Osteoporosis and shoulder osteoarthritis: incidence, risk factors, and surgical implications

Pervaiz, Khurram; Cabezas, Andres F.; Downes, Katheryne; Santoni, Brandon G.; Frankle, Mark A.

doi:10.1016/j.jse.2012.05.029

Cited by 63 publications

(49 citation statements)

References 25 publications

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“…One method is to group patients based on DXA and calculate mean HU and 95% confidence intervals. Studies by Schreiber et al 30 and Pervaiz et al 25 found similar values for normal, osteopenic, and osteoporotic patients in the spine and proximal humerus (Table 3). An important threshold based on these studies is an HU value of less than 120, which indicates likely bone insufficiency and suggests the need for further investigation (Fig.…”

Section: Hu Value and Osteoporosismentioning

confidence: 53%

“…This reliability has been confirmed in other investigations. 17,25 Using the average of 3 measurements at each vertebra compared with a single measurement appears to offer little advantage in terms of reliability. 26,27 No differences are seen at different levels within the vertebral body (Fig.…”

Section: Reliabilitymentioning

confidence: 99%

“…7 Multiple studies have explored the ability of diagnostic CT scanning to identify osteopenia and osteoporosis both based on HU values obtained from the spine 30,34 and proximal humerus. 25 With an estimated 62 million CT scanning studies being performed annually in the US, the information provided by these studies is oftentimes available to the practitioner at no additional cost and can provide invaluable assessments of the patient's local and global bone quality.…”

Section: Hu Value and Osteoporosismentioning

confidence: 99%

“…18,[25][26][27]30 The proof of concept that HU values can be used be used to estimate regional bone strength and fracture risk was first established using polyurethane foam, where a linear correlation was found between HU value and compressive strength across densities representative of human bone. 30 Estimation of fracture risk is a key variable in determining whether patients should be treated for metabolic bone disease.…”

Section: Hu Value and Spinal Fracture Riskmentioning

confidence: 99%

“…The HU values of local bone quality have been shown to not only affect fracture risk 17 but can also prognosticate implant stability 25 and hardware failure. 16 When instrumentation is required, the included levels chosen as well as technical modifications can be influenced by knowledge of local and global bone quality.…”

Section: Hu Value In Lumbar Traumamentioning

confidence: 99%

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Use of computed tomography for assessing bone mineral density

Schreiber

Anderson

Hsu

2014

FOC

202

135

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Assessing local bone quality on CT scans with Hounsfield unit (HU) quantification is being used with increasing frequency. Correlations between HU and bone mineral density have been established, and normative data have been defined throughout the spine. Recent investigations have explored the utility of HU values in assessing fracture risk, implant stability, and spinal fusion success. The information provided by a simple HU measurement can alert the treating physician to decreased bone quality, which can be useful in both medically and surgically managing these patients.

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Section: Hu Value and Osteoporosismentioning

confidence: 53%

Section: Reliabilitymentioning

confidence: 99%

Section: Hu Value and Osteoporosismentioning

confidence: 99%

Section: Hu Value and Spinal Fracture Riskmentioning

confidence: 99%

Section: Hu Value In Lumbar Traumamentioning

confidence: 99%

See 3 more Smart Citations

Use of computed tomography for assessing bone mineral density

Schreiber

Anderson

Hsu

2014

FOC

202

135

View full text Add to dashboard Cite

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Radiolucency in stemless shoulder arthroplasty is associated with an imaging phenomenon

et al. 2017

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Stemless humeral implants show comparable midterm clinical results compared to stemmed components. Recently, radiolucencies around the metaphyseal seating of humeral stemless implants were reported on postoperative radiographs. It is controversial whether they are attributable to bone resorption. We hypothesized these radiolucencies result from imaging artifacts. Seven cadaveric specimens (three male and four female) were first radiographed and then scanned with CT. A stemless humeral component of current design was implanted in each specimen. After implantation, all specimens were radiographed with different exposure settings. The implant was removed, and the specimens were scanned with CT again. Pre- and post-implantation radiographs and CT scans were compared. The mean Hounsfield units (HU) at the humeral resection plane from the pre-implantation CT were correlated with the diameter of the radiolucent halo on the post-implantation radiographs. A symmetric radiolucent halo of variable diameters occurred on all radiographs after implantation when an automatic exposure control was used. The halo disappeared in all specimens when the tube voltage was reduced. Lower CT-values (HU) before the implantation resulted in greater halos on the radiograph after implantation. Symmetric radiolucent halos can result from imaging artifacts, which is most likely due to radiation scatter. The halos can be minimized by reducing the tube voltage. The halo effect appears to be pronounced in bones with decreased density. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2040-2050, 2017.

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Structural analysis of hollow versus solid‐stemmed shoulder implants of proximal humeri with different bone qualities

Soltanmohammadi

Tavakoli

Langohr

et al. 2021

Journal Orthopaedic Research

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Stress shielding of the proximal humerus following total shoulder arthroplasty (TSA) can promote unfavorable bone remodeling, especially for osteoporotic patients. The objective of this finite element (FE) study was to determine if a hollow, rather than solid, titanium stem can mitigate this effect for healthy, osteopenic, and osteoporotic bone. Using a population-based model of the humerus, representative average healthy, osteopenic, and osteoporotic humerus FE models were created. For each model, changes in bone and implant stresses following TSA were evaluated for different loading scenarios and compared between solid versus hollow-stemmed implants. For cortical bone, using an implant decreased von Mises stress with respect to intact values up to 34.4%, with a more pronounced effect at more proximal slices. In the most proximal slice, based on changes in strain energy density, hollow-stemmed implants outperformed solid-stemmed ones through reducing cortical bone volume with resorption potential by 11.7% ± 2.1% (p = .01). For cortical bone in this slice, the percentage of bone with resorption potential for the osteoporotic bone was greater than the healthy bone by 8.0% ± 1.4% using the hollow-stemmed implant (p = .04). These results suggest a small improvement in boneimplant mechanics using hollow-stemmed humeral implants and indicate osteoporosis could exacerbate stress shielding to some extent. The hollow stems maintained adequate strength and using even thinner walls may further reduce stress shielding. After further developing these models, future studies could yield optimized implant designs tuned for varying bone qualities.

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Osteoporosis and shoulder osteoarthritis: incidence, risk factors, and surgical implications

Cited by 63 publications

References 25 publications

Use of computed tomography for assessing bone mineral density

Use of computed tomography for assessing bone mineral density

Radiolucency in stemless shoulder arthroplasty is associated with an imaging phenomenon

Structural analysis of hollow versus solid‐stemmed shoulder implants of proximal humeri with different bone qualities

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