Osteoporosis remains underdiagnosed, undertreated after periprosthetic femur fracture
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Key takeaways:
- Results showed 39% of patients were diagnosed with osteoporosis after periprosthetic femur fracture.
- Of the patients diagnosed with osteoporosis, 25%were treated with bisphosphonates.
Osteoporosis and osteopenia may be underdiagnosed and undertreated among patients treated for a periprosthetic fracture following total hip arthroplasty, according to published results.
“There remain major gaps in the screening, diagnosis and treatment of systemic osteoporosis and osteopenia after periprosthetic femur fractures,” Michael W. Seward, MD, a PGY-3 orthopedic surgery resident at the Mayo Clinic Rochester, and colleagues wrote in the study. “Like nonarthroplasty fragility fractures, a systematic approach is needed after periprosthetic femur fractures.”
Seward and colleagues retrospectively analyzed the electronic medical records of 171 patients with Vancouver B2 and B3 periprosthetic femur fractures (mean age, 75 years; mean follow-up, 11 years) treated with a modular fluted tapered stem between 2000 and 2018.
In the chart review, Seward and colleagues collected patient demographics, diagnosis and treatment of osteoporosis and osteopenia, and documentation of fracture risk assessment tools, including the Fracture Risk Assessment Tool and bone mineral density (BMD) tests.
Overall, Seward and colleagues found 94% of fractures were the result of a fall from a standing height. Although 39% of patients were diagnosed with osteoporosis after the fracture, 25% were treated with bisphosphonates following the fracture, according to the study.
In addition, Seward and colleagues acknowledged that 90% of the included patients were eligible for age-appropriate BMD testing at final follow-up, but 16% of those patients received the testing.
“An interdisciplinary approach to periprosthetic fractures may increase the rate of bone health referrals, appropriate diagnosis and subsequent treatment,” Seward and colleagues wrote. “Although additional screening may add cost to the health care system, the number of periprosthetic fractures is projected to increase, and the benefits of osteoporosis treatment extend beyond the potential prevention of only periprosthetic
fractures to also include other common fragility fractures, including the vertebrae, distal radius and uninstrumented proximal femur.”
Perspective
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Alana C. Serota, MD, CCFP, CCD
While osteoporosis and osteoarthritis are common, discrete disorders in the aging population, there does exist a great deal of confusion and conflation of these conditions among the general population.
For orthopedic surgeons concerned about perioperative bone health, our current screening modalities present limitations. The manifestations of the condition(s) they are treating — degenerative changes, osteophytes, sclerosis — can falsely elevate readings on the gold standard for osteoporosis screening, DEXA.
Osteoporosis remains underdiagnosed and undertreated in the general population. The impact of degenerative arthritis compounds misdiagnosis or delayed diagnosis even in those who are screened appropriately.
Recognition of these limitations by primary care doctors and orthopedic surgeons alike is critical to improve orthopedic outcomes.
Our goal should always be to prevent the first fracture by identifying those at risk. The Own the Bone program from the American Orthopaedic Association has called on orthopedic surgeons to “capture the fracture” (ie, recognize fragility fractures and recommend treatment for osteoporosis) to optimize bone health prior to elective orthopedic surgery.
The current paper adds to our growing body of evidence that consideration of underlying bone health is just as important to arthroplasty surgeons as to orthopedic trauma and spine surgeons.
Reference:
American Orthopaedic Association Own the Bone. https://www.ownthebone.org/. Accessed Sept. 24, 2024.
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Seward MW, et al. J Arthroplasty. 2024;doi:10.1016/j.arth.2024.06.002.
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