Symposium 4, entitled "Cutting-Edge Challenges in Osteoporosis Treatments" has been organized to facilitate a discourse on the complex issues frequently encountered in the clinical setting. The first speaker, Professor Yumie Rhee from Yonsei University, will vividly convey the latest consensus of the task force team on goal-directed treatment in patients with osteoporosis. Following Professor Rhee, Professor Sung Hye Kong from Seoul National University will address the current lack of clear guidelines for drug holidays following IV bisphosphonate treatment for the prevention of MRONJ, sharing recent research findings from Korea. To conclude the symposium, Dr. Byung-Woong Jang from Soonchunhyang University will discuss the Korean Society for Bone and Mineral Research's position statement on atypical femoral fractures. As we face an aging society with extended durations of osteoporosis treatment, Dr. Jang will provide insights into this increasingly common complication, sharing the society’s perspective and future research directions. This symposium aims to offer a platform for contemplating the real-world challenges that clinicians grapple with in the management of osteoporosis.

The skeletal system and the bone marrow immune system are not only physically adjacent but also regulate each other through precise molecular mechanisms. The interaction between the skeleton and the immune system, osteoimmunology, was first and best characterized in the molecular mechanism of osteoclastogenesis from monocytes. The most potent osteoclastogenic factor, RANKL, was first identified as a T cell factor. Subsequently, while the investigators tried to unravel the question of why osteoclasts exist only in bone while T cells are everywhere, the term osteoimmunology was coined by the group of Hiroshi Takayanagi and Professor Yongwon Choi, thereby opening the door to research in this field. Recently, osteoimmunology has been the focus of extensive research, centering on osteoclast biology, inflammatory bone diseases such as rheumatism/arthritis/periodontitis, and bone metastasis. For SSBH 2024, we invited three investigators who have recently made significant contributions to osteoimmunology. Notably, Professor Hiroyuki Okada from the University of Tokyo has developed a method to sequence the nuclei of osteoclasts separately, thereby revealing osteoclast biology with a unique approach in the era of single-cell transcriptomics. Prof. Okada gave a beautiful presentation at the last ASBMR, and we wanted to have an in-depth lecture and discussion. Professor Sungho Park from UNIST has been working on the epigenetic regulation mechanisms of rheumatoid arthritis after publishing a notable paper on the epigenetic regulation of osteoclasts, and he will update us on the latest research findings. Professor Je-Hwang Ryu from Chonnam National University College of Dentistry has recently published a paper on the role of cholesterol metabolism in the progression of periodontitis and will discuss this content and follow-up research.

Utilizing artificial intelligence based on musculoskeletal imaging for predicting fracture risk and establishing optimal treatment strategies is advancing from research into clinical practice. Symposium 6 will commence with a lecture by Professor Namki Hong from Yonsei University College of Medicine, providing an overview of the overall landscape of how artificial intelligence technology for predicting fracture risk based on general X-ray images and other musculoskeletal imaging is evolving, commonly encountered in clinical settings. Following this, Professor Benedikt Helgason from ETH-Zürich, an expert in biomechanically relevant finite element modeling, will introduce the latest research on fracture risk prediction and personalized patient approaches using artificial intelligence applied to computed tomography imaging. Finally, Professor Kyu-Hwan Jung, co-founder of Vuno and currently at Sungkyunkwan University Samsung Convergence Institute of Health Sciences, will discuss how generative artificial intelligence, currently one of the hottest topics, can be applied to musculoskeletal imaging and fracture risk prediction. Through this session, we hope to contemplate the present and future of artificial intelligence technology based on musculoskeletal imaging and its intersection with clinical practice.