Lee's TRIAD-osteoporosis, fragility fracture, and bone health optimization

Osteoporosis, fragility fractures, and bone health optimization share the same pathophysiology, diagnostic tools, risk assessment, and treatments. Grouping them into "Lee's TRIAD" allows surgeons and physicians to collaborate more efficiently, using unified principles and strategies for managing these conditions.

The primary goal of osteoporosis management is to prevent fragility fractures, which occur from falls from standing height or less in individuals over fifty. However, the management of bone health optimization is often neglected in patients undergoing elective surgeries, such as arthroplasty and spinal surgeries. The objective of this article is to link all these three conditions into a TRIAD so that surgeons and physicians can collaborate more effectively, utilizing similar principles and strategies for better management.

Clinical approaches based on country-specific guidelines are commonly used to manage osteoporosis. However, skeletal assessments are rarely conducted before or after elective procedures, leading to overlooked conditions such as osteoporosis, osteopenia, and fragility fracture risk factors. These three conditions are illustrated from the patient case study shown, to highlight the importance of not neglecting bone health optimization in high risk individuals undergoing elective surgery, with underlying osteopenia and multiple risk factors who sustained fragility fracture intraoperatively.

Patients undergoing elective surgeries often have their bone health neglected, leading to a higher incidence of complications such as aseptic loosening and peri-prosthetic fractures due to poor bone quality and density. Bone health assessment and optimization therefore is essential in patients with osteoporosis, osteopenia with clinical risk factors, and patients with history of fragility fracture, to ensure implants sit on bone with good density and quality to minimize the complications.

By combining osteoporosis, fragility fractures, and bone health optimization into a TRIAD, "Lee's TRIAD," surgeons and physicians can collaborate more effectively, utilizing similar principles and strategies for better management.