SHOULD WE BE ROUTINELY SCREENING FOR SYSTEMIC OSTEOPENIA FOLLOWING TOTAL HIP ARTHROPLASTY?

Periprosthetic fractures (PPF) following total hip arthroplasty (THA) are increasing in prevalence with significant morbidity and mortality for the patient. PPF risks include increasing age, female sex, inflammatory arthropathy and osteopenia. Falls from standing height resulting in PPF following THA are by definition fragility fractures and such patients fulfil the criteria for a diagnosis of osteoporosis. The prevalence of screening, diagnosis, and treatment of systemic osteoporosis/osteopenia in patients before presentation with a periprosthetic fracture following THA is however unclear. We utilised our prospective database of PPF to identify patients presenting with a PPF following THA to a district general hospital over a 14-year period between January 2011 and January 2025. Data parameters collected included patient demographics, co-morbidities, fracture classification, use of HRT, steroid, calcium supplements, or bisphosphonates prior to the PPF, fracture management, timing of surgery and length of stay. We identified 296 PPFs following THA. 59% were in women with a mean age of 80 years and 41% in men with a mean age of 77 years. 19%, 48% and 32% were Mcpherson Systemic Host grade A,B and C respectively. At the time of presentation, no patients had documented FRAX scores, none were receiving HRT, 4% were receiving systemic steroids and only 17% bisphosphonates. Patients with Vancouver B2 (32%) and B3 (15%) fractures were taking bisphosphonates in only 17% and 9% of cases respectively. Type C (16%) and D (6%) received bisphosphonates in 26% and 23% respectively. Average length of stay was 27 days with the wait to surgery longest for B3 fractures at 7.5 days compared to 4.1 days for the B1 fractures. Periprosthetic fractures are an increasing burden to the NHS. We have identified deficiencies in screening and treating osteopenia in patients who have undergone THA. Additional resources directed at screening and treating osteopenia following THA may not only result in a lower incidence of this devastating complication but may also potentially reduce the incidence of other fragility fractures. We recommend surgeons undertaking THA have a role in raising awareness of screening for osteopenia.