Review articleOsteoporosis and shoulder osteoarthritis: incidence, risk factors, and surgical implications
Section snippets
Materials and methods
Data from 2004 to 2010 were prospectively collected for 230 patients undergoing anatomic TSA at our institution. Patients who had undergone TSA for primary osteoarthritis of the shoulder and had preoperative DEXA and shoulder CT scans were candidates for inclusion in the study. Patient informed consent was waived.
Previously described radiographic criteria were used for the diagnosis of shoulder osteoarthritis, including joint space narrowing with osteophytes, subchondral sclerosis, and cyst
Results
Our 230 patients (155 men, 75 women) were a mean age of 68.2 years (range, 27.5-86.7 years). BMD values were significantly lower in women (0.89 ± 0.14 g/cm2 [mean ± standard deviation]) than in men (0.98 ± 0.14 g/cm2; P < 0.001). Bone density was classified as normal in 104 patients (45%). Of the 126 who exhibited abnormal bone density, 98 were osteopenic (43.6%) and 28 were osteoporotic (12.2%). Only 7 of the 28 osteoporotic patients (25%) were aware of their diagnosis and undergoing treatment
Discussion
Osteoporosis and shoulder arthritis can coexist,1, 4, 8, 11, 16, 20 and many of these patients are not aware of their coexisting diagnosis and risk for fragility fractures.7, 19, 21, 28 This point is made clear by our study findings: 75% of the osteoporotic patients were unaware of their coexisting metabolic disease and were subsequently referred for treatment after their preoperative workup. A number of additional studies have shown that osteoporosis is under-diagnosed and under-treated.6, 9
Conclusion
The present study suggests that orthopedic surgeons may be able to apply readily available data obtained from shoulder CT scans to predict the stability of humeral stems in patients diagnosed with osteoarthritis and undergoing TSA. In addition to preoperative planning, study results indicate that shoulder CTs may be of diagnostic value because they can be used to screen patients for metabolic bone diseases, such as osteoporosis, at no additional cost to the patient. These data, as well as the
Acknowledgment
The authors thank Rachel Clark and Chris Williams for their assistance with this project.
Disclaimer
The research foundation that employs Dr Santoni (Foundation for Orthopaedic Research and Education) received research support from DJO Surgical in the form of a research grant. Dr Frankle is a consultant for DJO Surgical and has received payment for lectures, including service on speaker's bureaus. Dr. Frankle has patents with DJO Surgical from which he has received royalties that are related to the subject of this work. The other authors, their immediate families, and any research foundations
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The Western Institutional Review Board, 3535 7th Ave SW, P.O. Box 12029, Olympia, WA 98502-5010, USA, approved this study (Study No.: 1129467) on Jan 6, 2012.