Rationale for Bone Health Optimization in Patients Undergoing Orthopaedic Surgery

Area of Science:

• Orthopedics
• Geriatrics
• Endocrinology

Background:

• Osteoporosis affects over 40 million individuals, leading to increased fracture risk, disability, and reduced independence.
• It is frequently underdiagnosed and undertreated, even post-fracture, missing opportunities for cost-effective secondary fracture prevention.
• Undiagnosed osteoporosis occurs in up to one-third of patients undergoing orthopedic and spine surgery, negatively impacting surgical outcomes.

Purpose of the Study:

• To highlight the importance of bone health optimization in patients undergoing elective orthopedic and spine surgery.
• To emphasize the need for improved screening and diagnosis of osteoporosis in surgical populations.
• To advocate for the integration of bone health programs into surgical care pathways.

Main Methods:

• Review of current clinical definitions of osteoporosis, including bone mineral density T-scores and fracture assessment.
• Description of a bone health optimization program involving patient screening, counseling on lifestyle factors, and fall risk assessment.
• Discussion of referral pathways to bone health specialists and fracture liaison programs.

Main Results:

• Recent diagnostic criteria for osteoporosis incorporate T-scores, fractures, and overall fracture risk.
• Bone health optimization programs can identify patients needing further assessment and intervention.
• Both antiresorptive and anabolic medications show efficacy in improving surgical outcomes and reducing complications.

Conclusions:

• Optimizing bone health is crucial for patients undergoing elective orthopedic and spine surgery.
• Early identification and management of osteoporosis can mitigate surgical risks and improve patient outcomes.
• Collaboration with bone health specialists and fracture liaison programs is essential for comprehensive care.