全髋关节置换术后假体周围骨折的系统性骨质疏松症和骨量减少症。

Systemic Osteoporosis and Osteopenia Among Periprosthetic Fractures After Total Hip Arthroplasty.

机构信息

Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.

Department of Endocrinology, Mayo Clinic, Rochester, Minnesota.

出版信息

J Arthroplasty. 2024 Oct;39(10):2621-2626. doi: 10.1016/j.arth.2024.06.002. Epub 2024 Jun 7.

DOI:10.1016/j.arth.2024.06.002

PMID:38852691

Abstract

BACKGROUND

Most periprosthetic fractures following total hip arthroplasty (THA) are fragility fractures that qualify patients for osteoporosis diagnoses. However, it remains unknown how many patients were diagnosed who had osteoporosis before injury or received the proper evaluation, diagnosis, and treatment after injury.

METHODS

We identified 171 Vancouver B2 (109) and B3 (62) periprosthetic femur fractures treated with a modular fluted tapered stem from 2000 to 2018 at 1 institution. The mean patient age was 75 years (range, 35 to 94), 50% were women, and the mean body mass index was 29 (range, 17 to 60). We identified patients who had osteoporosis or osteopenia diagnoses, a fracture risk assessment tool (FRAX), bone mineral density (BMD) testing, an endocrinology consult, and osteoporosis medications. Age-appropriate BMD testing was defined as no later than 1 year after the recommended ages of 65 (women) or 70 years (men). The mean follow-up was 11 years (range, 4 to 21).

RESULTS

Falls from standing height caused 94% of fractures and thus, by definition, qualified as osteoporosis-defining events. The prevalence of osteoporosis diagnosis increased from 20% before periprosthetic fracture to 39% after (P < .001). The prevalence of osteopenia diagnosis increased from 13% before the fracture to 24% after (P < .001). The prevalence of either diagnosis increased from 24% before fracture to 44% after (P < .001). No patients had documented FRAX scores before fracture, and only 2% had scores after. The prevalence of BMD testing was 21% before fracture and 22% after (P = .88). By the end of the final follow-up, only 16% had received age-appropriate BMD testing. The proportion of patients who had endocrinology consults increased from 6% before the fracture to 25% after (P < .001). The proportion on bisphosphonate therapy was 19% before fracture and 25% after (P = .08).

CONCLUSIONS

Although most periprosthetic fractures following THA are fragility fractures that qualify patients for osteoporosis diagnoses, there remain major gaps in diagnosis, screening, endocrinology follow-up, and treatment. Like nonarthroplasty fragility fractures, a systematic approach is needed after periprosthetic fractures.

LEVEL OF EVIDENCE

Level III, retrospective cohort study.

摘要

背景

大多数全髋关节置换术后（THA）的假体周围骨折是脆性骨折，这使患者符合骨质疏松症的诊断标准。然而，目前尚不清楚有多少患者在受伤前被诊断为骨质疏松症，或者在受伤后接受了适当的评估、诊断和治疗。

方法

我们在一家机构中，对 2000 年至 2018 年期间采用模块化带槽锥形柄治疗的 171 例温哥华 B2（109 例）和 B3（62 例）假体周围股骨骨折进行了识别。患者的平均年龄为 75 岁（范围 35 岁至 94 岁），50%为女性，平均体重指数为 29（范围 17 岁至 60 岁）。我们确定了患有骨质疏松症或骨量减少诊断、骨折风险评估工具（FRAX）、骨密度（BMD）检测、内分泌咨询和骨质疏松症药物治疗的患者。年龄适宜的 BMD 检测定义为不晚于 65 岁（女性）或 70 岁（男性）的推荐年龄后 1 年。平均随访时间为 11 年（范围 4 年至 21 年）。

结果

94%的骨折是由站立高度的跌倒引起的，因此根据定义，这些骨折符合骨质疏松症的定义事件。骨质疏松症诊断的患病率从假体周围骨折前的 20%增加到骨折后的 39%（P<.001）。骨量减少诊断的患病率从骨折前的 13%增加到骨折后的 24%（P<.001）。两种诊断的患病率从骨折前的 24%增加到骨折后的 44%（P<.001）。没有患者在骨折前有记录的 FRAX 评分，只有 2%的患者在骨折后有评分。骨折前 BMD 检测的患病率为 21%，骨折后为 22%（P=.88）。在最后一次随访结束时，只有 16%的患者接受了年龄适宜的 BMD 检测。骨折前接受内分泌咨询的患者比例从 6%增加到骨折后的 25%（P<.001）。骨折前接受双膦酸盐治疗的患者比例为 19%，骨折后为 25%（P=.08）。