Stopping denosumab without a bisphosphonate to follow carries a 71% higher vertebral fracture risk

The edition in brief

A GRADE-assessed review pooled six studies and 683 patients who stopped denosumab and either received alendronate or zoledronic acid or received nothing. Sequential bisphosphonate was associated with fewer incident vertebral fractures (RR 0.29, 95% CI 0.14 to 0.59), fewer multiple vertebral fractures (RR 0.08, 0.01 to 0.43) and fewer clinical vertebral fractures (RR 0.18, 0.07 to 0.49). Non-vertebral and any-fracture reductions were not significant, the protection came almost entirely from comparisons against no therapy, and certainty was low to very low because most studies were observational. The AAOS guideline on acute compartment syndrome, released in November 2025 and interpreted this month alongside the 2020 Chinese guideline, makes eight recommendations and seven consensus statements. It values compartment pressure monitoring mainly for ruling the diagnosis out dynamically, accepts myoglobinuria, serum troponin and in specific contexts femoral venous lactate only as adjuncts, and states explicitly that serum biomarkers must not be the basis for a fasciotomy decision in late or missed cases. Early fixation of associated long bone fractures moves from expert consensus to a limited recommendation. A JBJS review concludes robotic-assisted joint replacement reliably improves component positioning but that trials, meta-analyses and registries have not shown consistent gains in patient-reported outcomes, complications or implant survivorship. And an updated meta-analysis of 25 observational studies quantifies periprosthetic knee infection risk factors, with obesity (OR 5.72), pulmonary disease (OR 5.54) and prior hormone therapy (OR 4.88) at the top.