and sustained adherence support are essential to close persistent care gaps. Preventing hip fractures therefore requires an integrated, risk-stratified approach that combines skeletal protection, falls prevention, and reliable health-system delivery.

Stress fractures of the forearm are uncommon, and to our knowledge, sequential involvement of both the ulna and radius has not been well characterized. Neurofibromatosis type 1 is associated with increased bone fragility and delayed fracture healing due to impaired osteoblastic differentiation, reduced mineralization capacity, and increased osteoclastic activity. We report the case of a woman in her early 60s with neurofibromatosis type 1 and lower-extremity weakness who relied on upper-extremity weight-bearing ambulation. She initially developed a nondisplaced transverse stress fracture of the proximal ulnar shaft with delayed union, which subsequently achieved union following conservative treatment, including teriparatide. Approximately 24 months after the initial ulnar fracture, she developed a new nondisplaced stress fracture of the radial shaft, suggestive of a possible stress-transfer phenomenon related to altered load distribution across the forearm. Repeated conservative treatment with strict weight-bearing restriction resulted in radiographic union with restoration of functional forearm motion. This case highlights the importance of recognizing altered forearm load distribution to reduce the risk of secondary stress injury.

Medication-related osteonecrosis of the jaw (MRONJ) is a challenging complication associated with antiresorptive and antiangiogenic therapies. Prolonged suppression of bone remodeling has been implicated as a key mechanism in its pathophysiology. Teriparatide, an osteoanabolic agent that restores coupled bone remodeling, has been proposed as a potential therapeutic strategy. This review aimed to synthesize reported clinical outcomes of teriparatide use in MRONJ within a systemic remodeling-based framework. We conducted a structured descriptive review based on a systematic literature search and reported in accordance with PRISMA 2020. Studies reporting therapeutic use of teriparatide in established MRONJ were included regardless of the triggering medication. Data were extracted on patient characteristics, MRONJ stage, lesion site, antiresorptive exposure, teriparatide regimen, antiresorptive interruption, antiresorptive type, and clinical outcomes. Because of substantial heterogeneity in study design, patient populations, co-interventions, and outcome reporting, evidence was synthesized qualitatively. Thirty-four publications including 207 patients were included. Clinical outcomes were available for 201 patients: complete coverage/healing was reported in 163, partial improvement in 24, no change in 12, and worsening in 2. Teriparatide discontinuation or dropout after treatment initiation was reported in 13 patients. Stage 2 disease predominated among stageable cases, mandibular involvement was the most frequent anatomical site, and daily teriparatide dosing was more commonly reported than weekly regimens. Bisphosphonate exposure predominated, whereas denosumab-associated cases were fewer; therefore, differential effectiveness by antiresorptive class could not be determined. Published reports describe frequent clinical improvement after teriparatide use in MRONJ. However, the evidence remains descriptive, heterogeneous, and commonly confounded by concomitant therapies. These findings support a biologically plausible remodeling-based interpretation but do not establish efficacy or define teriparatide as standard therapy.