Shoulder Arthroplasty Patients Are Underscreened for Osteoporosis

Area of Science:

• Orthopedic Surgery
• Endocrinology
• Geriatric Medicine

Background:

• Osteoporosis screening and treatment reduce fragility fractures and periprosthetic fractures (PPF).
• Current screening and treatment rates for osteoporosis remain suboptimal.
• Total shoulder arthroplasty (TSA) patients represent a population where osteoporosis screening is crucial.

Purpose of the Study:

• Determine osteoporosis screening prevalence in TSA patients.
• Identify the proportion of TSA patients meeting osteoporosis screening criteria.
• Calculate the 5-year incidence of fragility fractures (FF) and PPF in TSA patients.

Main Methods:

• Utilized the PearlDiver database to identify TSA patients over 50.
• Stratified patients into high-risk and low-risk osteoporosis groups using ICD codes.
• Analyzed osteoporosis screening (DXA scan) rates and calculated 5-year FF/PPF incidence via Kaplan-Meier analysis.

Main Results:

• 65.5% of TSA patients were classified as high-risk for osteoporosis.
• Only 11.7% of high-risk TSA patients received preoperative osteoporosis screening.
• High-risk patients showed significantly higher 5-year cumulative incidence of PPF (HR: 1.4) and FF (HR: 2.42).

Conclusions:

• A high prevalence of osteoporosis exists in TSA patients, coupled with low screening rates.
• High-risk TSA patients have an elevated risk of fragility fractures and periprosthetic fractures.
• Increased osteoporosis screening and management in TSA patients could mitigate future fracture risks.