Periprosthetic fractures are osteoporotic fractures: missed opportunities for osteoporosis diagnosis

Whiting, Paul S.; Hare, Kristyn; Krueger, Diane; Borchardt, Gretta; Parvanta-Johnson, Kristina; Bernatz, James; Binkley, Neil; Anderson, Paul A.

doi:10.1007/s00198-024-07057-w

Cited by 5 publications

(1 citation statement)

References 37 publications

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“…A recent study has shown that osteoporosis was present in 67 to 78% of patients with periprosthetic fractures, including but not limited to periprosthetic femoral hip fractures. The prevalence of osteoporosis varied depending on the diagnostic criteria used, including whether the diagnosis was made through clinical assessment and medical history or by using DXA or computed tomography data of the lumbar spine [ 16 ]. In another previous study, low BMD, defined as T-score ≤ − 1.0, was associated with a higher rate of intraoperative PPF compared to patients with normal BMD [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Patients with Periprosthetic Femoral Hip Fractures are Commonly Classified as Having Osteoporosis Based on DXA Measurements

Ritter,

Alimy,

Simon

et al. 2024

Calcif Tissue Int

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Periprosthetic femoral hip fractures are subject to an increasing incidence and are often considered to be related to osteoporosis. However, there are no available studies that have determined the frequency of osteoporosis in affected patients using gold standard dual-energy X-ray absorptiometry (DXA). In this retrospective comparative study, we analyzed the DXA results of 40 patients with periprosthetic femoral hip fractures who were treated surgically in our department. DXA measurements were performed at the total hip and the lumbar spine to determine bone mineral density T-scores. Data were compared to two age-, sex-, and BMI-matched control groups in which patients underwent DXA prior to aseptic revision surgery for other causes or primary THA (consisting of 40 patients each). The mean T-score in the periprosthetic fracture cohort was significantly lower (− 1.78 ± 1.78) than that of the aseptic revision (− 0.65 ± 1.58, mean difference − 1.13 [95% CI − 1.88 to − 0.37]; p = 0.001) and the primary THA cohort (− 0.77 ± 1.34, mean difference − 1.01 [95% CI − 1.77 to − 0.26]; p = 0.005). Accordingly, osteoporosis was detected more frequently (45%) in the fracture cohort compared to patients undergoing aseptic revision (12.5%) and primary THA (10%). In conclusion, almost half of the patients with periprosthetic femoral hip fractures have osteoporosis according to DXA measurements. A regular assessment of bone health in THA enables identification of patients with osteoporosis who likely benefit from initiation of osteoporosis medication and cemented stem fixation.

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Section: Discussionmentioning

confidence: 99%

Patients with Periprosthetic Femoral Hip Fractures are Commonly Classified as Having Osteoporosis Based on DXA Measurements

Ritter,

Alimy,

Simon

et al. 2024

Calcif Tissue Int

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Risikofaktoren und Präventionsstrategien periprothetischer Femurfrakturen in der Hüftendoprothetik

Alimy,

Soltys,

Hubert

et al. 2024

Orthopädie

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Zusammenfassung Hintergrund Periprothetische Frakturen stellen eine bedeutende Komplikation der Endoprothetik dar, insbesondere nach Implantation einer Hüfttotalendoprothese (Hüft-TEP). Durch den demographischen Wandel wird prognostiziert, dass mit der steigenden Anzahl von Hüft-TEP-Implantationen auch eine Zunahme von periprothetischen Femurfrakturen (PPF) in den nächsten Jahrzehnten zu erwarten ist. Trotz der daraus abzuleitenden hohen klinischen Relevanz existiert bisher keine umfassende Übersicht zu Risikofaktoren und möglichen präventiven Ansätzen von PPF. Ziel der Arbeit Ziel dieser Übersichtsarbeit ist es, die aktuellen Erkenntnisse und Daten aus verschiedenen Studien darzustellen und daraus evidenzbasierte Empfehlungen für die klinische Praxis abzuleiten. Material und Methoden Narratives Review. Ergebnisse Das Auftreten von PPF kann durch verschiedene Risikofaktoren wie höheres Lebensalter, weibliches Geschlecht und rheumatische Erkrankungen begünstigt werden. Bei Vorliegen dieser Risikofaktoren sollte vor der Primäroperation die Indikation zur Untersuchung der Knochengesundheit, inklusive DXA-Messung, großzügig gestellt werden. Schlussfolgerungen Eine individualisierte Herangehensweise ist bei der Planung und Implantation einer Hüft-TEP essenziell, um das Risiko für PPF zu minimieren. Bei nachgewiesener Osteoporose oder einem Alter von ≥ 70 Jahren bei Frauen bzw. ≥ 75 Jahren bei Männern sollte eine zementierte Schaftverankerung gewählt werden, da zementfreie Schäfte in diesem Kontext mit einem erhöhten Risiko für PPF verbunden sind. Insgesamt sollte das klinische Risikoprofil bei der präoperativen Planung und der postoperativen Nachsorge berücksichtigt werden, um diese Komplikation zu reduzieren und die Patientenversorgung zu verbessern.

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Sex-Specific Association of Clinical Parameters and Components of Femoral Bone Quality in Patients Undergoing Total Hip Arthroplasty

Alimy,

Thiessen,

Strahl

et al. 2024

Calcif Tissue Int

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Poor bone quality is a critical factor associated with an increased risk of complications after total hip arthroplasty (THA). However, no consistent recommendations have yet been established for assessing indicators of bone quality preoperatively. Thus, it remains unclear which preoperatively available and readily accessible parameters are most closely associated with femoral bone quality. Here, we obtained femoral neck specimens from 50 patients undergoing THA. Preoperative Dual-energy X-ray absorptiometry (DXA) scans, pelvic radiographs, and laboratory parameters were analyzed. In the obtained specimens, bone microstructure was assessed using micro-CT and histomorphometry. Additionally, matrix mineralization and osteocyte lacunar morphology were evaluated using quantitative backscattered electron imaging. Our analysis revealed that DXA-derived T-scores correlated with trabecular microstructure. Furthermore, radiographic indices and body mass index correlated differentially with aspects of bone quality in women and men. Contrary to previous observations, no correlation was found between serum vitamin D levels and osteoid indices, nor between clinical parameters and matrix mineralization. Age was strongly associated with the number of mineralized osteocyte lacunae, a factor that appeared to be independent of sex. Taken together, our study demonstrates that no single preoperatively available parameter exhibits a strong and consistent association with femoral bone quality. However, DXA remains a reliable preoperative measure for determining the trabecular microstructure of the femoral neck. In clinical practice, surgeons should adopt an individualized approach to preoperative assessments by considering age, sex, BMI, and radiographic indices to enhance their insight into femoral bone quality, particularly when DXA is unavailable.

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Periprosthetic fractures are osteoporotic fractures: missed opportunities for osteoporosis diagnosis

Cited by 5 publications

References 37 publications

Patients with Periprosthetic Femoral Hip Fractures are Commonly Classified as Having Osteoporosis Based on DXA Measurements

Patients with Periprosthetic Femoral Hip Fractures are Commonly Classified as Having Osteoporosis Based on DXA Measurements

Risikofaktoren und Präventionsstrategien periprothetischer Femurfrakturen in der Hüftendoprothetik

Sex-Specific Association of Clinical Parameters and Components of Femoral Bone Quality in Patients Undergoing Total Hip Arthroplasty

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