High prevalence and undertreatment of osteoporosis in elderly patients undergoing total hip arthroplasty

Delsmann, Maximilian M.; Strahl, André; Mühlenfeld, Moritz; Jandl, Nico Maximilian; Beil, Frank Timo; Ries, Christian; Rolvien, Tim

doi:10.1007/s00198-021-05881-y

Cited by 46 publications

(26 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Interestingly, no differences in BMD were observed between elderly patients awaiting TKA and those scheduled for THA. While in our previous study [10], analyzing patients prior to THA, osteoporosis was diagnosed in 18% and osteopenia in 41%, in the present study osteoporosis was diagnosed in 17% and osteopenia in 46%. Also, no significant differences were measured at the individual DXA measurement sites between these two patient cohorts, indicating that the manifestation site of OA is independent of BMD or, in other words, that knee and hip OA equally affect BMD.…”

Section: Discussioncontrasting

confidence: 54%

“…Owing to the considerable risk of osteoporosis in elderly patients with OA [8][9][10], the International Society for Clinical Densitometry (ISCD) recommends an assessment of bone mineral density (BMD) in women aged ≥ 65 years and men aged ≥ 70 years prior to orthopedic surgery, including TKA, to avoid adverse outcomes [11]. In TKA, poor bone status has been associated with intraoperative and periprosthetic fractures, migration of components, and aseptic loosening [12][13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Prevalence of osteoporosis and osteopenia in elderly patients scheduled for total knee arthroplasty

Delsmann

Schmidt

Mühlenfeld

et al. 2021

Arch Orthop Trauma Surg

View full text Add to dashboard Cite

Introduction Osteoporosis is a common comorbidity in elderly patients with osteoarthritis (OA) and may increase perioperative complications in orthopedic surgery (e.g., component migration, periprosthetic fractures). As there is no investigation of bone mineral density (BMD) in elderly patients prior to total knee arthroplasty (TKA) in Europe, we investigated this issue with a particular focus on a potential treatment gap. Materials and methods We assessed the BMD by dual-energy X-ray absorptiometry (DXA) in 109 consecutive elderly patients (age ≥ 70 years) scheduled for TKA. In addition to a detailed assessment of osteoporosis and osteopenia, the influence of clinical risk factors and radiological OA severity on BMD was evaluated using group comparisons and linear regression models. In addition, we analyzed differences in BMD between patients scheduled for TKA vs. total hip arthroplasty (THA). Results Of the included 109 patients, 19 patients (17.4%) were diagnosed with osteoporosis and 50 (45.9%) with osteopenia. In the osteoporotic patients, a clinically relevant underdiagnosis concomitant with a serious treatment gap was observed in 95.0% of the patients. Body mass index, OA grade, and glucocorticoid use were identified as independent factors associated with BMD. No differences in BMD were found between the patients scheduled for TKA vs. THA. Conclusions Considering the high prevalence of osteoporosis and osteopenia in elderly patients, DXA screening should be recommended for patients ≥ 70 years indicated for TKA.

show abstract

Section: Discussioncontrasting

confidence: 54%

Section: Introductionmentioning

confidence: 99%

Prevalence of osteoporosis and osteopenia in elderly patients scheduled for total knee arthroplasty

Delsmann

Schmidt

Mühlenfeld

et al. 2021

Arch Orthop Trauma Surg

View full text Add to dashboard Cite

show abstract

“…In patients aged ≥70 years qualified for THA, a high frequency of decreased BMD was found [16]. Our study confirms the reduced mineral content in this age group; at the same time, a bone density assessment should be considered before performing THA.…”

Section: Discussionsupporting

confidence: 81%

“…Our study confirms the reduced mineral content in this age group; at the same time, a bone density assessment should be considered before performing THA. On the other hand, studies indicate no correlation between the BMD of the femoral neck and cementless loosening after THA in 2-year follow-up in patients under 75 years of age without osteoporosis [16]. Patients with OA have been shown to have higher BMD compared to control, which is probably associated with increased sclerotization and remodeling within the joint [17].…”

Section: Discussionmentioning

confidence: 99%

Sex- and Age-Related Dynamic Changes of the Macroelements Content in the Femoral Bone with Hip Osteoarthritis

Dąbrowski

Zioła-Frankowska

Frankowski

et al. 2022

Biology

View full text Add to dashboard Cite

Background: The content of macroelements in bones varies with age and depends on sex. The aim of the study was to evaluate the content of macroelements and its correlation with age and sex in the femoral bone obtained during total hip arthroplasty. Methods: In the 86 patients, the content of macroelements (Ca, P, Mg, and Na) in the femoral head and neck (cancellous and cortical bone) was assessed by means of the inductively coupled plasma optical emission spectrometry analytical technique (ICP-OES). Results: There was a decrease in the content of macroelements in the cortical bone with age in the women in the 51–60 years (statistically significant: −0.59 for Ca, −0.65 for P) and over 70 years age groups (correlation not statistically significant: −0.29 for Ca, −0.38 for P). A significant decrease in the content of macroelements in the cortical bone was found in men over 70 years of age. Conclusions: Patterns of increased loss of macronutrients (Ca, P, and Mg) in the femoral neck (cortical bone) were demonstrated in the following patients with osteoarthritis: women aged 51–60 years and patients of both sexes over 70 years of age.

show abstract

“…In this study, in concordance with the previous studies, 5 osteoporosis was identified from DXA and was defined as the BMD T-score of less than or equal to 22.5. 13 Based on our patient cohort, the rate of revision surgery in this study was 5.2% at a 3.7-year follow-up time (range: 2.1 to 5.2 years). Previous retrospective studies showed an increased risk of surgical failure in osteoporotic patients who underwent primary noncemented THA, with revision rates ranging between 2.2% and 8.9%.…”

Section: Figurementioning

confidence: 75%

Artificial Neural Networks Can Predict Early Failure of Cementless Total Hip Arthroplasty in Patients With Osteoporosis

Cohen-Levy¹,

Melnic²,

Kwon³

2022

J Am Acad Orthop Surg

View full text Add to dashboard Cite

Background: Total hip arthroplasty (THA) done in the aging population is associated with osteoporosis-related complications. The altered bone density in osteoporotic patients is a risk factor for revision surgery. This study aimed to develop and validate machine learning (ML) models to predict revision surgery in patients with osteoporosis after primary noncemented THA. Methods: We retrospectively reviewed a consecutive series of 350 patients with osteoporosis (T-score less than or equal to 22.5) who underwent primary noncemented THA at a tertiary referral center. All patients had a minimum 2-year follow-up (range: 2.1 to 5.6). Four ML algorithms were developed to predict the probability of revision surgery, and these were assessed by discrimination, calibration, and decision curve analysis. Results: The overall incidence of revision surgery was 5.2% at a mean follow-up of 3.7 years after primary noncemented THA in osteoporotic patients. Revision THA was done because of periprosthetic fracture in nine patients (50%), aseptic loosening/subsidence in five patients (28%), periprosthetic joint infection in two patients (11%) and dislocation in two patients (11%). The strongest predictors for revision surgery in patients after primary noncemented THA were female sex, BMI (.35 kg/m 2 ), age (.70 years), American Society of Anesthesiology score ($3), and T-score. All four ML models demonstrated good model performance across discrimination (AUC range: 0.78 to 0.81), calibration, and decision curve analysis. Conclusion:The ML models presented in this study demonstrated high accuracy for the prediction of revision surgery in osteoporotic patients after primary noncemented THA. The presented ML models have the potential to be used by orthopaedic surgeons for preoperative patient counseling and optimization to improve the outcomes of primary noncemented THA in osteoporotic patients.

show abstract

High prevalence and undertreatment of osteoporosis in elderly patients undergoing total hip arthroplasty

Cited by 46 publications

References 32 publications

Prevalence of osteoporosis and osteopenia in elderly patients scheduled for total knee arthroplasty

Prevalence of osteoporosis and osteopenia in elderly patients scheduled for total knee arthroplasty

Sex- and Age-Related Dynamic Changes of the Macroelements Content in the Femoral Bone with Hip Osteoarthritis

Artificial Neural Networks Can Predict Early Failure of Cementless Total Hip Arthroplasty in Patients With Osteoporosis

Contact Info

Product

Resources

About