Moritz Mühlenfeld1, André Strahl1, Ulrich Bechler1, Nico Maximilian Jandl1,2, Jan Hubert1, Tim Rolvien3,4. 1. Department of Orthopedics, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany. 2. Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestrasse 59, 22529, Hamburg, Germany. 3. Department of Orthopedics, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany. t.rolvien@uke.de. 4. Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestrasse 59, 22529, Hamburg, Germany. t.rolvien@uke.de.
Abstract
BACKGROUND: Patients with rheumatic diseases have a high risk for joint destruction and secondary osteoarthritis (OA) as well as low bone mineral density (BMD, i.e., osteoporosis). While several factors may lead to low BMD in these patients, the value of BMD measurements in rheumatic patients with end-stage OA scheduled for total joint arthroplasty is unknown. METHODS: In this retrospective cross-sectional study of 50 adults with secondary OA due to rheumatic diseases, we evaluated dual energy X-ray absorptiometry (DXA) measurements of both hips and the spine performed within 3 months prior to arthroplasty (n = 25 total hip arthroplasty, THA; n = 25 total knee arthroplasty, TKA). We analyzed various demographic and disease-specific characteristics and their effect on DXA results by using group comparisons and multivariate linear regression models. RESULTS: Although patients undergoing TKA were younger (63.2 ± 14.2 vs. 71.0 ± 10.8 yr., p = 0.035), osteoporosis was observed more frequently in patients scheduled for TKA than THA (32% vs. 12%). Osteopenia was detected in 13/25 patients (52%) in both the THA and TKA cohort. In the THA cohort, female sex, lower BMI and prednisolone use were associated with lower T-score in the hip. In TKA patients, higher OA grade determined by Kellgren-Lawrence score was associated with lower T-score in the hip of the affected side. CONCLUSIONS: Osteoporosis is present in a considerable frequency of rheumatic patients with end-stage OA, and THA and TKA patients show distinct frequencies and risk factors of low BMD. Our findings point to a potential value of DXA regarding preoperative evaluation of bone status.
BACKGROUND:Patients with rheumatic diseases have a high risk for joint destruction and secondary osteoarthritis (OA) as well as low bone mineral density (BMD, i.e., osteoporosis). While several factors may lead to low BMD in these patients, the value of BMD measurements in rheumaticpatients with end-stage OA scheduled for total joint arthroplasty is unknown. METHODS: In this retrospective cross-sectional study of 50 adults with secondary OA due to rheumatic diseases, we evaluated dual energy X-ray absorptiometry (DXA) measurements of both hips and the spine performed within 3 months prior to arthroplasty (n = 25 total hip arthroplasty, THA; n = 25 total knee arthroplasty, TKA). We analyzed various demographic and disease-specific characteristics and their effect on DXA results by using group comparisons and multivariate linear regression models. RESULTS: Although patients undergoing TKA were younger (63.2 ± 14.2 vs. 71.0 ± 10.8 yr., p = 0.035), osteoporosis was observed more frequently in patients scheduled for TKA than THA (32% vs. 12%). Osteopenia was detected in 13/25 patients (52%) in both the THA and TKA cohort. In the THA cohort, female sex, lower BMI and prednisolone use were associated with lower T-score in the hip. In TKA patients, higher OA grade determined by Kellgren-Lawrence score was associated with lower T-score in the hip of the affected side. CONCLUSIONS:Osteoporosis is present in a considerable frequency of rheumaticpatients with end-stage OA, and THA and TKA patients show distinct frequencies and risk factors of low BMD. Our findings point to a potential value of DXA regarding preoperative evaluation of bone status.
Entities:
Keywords:
Arthroplasty; Bone mineral density; DXA; Rheumatoid arthritis
Authors: Klemmens Trieb; Maximillian Schmid; Thomas Stulnig; Wolfgang Huber; Axel Wanivenhaus Journal: Joint Bone Spine Date: 2007-09-24 Impact factor: 4.929
Authors: M C Lodder; Z de Jong; P J Kostense; E T H Molenaar; K Staal; A E Voskuyl; J M W Hazes; B A C Dijkmans; W F Lems Journal: Ann Rheum Dis Date: 2004-12 Impact factor: 19.103
Authors: Martin Lindberg-Larsen; Christoffer C Jørgensen; Søren Solgaard; Anne G Kjersgaard; Henrik Kehlet Journal: Acta Orthop Date: 2017-03-14 Impact factor: 3.717
Authors: Maximilian M Delsmann; Constantin Schmidt; Moritz Mühlenfeld; Nico Maximilian Jandl; Christoph Kolja Boese; Frank Timo Beil; Tim Rolvien; Christian Ries Journal: Arch Orthop Trauma Surg Date: 2021-12-17 Impact factor: 3.067