Yoshinori Ishii1, Hideo Noguchi1, Junko Sato1, Ikuko Takahashi1, Hana Ishii2, Ryo Ishii3, Kei Ishii4, Shin-Ichi Toyabe5. 1. Ishii Orthopaedic & Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama 361-0037, Japan. 2. Kanazawa Medical University, School of Plastic Surgery, 1-1 Daigaku Uchinada, Ishikawa 920-0253, Japan. 3. Shinshu University Hospital, 3-1-1 Asahi Matsumoto, Nagano 390-8621, Japan. 4. Iwate Prefectural Ninohe Hospital, 38 Horino, Ninohe, Iwate 028-6193, Japan. 5. Niigata University Crisis Management Office, Niigata University Hospital, Niigata University Graduate School of Medical and Dental Sciences, 1 Asahimachi Dori Niigata, Niigata 951-8520, Japan.
Abstract
BACKGROUND: The preoperative overall bone quality in patients undergoing total knee arthroplasty (TKA) might influence the development of postoperative bone-derived complications. This study was performed to simultaneously evaluate the baseline bone mineral density (BMD) and bone turnover in these patients. METHODS: We prospectively measured the lumbar spine, total hip, and femoral neck BMD using dual-energy X-ray absorptiometry (DXA) in 214 patients (239 knees; women, 199 knees; men, 40 knees) 1 day preoperatively. Women were stratified into three age groups: <70 years (60s), <80 years (70s), and ≥80 years (80s). We assessed bone turnover using the urinary level of N-telopeptide (NTx) normalized to creatinine (NTx/Cre). RESULTS: The prevalence of osteoporosis as assessed by DXA (T-score of ≤ -2.5) was 22% in women and 5% in men. A decline in BMD with aging was found in the hip but not in the lumbar spine with significant differences among ages. Women showed a higher NTx/Cre level than men (p = 0.033). An NTx/Cre level suggesting a high fracture risk (>56.5 mmol BCE/mmol Cre) was present in 54% of women and 35% of men (p = 0.037). No significant differences were found in this prevalence among age groups in women. Seventeen percent of women and 0% of men had both osteoporosis and a high fracture risk simultaneously (p = 0.002). The proportion of women in this category was lower in the 60s than 70s age group (p = 0.019). CONCLUSIONS: Preoperative bone health screening before TKA might be necessary for women aged ≥70 years to prevent complications caused by perioperative poor bone condition.
BACKGROUND: The preoperative overall bone quality in patients undergoing total knee arthroplasty (TKA) might influence the development of postoperative bone-derived complications. This study was performed to simultaneously evaluate the baseline bone mineral density (BMD) and bone turnover in these patients. METHODS: We prospectively measured the lumbar spine, total hip, and femoral neck BMD using dual-energy X-ray absorptiometry (DXA) in 214 patients (239 knees; women, 199 knees; men, 40 knees) 1 day preoperatively. Women were stratified into three age groups: <70 years (60s), <80 years (70s), and ≥80 years (80s). We assessed bone turnover using the urinary level of N-telopeptide (NTx) normalized to creatinine (NTx/Cre). RESULTS: The prevalence of osteoporosis as assessed by DXA (T-score of ≤ -2.5) was 22% in women and 5% in men. A decline in BMD with aging was found in the hip but not in the lumbar spine with significant differences among ages. Women showed a higher NTx/Cre level than men (p = 0.033). An NTx/Cre level suggesting a high fracture risk (>56.5 mmol BCE/mmol Cre) was present in 54% of women and 35% of men (p = 0.037). No significant differences were found in this prevalence among age groups in women. Seventeen percent of women and 0% of men had both osteoporosis and a high fracture risk simultaneously (p = 0.002). The proportion of women in this category was lower in the 60s than 70s age group (p = 0.019). CONCLUSIONS: Preoperative bone health screening before TKA might be necessary for women aged ≥70 years to prevent complications caused by perioperative poor bone condition.
Keywords:
Bone turnover; Dual-energy X-ray absorptiometry; Osteoporosis; Preoperative bone mineral density; Total knee arthroplasty; Urinary N-Telopeptide
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