Preoperative Bone Mineral Density and Bone Turnover in Women Before Primary Knee Arthroplasty

Abstract

Purpose:The preoperative prevalence of osteoporosis and/or osteopenia and overall bone quality in prospective total knee arthroplasty (TKA) patients may affect the postoperative outcome after prosthetic insertion into the bone. The purpose of this study is to determine the baseline bone mineral density (BMD) and bone turnover in preoperative, female, primary TKA patients.Methods:We prospectively measured the lumbar spine and hip BMDs using dual-energy X-ray absorptiometry (DEXA) scans in a cohort of 119 knees (107 patients) one day before surgery. We also assessed bone turnover using urinary levels of N-telopeptide (NTX), a type I collagen crosslinker, normalized to creatinine.Results:The prevalence of osteoporosis by DEXA scan (T-score ≤ −2.5) among the TKAs was 12% in the spine and 10% in the hip. Eighty-three knees (70%) had osteopenia or osteoporosis of either the spine or hip. The mean T-score of the spine was −0.7 (SD 1.6), which is within normal limits, and of the hip was −1.2 (SD 1.0), which is defined as osteopenia. The mean Z-scores of 0.9 (SD 1.4) in the spine and 0.6 (SD 0.9) in the hip were positive. The median urinary NTX/creatinine ratio was elevated at 58.1 (interquartile range: 13.7 to 188.4).Conclusion:Based on Z-scores, the TKA patients had higher spine and hip BMDs than the age-matched general population. Elevated NTX levels may suggest a systemic or local abnormal bone turnover. Further study is needed to determine whether such turnover, as a type of patient-related medical systemic disorder, affects postoperative clinical outcomes.

Importance of Routine Bone Mineral Density Screening Prior to Elective Total Joint Replacement

“…L ow bone mineral density (BMD) appears to be common in patients undergoing total joint replacement (TJR), with up to two thirds and one third meeting criteria for osteopenia and osteoporosis, respectively. [1][2][3][4][5][6][7][8][9] Emerging data raise concerns that low BMD may increase the risk of intraoperative and postoperative complications in patients undergoing TJR. In a study of total ankle arthroplasty, low tibial BMD, as measured by Hounsfield units, from preoperative ankle computed tomography scan was associated with a higher risk for periprosthetic fracture (P=.018), with all intraoperative fractures occurring in patients with tibial Hounsfield units less than 200.…”

Osteoporosis in Indian Patients Undergoing Elective Arthroplasty and Spinal Procedures: An Observational Study

“…These findings were substantiated by a retrospective case series of 200 patients undergoing TKR/THR at a single tertiary-care center that showed evidence of low bone mass in 86% of the patients, with osteoporosis prevalent in one-third (33%) of them [ 15 ]. In another prospective study between October 2009 and November 2014, which evaluated 107 Japanese postmenopausal women (aged ≥55 years) undergoing TKR, 70% of patients had low BMD, with an osteoporosis prevalence ranging between 10% and 18%, based on the site of BMD evaluation [ 13 ].…”

“…Osteoporosis and osteoarthritis share common risk factors such as age and female gender; hence they can be present concomitantly, especially in patients with chronic osteoarthritis [11][12][13][14]. Osteoporosis is relatively common in patients undergoing total joint arthroplasty (including total knee replacement {TKR}/total hip replacement {THR}) and spinal procedures [15,16].…”

“…However, newer studies on the association between osteoarthritis and osteoporosis with subsequent fracture risk show conflicting results [21,22]. While some studies show a low prevalence of osteoporosis and increased bone mass in patients with osteoarthritis undergoing TKR/THR [13,22,23], others show a prevalence roughly equal to that in the general population [12,24], while yet others show an increased risk of fractures in these patients [25][26][27][28].…”

“…Despite several international studies reporting the prevalence of osteoporosis in patients undergoing arthroplasty and spinal procedures [13,[22][23][24][44][45][46][47][48], adequate research on osteoporosis prevalence in Indian patients undergoing these procedures is lacking. While several papers have examined implant design in arthroplasty [13,[22][23][24]47,48], relatively fewer have assessed the quality of the underlying bone into which the implants are inserted [13,22].…”