Bibliometric analysis of β - CTX and N-MID in the detection of osteoporosis and osteoporotic fractures

Background: With the intensification of population aging, osteoporosis has become the second most common chronic disease globally. The incidence of osteoporotic fractures (OF) has also shown a significant upward trend. According to the ''Guidelines for the Diagnosis and Treatment of Primary Osteoporosis (2022)'', China's osteoporosis faces the severe challenge of ''one high and three lows'' (high prevalence, low awareness, low diagnosis rate, and low treatment rate), leading to OF being characterised by ''three highs and one low'': high incidence, high disability rate, high mortality, and low diagnosis rate, which affects diagnosis and treatment. Osteoporosis is characterised by reduced bone mass and impaired microarchitecture. It increases the risk of fractures and places a burden on global healthcare systems. As key bone turnover markers, β-CTX and N-MID are essential for evaluating metabolic activity, diagnosing osteoporosis and fractures, and monitoring treatment. Although research into their molecular mechanisms and clinical applications has increased, a comprehensive bibliometric analysis of trends, contributors, and networks is lacking. Method: The literature was sourced from the Web of Science Core Collection (WOSCC) database, with the search period spanning from 2005 to 2025. An initial search yielded 8902 studies. Following manual screening to exclude incomplete information, duplicate publications, conference papers, news reports and literature unrelated to the research topic, 6239 articles were ultimately included. VOSviewer 1.6.20 was used for overlay and network visualization, with parameters such as association strength, attraction/repulsion, scaling ratio and labels dynamically adjusted to optimise the presentation of the co-occurrence network. CiteSpace 6.2R6 was used for bibliometric visualization, importing 'full records with citations' text data. The time slice was set to one year and network strength was calculated using the cosine algorithm. The top 10% of targets were extracted from each time slice. Node types included keywords (threshold: top 50), with node extraction employing k = 25. Pathfinder and pruning were used to optimise the network structure, while keyword clustering employed the Log-Likelihood Ratio (LLR) algorithm for labelling. Result: From 2005 to 2025, the annual publication output in this field showed fluctuating trends. After periods of steady accumulation, growth and volatility, the 2020 pandemic caused significant fluctuations. Data for 2025 may be incomplete due to the short time period for which data is available. China led the way with 1927 publications, followed by the United States, Japan and South Korea. European nations made significant contributions in areas such as evidence-based research. Institutionally, Shanghai Jiao Tong University was central with 114 publications, while the University of Sheffield and Fudan University each focused on distinct areas, reflecting strong international collaboration. Core journals include Bone and Osteoporosis International, which cover fundamental, clinical, and translational research, while general journals also facilitate the dissemination of knowledge. Key themes include 'bone density' and 'postmenopausal women', and cluster analysis highlights three main areas: core indicators, pathological associations, and others. Emerging keywords suggest a shift in research focus from treatment to molecular mechanisms and clinical translation. Conclusion: This bibliometric Analysis system summarises the research landscape surrounding the use of β-CTX and N-MID in the detection of osteoporosis and osteoporotic fractures between 2005 and 2025. The field has shown steady growth, with fluctuations influenced by global events such as the 2019–2020 pandemic. Leading institutions, including those in China, the United States and Shanghai Jiao Tong University, are key contributors, and collaboration is driving the exchange of knowledge. Research has focused on integrated diagnostics that combine β-CTX/N-MID with bone mineral density testing, risk assessment in postmenopausal women and multifactorial interventions (e.g. endocrine regulation and oxidative stress management). Emerging priorities include standardised testing of bone turnover markers and their application in fracture risk prediction. Future research should prioritise the standardised measurement of β-CTX/N-MID, the integration of multicentre data across populations, and the translation of molecular mechanisms into clinical practice, with the aim of enhancing the precision of osteoporosis management.