What Is the Role of the Orthopaedic Surgeon in Management of Fragility Fractures?

Sharif, Khalid; Dimitriou, Rozalia; Giannoudis, Peter V.

doi:10.1097/bot.0b013e31821ac6e3

Cited by 6 publications

(2 citation statements)

References 20 publications

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“…Multiple studies have suggested algorithms to combat this phenomenon. [34][35][36][37][38][39] Although osteoporosis rates are now at pandemic proportions, few studies exist in the orthopedic and neurosurgical literature describing osteoporosis prevalence based on BMD measurements in patients presenting with musculoskeletal complaints other than fracture. One study of 500 general orthopedic outpatients whose mean age was 67 years quantified BMD with calcaneal quantitative ultrasound and found that 31% had abnormal BMD.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of osteoporosis and osteopenia diagnosed using quantitative CT in 296 consecutive lumbar fusion patients

Carlson

Salzmann²,

Shirahata³

et al. 2020

Neurosurgical Focus

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OBJECTIVEOsteoporosis is a metabolic bone disease that increases the risk for fragility fractures. Screening and diagnosis can be achieved by measuring bone mineral density (BMD) using quantitative CT tomography (QCT) in the lumbar spine. QCT-derived BMD measurements can be used to diagnose osteopenia or osteoporosis based on American College of Radiology (ACR) thresholds. Many reports exist regarding the disease prevalence in asymptomatic and disease-specific populations; however, osteoporosis/osteopenia prevalence rates in lumbar spine fusion patients without fracture have not been reported. The purpose of this study was to define osteoporosis and osteopenia prevalence in lumbar fusion patients using QCT.METHODSA retrospective review of prospective data was performed. All patients undergoing lumbar fusion surgery who had preoperative fine-cut CT scans were eligible. QCT-derived BMD measurements were performed at L1 and L2. The L1–2 average BMD was used to classify patients as having normal findings, osteopenia, or osteoporosis based on ACR criteria. Disease prevalence was calculated. Subgroup analyses based on age, sex, ethnicity, and history of abnormal BMD were performed. Differences between categorical groups were calculated with Fisher’s exact test.RESULTSOverall, 296 consecutive patients (55.4% female) were studied. The mean age was 63 years (range 21–89 years). There were 248 (83.8%) patients with ages ≥ 50 years. No previous clinical history of abnormal BMD was seen in 212 (71.6%) patients. Osteopenia was present in 129 (43.6%) patients and osteoporosis in 44 (14.9%). There were no prevalence differences between sex or race. Patients ≥ 50 years of age had a significantly higher frequency of osteopenia/osteoporosis than those who were < 50 years of age.CONCLUSIONSIn 296 consecutive patients undergoing lumbar fusion surgery, the prevalence of osteoporosis was 14.9% and that for osteopenia was 43.6% diagnosed by QCT. This is the first report of osteoporosis disease prevalence in lumbar fusion patients without vertebral fragility fractures diagnosed by QCT.

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Section: Discussionmentioning

confidence: 99%

Prevalence of osteoporosis and osteopenia diagnosed using quantitative CT in 296 consecutive lumbar fusion patients

Carlson

Salzmann²,

Shirahata³

et al. 2020

Neurosurgical Focus

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“…A prospective randomized trial found that compared with ''usual'' care, patients were twice as likely to be taking treatment for OSP management six months following fracture if it was initiated by the attending orthopaedic surgeon with follow-up in a dedicated orthopaedic OSP clinic [45]. Fracture care by the orthopaedic surgeon should be followed by efforts to prevent subsequent fracture such as a falls prevention assessment, an exercise programme to improve muscle tone and strength and commencement of bone protective therapy with BMD assessment by DXA for risk stratification and provision of a baseline to guide therapy [46]. While some of these interventions may be outside the skill-set of most orthopaedic surgeons they are easily accessible by referral to rheumatology, endocrinology or geriatric medicine colleagues who have an interest in bone disease.…”

Section: Secondary Fracture Preventionmentioning

confidence: 99%

Osteoporotic Fracture – When Repairing the Fracture is not enough

Wong¹,

Epi²

2014

Orthop Muscul Syst

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Osteoporotic fractures are a major public health problem in most Western countries. Due to their ageing population, Asia and South America will soon feel the burden of this issue. Osteoporotic/low trauma fractures are associated with increased morbidity and mortality and are often followed by further fractures. Effective and welltolerated bone protective medication such as bisphosphonates and denosumab are readily available and has been shown to prevent further fractures. As the molecular biology of bone turnover is now well-characterised, more specific targeted therapies are currently undergoing clinical trial. Despite these advances in pharmacotherapy secondary prevention of osteoporosis following low trauma fracture is often not implemented. Reasons for this include lack of appreciation of the importance of a low trauma fracture as a predictor of morbidity and mortality, lack of time on the part of treating clinicians and uncertainty regarding whose role it is to address secondary fracture prevention. However, many would suggest that best-practice surgical repair of an osteoporotic fracture also involves measures to prevent the next one. Such measures include bone mineral density assessment by dual x-ray absorptiometry, commencement of bone protective therapy and falls prevention strategies. This multi-faceted secondary prevention programme requires close cooperation between the orthopaedic surgical, nursing and physiotherapy team and a medical team with expertise in bone health. This occurs infrequently. The role of a Fracture Liaison Service built around a dedicated Fracture Liaison Coordinator will be discussed as this is probably the most effective strategy to ensure consistent secondary prevention of osteoporosis following low trauma fracture.

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A rare complication after intertrochanteric fracture treated with proximal femoral nail: femoral neck insufficiency fracture

Kayalı

Altay

Kement

et al. 2013

Eur J Orthop Surg Traumatol

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We present a case, 82-year-old woman, sustaining intertrochanteric fracture treated with proximal femoral nail. Up to 14 months postoperatively, everything went on seamlessly. Then, there was a rapid onset of worsening of the functional capacity. She came to outpatient clinic by using wheelchair. Plain X-rays revealed a femoral neck fracture on the operative side with no history of trauma. Laboratory studies showed no significant abnormalities but vitamin D [25 (OH) D] level was 14.82 ng/ml. X-ray survey of skeletal system was not indicative of osteomalacia. We performed total hip replacement instead of internal fixation due to patient's age. Vitamin D replacement therapy was launched. Three months later, she was totally satisfactory with clinical result and 25 (OH) D level increased to 53.68 ng/ml. At the last visit, the patient was pain free and active in all her recreational activities.

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What Is the Role of the Orthopaedic Surgeon in Management of Fragility Fractures?

Cited by 6 publications

References 20 publications

Prevalence of osteoporosis and osteopenia diagnosed using quantitative CT in 296 consecutive lumbar fusion patients

Prevalence of osteoporosis and osteopenia diagnosed using quantitative CT in 296 consecutive lumbar fusion patients

Osteoporotic Fracture – When Repairing the Fracture is not enough

A rare complication after intertrochanteric fracture treated with proximal femoral nail: femoral neck insufficiency fracture

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