The Association of Osteoporosis and Bisphosphonate Use With Revision Shoulder Surgery After Rotator Cuff Repair

Cancienne, Jourdan M.; Brockmeier, Stephen F.; Kew, Michelle E.; Deasey, Matthew J.; Werner, Brian C.

doi:10.1016/j.arthro.2019.03.036

Cited by 31 publications

(27 citation statements)

References 32 publications

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“…Yet, patients with a diagnosis of osteoporosis who were appropriately prescribed bisphosphonates did not have significantly lower revision RCR rates as compared with age- and sex-matched patients with osteoporosis not receiving bisphosphonates. 27 These results suggest that bisphosphonate therapy in the patient with osteoporosis and an RC tear may not necessarily lead to improvement in clinical outcomes. Teriparatide has been shown in an animal model to increase bone density of the humeral head, and it may improve the mechanical properties of the infraspinatus tendon enthesis.…”

Section: Discussionmentioning

confidence: 94%

Osteoporosis Screening Is Often Indicated but Overlooked Prior to Rotator Cuff Repair

Cotter

Klosterman

Winzenried

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose To (1) report the percentage of patients undergoing rotator cuff repair (RCR) who were appropriately screened with dual-energy X-ray absorptiometry testing prior to surgery, if indicated, and (2) determine the percentage of patients properly prescribed osteoporosis medications within 6 months of surgery. Methods Consecutive patients aged 50 years or older who underwent elective RCR at a single tertiary-care center over a 1-year period were reviewed. Fracture risk was estimated using the Fracture Risk Assessment Tool (FRAX) with and without bone mineral density. The U.S. National Osteoporosis Foundation (NOF) criteria for screening and treatment were applied. Patients with acute fractures or revision surgery were excluded. Results Of the 218 patients included, 129 were women (58.1%). The mean age was 61.5 ± 7.2 years. One hundred thirty-one RCRs (60.1%) occurred within 3 months of injury. A total of 69 patients (31.7%) met the NOF criteria for bone mineral density screening. Of these patients, 23 (33.3%) were appropriately screened with a dual-energy X-ray absorptiometry scan. Primary care providers initiated bone health assessment in 18 of the 23 appropriately screened patients, with orthopaedic providers initiating the workup in 3 patients (13.0%). Thirty-two patients (14.7%) met the NOF criteria for pharmacologic management of osteoporosis. Of these patients, 5 (15.6%) were treated. Patients meeting the medication criteria were older (69.1 ± 7.7 years vs 60.2 ± 6.3 years, P < .001), had a lower body mass index (28.8 ± 6.1 vs 31.5 ± 6.5, P = .028), and had chronic rotator cuff tears ( P = .015). Conclusions Patients aged 50 years or older undergoing RCR are often not appropriately screened for osteoporosis. Even when appropriately screened, only 15.6% of patients meeting the indications for pharmacologic intervention for bone health optimization were prescribed appropriate medications. Although bone health optimization may or may not affect surgical timing, patient encounters related to rotator cuff tears can be used as an opportunity for providers to initiate osteoporosis screening and treatment protocols. Level of Evidence Level IV, therapeutic case series.

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Section: Discussionmentioning

confidence: 94%

Osteoporosis Screening Is Often Indicated but Overlooked Prior to Rotator Cuff Repair

Cotter

Klosterman

Winzenried

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

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“…11,16,38,39 The prevalence of osteoporosis in patients with RCTs has been reported to be approximately 14% to 17%. 4,6 Moreover, osteoporosis has been determined to be an independent risk factor that affects rotator cuff healing, thereby causing higher rates of revision surgery. 4,6 However, to the best of our knowledge, no basic science research has explored the effect of biological mechanisms of osteoporosis on tendonto-bone healing of the rotator cuff.…”

mentioning

confidence: 99%

“…4,6 Moreover, osteoporosis has been determined to be an independent risk factor that affects rotator cuff healing, thereby causing higher rates of revision surgery. 4,6 However, to the best of our knowledge, no basic science research has explored the effect of biological mechanisms of osteoporosis on tendonto-bone healing of the rotator cuff. Furthermore, it remains unknown whether bisphosphonate (eg, risedronate), a first-line commonly used antiosteoporosis drug, 8,10 would enhance rotator cuff healing in patients with osteoporosis.…”

mentioning

confidence: 99%

The Effect of Antiosteoporosis Therapy With Risedronate on Rotator Cuff Healing in an Osteoporotic Rat Model

Chen

et al. 2021

Am J Sports Med

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Background: Osteoporosis increases the revision rate of rotator cuff repair (RCR). Weak fixation might not be the only cause of high RCR failure rates. The biological mechanism associated with tendon-to-bone healing after RCR in osteoporosis should be investigated. Hypothesis: (1) Osteoporosis would impair rotator cuff healing through the high osteoclastic activity at the repaired interface. (2) Risedronate would promote rotator cuff healing by reducing osteoclastic activity at the repaired interface. Study Design: Controlled laboratory study. Methods: A total of 84 female Sprague Dawley rats were randomly treated using ovariectomy or sham surgeries to establish osteoporotic and nonosteoporotic rat models. After confirming osteoporosis, a chronic rotator cuff tear model was created and RCR was performed. Postoperatively, osteoporotic rats were randomly divided into osteoporosis (OP) and osteoporosis with risedronate administration (OP+RIS) groups. Nonosteoporotic rats were used as the control (CON) group. Osteoclastic activity was measured at 1 and 3 weeks after RCR, and histologic analysis of the tendon-to-bone interface, bone morphometric evaluation, and biomechanical tests were performed at 4 and 8 weeks. Results: At the early healing stages of 1 and 3 weeks after RCR, the OP group showed the highest osteoclast density at the repaired interface. Compared with the OP group, risedronate administration significantly decreased osteoclast density in the OP+RIS group. At 8 weeks, histologic scores were greater in the OP+RIS group than in the OP group but still lower than in the CON group. Histologic scores at 8 weeks were negatively correlated with osteoclast density at the early healing stage. Additionally, the OP+RIS group showed better bone morphometric parameters and biomechanical properties than did the OP group. Conclusion: Osteoporosis impaired rotator cuff healing, which might be related to the high osteoclast density at the repaired interface at the early healing stage. Postoperative risedronate administration decreased osteoclast density and enhanced rotator cuff healing in osteoporotic rats, although the effect was inferior to that in nonosteoporotic rats. Clinical Relevance: Postoperative risedronate administration can be considered a potential therapy to enhance rotator cuff healing in patients with postmenopausal osteoporosis. However, this needs to be verified in a clinical setting.

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“…In a large database analysis, revision rates after RC surgery were significantly higher in patients with osteoporosis compared with age- and sex-matched controls without decreased BMD. 9…”

mentioning

confidence: 99%

“…In a large database analysis, revision rates after RC surgery were significantly higher in patients with osteoporosis compared with age-and sex-matched controls without decreased BMD. 9 Therefore, BMD augmentation seems indispensable for patients with reduced BMD to improve healing after surgical RC reconstruction. Until now, BMD augmentation techniques in preclinical animal models were solely investigated in acute RC ruptures.…”

mentioning

confidence: 99%

Zoledronic Acid Substantially Improves Bone Microarchitecture and Biomechanical Properties After Rotator Cuff Repair in a Rodent Chronic Defect Model

et al. 2020

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Background: Bone mineral density at the humeral head is reduced in patients with chronic rotator cuff tears. Bone loss in the humeral head is associated with repair failure after rotator cuff reconstruction. Bisphosphonates (eg, zoledronic acid) increase bone mineral density. Hypothesis: Zoledronic acid improves bone mineral density of the humeral head and biomechanical properties of the enthesis after reconstruction of chronic rotator cuff tears in rats. Study Design: Controlled laboratory study. Methods: A total of 32 male Sprague-Dawley rats underwent unilateral (left) supraspinatus tenotomy with delayed transosseous rotator cuff reconstruction after 3 weeks. All rats were sacrificed 8 weeks after rotator cuff repair. Animals were randomly assigned to 1 of 2 groups. At 1 day after rotator cuff reconstruction, the intervention group was treated with a single subcutaneous dose of zoledronic acid at 100 µg/kg bodyweight, and the control group received 1 mL of subcutaneous saline solution. In 12 animals of each group, micro–computed tomography scans of both shoulders were performed as well as biomechanical testing of the supraspinatus enthesis of both sides. In 4 animals of each group, histological analyses were conducted. Results: In the intervention group, bone volume fraction (bone volume/total volume [BV/TV]) of the operated side was higher at the lateral humeral head ( P = .005) and the medial humeral head ( P = .010) compared with the control group. Trabecular number on the operated side was higher at the lateral humeral head ( P = .004) and the medial humeral head ( P = .001) in the intervention group. Maximum load to failure rates on the operated side were higher in the intervention group ( P < .001). Cortical thickness positively correlated with higher maximum load to failure rates in the intervention group ( r = 0.69; P = .026). Histological assessment revealed increased bone formation in the intervention group. Conclusion: Single-dose therapy of zoledronic acid provided an improvement of bone microarchitecture at the humeral head as well as an increase of maximum load to failure rates after transosseous reconstruction of chronic rotator cuff lesions in rats. Clinical Relevance: Zoledronic acid improves bone microarchitecture as well as biomechanical properties after reconstruction of chronic rotator cuff tears in rodents. These results need to be verified in clinical investigations.

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The Association of Osteoporosis and Bisphosphonate Use With Revision Shoulder Surgery After Rotator Cuff Repair

Cited by 31 publications

References 32 publications

Osteoporosis Screening Is Often Indicated but Overlooked Prior to Rotator Cuff Repair

Osteoporosis Screening Is Often Indicated but Overlooked Prior to Rotator Cuff Repair

The Effect of Antiosteoporosis Therapy With Risedronate on Rotator Cuff Healing in an Osteoporotic Rat Model

Zoledronic Acid Substantially Improves Bone Microarchitecture and Biomechanical Properties After Rotator Cuff Repair in a Rodent Chronic Defect Model

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