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Inflammatory signals and platelet abnormalities are discussed as modulators of osteoclast activity and fracture healing. Limitations include unclear thresholds, restricted longitudinal data, and unresolved causality, so mechanisms and whether hematologic correction improves outcomes require further 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2025;40:811-820 [https://doi.org/10.3803/EnM.2025.2695](https://doi.org/10.3803/EnM.2025.2695)[ ](https://doi.org/10.3803/EnM.2025.2695)[pISSN 2093-596X](pISSN 2093-596X) · eISSN 2093-5978  \nComplete Blood Count Parameters and Bone Health: Clinical and Experimental Evidence  \nJeonghoon Ha 1,2, Mayo Ono 1,3, Hui Zhu1, Caroline Cencer1, Xiyu Ge 1, Joy Y. Wu 1  \n1Division of Endocrinology, Stanford University School of Medicine, Stanford, CA, USA; 2Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea; 3Department of Endocrinology, Metabolism and Nephrology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan  \nOsteoporotic fractures pose a significant burden in aging populations, yet current assessment strategies may overlook systemic factors influencing bone health. Emerging evidence suggests that complete blood count (CBC) parameters, including red blood cell indices, white blood cell (WBC) counts and subtypes, and platelet counts, are associated with skeletal fragility and fracture risk. Anemia has been consistently linked to reduced bone mineral density and increased fracture susceptibility, potentially due to impaired oxygen delivery and osteoblast dysfunction. Elevated red cell distribution width may reflect oxidative stress and has been associated with bone loss. Inflammatory markers such as high WBC count and neutrophil-to-lymphocyte ratio are implicated in enhanced osteoclast activity, while platelet abnormalities may influence bone remodeling and fracture healing. These associations suggest that CBC-derived markers could serve as accessible and cost-effective indicators to support osteoporosis evaluation. However, important limitations remain, including undefined clinical thresholds, limited longitudinal evidence, and uncertain causality. Further research is needed to clarify underlying mechanisms and determine whether correcting hematological abnormalities can improve skeletal outcomes. A cautious, evidence-based approach is warranted to define the role of CBC parameters in the clinical assessment of bone health.  \n\n| Keywords: Complete blood count; Bone; Osteoporotic fractures; Anemia |  |\n| --- | --- |\n| INTRODUCTION\u003Cbr>Osteoporotic fractures are a major global health concern, particularly in the aging population [1]. As life expectancy increases, the prevalence of osteoporosis and hematological disorders also rises [2,3] . These fractures considerably contribute to morbidity and mortality, leading to functional decline, reduced quality of life, and increased healthcare costs. In Korea, hip fractures are associated with poor prognosis, with 1-year post-hospitalization | mortality rates of approximately 21% in men and 14% in women, which increase with age [4] . Given these implications, identifying modifiable risk factors for fracture susceptibility is crucial for enhancing patient outcomes and alleviating healthcare burden.\u003Cbr>Hematopoiesis occurs in the bone marrow, where hematopoietic stem cells (HSCs) and mesenchymal stem cells (MSCs) coexist within a shared regulatory microenvironment [5,6] . This spatial and functional proximity enables bidirectional crosstalk |\n| Received: 9 October 2025, Revised: 13 October 2025, Accepted: 14 October 2025\u003Cbr>Corresponding author: Joy Y. Wu\u003Cbr>Division of Endocrinology, Stanford University School of Medicine, 300 Pasteur\u003Cbr>Dr., S-025 Stanford, CA 94305, USA\u003Cbr>Tel: +1-650-736-9654, E-mail:[jywu1@stanford.edu](jywu1@stanford.edu) | Copyright © 2025 Korean Endocrine Society\u003Cbr>This is an Open Access article distributed under the terms of\u003Cbr>the Creative Commons Attribution Non-Commercial License ([https://creativecommons.org/licenses/by-nc/4.0/](https://creativecommons.org/licenses/by-nc/4.0/)) which permits unrestricted\u003Cbr>non-commercial use, distribution, and reproduction in any medium, provided\u003Cbr>the original work","cbCaibwsrCOzv4Kt","https://ap.wps.com/l/cbCaibwsrCOzv4Kt","pdf",925841,"English","# Introduction\n## Osteoporotic fractures and aging burden\n## Hematopoiesis-bone crosstalk\n## CBC as a diagnostic window into bone metabolism\n# Clinical evidence linking CBC to fracture risk\n## Anemia and oxygen delivery\n## RDW and oxidative stress\n## Inflammation, WBC/NLR, and osteoclast activity\n## Platelet abnormalities and bone remodeling\n# Mechanistic interpretation and research gaps","[{\"question\":\"How do CBC parameters relate to osteoporotic fracture risk?\",\"answer\":\"The review summarizes evidence that CBC-derived markers, including red blood cell indices, white blood cell counts and subtypes, and platelet measures, correlate with skeletal fragility and fracture susceptibility.\"},{\"question\":\"Why is anemia considered relevant to bone health?\",\"answer\":\"Anemia is associated with reduced oxygen delivery to musculoskeletal tissues, impaired bone remodeling, decreased muscle strength, and higher risk of falls and fractures.\"},{\"question\":\"What limitations prevent CBC markers from being used as definitive clinical thresholds?\",\"answer\":\"The review highlights undefined clinical threshold values, limited longitudinal evidence, and uncertain causal relationships between hematological abnormalities and skeletal outcomes.\"}]","Complete Blood Count Parameters and Bone Health - Clinical and Experimental Evidence | PDF",1790666420,25]