Osteoporosis Is Common and Undertreated Prior to Total Joint Arthroplasty

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: arthroplasty; bone health; osteoporosis; total hip arthroplasty; total knee arthroplasty.