Department of Orthopedics & Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, WI.
Divisions of Endocrinology and Geriatrics, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI.
J Arthroplasty. 2019 Jul;34(7):1347-1353. doi: 10.1016/j.arth.2019.03.044. Epub 2019 Mar 28.
Osteoporosis is common in total joint arthroplasty (TJA) patients and likely contributes to the increasing incidence of periprosthetic fracture. Despite this, the prevalence of osteoporosis in patients undergoing elective TJA is inadequately studied. We hypothesize that preoperative osteoporosis is underrecognized and undertreated in the TJA population. The purpose of this study is to report preoperative osteoporosis screening rates and prevalence prior to TJA and rates of pharmacologic osteoporosis treatment in the TJA population.
This is a retrospective case series of 200 consecutive adults (106F, 94M) aged 48-92 years who underwent elective TJA (100 total hip, 100 total knee) at a single tertiary-care center. Charts were retrospectively reviewed to determine preoperative osteoporosis risk factors, prior dual-energy X-ray absorptiometry (DXA) testing, and prior osteoporosis pharmacotherapy. Fracture risk was estimated using the Fracture Risk Assessment Tool and the National Osteoporosis Foundation criteria for screening and treatment were applied to all patients.
One hundred nineteen of 200 patients (59.5%) met criteria for DXA testing. Of these 119, 21 (17.6%) had DXA testing in the 2 years prior to surgery, and 33% had osteoporosis by T-score. Forty-nine patients (24.5%) met National Osteoporosis Foundation criteria for pharmacologic osteoporosis treatment, and 11 of these 49 received a prescription for pharmacotherapy within 6 months before or after surgery.
One quarter of TJA patients meet criteria to receive osteoporosis medications, but only 5% receive therapy preoperatively or postoperatively. This lack of preoperative osteoporosis screening and treatment may contribute to periprosthetic fracture risk.
骨质疏松症在全关节置换术（TJA）患者中很常见，可能导致假体周围骨折的发生率增加。尽管如此，接受择期 TJA 的患者中骨质疏松症的患病率研究不足。我们假设 TJA 人群中术前骨质疏松症的识别和治疗不足。本研究旨在报告 TJA 前的术前骨质疏松症筛查率和患病率，以及 TJA 人群中药物治疗骨质疏松症的比率。
这是一项回顾性病例系列研究，纳入了 200 名连续的 48-92 岁成年患者（106 名女性，94 名男性），他们在一家三级保健中心接受了择期 TJA（100 例全髋关节置换术，100 例全膝关节置换术）。回顾性分析病历以确定术前骨质疏松症的危险因素、双能 X 线吸收测定法（DXA）检测和先前的骨质疏松症药物治疗情况。使用骨折风险评估工具估计骨折风险，并应用国家骨质疏松基金会的筛查和治疗标准对所有患者进行评估。
200 名患者中有 119 名（59.5%）符合 DXA 检测标准。在这 119 名患者中，21 名（17.6%）在手术前 2 年内进行了 DXA 检测，其中 33%的患者按 T 评分诊断为骨质疏松症。49 名患者（24.5%）符合国家骨质疏松基金会药物治疗骨质疏松症的标准，其中 11 名患者在手术前或手术后 6 个月内获得了药物治疗处方。
四分之一的 TJA 患者符合接受骨质疏松症药物治疗的标准，但只有 5%的患者在术前或术后接受治疗。这种术前骨质疏松症筛查和治疗的缺乏可能导致假体周围骨折的风险增加。
