RUNX2 and osteoporosis: With respect to bone formation (22), studies utilizing various in vitro and in vivo models (including some osteoporosis models) have shown that ESWT can enhance the transcriptional activity of osteogenic genes like Runx2, OCN, and ALP, and promote the differentiation of mesenchymal stem cells towards an osteoblastic lineage (18, 19, 23, 24).