Shoulder Arthroplasty Patients Are Underscreened for Osteoporosis

Osteoporosis screening and subsequent treatment has been shown to be efficacious in decreasing the rates of fragility fractures and periprosthetic fractures (PPF). However, current screening and treatment rates are low. This study aims to determine (1) the prevalence of total shoulder arthroplasty (TSA) patients who meet criteria for osteoporosis screening, (2) the prevalence of those screened, and (3) the 5-year cumulative incidence of fragility fracture (FF) and periprosthetic fractures (PPF).

The PearlDiver database was used to identify all patients older than 50 years who underwent TSA. Guidelines from the American Association of Clinical Endocrinologists were used to stratify patients into "high risk" and "low risk" of osteoporosis cohorts using International Classification of Disease codes for various risk factors. The prevalence of osteoporosis screening using dual-energy x-ray absorptiometry (DXA) scan was analyzed, and the 5-year cumulative incidence of FF and PPF was calculated between the "low-risk" and "high-risk" groups using Kaplan-Meier analysis.

In total, 66,140 (65.5%) who underwent TSA were considered "high risk" for osteoporosis. Of the "high-risk" patients, 11.7% patients received routine osteoporosis screening preoperatively. Within 5 years, "high-risk" TSA patients had markedly higher cumulative incidence for PPF (HR: 1.4; 95% CI: 1.0-1.9; P = 0.037) and FF (HR: 2.42; 95% CI: 2.1-2.8; P < 0.001) when compared with those at "low risk".

There is a high prevalence of osteoporosis among patients undergoing TSA but a low rate of routine osteoporosis screening in this cohort. Patients with osteoporosis who are categorized as "high risk" have an increased rate of fragility fractures and PPF. Therefore, there is an opportunity to increase appropriate osteoporosis screening and management in this cohort, which may affect future risk of FF and periprosthetic fracture.

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