Trends in screening and treatment of osteoporosis after periprosthetic fractures from 2010 to 2020

Jackson W Durbin; Amy Y Zhao; Eric Cui; Amil R Agarwal; Andrew Smith; Alex Gu; Gregory J Golladay; Savyasachi C Thakkar

doi:10.1007/s00198-025-07385-5

Trends in screening and treatment of osteoporosis after periprosthetic fractures from 2010 to 2020

Osteoporos Int. 2025 Jan 15. doi: 10.1007/s00198-025-07385-5. Online ahead of print.

Authors

Jackson W Durbin¹, Amy Y Zhao^{2

3}, Eric Cui², Amil R Agarwal³, Andrew Smith², Alex Gu², Gregory J Golladay⁴, Savyasachi C Thakkar³

Affiliations

¹ Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, 2300 I St NW, Washington, DC, 20052, USA. jackson.durbin@gwmail.gwu.edu.
² Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, 2300 I St NW, Washington, DC, 20052, USA.
³ Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁴ Department of Orthopaedic Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.

PMID: 39812673
DOI: 10.1007/s00198-025-07385-5

Abstract

Osteoporosis is often underrecognized and undertreated following periprosthetic fractures (PPF). Our study found that between 2010 and 2020, there has been no significant change in the rates of osteoporosis screening or treatment within 1 year following PPF. Orthopedic surgeons can play an integral role in helping to curtail the osteoporosis epidemic.

Purpose: Periprosthetic fractures (PPF) typically occur from low-energy mechanisms and are pathognomonic for osteoporosis. However, osteoporosis is often underrecognized and undertreated. The aim of this study was to examine trends in dual energy X-ray absorptiometry (DXA) scans and treatment of osteoporosis after PPF between 2010 and 2020.

Methods: Patients older than 40 who experienced a lower extremity PPF between 2010 and 2020 and had no prior history of osteoporosis screening or treatment were identified utilizing a large national administrative database. Rates of bone mineral density (BMD) measurement using DXA and anti-osteoporotic treatment with pharmacotherapy, or either intervention within 1 year following experiencing a PPF were determined. The rate of change for these interventions was calculated using the compounded annual growth rate (CAGR), with linear regression used to determine whether trends were statistically significant.

Results: In total, 5.7% and 3.6% of patients were screened and treated for osteoporosis, respectively. Between 2010 and 2020, there was no significant change in rates of osteoporosis screening (CAGR + 0.1%; p = 0.13), treatment (CAGR - 2.4%; p = 0.29), or either intervention (CAGR - 1.1%; p = 0.77) within 1 year following PPF. Factors associated with intervention included older age, female sex, and increased comorbidities.

Conclusion: Our study found that there has been no significant change in the rates of osteoporosis screening or treatment within 1 year following PPF. Orthopedic surgeons and allied healthcare workers can play an integral role in helping to curtail the osteoporosis epidemic.

Keywords: Osteoporosis epidemic; Osteoporosis screening; Periprosthetic fractures.