Symposium: Gender-specific Issues in Orthopaedic Surgery

Clinical Orthopaedics and Related Research®

, Volume 468, Issue 7, pp 1765-1772

First online:

Prevalence and Predictors of Osteoporosis Risk in Orthopaedic Patients

  • Tamara D. RozentalAffiliated withDepartment of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School Email author 
  • , Jalaal ShahAffiliated withChicago College of Osteopathic Medicine, Midwestern University
  • , Aron T. ChackoAffiliated withDepartment of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School
  • , David ZurakowskiAffiliated withDepartment of Anesthesiology and Surgery, Childrens’ Hospital Boston, Harvard Medical School

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Current physician practices are not effective in adequately evaluating and treating patients for osteoporosis. While dual-energy xray absorptiometry is the gold standard in evaluating bone mineral density, calcaneal quantitative ultrasound has emerged as a low-risk and low-cost alternative.


We estimated the prevalence of abnormal bone mineral density with calcaneal quantitative ultrasound and developed criteria for risk stratification in female and male orthopaedic patients.


We enrolled 500 patients (331 women, 169 men) with a mean age of 67 years (range, 55–94 years) and screened them for osteoporosis with calcaneal quantitative ultrasound. Multivariate logistic regression was used to identify predictors of low bone mineral density and a risk model was developed.


Quantitative ultrasound identified 154 patients with low bone mineral density at the time of enrollment. The prevalence of abnormal bone mineral density was 31% (women: 38%, men: 17%). Multivariate analysis demonstrated age, female gender, smoking, wrist fracture, and spinal deformities independently predicted low bone mineral density. The probability of low bone mineral density among patients with more than one risk factor was greater than 50% among women and greater than 30% among men.


Low bone mineral density is common among orthopaedic outpatients. Age, female gender, smoking, wrist fractures, and spinal deformities are independent risk factors for osteoporosis. We present a probability model designed to assist orthopaedic surgeons in identifying high-risk patients and initiating adequate preventative measures.

Level of Evidence

Level I, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.