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Periprosthetic fractures are osteoporotic fractures: missed opportunities for osteoporosis diagnosis

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Abstract

Summary

Joint replacement surgery is common in older adults, leading to increasing periprosthetic fracture (PPFx) occurrence. We reviewed all PPFx seen over a 4-year period at an academic hospital. Clinical osteoporosis could be diagnosed based on existing data in 104 (67%) at the time of PPFx. Periprosthetic fractures are generally osteoporosis-related.

Purpose

Periprosthetic fractures (PPFx) cause morbidity, mortality, and cost. This study’s purpose was to describe osteoporosis-related data available at the time of PPFx.

Methods

The electronic medical record (EMR) of PPFx patients seen over 4 years in a university orthopedic practice were reviewed. Demographic data and osteoporosis relevant parameters were collected. Prior DXA studies were reviewed, and L1 Hounsfield unit (HU) measurements were performed on CT scans obtained within 2 years before PPFx. Clinical osteoporosis was defined as prior diagnosis, prescribed osteoporosis treatment, T-score ≤  − 2.5, HU ≤ 100, or prior fracture.

Results

Records of 156 PPFx patients (115 F/41 M), mean (SD) age 75.4 (11.9), were reviewed. Almost all 153/156 (98%) of these fractures were femoral. Falls caused 139 (89%); 12 (8%) were spontaneous. Mean time post-arthroplasty was 7.9 (6.3) years. Prior fragility fracture(s) occurred in 72 (46%); 14 were PPFx. Osteoporosis was previously diagnosed in 45 (29%) and medications prescribed in 41 (26%). Prior to PPFx, DXA data were available in 62, mean (SD) lowest T-score was − 1.9 (0.9) and was ≤  − 2.5 in 19. CT data were available in 46; mean (SD) L1 HU was 79.0 (29.4) and was ≤ 100 in 35. Based on existing data, clinical osteoporosis could have been diagnosed in 104 (67%) at the time of PPFx.

Conclusion

Periprosthetic fractures are osteoporosis-related. They occur in older adults, often female, and result from falls; BMD, when assessed, is low. Data available at the time of PPFx often allows osteoporosis diagnosis; this should prompt evaluation and pharmacologic treatment consideration.

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Authors and Affiliations

  1. Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, 1685 Highland Ave, MFCB 6227, Madison, WI, 53705, USA

    Paul S. Whiting, Kristyn Hare, Kristina Parvanta-Johnson, James Bernatz & Paul A. Anderson

  2. Osteoporosis Clinical Research Program, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA

    Diane Krueger, Gretta Borchardt & Neil Binkley

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  1. Paul S. Whiting
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  2. Kristyn Hare
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  3. Diane Krueger
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Correspondence to Paul S. Whiting.

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P. S Whiting, K. Hare, D. Krueger, G. Borchardt, K. Parvanta-Johnson, J. Bernatz, and P. A. Anderson declare no conflict of interest. Neil Binkley declares no conflict of interest for the content of this paper; research funding from Radius; consultant Amgen and Radius.

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Whiting, P.S., Hare, K., Krueger, D. et al. Periprosthetic fractures are osteoporotic fractures: missed opportunities for osteoporosis diagnosis. Osteoporos Int (2024). https://doi.org/10.1007/s00198-024-07057-w

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