Under the Radar: Low Rates of Dual-Energy Radiograph Absorptiometry Screening and Associated Fracture Risk in Female...

Area of Science:

• Orthopedics
• Gerontology
• Public Health

Background:

• Osteoporosis is common in total shoulder arthroplasty (TSA) patients, impacting outcomes and increasing fragility fracture risk.
• Despite guidelines, preoperative dual-energy X-ray absorptiometry (DXA) screening rates for osteoporosis before TSA remain low.
• Rising TSA rates necessitate understanding factors limiting DXA utilization and predicting postoperative fractures.

Purpose of the Study:

• To assess the impact of demographic and social determinants of health on preoperative DXA screening rates in women undergoing TSA.
• To identify predictors of postoperative fragility fractures in this patient population.

Main Methods:

• Retrospective review of female TSA patients (2016-2024) meeting DXA screening indications.
• Multivariable logistic regression to identify predictors of DXA utilization.
• Firth penalized Cox regression and bootstrap analysis to assess predictors of postoperative fractures.

Main Results:

• Only 39.7% of eligible women received preoperative DXA screening.
• Married patients had higher odds of screening; public insurance was associated with lower odds compared to private insurance.
• Current tobacco use significantly increased postoperative fracture risk (HR 14.87), while higher BMI was protective (overweight HR 0.27, obese HR 0.03).

Conclusions:

• Preoperative DXA screening is significantly underused in women undergoing TSA.
• Marital status and insurance type are key determinants of screening rates.
• Low BMI and tobacco use are critical predictors of fragility fractures, highlighting the need for targeted bone health management strategies.