Gender perspective in clinical research on osteoporosis and fractures: an urgent methodological need

BACKGROUND: Osteoporosis and fragility fractures in individuals over 50 years of age are a public health concern. Although their prevalence is higher in postmenopausal women, other gender identities also face risks that have historically been over-looked in research and clinical care. OBJECTIVE: To analyze the integration of a gender perspective in clinical studies on osteoporosis and fractures, identifying methodological gaps and structural biases. MATERIALS AND METHODS: A systematic review was conducted using PubMed, Cochrane Library, and TripDatabase (2000-2025), including 22 relevant studies without restriction by study design, focused on sex and gender differences in diagnosis, treatment, and outcomes. RESULTS: Inequities in diagnosis and treatment were identified, particularly affecting individuals outside the cisgender female model. The lack of gender-disaggregated data and the absence of contextual variables limit the applicability of findings. Studies employing gender-sensitive approaches show improvements in risk estimation and therapeutic equity. CONCLUSIONS: Including a gender perspective beyond the binary enhances scientific validity and promotes health equity. It is essential to adopt methodological guidelines that ensure this integration at all stages of the research process.