Prevalence and Risk Factors of Osteoporosis in Chinese Postmenopausal Women Awaiting Total Knee Arthroplasty

Abstract

Background Total knee arthroplasty (TKA) complications associated with low bone quality are challenging for orthopaedic surgeons to treat, but little is known about bone quality in Chinese postmenopausal women awaiting TKA. This study investigated the incidence of osteoporosis (OP) and explored the preoperative risk factors for OP in this population. Methods We retrospectively reviewed the data of Chinese postmenopausal women who were indicated for TKA between May 2017 and June 2020. The bone mineral density (BMD) of the hip and lumbar spine and multiple preoperative parameters were collected and analyzed. Binary logistic regression analysis was performed to identify independent risk factors for OP in this population. Results A total of 204 postmenopausal women with advanced knee OA were included in the study (age: 69.7±8.5 years; body mass index [BMI]: 25.5±4.0 kg/m2). The OP prevalence among all participants was 59.8%, and the patients aged 60–80 years had a significantly lower BMD than did the age/ethnicity-adjusted population. An age ≥60 years, a BMI<25, and the presence of a varus knee deformity were independent risk factors for preoperative OP in the postmenopausal women awaiting TKA. Conclusion The prevalence of OP in Chinese postmenopausal women awaiting TKA is higher than that in the age/ethnicity-adjusted normal population. An age ≥60 years, a BMI<25, and the presence of a varus knee deformity are independent risk factors that can be used to predict preoperative OP in this population.

Prevalence of osteoporosis and osteopenia in elderly patients scheduled for total knee arthroplasty

“…In this regard, Asian studies in particular show high osteoporosis rates by DXA in patients undergoing TKA, but the underlying reason is unclear. Specifically, osteoporosis was detected in 59.8% of Chinese postmenopausal women (69.7 ± 8.5 years) prior to TKA [ 19 ]. The prevalence is markedly lower in our cohort (18.1%) even though our patients are comparably older (77.9 ± 4.1 years).…”

“…A significant prevalence of osteoporosis in patients undergoing arthroplasty has been reported previously, but methodological differences, such as a broad age range, pre-vs. postoperative evaluation, no differentiation between knee vs. hip replacement were limiting factors, resulting in a heterogeneous osteoporosis frequency ranging from 20.0 to 59.8% [8,9,[17][18][19][20]. In addition, there appears to be a geographic difference in the prevalence of osteoporosis before total joint arthroplasty, with more than twice as high values in Asian than in more western countries [8,9,[17][18][19]. Importantly, no study exists investigating the occurrence of osteoporosis in an elderly population prior to TKA in Europe.…”

The definition of spine bone mineral density (BMD)-classified osteoporosis and the much inflated prevalence of spine osteoporosis in older Chinese women when using the conventional cutpoint T-score of −2.5

“…However, the reported data show a quite different picture. Figure 5 shows one result from a meta-analysis of different Chinese female populations, four population-based studies from mainland China, two population-based studies from Taiwan and two population-based studies from Korea, and one each from Hong Kong and Japan (21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34). Except for the meta-analysis result, all other results were randomly selected from the literature.…”

Prevalence of osteoporosis in patients awaiting unicompartmental knee arthroplasty: a cross-sectional study

“…This is similar to the results of a survey of bone mass abnormalities prior to TJA (86%) ( 7 ). Patients awaiting UKA were younger than those awaiting TKA (mean age: 63.5 years vs. 69.7 years) and had a relatively lower prevalence of osteoporosis (40.88% vs. 59.8%) compared to patients in a previous survey of the population awaiting TKA in China ( 19 ). However, a study from Europe that included older (mean age: 77.9 years) patients awaiting TKA found a significantly lower prevalence of osteoporosis (18.1%) as well as osteopenia (46%) than was revealed in our results ( 19 ), possibly due to geographical differences, dietary structure, genetics, and other factors; with some studies suggesting that postmenopausal bone loss is significantly higher in Asian females than in European females ( 20 ).…”