Preoperative bone screening should be considered for patients older than 50 years
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Due to a high prevalence of osteoporosis and degraded bone health in patients older than 50 years, surgeons should consider fracture risk assessment and dual X-ray absorptiometry prior to surgery, according to an orthopedic specialist.
Paul A. Anderson, MD, and colleagues from the University of Wisconsin School of Medicine and Public Health, analyzed 124 patients with a mean age of 69.2 years who were referred for bone health optimization prior to total joint arthroplasty or thoracolumbar surgery.
According to the study, Anderson and colleagues collected fracture risk assessment tool and dual X-ray absorptiometry (DXA) results prior to surgery. They also evaluated CT imaging and trabecular bone score when available.
Following WHO diagnostic and National Osteoporosis Foundation (NOF) treatment guidelines, researchers found 3% of female and 10% of male patients had a normal bone mineral density, as defined by NOF T-scores. They also found osteoporosis (T-score of -2.5) was present in 45% of female and 20% of male patients, with 91% of all patients meeting the NOF threshold for osteoporosis treatment.
Of the 83 patients evaluated for trabecular bone scores, 34% had degraded bone microarchitecture and 30% had partially degraded bone microarchitecture. Investigators found, 45% of all patients were prescribed anabolic therapy and 30% were prescribed antiresorptive therapy.
“Patients over 50 years of age undergoing elective orthopedic surgery should be evaluated for bone health,” Anderson told Healio Orthopedics. “The goal is to determine who needs further diagnostic testing of a DXA to determine bone mineral density. Those who prove to have osteoporosis are at risk of complications and may be candidates for bone health optimization,” he said.
“For arthroplasty and spine patients, our experience shows that 60% of patients meet criteria for DXA and that overall, 20% to 30% have osteoporosis,” Anderson said.
Perspective
Back to TopAzeem Tariq Malik, MD; Carmen E. Quatman, MD, PhD
Osteoporosis is a major public health concern. With an aging population nationally, it is likely the proportion of individuals seeking orthopedic surgical care for the management of elective and nonelective musculoskeletal ailments will rise significantly over the coming decade. Although osteoporosis has been shown to be associated with adverse outcomes following orthopedic surgery, preoperative bone health optimization often goes overlooked.
In their single-institution study, Kadri and colleagues retrospectively reviewed patients who were referred for bone health optimization prior to elective spine surgery or total joint arthroplasty. Using a detailed approach, that involved imaging (ie, DXA, CT, trabecular bone scoring) and Fracture Risk Assessment Tool assessments, the authors found that a significant proportion of patients have poor bone health and may benefit from optimization prior to undergoing major elective procedures. While the study rightfully promotes routine bone health assessment in patients undergoing elective orthopedic surgery, it is important to note the authors’ institution has a robust fracture liaison service in place. Having a fracture liaison service embedded within the orthopedic department allows efficient and prompt coordination of care, particularly during the preoperative period where time is of the essence. Although not all institutions have a fracture liaison service in place, these findings support the need of mandating every hospital (community and teaching) to have access to such a service to allow appropriate care of patients, and thus avoid occurrences of adverse events.
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