Popescu D, Ene R, Cirstoiu C
Orthopedics-Traumatology Clinic, University Hospital, Bucharest, Romania.
J Med Life. 2011 May 15;4(2):178-81. Epub 2011 May 25.
Patients with incipient hip arthrosis may benefit from a relatively new therapeutical approach using resurfacing total hip replacement, but in those with associated osteoporosis, this type of surgical intervention is contraindicated, given the poor quality of osteoporotic bones. We assessed the efficacy of the antiosteoporotic pharmacological therapy to improve bone quality and bone strength in postmenopausal women diagnosed with hip arthrosis and osteoporosis thus facilitating the hip surgical intervention.
We evaluated 20 postmenopausal women aged between 53-60 years diagnosed with osteoporosis according to the WHO criteria, by using dual-energy X-ray absorptiometry (DXA) for bone mineral density measurements. All these patients had low hip T score (osteopenia/ osteoporosis) and also incipient hip arthrosis. The surgical approach was delayed for 12 months and all the patients received bisphosphonate therapy with calcium and vitamin D supplements. DXA scans were performed after 12 months of therapy in all the patients.
A surgical intervention with resurfacing total hip replacement was performed in 12 of the 16 patients presenting with increasing BMD, 4 of them showing elements of rapidly advancing hip arthrosis to a stage that made this type of intervention impossible. We chose not to use this technique in the group with stable BMD (4 patients). All 12 women surgically treated had a favorable post-operative outcome without experiencing a femoral neck fracture during the surgical intervention or during the twelve-month follow-up. All 20 patients continued to receive bisphosphonate therapy.
In postmenopausal women with osteoporosis and associated hip arthrosis, improving bone mass and bone quality with bisphosphonate therapy is necessary and important in order to allow hip arthroplasty, by using the technique of resurfacing, avoiding the risk of intra-operative fractures and with a favorable post-operative long-term outcome.
早期髋关节骨关节炎患者可能会从一种相对较新的治疗方法——表面置换全髋关节置换术中获益，但对于伴有骨质疏松症的患者，鉴于骨质疏松骨质量较差，这种手术干预是禁忌的。我们评估了抗骨质疏松药物治疗对改善诊断为髋关节骨关节炎和骨质疏松症的绝经后女性的骨质量和骨强度的疗效，从而促进髋关节手术干预。
我们根据世界卫生组织标准，使用双能X线吸收法（DXA）测量骨密度，评估了20名年龄在53 - 60岁之间诊断为骨质疏松症的绝经后女性。所有这些患者髋关节T值较低（骨量减少/骨质疏松症），且患有早期髋关节骨关节炎。手术推迟12个月，所有患者均接受双膦酸盐治疗并补充钙和维生素D。所有患者在治疗12个月后进行DXA扫描。
16名骨密度增加的患者中有12名接受了表面置换全髋关节置换手术干预，其中4名患者显示髋关节骨关节炎迅速进展至无法进行此类干预的阶段。我们选择不对骨密度稳定的组（4名患者）使用该技术。所有12名接受手术治疗的女性术后结果良好，在手术干预期间或十二个月的随访期间均未发生股骨颈骨折。所有20名患者继续接受双膦酸盐治疗。
在患有骨质疏松症和相关髋关节骨关节炎的绝经后女性中，使用双膦酸盐治疗改善骨量和骨质量对于通过表面置换技术进行髋关节置换术是必要且重要的，可避免术中骨折风险并获得良好的术后长期结果。
