Osteoporosis and Joint Replacement

Abstract

Over the past few decades, the number of endoprosthetic joint replacements has steadily increased. Most of these patients are of higher age and due to osteoporosis may have a reduced bone quality. In te case of patients with joint replacements and osteoporosis the following complications are often seen: intraoperative periprosthetic fractures, periprosthetic osteolysis, increased implant migration or postoperative periprosthetic fractures. We present a literature review on issues of osteoporosis in patients with endoprosthetic joint replacements. Evaluation of bone quality seems a essential point in patient management to provide the best possible care and to optimize long term surgical outcomes. If necessary, patients should be educated about a possible calcium and vitamin D supplementation. In addition, it seems reasonable to aim for physiological vitamin D levels perioperatively. In postmenopausal women, men over 70 years and both women and men with an increased risk of osteoporosis within two years of implantation of a total joint replacement a bone mineral density measurement should be performed. In patients with reduced bone quality, treatment with bisphosphonates, denosumab or teriparatide should be considered as to improve the osseous integration of cementless implants, and increase the lifespan of implants as well as to reduce periprosthetic fractures and fractures in general. In individual cases of patients with osteoporosis cementation of prosthetic components (especially in total hip replacements) may be required.

Keywords

• osteoporosis
• fractures
• endoprosthetic joint replacement
• bisphosphonates
• denosumab
• teriparatide
• review