“We believe that bone health screening should be considered in all orthopaedic surgical candidates who are ≥50 years of age.” So proclaim Kadri et al., based on results of their study of 124 patients who were referred by orthopaedic surgeons for preoperative bone health optimization. The study appeared in the April 1, 2020 issue of The Journal of Bone & Joint Surgery.
The importance of identifying poor bone health before reconstructive orthopaedic surgery is well known but poorly implemented. The bone health evaluation in this cohort consisted of a physical examination, structured history-taking focused on prior fracture, and collection of Fracture Risk Assessment Tool (FRAX) data. Most (122 patients) also underwent dual X-ray absorptiometry (DXA), and more than two-thirds were evaluated with a trabecular bone score. Incidental CT scans were available for and evaluated in 43 patients. Based on these data, Kadri et al. found the following:
- >90% of the cohort met National Osteoporosis Foundation criteria for osteoporosis treatment.
- A high FRAX risk (major osteoporotic fracture ≥20% or hip ≥3%) was present in 82% of the patients.
- Osteoporosis, as defined by T scores of ≤─2.5 points, was present in 45% of the women and 20% of the men.
- Trabecular bone scores identified 34% of patients as having degraded bone microarchitecture.
As a result of these findings, 75% of the cohort were prescribed treatment for osteoporosis; 45% were prescribed anabolic agents and 30% were prescribed antiresorptive therapy.
For patients with clinical risk factors for osteoporosis and high FRAX risk, Kadri et al. recommend bone health optimization strategies for a minimum of 3 months prior to any planned orthopaedic surgery. “It has been our experience that patients are generally satisfied and are grateful to undergo bone health optimization despite a delay in the surgical procedure,” they write.
Although postsurgical outcomes among these patients were not analyzed, the authors intuitively point out that bone health optimization probably reduces the likelihood of postoperative complications and revisions and therefore would lead to improved outcomes and lower costs. Preoperative bone health optimization could also help surgeons select the most effective surgical technique and/or implant, they say.