Introduction

Osteoporosis is highly prevalent in elective orthopedic surgery. While preoperative bone health optimization decreases osteoporosis-related complications, there is an unmet need to establish who may benefit from preoperative dual-energy x-ray absorptiometry (DXA). This study assesses a novel, simple screening protocol to identify orthopedic surgical patients for preoperative DXA.

Materials/Methods

This retrospective cohort study included 628 patients undergoing total knee, hip, or shoulder arthroplasty or thoracolumbar spine fusion. Inclusion criteria were ≥40 years undergoing primary elective surgery. Screening criteria defining who should obtain DXA due to high osteoporosis risk included: female ≥65, male ≥70, fracture history when ≥50 years, or FRAX major osteoporotic fracture risk (without bone mineral density [BMD]-adjustments) ≥8.4%. Osteoporosis was defined by World Health Organization criteria [T-score ≤ −2.5], clinical National Osteoporosis Foundation (NOF) criteria [T-score ≤ −2.5, elevated BMD-adjusted FRAX risk, or prior hip/spine fracture], and modified clinical criteria [NOF criteria simplified to include any non-traumatic prior fracture and FRAX without BMD].

Results

The study included 100 TKAs, 100 THAs, 251 TSAs, and 177 spine fusions, average age 65.6 ± 9.8. DXA was available for 209 patients. Screening criteria recommending DXA was met by 362 patients. For those with DXA, screening sensitivity was .96 (CI: .78 to .99) and specificity was .19 (CI: .14 to .25) for identifying T-score osteoporosis. Similar sensitivity of .99 (CI: .91 to .99) and specificity of .61 (CI: .56 to .66) were found for modified clinical osteoporosis. For modified clinical osteoporosis, 192 patients with osteoporosis met criteria (true pos.), 1 patient with osteoporosis did not meet criteria (false neg.), 170 patients without osteoporosis met criteria (false pos.), and 265 patients without osteoporosis did not meet criteria (true neg.).

Discussion/Conclusion

A simple screening protocol identifies orthopedic surgical candidates at risk of T-score or clinical osteoporosis for preoperative DXA with high sensitivity.

中文翻译：

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一种新的骨质疏松症筛查方案，用于识别骨科手术患者以优化术前骨骼健康

 介绍

骨质疏松症在择期骨科手术中非常普遍。虽然术前骨骼健康优化可减少骨质疏松相关并发症，但确定谁可以从术前双能 X 射线骨密度测定 (DXA) 中受益的需求尚未得到满足。本研究评估了一种新颖、简单的筛查方案，用于识别骨科手术患者进行术前 DXA。

 材料/方法

这项回顾性队列研究包括 628 名接受全膝关节、髋关节或肩关节置换术或胸腰椎融合术的患者。纳入标准为≥40岁接受初次择期手术。定义因高骨质疏松风险而应接受 DXA 的筛选标准包括：女性≥65、男性≥70、骨折史≥50 年或 FRAX 主要骨质疏松性骨折风险（未经骨密度 [BMD] 调整）≥8.4%。骨质疏松症的定义为世界卫生组织标准 [T 分数 ≤ -2.5]、国家骨质疏松症基金会 (NOF) 临床标准 [T 分数 ≤ -2.5、BMD 调整后 FRAX 风险升高或既往髋部/脊柱骨折]，并经过修改临床标准 [NOF 标准简化为包括任何非创伤性既往骨折和无 BMD 的 FRAX]。

 结果

该研究包括 100 例 TKA、100 例 THA、251 例 TSA 和 177 例脊柱融合术，平均年龄 65.6 ± 9.8 岁。 DXA 可供 209 名患者使用。 362 名患者符合推荐 DXA 的筛查标准。对于 DXA 患者，识别 T 评分骨质疏松症的筛查敏感性为 0.96（CI：0.78 至 0.99），特异性为 0.19（CI：0.14 至 0.25）。对于改良临床骨质疏松症，发现类似的敏感性为 0.99（CI：0.91 至 0.99）和特异性为 0.61（CI：0.56 至 0.66）。对于改良临床骨质疏松症，192 名骨质疏松症患者符合标准（真阳性），1 名骨质疏松症患者不符合标准（假阴性），170 名无骨质疏松症患者符合标准（假阳性），265 名无骨质疏松症患者不符合标准。符合标准（真否定）。

 讨论/结论

一个简单的筛查方案可以通过高灵敏度的术前 DXA 识别存在 T 评分或临床骨质疏松症风险的骨科手术候选人。