Osteoporosis Surprisingly Undertreated Risk Factor

Research from the University of Wisconsin in Madison has determined that osteoporosis is common but surprisingly under recognized and, therefore, undertreated prior to total joint arthroplasty (TJA).

The study, “Osteoporosis Is Common and Undertreated Prior to Total Joint Arthroplasty,” appears in the July 2019 edition of The Journal of Arthroplasty.

Co-author James Bernatz, M.D., with the Department of Orthopedic Surgery at the University of Wisconsin, explained the genesis of the study to OTW, “We were seeing a bevy of periprosthetic fractures. After referring these patients to our Fracture Liaison Service, we found that many of them had poor bone health, and if they had been treated around the time of their arthroplasty, they may not have had this devastating complication.”

The study looked at data for 200 consecutive adults aged 48-92 years who underwent elective TJA (100 total hip, 100 total knee). The study investigators reviewed their charts to determine preoperative osteoporosis risk factors, prior dual-energy X-ray absorptiometry (DXA) testing, and prior osteoporosis pharmacotherapy. They then estimated fracture risk using the Fracture Risk Assessment Tool and the National Osteoporosis Foundation criteria.

Dr. Bernatz summarized the team’s findings to OTW, “We found that osteoporosis is incredibly common in the total joint arthroplasty population. Orthopedic surgeons need to be aware of the high prevalence of osteoporosis in these patients.”

“We would encourage all arthroplasty providers to be familiar with the National Osteoporosis Foundation guidelines for osteoporosis screening. In essence, any female over 65 or men over 70, adults with previous fracture, as well as those with a history of medical conditions that can affect bone health (smoking, parathyroid disease, etc.) should be screened with DXA prior to elective surgery.”

“Osteoporosis is common and under-recognized prior to total joint arthroplasty. Be on the lookout for it and consider DXA screening and referral to a bone health specialist if indicated prior to elective surgery.”