What is known about osteoporosis research in Latin America?: A bibliometric analysis of three decades

Abstract

Identifying the gaps in scientific production in a topic allows directing research in order to make better public investment decisions. Bibliometric data on osteoporosis in Latin America are very limited and unclear and, given the impact of this disease in this region, it is relevant to analyze the latest trends in the subject. The study approach was quantitative, observational-descriptive, cross-sectional. Data were collected from journals indexed in Scopus between 1990 and 2019, using a search strategy that included Medical Subject Headings terms for “Osteoporosis” and other related terms, as well as VOSviewer software to create cooperative and co-occurrence word maps. 3261 documents were analyzed, with an annual scientific production rate of 5% (163 documents), where 73.9% were original articles. The countries with the highest scientific production in osteoporosis were Brazil (55.2%) and Argentina (18%). Extra-regional cooperation was mainly with the United States (16.35%) and Spain (5.18%). Six of the 10 most productive countries had their own government agencies as the main funders. The National Council for Scientific and Technological Development was the institution that funded the most (n = 194). The term “osteoporosis” together with the terms “bone mineral density,” “fractures,” and “menopause” were the most frequently addressed subjects. Latin American scientific production in osteoporosis has shown a significant increase. However, in the last 3 years it has shown a slight reduction. Greater intraregional collaboration involving universities, institutions and health societies is needed.

1. Introduction

Osteoporosis is a skeletal comorbidity characterized by a reduction in bone mass.^[1] It causes increased fragility and an increased risk of fractures^[2] in more than 200 million people worldwide.^[3] In particular, it leads to hip fractures, which have an annual incidence of 1.7 million cases worldwide. It also increases mortality in women by 10% to 20% over what is expected for their age.^[3] The odds of death are 5 to 8 times higher in the first 3 months after a fracture, which is substantially comparable to stroke and breast cancer.^[4]

Certain data in Latin America show that in Argentina between 260 and 330 per 100 thousand people aged 50 years and over with femoral osteoporosis suffer from hip fractures. Whereas in Perú, México, Chile, Venezuela and Panama there are between 40 and 360 hip fractures per 100 thousand people aged 50 years and over. Furthermore, between 17% and 37% of patients with hip fractures die within a year of the fracture.^[5] Therefore, it is important in Latin America to continue developing research for the adequate management of osteoporosis and its repercussions.

Bibliometrics is a set of mathematical and statistical methods used to analyze the quantity and quality of scientific publications.^[6] It measures the impact of research through the use of various bibliometric indicators such as the impact factor^[7] and the H-index.^[8] They make it possible to detect gaps in scientific production, thus allowing better decisions to be made regarding public investment in research in a specific field.^[9]

Previous bibliometric studies on osteoporosis worldwide^[10,11] have confirmed that the general trend in scientific production has decreased. The leading country is the United States,^[10] followed by China and Japan, with minimal participation from other developing countries.^[11] However, it is important to emphasize that these studies^[10,11] provided very limited and unspecific data on productivity in Latin America, and given the impact of this disease in Latin America it is relevant to analyze trends.

For this reason, a bibliometric analysis focused on this region will help to identify the current situation, so that it can be a starting point for further analysis, as well as a contribution to the management of research on the disease in Latin American institutions. For this reason, this study aims to analyze the Latin American scientific production in osteoporosis with a focus on the period 1990 to 2019.

2. Materials and methods

2.1. Study design and information source

A bibliometric analysis was performed using studies published in journals indexed in Scopus (Elsevier BV, The Netherlands) between 1990 to 2019. Scopus was used because it is the largest database of peer-reviewed scientific abstracts covering more than 22 thousand publisher titles, including all MEDLINE documents. It features a large number of high quality journals and a search engine that helps to evaluate scientific work.^[12]

2.2. Search strategy

The search strategy encompassed terms related to “Osteoporosis” as recommended by Medical Subject Headings, including: “Osteoporosis,” “Osteoporoses,” “Bone Loss Age-Related,” “Bone Losses Age-Related,” and “Osteoporoses senile.” Additionally, terms recommended by Embase Subject Headings were incorporated. The latter was utilized because, besides considering Medical Subject Headings terms, it presented additional variants that yielded more results on the topic that were not previously considered. Each term was manually tested to ensure that it indeed contributed to retrieving additional relevant manuscripts.

The selected synonyms and variants related to osteoporosis were linked using the boolean operator “OR.” Furthermore, the search was limited to the publication dates: January 01, 1990 to December 31, 2019, and to countries in Latin America, which are detailed in Table 1.

Table 1.

Scopus search strategy.

Search terms used in Scopus.

((TITLE(Osteoporo*) AND TITLE(primary OR secondary OR experimental OR idiopathic OR involutional OR juvenil* OR *menopaus* OR *traumatic* OR primary OR Involutional OR “Age-Related” OR “age related” OR “*esteroid induced” OR endocrine AND experimental OR senil* OR juvenile OR involutional OR ovareictomy OR steroid)) OR (TITLE-ABS-KEY(osteoporo* OR “anti-osteoporosis” OR antiosteoporotic OR “anti-osteoporosis action” OR “anti-osteoporosis activity” OR “anti-osteoporosis effect” OR “corticosteroid induced osteoporosis” OR “steroid-induced osteoporosis” OR “corticosteroid osteoporosis” OR “corticosteroid-induced osteoporosis” OR “steroid induced osteoporosis” OR “experimentally induced osteoporosis” OR “idiopathic juvenile osteoporosis” OR “osteoporosis prevention activity” OR “osteoporosis-inhibiting activity” OR “ovariectomy-induced osteoporosis” OR “Osteoporosis Post-Traumatic” OR “Post-Traumatic Osteoporoses”))) AND (LIMIT-TO (SRCTYPE,”j”)) AND (AFFILCOUNTRY(argentina OR bolivia OR brazil OR chile OR colombia OR “Costa Rica” OR cuba OR ecuador OR “El Salvador” OR guatemala OR haiti OR honduras OR mexico OR mejico OR suriname OR nicaragua OR panama OR paraguay OR peru OR “Puerto Rico” OR “Dominican Republic” OR uruguay OR venezuela OR “Latin America” OR caribbean)) AND (PUBYEAR > 1989) AND (EXCLUDE (PUBYEAR,2021) OR EXCLUDE (PUBYEAR,2020))

The search was conducted during January 13, 2021. Manual testing of the search strategy’s validity involved examining the reports that were found. A report on osteoporosis from the Latin American region was considered as one with an author affiliated with any Latin American country.

2.3. Ethical considerations

As a retrospective study utilizing publicly available data from Scopus, and not involving human or animal subjects, and being purely bibliometric in nature, it did not undergo an ethics committee review by regulatory entities.

2.4. Data collection and analysis

Articles from the search results are downloaded in the format of comma-separated values (.csv) and imported into Microsoft Excel 2016 (Washington, DC). Bibliometric indicators were presented for: annual production, by country and institution, publication type, journal metrics, funding, keywords, and intra- and extra-regional collaboration. The t-Student test was used to determine differences in the number of publications among cohorts. A significant P value of less than .05 will be considered significant.

VOSviewer software, version 1.6.6 (Leiden University, The Netherlands) was used for visualization maps in collaborative networks. The 3 attributes of size, distance, and color are used to comprehend the map that is being displayed. A closer distance between 2 terms indicates that they will be more closely related. The frequency of occurrence increases with the size of the term. Last but not least, related hues represent expression clusters that are tightly related.

3. Results

The initial search retrieved 142,162 scientific publications, of which 138,563 were excluded for being outside Latin America and 338 for not belonging to the period from 1990 to 2019. Therefore, 3261 documents were finally analyzed. One hundred sixty-three documents were produced annually on average in the field of science, with a 5% annual growth rate (Fig. 1).

Figure 1.

Trend of annual research papers on osteoporosis in Latin America, from 1990 to 2019.

The countries with the highest scientific production on osteoporosis were: Brazil with 1961 (55.3%) papers, followed by Argentina (n = 614; 18%), Mexico (n = 473; 13.6%), Chile (n = 208; 5.9%) and Colombia (n = 171; 4.5%) (Table 2).

Table 2.

Top 10 Latin American countries with the highest scientific production about osteoporosis, 1990 to 2019.

Rankin	Country	Documents	Documents/year	Documents/1 million inhabitants*	Citations†/document	h-index	Major funder (n)	Author with highest production (n)
1	Brazil	1961	65.4	9,3	25,6	85	CNPq (194)	Pereira, Rosa Maria Rodrigues (60)
2	Argentina	614	20.5	13,7	49.6	73	CONICET (27)	Zanchetta, José Rubén (60)
3	México	473	15.8	3,7	33.6	59	CONACYT (57)	Clark, Patricia. (38)
4	Chile	208	6.9	11	43.5	45	FONDECYT (9)	Pino, Ana María (14)
5	Colombia	171	5.7	6	18.3	24	COLCIENCIAS (5)	Curcio, Carmen Lucia (7)
6	Venezuela	70	2.3	2,5	27,7	21	FONACIT (5)	Martinis, Ruby (5)
7	Cuba	53	1.8	4,7	5,5	6	–	Mendoza, Sarahí (13)
8	Puerto Rico	45	1.5	14,1	4	18	NCRR (13)	Haddock, Lillian/Mayor, Ángel M/Vilá, Luis M (4)
9	Perú	33	1.1	1	45,5	14	NCI (2)	Vidal, Luis Fernando (2)
10	Ecuador	30	1	1,7	10,4	7	–	Chedraui, Peter A. (5)

^*Population of the year 2019, World Bank Group.

^†Citations from the year 1990 to 2019; CNPq: National Council for Scientific and Technological Development, Brazil; CONICET: Consejo Nacional de Investigaciones Científicas y Técnicas, Argentina; CONACYT: Consejo Nacional de Ciencia y Tecnología - Mexico; FONDECYT: Fondo Nacional de Desarrollo Científico y Tecnológico, Chile; COLCIENCIAS: Departamento administrativo de ciencia, tecnología e innovación, Colombia; FONACIT: Fondo Nacional de Ciencia Tecnología e Innovación, Venezuela; NCRR: National Center for Research Resources, United States; NCI: National Cancer Institute, United States.

In the last decade (2010–2019), there was a significant increase of up to 2.14 times the scientific output (P = .21) compared to 2000 to 2009. Original articles (73.9%) and review articles (18.6%) made up the majority of publications (Table 3).

Table 3.

Years of publication and types of journal articles.

Year	Documents	Originals	Reviews	Letters	Other*	P
1990–1994	72	44	19	5	4	.21† difference mean.
1995–1999	211	150	41	2	18
2000–2004	324	223	65	9	27
2005–2009	623	444	134	12	33
2010–2014	935	698	166	23	48
2015–2019	1096	852	183	24	37
Total	3261	2411 (73.9%)	608 (18.6%)	75 (2.3%)	167 (5.1%)

^*Other: Conference Paper, Note, Editorial, Brief Survey, Erratum.

^†Significant P-value, evaluate the differences between (2000–2009) and (2010–2019).

Between 1990 and 2019, the 10 journals with the highest publishing record published a minimum of 23 papers; 6 of these publications were from Latin America. According to the number of papers, the top journal was “Osteoporosis International” with 171 (5.2%). However, “Journal of Bone and Mineral Research” was ranked as the most cited journal (CiteScore = 10.2), with the highest SCImago Journal Rank, SCImago Journal Rank = 2.1, and with the highest percentage of scientific collaboration (40.15%) (Table 4).

Table 4.

Top 10 journals with published papers on osteoporosis in Latin America, 1990 to 2019.

Journal	Number of documents (%)	Number of citations	Citation/document	Quartile scores*	Cite score 2019†	SJR 2019†	% colaboración internacional (2019)ª
United Kingdom
Osteoporosis international	171 (5.2)	6666	38.98	Q1	7.4	1.4	29.6%
Brazil
Arquivos brasileiros de endocrinologia e metabologia‡	84 (2.6)	1472	17.52	Discontinued from Scopus	–	–	–
Revista brasileira de reumatologia1‡	66 (2.0)	384	5.82	Discontinued from Scopus	–	–	–
Revista Brasileira de Medicina‡	44 (1.4)	20	0.45	Discontinued from Scopus	–	–	–
Argentina
Actualizaciones en Osteología	61 (1.9)	25	0.41	Q4	0.2	0.1	1%
Medicina	49 (1.5)	229	4.67	Q3	0.6	0.18	7.6%
U.S.A.
Journal of Bone and Mineral Research	57 (1.8)	4123	72.33	Q4	10.2	2.1	40.15%
Journal of Clinical Densitometry	46 (1.4)	1135	24.67	Q2	3.8	0.7	32.14%
Chile
Revista Médica de Chile	50 (1.5)	211	4.22	Q3	0.9	0.2	18.14%
Netherlands
Bone	43 (1.3)	1810	42.09	Q1	7.2	1.4	32.02%

^*From: SCImago Journal & Country Rank (2019).

^†From: SCOPUS (2019).

^‡Discontinued Scopus journal, U.S.A: United States of America, SJR: SCImago Journal Rank.

The top 10 most prolific institutions (Table 5) are mainly from Brazil, Mexico, and Argentina, accounting for 45.9% of the total number of papers and 39.3% of the citations. Of the universities, the most productive was the “Universidade de Sao Paulo” with 522 papers. However, the “Universidade Federal de Sao Paulo” had the highest number of citations. On the other hand, the “Instituto de Investigaciones Metabolicas” of Argentina was the medical institution with the highest number of documents (n = 115) and number of citations per document (n = 41.9).

Table 5.

Main Latin American institutions publishing research on osteoporosis, 1990 to 2019.

Ranking	Institution	Country	Documents (n)	Citations (1990–2019)	Citations/documents
Universities
1	Universidade de Sao Paulo	Brazil	522	8195	15.70
2	Universidade Federal de Sao Paulo	Brazil	262	5338	20.37
3	Universidade Estadual Paulista	Brazil	159	2127	13.38
4	Universidad Estadual de Cambinas	Brazil	152	2553	16.80
5	Universidade Federal do Rio de Janeiro	Brazil	112	1537	13.72
Health Care Institutions
1	Instituto de Investigaciones Metabolicas	Argentina	115	4822	41.93
2	Instituto Mexicano del Seguro Social	Mexico	103	1306	12.68
3	Hospital Universitario Dr Jose Eleuterio Gonzalez	Mexico	28	901	32.18
4	Instituto Nacional de Salud Pública	Mexico	28	514	18.36
5	Hospital de Clinicas de Porto Alegre	Brazil	27	514	19.04

With respect to funding, 6 of the ten most productive countries had their own state agencies as the main funders. In particular, Brazilian institutions such as the National Council for Scientific and Technological Development (n = 194), the São Paulo State Research Support Foundation (n = 164) and the Coordination of Higher Level Personnel Training (n = 130) funded the most osteoporosis research in Latin America.

Regarding the subjects investigated, the key words of the articles were determined in order to provide an overview of the most frequently studied topics in the region. These were “osteoporosis” together with the terms “bone mineral density,” “fractures” and “menopause” (Table 6). In turn, Figure 2 shows the co-occurrence and strength of connection of the most representative words. The same also shows the collaborative networks in which 39 countries with a minimum of 15 publications in Scopus were registered. Brazil (n = 34), Argentina (n = 36) and Mexico (n = 37) had the highest number of collaborative networks with other countries. The majority of the extraregional collaboration involved the United States. (16.35%), Spain (5.18%), Canada (4.81%) and the United Kingdom (4.81%).

Table 6.

Most commonly used terms in osteoporosis publications by Latin American authors.

Terms most commonly used	Representation
1. Osteoporosis	Osteoporosis is a bone disorder with marked changes in bone biological material and consequent bone structural distraction.[1]
2. Bone mineral density	Low bone mineral density is the primary diagnostic method for osteoporosis. There are several methods, so it is commonly used in studies.[13]
3. Fractures	Osteoporosis often remains undiagnosed until it manifests as a fracture, hence the importance of performing studies to predict, prevent, diagnose early and manage a fracture.[2]
4. Menopause	Most postmenopausal women have bone loss related to estrogen deficiency. Therefore, early diagnosis with bone quantification and fracture risk in this population is of great importance.[14]
5. Vitamin D	Vitamin D improves intestinal absorption of calcium and phosphate. They are generally suggested as part of the treatment of osteoporosis.[15]
6. Obesity	Historically, obesity was thought to protect against osteoporosis; however, several studies have challenged this belief and the effect of obesity on skeletal microarchitecture remains unclear.[16]
7. Bisphosphonates	Antiresorptive drugs used as one of the first-line treatments for the prevention and treatment of osteoporosis.[17]
8. Bone	Osteoporosis is a purely skeletal disorder characterized by compromised bone mass or quality (or both).[18]
9. Aging	Aging is related to several comorbidities, osteoporosis being one of the most frequent and is therefore commonly investigated.[19]
10. Risk factors	There are many genes involved, including environmental factors as risk factors. Studying related cofactors is important to influence them.[1]There are many genes involved, including environmental factors as risk factors. Studying the related cofactors is important to take action on them.[1]

Figure 2.

Analysis in VOSviewer for collaborative maps. (A) Network of co-occurrence of keywords on osteoporosis in Latin America. (B) Network of extra-regional collaboration in osteoporosis research in Latin America.

4. Discussion

4.1. Annual publications

Visual analysis reveals a progressively increasing volume of research on osteoporosis in Latin America. This trend is particularly pronounced in the decades from 2010 to 2019, contrasting with the period from 2000 to 2009. One explanation for this phenomenon is the global aging trend, resulting in a higher incidence of osteoporosis and an increased burden on Latin American countries.^[20,21] Another significant factor driving this growth is the continuous discovery of new insights in this field. This expanding knowledge base has led to a broader scope of research and an increasing number of unanswered questions over time. It iss worth noting that this overall increase can be primarily attributed to specific countries, with Brazil playing a particularly prominent role.

However, since 2017, a slight decline has been observed, which has occurred periodically in previous years, such as in 2013, 2011, and 2008. These declines can be attributed to previous research peaks, typically 1 or 2 years prior, primarily driven by leading research contributors, such as Brazil in our case. This global trend is corroborated by various bibliometric studies related to osteoporosis, all demonstrating a similar pattern with different research leaders.^[22–26]

On the other hand, when adjusting the number of publications throughout the years of study, it was identified that on average only 5 countries had 5 or more publications per year.

This premise suggests the lack of attention paid to this topic by experts and academics in the region, so more interest is needed in the study of osteoporosis in a region with a considerable frequency of osteoporosis.^[27]

4.2. Most productive countries

Among the countries, Brazil was the most productive with the most papers per year. In general, this is due to several factors. First, depending on the demographic and other factors assessed, osteoporosis prevalence varies from 5% to 30% in Brazilian research.^[28–30] Second, our nations diverse racial makeup and uneven regional distribution suggest that there are various risk factors for osteoporosis and fractures.^[31] Thirdly, the Brazilian Ministry of Health spends roughly 11% of all high-cost prescription spending on medications that affect bone form and mineralization^.[32]

All this places Brazil as one of the countries with the greatest need for research given that they have concise data on the current burden of this disease. However, despite this, indispensable policies to reduce the prevalence of osteoporosis such as food fortification with vitamin D do not exist in this country,^[33] unlike other Latin American countries.^[34,35] For this reason, it is necessary to take into account not only a country’s research, but also its policies. With this, it is necessary to formulate policy strategies to see a real change in the burden of disease.

On the other hand, Puerto Rico was the most prolific country when adjusting for population size. In fact, in Puerto Rico the prevalence of osteopenia and osteoporosis in women aged 50 to 69 years is 12% and 42% respectively, when the lumbar spine is measured, and 8.7% and 56% respectively, when the femoral neck is measured by bone density examination.^[36] In addition, the percentage of asymptomatic osteoporotic vertebral fractures ranges between 5.3% and 21.5%.^[27] Taking this into account and also the less vast population that Puerto Rico has in comparison with other Latin American countries,^[36] it is clear to see why it is the most prolific with respect to its population.

Despite this and the prolificness of research by population size, many studies show that knowledge about osteoporosis in Puerto Rican populations is deficient^[37,38] and no educational policies or health programs have been proposed for this specific problem at present.^[39] In accordance with this and as in Brazil, despite the existence of research on this subject, behavioral changes will not take place in the population unless policies are proposed to improve this burden in the country.

Given that, comparatively, it is known that the burden of osteoporosis varies among countries^[40] such as Mexico, Brazil, and Cuba, which have made osteoporosis a health priority, however, there are no national programs for both secondary and primary prevention of fractures, nor are there any programs at the national level that cover modifiable risk factors for the benefit of bone health in the elderly.^[41] It is therefore necessary to point out that new ways should be considered throughout Latin America, so that national health programs on osteoporosis are more effective and efficient in reducing the burden of this disease.

The H index and the total number of citations per document are indicators of vital importance, since they show the academic impact and the quality of a publication.^[42] Individually, the disease burden of osteoporosis in a year in Argentina and Brazil is $359,906,247 and $309,507,247 respectively,^[20] so it is not surprising that research in these countries is given greater emphasis given the high burden it represents.

On the other hand, many countries in the region have not surveyed the burden that this disease truly represents for their territory, causing the lack of interest in research by governments and the centralization of research in certain Latin American countries, which suggests that studies should be implemented where the burden of osteoporosis disease in each of the Latin American countries can be seen, since this will produce a greater importance of research in these countries.

4.3. Journals

Among the top ten journals that published the most articles on osteoporosis, the journal with the highest number of papers and citations is the UK journal “Osteoporosis International” which is quartile one in paper quality. This reflects the good quality of much research in the region that is of international interest and useful to science and plays a key role in the advancement of osteoporosis.

Thus, 3 journals belonging to Brazil were found to be discontinued from Scopus, leaving “Actualizaciones en Osteología” as the indexed journal with the most articles published on osteoporosis in Latin America. Although it has more documents, it is in quartile four and has fewer citations than the journal “Medicina,” which is in quartile three and has fewer documents but a greater number of citations, which indicates that its documents on osteoporosis are more useful despite the fact that it has fewer documents.

It should be taken into account that in Latin America the contributions in osteoporosis come from external countries such as the United Kingdom and the USA. This should be of concern among Latin American countries since policies and dynamics should be strengthened in terms of scientific production in this field.

4.4. Institutional support and financing

The top 10 institutions, which accounted for 45.9% of all papers, were mostly from Brazil, Mexico, and Argentina., with Brazil having the highest ranking of the 6 institutions in their ranking, which goes hand in hand with funding, given that it was in this country that the most osteoporosis papers were funded in Latin America. These results lead us to indicate that countries with better funding together with first class research institutions improve the contributions to science in a country. Therefore, it is important that each country should organize its funding resources or create entities to support it, so that the contribution to research is notable in each of them.

4.5. Cooperation among countries

Intra-regional collaboration was very low and the ranking only shows those countries that obtained the largest number of documents on the subject. This emphasizes that the greater the intraregional collaboration, the greater the number of articles published for each country. Extra-regionally, the USA obtained the greatest collaboration, followed by countries that are outside the American continent but are interested in the Latin American population with respect to Osteoporosis. Even so, globally, there is a need to improve the links among countries with respect to Osteoporosis both extra-regionally and inter-regionally, for which alliances should be formulated, as well as scientific associations among countries with emphasis on topics to improve the statistics presented.

4.6. Keywords and trends

Keyword analysis is an important bibliometric tool, which is useful for monitoring and discovering directions for popular research topics.^[43] In this study, the focus of keywords in recent years has been on the most economically burdensome consequences for countries, namely fractures, as well as the direction they give to causes such as menopause, obesity, vitamin D, and aging. These same words present a direct approach to osteoporosis, as well as to the history of the disease, thus seeking the resolution of its consequences and prevention by treating the causes or predisposing factors. As for treatment, only bisphosphonates are used, suggesting that research related to the treatment-effect of osteoporosis requires more attention in Latin American countries.

4.7. Limitations

This study had some limitations. First, the scientific production of the region was measured based on articles published in Scopus, solely. This should not be extrapolated to other international databases, such as the Core collection of Web of Science, or regional databases, such as Scientific Electronic Library Online and Latin American and Caribbean Literature in Health Sciences, where scientific production could vary because they are different sources. In our case, Scopus was used due to its quality, scope, and optimal engine for bibliometric analysis. Second, articles with a research focus not directly related with the topic of analysis may have been included despite using a precise search strategy for the topic. However, this possibility is always present in bibliometric analyses.^[44]

5. Conclusion

An increase in scientific productivity on osteoporosis was evidenced during the years 1990 to 2019. However, in the last 3 years it has shown a slight reduction. The majority of publications have been in high impact journals. It was determined that Brazil plays a key role since it represents the largest production and collaboration on the subject, with the most prolific institutions and the largest number of funding agencies. The United States was the extra-regional country that collaborated the most. However, intraregional and extraregional scientific collaboration on osteoporosis is still scarce. Therefore, we recommend strengthening collaboration between countries through scientific exchange between researchers from regional and international institutions, which will greatly improve the osteoporosis research and development process.

Author contributions

Conceptualization: David Espinoza-Martinez, Shamir Barros-Sevillano, Luis Rubio-Zavaleta.

Data curation: David Espinoza-Martinez, Shamir Barros-Sevillano, Luis Rubio-Zavaleta.

Formal analysis: David Espinoza-Martinez, Shamir Barros-Sevillano, Luis Rubio-Zavaleta.

Funding acquisition: David Espinoza-Martinez, Shamir Barros-Sevillano, Luis Rubio-Zavaleta.

Investigation: David Espinoza-Martinez, Shamir Barros-Sevillano, Luis Rubio-Zavaleta.

Methodology: David Espinoza-Martinez, Shamir Barros-Sevillano, Luis Rubio-Zavaleta.

Project administration: David Espinoza-Martinez, Shamir Barros-Sevillano, Luis Rubio-Zavaleta.

Resources: David Espinoza-Martinez, Shamir Barros-Sevillano, Luis Rubio-Zavaleta.

Software: David Espinoza-Martinez, Shamir Barros-Sevillano, Luis Rubio-Zavaleta.

Supervision: David Espinoza-Martinez, Shamir Barros-Sevillano, Luis Rubio-Zavaleta.

Validation: David Espinoza-Martinez, Shamir Barros-Sevillano, Luis Rubio-Zavaleta.

Visualization: David Espinoza-Martinez, Shamir Barros-Sevillano, Luis Rubio-Zavaleta.

Writing – original draft: David Espinoza-Martinez, Shamir Barros-Sevillano, Luis Rubio-Zavaleta.

Writing – review & editing: David Espinoza-Martinez, Shamir Barros-Sevillano, Luis Rubio-Zavaleta.