Shoulder arthroplasty in the osteoporotic patient: do bisphosphonates make a difference?

Area of Science:

• Orthopedic Surgery
• Bone Metabolism and Disease
• Biomaterials and Implantology

Background:

• Osteoporosis (OP) significantly increases postoperative complication risks for patients undergoing arthroplasty, particularly total shoulder arthroplasty (TSA).
• Bisphosphonates (BP) are commonly used to improve bone quality in osteoporotic patients.
• Understanding the impact of BP management on TSA outcomes is crucial for orthopedic surgeons.

Purpose of the Study:

• To compare postoperative outcomes in osteoporotic patients undergoing TSA who received bisphosphonate (BP) therapy versus those who did not.
• To evaluate the efficacy of BP management in mitigating surgical complications in the context of osteoporosis and TSA.

Main Methods:

• A retrospective cohort study using the TriNetX database.
• Identified osteoporotic patients who underwent primary TSA, propensity-matched into BP-treated and non-treated (noTx) groups.
• Compared rates of periprosthetic fracture, infection (including PJI), osteolysis, mechanical loosening, dislocation, and revision surgery at 3 months, 1 year, and 2 years.

Main Results:

• The BP group showed significantly lower rates of periprosthetic fracture, prosthetic joint infection (PJI), and revision TSA within 90 days.
• At 1 and 2 years, the BP group had reduced rates of PJI and mechanical loosening.
• No significant differences were observed in non-PJI postoperative infection or dislocation rates between the groups.

Conclusions:

• Bisphosphonate treatment in osteoporotic patients undergoing TSA is associated with reduced rates of periprosthetic fracture, osteolysis, and revision surgery.
• BP therapy demonstrates a protective effect against prosthetic joint infection and mechanical loosening post-TSA.
• Medical management of osteoporosis with bisphosphonates appears to improve surgical outcomes for total shoulder arthroplasty patients.