Osteoporosis prior to surgery may not affect outcomes of proximal humerus fractures
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Results showed preoperative osteoporosis and loss of bone mineral density after surgery did not affect failure risk or functional outcomes after open reduction and internal fixation of three- or four-part proximal humerus fractures.
“Osteoporosis may not be regarded as a contraindication for treatment of displaced three- or four-part fractures with [open reduction and internal fixation] ORIF,” the authors wrote.
Researchers collected preoperative, 6-week and 3-, 6- and 12-month postoperative radiographs and DXA scans in four templated regions of interest among 36 patients who underwent ORIF for unilateral displaced three- or four-part proximal humerus fractures. Researchers also assessed functional outcomes using the Western Ontario Osteoarthritis of the Shoulder (WOOS) index, Constant score, VAS pain scale and SF-36 questionnaire.
Researchers found 17 of 36 patients had osteoporosis. Results showed patients in the osteoporosis group and non-osteoporosis group had no differences in bone mineral density (BMD) changes, functional outcomes, radiology or need for revision surgery. In all four regions of interest, researchers noted a gradual decline of BMD values in the operated shoulders from baseline to 3-month follow-up. Although healthy shoulders had no significant BMD changes during the study, results showed a reduction in BMD in all four regions of interest in the operated shoulder at 3, 6 and 12 months compared with baseline. Researchers found an increase in the Constant score from 3 to 12 months but a decrease in physical function, general health and bodily pain domains of the SF-36 from preinjury to 12-month follow-up. Researchers noted comparable WOOS index and VAS pain at rest and activity preinjury and at 12-month follow-up.
Perspective
Back to TopGrant E. Garrigues, MD, and Burton D. Dunlap, MD
Osteoporosis is a known risk factor for proximal humerus fracture and, unfortunately, also complicates treatment as even angular-stable proximal humerus plate and screw constructs can have difficulty in poor quality bone. Mats Bue, MD PhD, and colleagues should be saluted for examining their experience with both sides of this coin. This prospective, multicenter study showed, unsurprisingly, that 17 of 36 patients (age range 38 to 83 years) with displaced three- and four-part fractures had osteoporosis. Serial DEXA scans evaluated bone mineral density in multiple sites in both the fractured arm and contralateral well arm at 6 weeks, 3 months, 6 months and 1 year after ORIF of the proximal humerus fracture. Perhaps also not surprisingly, the bone mineral density decreased from the surgery date to 3 months postoperatively, while the well arm did not change significantly. This is likely due to Wolff’s law and the disuse osteopenia on the injured side.
Interestingly, the decrease in bone mineral density did not recover in every region of the proximal humerus — even as far out as the 1-year time point. While this might seem like more bad news for treating patients with osteoporosis with proximal humerus fractures, their clinical outcomes showed similar rates of hardware failure in both osteoporotic and non-osteoporotic patients. This paper provides important information on the bone mineral changes that occur after proximal humerus fracture treated with ORIF and another important reminder on management of post-fracture bone quality.
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