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Team Approach: Bone Health Optimization in Orthopaedic Surgery
Ignacio Pasqualini1, Nickelas Huffman1, Sarah F Keller2
1Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio.
JBJS Reviews
|December 15, 2023
Summary
Optimizing bone health (BHO) before orthopaedic surgery is crucial for better outcomes. A collaborative approach involving multiple specialists and bone density evaluation can prevent complications like implant failure and improve patient quality of life.
Area of Science:
- Orthopaedic Surgery
- Bone Metabolism
- Geriatric Medicine
Background:
- Bone health optimization (BHO) is increasingly vital in orthopaedic surgery due to the link between poor bone density and adverse surgical outcomes.
- Patients with compromised bone health are often asymptomatic, necessitating proactive identification of risk factors like age, sex, and low BMI.
- Effective management requires a multidisciplinary team, including orthopaedic surgeons, primary care physicians, nutritionists, and metabolic bone specialists.
Purpose of the Study:
- To emphasize the importance of bone health optimization (BHO) in orthopaedic surgery.
- To outline diagnostic criteria and recommended workup for patients with suspected poor bone health.
- To highlight the benefits of a collaborative, multidisciplinary approach to BHO.
Main Methods:
- Bone density evaluation using dual-energy x-ray absorptiometry (DXA) is recommended for specific patient groups.
- DXA screening is advised for women aged 65+, men aged 70+, and younger individuals with risk factors or fractures.
- Fracture assessment guides the need for DXA and comprehensive bone health workup.
Main Results:
- Failure to address poor bone health can lead to significant surgical complications, including implant failure, infection, and nonunion.
- Early recognition and intervention through personalized care plans can mitigate these risks.
- Collaborative care plans may include nutritional support, pharmacologic treatments, and exercise regimens.
Conclusions:
- Proactive bone health optimization (BHO) is essential for improving orthopaedic surgical success rates.
- A coordinated, multidisciplinary healthcare approach is key to successful BHO.
- Optimizing bone health ultimately enhances surgical outcomes and patient quality of life.
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