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Fracture Risk Assessment Tool Scores and Radiographical Bone Measurements in Total Hip Arthroplasty Patients

      Abstract

      Background

      Osteoporosis is a major risk factor for periprosthetic fractures (PPFx) in total hip arthroplasty (THA) patients but is not routinely screened for in this population. Given the availability of hip x-rays and preoperative screenings, Fracture Risk Assessment Tool (FRAX) scores and radiographic bone measurements are potentially promising, novel risk stratification tools. This study aims to characterize FRAX scores and radiographic bone measurements in THA and PPFx patients.

      Methods

      A retrospective chart review for demographic variables and FRAX scores was performed on 250 THA and 40 PPFx patients. Radiographic bone measurements including cortical thicknesses (both antero-posterior [AP] and lateral), canal to calcar ratio, canal flare index, and Dorr classifications were obtained from preoperative x-rays. Correlation between FRAX scores and radiographic bone measurements was investigated with linear regressions. FRAX scores and radiographic bone measurements were compared between the THA and PPFx patients. Multivariate logistic regressions were used to identify factors predicting PPFx.

      Results

      FRAX scores were significantly correlated with both AP (P < .001) and lateral (P = .007) cortical thicknesses. Compared to THA patients, those with PPFx had significantly higher FRAX scores (P = .003) and lower AP cortical thickness (P = .005). Multivariate logistic regressions demonstrated that FRAX major osteoporotic fracture risk score and AP cortical thickness were independent predictors of PPFx (P = .001 and .024, respectively).

      Conclusion

      Cortical thicknesses are good proxy measurements of osteoporosis-related fracture risk in THA patients. In addition, both major and AP cortical thickness indices are promising tools for identifying patients who are at a high risk of PPFx in the THA population.

      Keywords

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      References

        • Bernatz J.T.
        • Brooks A.E.
        • Squire M.W.
        • Illgen R.I.
        • Binkley N.C.
        • Anderson P.A.
        Osteoporosis is common and undertreated prior to total joint arthroplasty.
        J Arthroplasty. 2019; 34: 1347-1353https://doi.org/10.1016/j.arth.2019.03.044
        • Nguyen B.N.T.
        • Hoshino H.
        • Togawa D.
        • Matsuyama Y.
        Cortical thickness index of the proximal femur: a radiographic parameter for preliminary assessment of bone mineral density and osteoporosis status in the age 50 years and over population.
        Clin Orthop Surg. 2018; 10: 149-156https://doi.org/10.4055/cios.2018.10.2.149
        • Hoff M.
        • Meyer H.E.
        • Skurtveit S.
        • Langhammer A.
        • Søgaard A.J.
        • Syversen U.
        • et al.
        Validation of FRAX and the impact of self-reported falls among elderly in a general population: the HUNT study, Norway.
        Osteoporos Int. 2017; 28: 2935-2944https://doi.org/10.1007/s00198-017-4134-9
        • Kim J.W.
        • Koh J.M.
        • Park J.H.
        • Chang J.S.
        Validation of FRAX without BMD: an age-related analysis of the fifth Korean national health and nutrition examination survey (KNHANES V-1, 2010).
        Bone. 2015; 75: 27-31https://doi.org/10.1016/j.bone.2015.02.013
        • Kral R.
        • Osima M.
        • Borgen T.T.
        • Vestgaard R.
        • Richardsen E.
        • Bjørnerem Å.
        Increased cortical porosity and reduced cortical thickness of the proximal femur are associated with nonvertebral fracture independent of Fracture Risk Assessment Tool and Garvan estimates in postmenopausal women.
        PLoS One. 2017; 12: e0185363https://doi.org/10.1371/journal.pone.0185363
        • Wang Z.
        • Levin J.
        • Amen T.
        • Arzani A.
        • Manzi J.E.
        • Lane J.M.
        Total joint arthroplasty and osteoporosis: looking beyond the joint to bone health.
        J Arthroplasty. 2022; 37: 1719-1725.e1https://doi.org/10.1016/j.arth.2022.04.010
        • Dorr L.D.
        • Faugere M.C.
        • Mackel A.M.
        • Gruen T.A.
        • Bognar B.
        • Malluche H.H.
        Structural and cellular assessment of bone quality of proximal femur.
        Bone. 1993; 14: 231-242https://doi.org/10.1016/8756-3282(93)90146-2
        • Noble P.C.
        • Box G.G.
        • Kamaric E.
        • Fink M.J.
        • Alexander J.W.
        • Tullos H.S.
        The effect of aging on the shape of the proximal femur.
        Clin Orthop Relat Res. 1995; : 31-44
        • Karayiannis P.N.
        • Cassidy R.S.
        • Hill J.C.
        • Dorr L.D.
        • Beverland D.E.
        The relationship between canal diameter and the Dorr classification.
        J Arthroplasty. 2020; 35: 3204-3207https://doi.org/10.1016/j.arth.2020.05.066
        • Camacho P.M.
        • Petak S.M.
        • Binkley N.
        • Diab D.L.
        • Eldeiry L.S.
        • Farooki A.
        • et al.
        American association of clinical endocrinologists/American college of endocrinology clinical practice guidelines for the diagnosis and treatment of postmenopausal osteoporosis-2020 update.
        Endocr Pract. 2020; 26: 1-46https://doi.org/10.4158/GL-2020-0524SUPPL
        • Harris P.A.
        • Taylor R.
        • Minor B.L.
        • Elliott V.
        • Fernandez M.
        • O’Neal L.
        • et al.
        The REDCap consortium: building an international community of software platform partners.
        J Biomed Inform. 2019; 95: 103208https://doi.org/10.1016/j.jbi.2019.103208
        • Harris P.A.
        • Taylor R.
        • Thielke R.
        • Payne J.
        • Gonzalez N.
        • Conde J.G.
        Research electronic data capture (REDCap)-A metadata-driven methodology and workflow process for providing translational research informatics support.
        J Biomed Inform. 2009; 42: 377-381https://doi.org/10.1016/j.jbi.2008.08.010
        • Sah A.P.
        • Thornhill T.S.
        • LeBoff M.S.
        • Glowacki J.
        Correlation of plain radiographic indices of the hip with quantitative bone mineral density.
        Osteoporos Int. 2007; 18: 1119-1126https://doi.org/10.1007/s00198-007-0348-6
        • Mather J.
        • MacDermid J.C.
        • Faber K.J.
        • Athwal G.S.
        Proximal humerus cortical bone thickness correlates with bone mineral density and can clinically rule out osteoporosis.
        J Shoulder Elbow Surg. 2013; 22: 732-738https://doi.org/10.1016/j.jse.2012.08.018
        • Patterson J.
        • Rungprai C.
        • Hartog T.D.
        • Gao Y.
        • Amendola A.
        • Phisitkul P.
        • et al.
        Cortical bone thickness of the distal part of the tibia predicts bone mineral density.
        J Bone Joint Surg Am. 2016; 98: 751-760https://doi.org/10.2106/JBJS.15.00795
        • Baumgärtner R.
        • Heeren N.
        • Quast D.
        • Babst R.
        • Brunner A.
        Is the cortical thickness index a valid parameter to assess bone mineral density in geriatric patients with hip fractures?.
        Arch Orthop Trauma Surg. 2015; 135: 805-810https://doi.org/10.1007/s00402-015-2202-1
        • Dan D.
        • Germann D.
        • Burki H.
        • Hausner P.
        • Kappeler U.
        • Meyer R.P.
        • et al.
        Bone loss after total hip arthroplasty.
        Rheumatol Int. 2006; 26: 792-798https://doi.org/10.1007/s00296-005-0077-0
        • Yeung Y.
        • Chiu K.Y.
        • Yau W.P.
        • Tang W.M.
        • Cheung W.Y.
        • Ng T.P.
        Assessment of the proximal femoral morphology using plain radiograph-can it predict the bone quality?.
        J Arthroplasty. 2006; 21: 508-513https://doi.org/10.1016/j.arth.2005.04.037
        • Weiser L.
        • Korecki M.A.
        • Sellenschloh K.
        • Fensky F.
        • Püschel K.
        • Morlock M.M.
        • et al.
        The role of inter-prosthetic distance, cortical thickness and bone mineral density in the development of inter-prosthetic fractures of the femur.
        Bone Joint J. 2014; 96-B: 1378-1384https://doi.org/10.1302/0301-620X.96B10
        • Meek R.M.D.
        • Norwood T.
        • Smith R.
        • Brenkel I.J.
        • Howie C.R.
        The risk of peri-prosthetic fracture after primary and revision total hip and knee replacement.
        J Bone Joint Surg Br. 2011; 93: 96-101https://doi.org/10.1302/0301-620X.93B1