Evaluation of Bone Mineral Density in Patients Undergoing Total Hip Arthroplasty and Total Knee Arthroplasty
Abstract
Background: Osteoarthritis and osteoporosis are the most prevalent musculoskeletal disorders (MSDs) in middle aged and elderly individuals and affect their quality of life (QOL). The presence of both these disorders is rarely reported in an individual patient. This study was conducted with the aim to assess this association using Dual-energy X-ray absorptiometry (DEXA) as a measure of bone mineral density (BMD) in patients undergoing hip and knee arthroplasty.
Methods: Between August 2015 and August 2018, 71 patients were selected as the study participants. The inclusion criteria included age of higher than 50 years and presence of primary or secondary arthritic conditions. The exclusion criteria were age of below 50 years, prolonged steroid intake (3 months), metabolic disease, and performance of arthroplasty for the management of fractures. Results: The incidence rate of osteoporosis was found to be higher in higher age groups of patients undergoing arthroplasty. Furthermore, there was no statistical difference in the T-scores with respect to the sex of the patients.
Conclusion: Osteoarthritis and osteoporosis can occur simultaneously in an individual. The development of osteoarthritis does not prevent the development of generalized osteoporosis in an individual patient.
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4. National Joint Registry. National Joint Registry for England and Wale. 7th Annual Report 2010 [Online].
[cited 2010]; Available from: URL: https://www.njrcentre.org.uk/njrcentre/Portals/0/NJR%207th%2 0Annual%20Report%202010.pdf
5. Pachore JA, Vaidya SV, Thakkar CJ, Bhalodia HK, Wakankar HM. ISHKS joint registry: A preliminary report. Indian J Orthop. 2013;47(5):505-9. doi: 10.4103/0019-5413.118208. [PubMed: 24133312]. [PubMed Central: PMC3796925].
6. Khadilkar AV, Mandlik RM. Epidemiology and treatment of osteoporosis in women: An Indian perspective. Int J Womens Health. 2015;7:841-50. doi: 10.2147/IJWH.S54623. [PubMed: 26527900]. [PubMed Central: PMC4621228].
7. Black DM, Cummings SR, Genant HK, Nevitt MC, Palermo L, Browner W. Axial and appendicular bone density predict fractures in older women. J Bone Miner Res. 1992;7(6):633-8. doi: 10.1002/jbmr.5650070607. [PubMed: 1414481].
8. Foss MV, Byers PD. Bone density, osteoarthrosis of the hip, and fracture of the upper end of the femur. Ann Rheum Dis. 1972;31(4):259-64. doi: 10.1136/ard.31.4.259. [PubMed: 5045904]. [PubMed Central: PMC1005923].
9. Pogrund H, Makin M, Robin G, Menczel J, Steinberg R. Osteoporosis of the spine, pelvis and hand. A comparative study in a femoral neck fracture series. Clin Orthop Relat Res. 1979;(139):156-63.. [PubMed: 455833].
10. Hannan MT, Anderson JJ, Zhang Y, Levy D, Felson DT. Bone mineral density and knee osteoarthritis in elderly men and women. The Framingham Study. Arthritis Rheum. 1993;36(12):1671-80. doi: 10.1002/art.1780361205. [PubMed: 8250986].
11. Hart DJ, Mootoosamy I, Doyle DV, Spector TD. The relationship between osteoarthritis and osteoporosis in the general population: The Chingford Study. Ann Rheum Dis. 1994;53(3):158-62. doi: 10.1136/ard.53.3.158. [PubMed: 8154931]. [PubMed Central: PMC1005278].
12. Marcelli C, Favier F, Kotzki PO, Ferrazzi V, Picot MC, Simon L. The relationship between osteoarthritis of the hands, bone mineral density, and osteoporotic fractures in elderly women. Osteoporos Int. 1995;5(5):382-8. doi: 10.1007/BF01622261. [PubMed: 8800789].
13. Burger H, van Daele PL, Odding E, Valkenburg HA, Hofman A, Grobbee DE, et al. Association of radiographically evident osteoarthritis with higher bone mineral density and increased bone loss with age. The Rotterdam Study. Arthritis Rheum. 1996;39(1):81-6. doi: 10.1002/art.1780390111. [PubMed: 8546742].
14. Stewart A, Black A, Robins SP, Reid DM. Bone density and bone turnover in patients with osteoarthritis and osteoporosis. J Rheumatol. 1999;26(3):622-6. [PubMed: 10090173].
15. Sowers M, Lachance L, Jamadar D, Hochberg MC, Hollis B, Crutchfield M, et al. The associations of bone mineral density and bone turnover markers with osteoarthritis of the hand and knee in pre- and perimenopausal women. Arthritis Rheum. 1999;42(3):483-9. doi: 10.1002/1529-0131(199904)42:3<483::AID-ANR13>3.0.CO;2-O. [PubMed: 10088771].
16. Lethbridge-Cejku M, Tobin JD, Scott WW, Reichle R, Roy TA, Plato CC, et al. Axial and hip bone mineral density and radiographic changes of osteoarthritis of the knee: data from the Baltimore Longitudinal Study of Aging. J Rheumatol. 1996;23(11):1943-7.. [PubMed: 8923372].
17. Nevitt MC, Lane NE, Scott JC, Hochberg MC, Pressman AR, Genant HK, et al. Radiographic osteoarthritis of the hip and bone mineral density. The Study of Osteoporotic Fractures Research Group. Arthritis Rheum. 1995;38(7):907-16. doi: 10.1002/art.1780380706. [PubMed: 7612040].
18. Verstraeten A, Van EH, Haghebaert G, Nijs J, Geusens P, Dequeker J. Osteoarthrosis retards the development of osteoporosis. Observation of the coexistence of osteoarthrosis and osteoporosis. Clin Orthop Relat Res. 1991;(264):169-77. [PubMed: 1997232].
19. Dequeker J, Johnell O. Osteoarthritis protects against femoral neck fracture: the MEDOS study experience. Bone. 1993;14(Suppl 1):S51-S56. doi: 10.1016/8756-3282(93)90350-j.[PubMed: 8110521].
20. Maier GS, Kolbow K, Lazovic D, Maus U. The importance of bone mineral density in hip arthroplasty: Results of a survey asking orthopaedic surgeons about their opinions and attitudes concerning osteoporosis and hip arthroplasty. Adv Orthop. 2016;2016:8079354. doi: 10.1155/2016/8079354. [PubMed: 27999686]. [PubMed Central: PMC5141559].
21. Arden NK, Griffiths GO, Hart DJ, Doyle DV, Spector TD. The association between osteoarthritis and osteoporotic fracture: the Chingford Study. Br J Rheumatol. 1996;35(12):1299-304. doi: 10.1093/rheumatology/35.12.1299. [PubMed: 9010060].
22. Bergink AP, van der Klift M, Hofman A, Verhaar JA, van Leeuwen JP, Uitterlinden AG, et al. Osteoarthritis of the knee is associated with vertebral and nonvertebral fractures in the elderly: the Rotterdam Study. Arthritis Rheum. 2003;49(5):648-
57. doi: 10.1002/art.11380. [PubMed: 14558050].
23. Dequeker J, Mokassa L, Aerssens J. Bone density and osteoarthritis. J Rheumatol Suppl. 1995;43:98-100. [PubMed: 7752151].
24. James SJ, Mirza SB, Culliford DJ, Taylor PA, Carr AJ, Arden NK. Baseline bone mineral density and boneturnover in pre-operative hip and knee arthroplasty patients. Bone Joint Res. 2014;3(1):14-9. doi: 10.1302/2046-3758.31.2000218. [PubMed: 24443424]. [PubMed Central: PMC3904490].
25. Chang CB, Kim TK, Kang YG, Seong SC, Kang SB. Prevalence of osteoporosis in female patients with advanced knee osteoarthritis undergoing total knee arthroplasty. J Korean Med Sci. 2014;29(10):1425-31. doi: 10.3346/jkms.2014.29.10.1425. [PubMed: 25368498]. [PubMed Central: PMC4214945].
26. Lingard EA, Mitchell SY, Francis RM, Rawlings D, Peaston R, Birrell FN, et al. The prevalence of osteoporosis in patients with severe hip and knee osteoarthritis awaiting joint
arthroplasty. Age Ageing. 2010;39(2):234-9. doi:
10.1093/ageing/afp222. [PubMed: 20032523].
27. Gunther KP, Sturmer T, Sauerland S, Zeissig I, Sun Y, Kessler S, et al. Prevalence of generalised osteoarthritis in patients with advanced hip and knee osteoarthritis: the Ulm Osteoarthritis Study. Ann Rheum Dis. 1998;57(12):717-23. doi: 10.1136/ard.57.12.717. [PubMed: 10070270]. [PubMed Central: PMC1752518].
28. Fang M, Noiseux N, Linson E, Cram P. The Effect of advancing age on total joint replacement outcomes. Geriatr Orthop Surg Rehabil. 2015;6(3):173-9. doi: 10.1177/2151458515583515. [PubMed: 26328232]. [PubMed Central: PMC4536505].
29. Heidari B. Knee osteoarthritis prevalence, risk factors, pathogenesis and features: Part I. Caspian J Intern Med. 2011;2(2):205-12. [PubMed: 24024017]. [PubMed Central:PMC3766936].
30. Chidambaram R, Cobb A. Change in the age distribution of patients undergoing primary hip and knee replacements over 13 years: An increase in the number of younger men having hip surgery. J Bone Joint Surg Br. 2009;91.
31. Domingues VR, de Campos GC, Plapler PG, de Rezende MU. Prevalence of osteoporosis in patients awaiting total hip arthroplasty. Acta Ortop Bras. 2015;23(1):34-7. doi: 10.1590/1413-
78522015230100981. [PubMed: 26327793]. [PubMed Central: PMC4544518].
32. Makinen TJ, Alm JJ, Laine H, Svedstrom E, Aro HT. The incidence of osteopenia and osteoporosis in women with hip osteoarthritis scheduled for cementless total joint
replacement. Bone. 2007;40(4):1041-7. doi: 10.1016/j.bone.2006.11.013. [PubMed: 17239668].
33. Glowacki J, Hurwitz S, Thornhill TS, Kelly M, LeBoff MS.
Osteoporosis and vitamin-D deficiency among postmenopausal women with osteoarthritis undergoing total hip arthroplasty. J Bone Joint Surg Am. 2003;85(12):2371-7. doi: 10.2106/00004623-200312000-00015. [PubMed: 14668507].
34. Sadigursky D, Barretto LJ, Lobao DMV, Carneiro RJF, Colavolpe
PO. Osteoporosis in brazilian patients awaiting knee
arthroplasty. Acta Ortop Bras. 2017;25(3):74-7.
doi: 10.1590/1413-785220172503167325. [PubMed: 28642665].
[PubMed Central: PMC5474407].
35. Holzer G, Holzer L. Osteoporosis and joint replacement. Journal of the Grodno State Medical University. 2018;16:251-6. doi: 10.25298/2221-8785-2018-16-3-251-256
36. Huang CC, Jiang CC, Hsieh CH, Tsai CJ, Chiang H. Local bone quality affects the outcome of prosthetic total knee arthroplasty. J Orthop Res. 2016;34(2):240-8. doi: 10.1002/jor.23003. [PubMed: 26222735].
37. Safer U, Safer VB, Demir SO, Yanikoglu I. Effects of Bisphosphonates and Calcium plus Vitamin-D Supplements on Cognitive Function in Postmenopausal Osteoporosis section sign. Endocr Metab Immune Disord Drug Targets. 2016;16(1):56-60. doi: 10.2174/1871530316666160330105952. [PubMed: 27026340].
38. Gielen E, Boonen S, Vanderschueren D, Sinnesael M, Verstuyf A, Claessens F, et al. Calcium and vitamin d supplementation in men. J Osteoporos. 2011;2011:875249. doi: 10.4061/2011/875249. [PubMed: 21876835]. [PubMed Central: PMC3163142].
39. Bouillon R, Lips P, Bilezikian JP. Vitamin D supplementation and musculoskeletal health. Lancet Diabetes Endocrinol. 2019;7(2):85-6. doi: 10.1016/S2213-8587(18)30348-6. [PubMed: 30683216].
2. Labuda A, Papaioannou A, Pritchard J, Kennedy C, DeBeer J, Adachi JD. Prevalence of osteoporosis in osteoarthritic patients undergoing total hip or total knee arthroplasty. Arch Phys Med Rehabil. 2008;89(12):2373-4. doi: 10.1016/j.apmr.2008.06.007. [PubMed: 18976978]. [PubMed Central: PMC5101053].
3. Garg SK. Diagnosis and treatment of osteoporosis: are we doing enough? Bone Rep Recommendations. 2016;1:1. doi: 10.4172/2469-6684.10004
4. National Joint Registry. National Joint Registry for England and Wale. 7th Annual Report 2010 [Online].
[cited 2010]; Available from: URL: https://www.njrcentre.org.uk/njrcentre/Portals/0/NJR%207th%2 0Annual%20Report%202010.pdf
5. Pachore JA, Vaidya SV, Thakkar CJ, Bhalodia HK, Wakankar HM. ISHKS joint registry: A preliminary report. Indian J Orthop. 2013;47(5):505-9. doi: 10.4103/0019-5413.118208. [PubMed: 24133312]. [PubMed Central: PMC3796925].
6. Khadilkar AV, Mandlik RM. Epidemiology and treatment of osteoporosis in women: An Indian perspective. Int J Womens Health. 2015;7:841-50. doi: 10.2147/IJWH.S54623. [PubMed: 26527900]. [PubMed Central: PMC4621228].
7. Black DM, Cummings SR, Genant HK, Nevitt MC, Palermo L, Browner W. Axial and appendicular bone density predict fractures in older women. J Bone Miner Res. 1992;7(6):633-8. doi: 10.1002/jbmr.5650070607. [PubMed: 1414481].
8. Foss MV, Byers PD. Bone density, osteoarthrosis of the hip, and fracture of the upper end of the femur. Ann Rheum Dis. 1972;31(4):259-64. doi: 10.1136/ard.31.4.259. [PubMed: 5045904]. [PubMed Central: PMC1005923].
9. Pogrund H, Makin M, Robin G, Menczel J, Steinberg R. Osteoporosis of the spine, pelvis and hand. A comparative study in a femoral neck fracture series. Clin Orthop Relat Res. 1979;(139):156-63.. [PubMed: 455833].
10. Hannan MT, Anderson JJ, Zhang Y, Levy D, Felson DT. Bone mineral density and knee osteoarthritis in elderly men and women. The Framingham Study. Arthritis Rheum. 1993;36(12):1671-80. doi: 10.1002/art.1780361205. [PubMed: 8250986].
11. Hart DJ, Mootoosamy I, Doyle DV, Spector TD. The relationship between osteoarthritis and osteoporosis in the general population: The Chingford Study. Ann Rheum Dis. 1994;53(3):158-62. doi: 10.1136/ard.53.3.158. [PubMed: 8154931]. [PubMed Central: PMC1005278].
12. Marcelli C, Favier F, Kotzki PO, Ferrazzi V, Picot MC, Simon L. The relationship between osteoarthritis of the hands, bone mineral density, and osteoporotic fractures in elderly women. Osteoporos Int. 1995;5(5):382-8. doi: 10.1007/BF01622261. [PubMed: 8800789].
13. Burger H, van Daele PL, Odding E, Valkenburg HA, Hofman A, Grobbee DE, et al. Association of radiographically evident osteoarthritis with higher bone mineral density and increased bone loss with age. The Rotterdam Study. Arthritis Rheum. 1996;39(1):81-6. doi: 10.1002/art.1780390111. [PubMed: 8546742].
14. Stewart A, Black A, Robins SP, Reid DM. Bone density and bone turnover in patients with osteoarthritis and osteoporosis. J Rheumatol. 1999;26(3):622-6. [PubMed: 10090173].
15. Sowers M, Lachance L, Jamadar D, Hochberg MC, Hollis B, Crutchfield M, et al. The associations of bone mineral density and bone turnover markers with osteoarthritis of the hand and knee in pre- and perimenopausal women. Arthritis Rheum. 1999;42(3):483-9. doi: 10.1002/1529-0131(199904)42:3<483::AID-ANR13>3.0.CO;2-O. [PubMed: 10088771].
16. Lethbridge-Cejku M, Tobin JD, Scott WW, Reichle R, Roy TA, Plato CC, et al. Axial and hip bone mineral density and radiographic changes of osteoarthritis of the knee: data from the Baltimore Longitudinal Study of Aging. J Rheumatol. 1996;23(11):1943-7.. [PubMed: 8923372].
17. Nevitt MC, Lane NE, Scott JC, Hochberg MC, Pressman AR, Genant HK, et al. Radiographic osteoarthritis of the hip and bone mineral density. The Study of Osteoporotic Fractures Research Group. Arthritis Rheum. 1995;38(7):907-16. doi: 10.1002/art.1780380706. [PubMed: 7612040].
18. Verstraeten A, Van EH, Haghebaert G, Nijs J, Geusens P, Dequeker J. Osteoarthrosis retards the development of osteoporosis. Observation of the coexistence of osteoarthrosis and osteoporosis. Clin Orthop Relat Res. 1991;(264):169-77. [PubMed: 1997232].
19. Dequeker J, Johnell O. Osteoarthritis protects against femoral neck fracture: the MEDOS study experience. Bone. 1993;14(Suppl 1):S51-S56. doi: 10.1016/8756-3282(93)90350-j.[PubMed: 8110521].
20. Maier GS, Kolbow K, Lazovic D, Maus U. The importance of bone mineral density in hip arthroplasty: Results of a survey asking orthopaedic surgeons about their opinions and attitudes concerning osteoporosis and hip arthroplasty. Adv Orthop. 2016;2016:8079354. doi: 10.1155/2016/8079354. [PubMed: 27999686]. [PubMed Central: PMC5141559].
21. Arden NK, Griffiths GO, Hart DJ, Doyle DV, Spector TD. The association between osteoarthritis and osteoporotic fracture: the Chingford Study. Br J Rheumatol. 1996;35(12):1299-304. doi: 10.1093/rheumatology/35.12.1299. [PubMed: 9010060].
22. Bergink AP, van der Klift M, Hofman A, Verhaar JA, van Leeuwen JP, Uitterlinden AG, et al. Osteoarthritis of the knee is associated with vertebral and nonvertebral fractures in the elderly: the Rotterdam Study. Arthritis Rheum. 2003;49(5):648-
57. doi: 10.1002/art.11380. [PubMed: 14558050].
23. Dequeker J, Mokassa L, Aerssens J. Bone density and osteoarthritis. J Rheumatol Suppl. 1995;43:98-100. [PubMed: 7752151].
24. James SJ, Mirza SB, Culliford DJ, Taylor PA, Carr AJ, Arden NK. Baseline bone mineral density and boneturnover in pre-operative hip and knee arthroplasty patients. Bone Joint Res. 2014;3(1):14-9. doi: 10.1302/2046-3758.31.2000218. [PubMed: 24443424]. [PubMed Central: PMC3904490].
25. Chang CB, Kim TK, Kang YG, Seong SC, Kang SB. Prevalence of osteoporosis in female patients with advanced knee osteoarthritis undergoing total knee arthroplasty. J Korean Med Sci. 2014;29(10):1425-31. doi: 10.3346/jkms.2014.29.10.1425. [PubMed: 25368498]. [PubMed Central: PMC4214945].
26. Lingard EA, Mitchell SY, Francis RM, Rawlings D, Peaston R, Birrell FN, et al. The prevalence of osteoporosis in patients with severe hip and knee osteoarthritis awaiting joint
arthroplasty. Age Ageing. 2010;39(2):234-9. doi:
10.1093/ageing/afp222. [PubMed: 20032523].
27. Gunther KP, Sturmer T, Sauerland S, Zeissig I, Sun Y, Kessler S, et al. Prevalence of generalised osteoarthritis in patients with advanced hip and knee osteoarthritis: the Ulm Osteoarthritis Study. Ann Rheum Dis. 1998;57(12):717-23. doi: 10.1136/ard.57.12.717. [PubMed: 10070270]. [PubMed Central: PMC1752518].
28. Fang M, Noiseux N, Linson E, Cram P. The Effect of advancing age on total joint replacement outcomes. Geriatr Orthop Surg Rehabil. 2015;6(3):173-9. doi: 10.1177/2151458515583515. [PubMed: 26328232]. [PubMed Central: PMC4536505].
29. Heidari B. Knee osteoarthritis prevalence, risk factors, pathogenesis and features: Part I. Caspian J Intern Med. 2011;2(2):205-12. [PubMed: 24024017]. [PubMed Central:PMC3766936].
30. Chidambaram R, Cobb A. Change in the age distribution of patients undergoing primary hip and knee replacements over 13 years: An increase in the number of younger men having hip surgery. J Bone Joint Surg Br. 2009;91.
31. Domingues VR, de Campos GC, Plapler PG, de Rezende MU. Prevalence of osteoporosis in patients awaiting total hip arthroplasty. Acta Ortop Bras. 2015;23(1):34-7. doi: 10.1590/1413-
78522015230100981. [PubMed: 26327793]. [PubMed Central: PMC4544518].
32. Makinen TJ, Alm JJ, Laine H, Svedstrom E, Aro HT. The incidence of osteopenia and osteoporosis in women with hip osteoarthritis scheduled for cementless total joint
replacement. Bone. 2007;40(4):1041-7. doi: 10.1016/j.bone.2006.11.013. [PubMed: 17239668].
33. Glowacki J, Hurwitz S, Thornhill TS, Kelly M, LeBoff MS.
Osteoporosis and vitamin-D deficiency among postmenopausal women with osteoarthritis undergoing total hip arthroplasty. J Bone Joint Surg Am. 2003;85(12):2371-7. doi: 10.2106/00004623-200312000-00015. [PubMed: 14668507].
34. Sadigursky D, Barretto LJ, Lobao DMV, Carneiro RJF, Colavolpe
PO. Osteoporosis in brazilian patients awaiting knee
arthroplasty. Acta Ortop Bras. 2017;25(3):74-7.
doi: 10.1590/1413-785220172503167325. [PubMed: 28642665].
[PubMed Central: PMC5474407].
35. Holzer G, Holzer L. Osteoporosis and joint replacement. Journal of the Grodno State Medical University. 2018;16:251-6. doi: 10.25298/2221-8785-2018-16-3-251-256
36. Huang CC, Jiang CC, Hsieh CH, Tsai CJ, Chiang H. Local bone quality affects the outcome of prosthetic total knee arthroplasty. J Orthop Res. 2016;34(2):240-8. doi: 10.1002/jor.23003. [PubMed: 26222735].
37. Safer U, Safer VB, Demir SO, Yanikoglu I. Effects of Bisphosphonates and Calcium plus Vitamin-D Supplements on Cognitive Function in Postmenopausal Osteoporosis section sign. Endocr Metab Immune Disord Drug Targets. 2016;16(1):56-60. doi: 10.2174/1871530316666160330105952. [PubMed: 27026340].
38. Gielen E, Boonen S, Vanderschueren D, Sinnesael M, Verstuyf A, Claessens F, et al. Calcium and vitamin d supplementation in men. J Osteoporos. 2011;2011:875249. doi: 10.4061/2011/875249. [PubMed: 21876835]. [PubMed Central: PMC3163142].
39. Bouillon R, Lips P, Bilezikian JP. Vitamin D supplementation and musculoskeletal health. Lancet Diabetes Endocrinol. 2019;7(2):85-6. doi: 10.1016/S2213-8587(18)30348-6. [PubMed: 30683216].
| Files | ||
| Issue | Vol 8, No 1 (2022) | |
| Section | Research Articles | |
| DOI | https://doi.org/10.18502/jost.v8i1.9039 | |
| Keywords | ||
| Osteoarthritis Dual-Energy X-Ray Absorptiometry Arthroplasty Osteoporosis | ||
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How to Cite
1.
Gupta P, Garg S, Mittal N, Garg S, Jindal M. Evaluation of Bone Mineral Density in Patients Undergoing Total Hip Arthroplasty and Total Knee Arthroplasty. J Orthop Spine Trauma. 2022;8(1):9-14.
