Team Approach: Bone Health Optimization in Orthopaedic Surgery.
Ignacio PasqualiniNickelas HuffmanSarah F KellerJohn P McLaughlinRobert M MolloyMatthew E DerenNicolas Santiago PiuzziPublished in: JBJS reviews (2023)
» Bone health optimization (BHO) has become an increasingly important consideration in orthopaedic surgery because deterioration of bone tissue and low bone density are associated with poor outcomes after orthopaedic surgeries.» Management of patients with compromised bone health requires numerous healthcare professionals including orthopaedic surgeons, primary care physicians, nutritionists, and metabolic bone specialists in endocrinology, rheumatology, or obstetrics and gynecology. Therefore, achieving optimal bone health before orthopaedic surgery necessitates a collaborative and synchronized effort among healthcare professionals.» Patients with poor bone health are often asymptomatic and may present to the orthopaedic surgeon for reasons other than poor bone health. Therefore, it is imperative to recognize risk factors such as old age, female sex, and low body mass index, which predispose to decreased bone density.» Workup of suspected poor bone health entails bone density evaluation. For patients without dual-energy x-ray absorptiometry (DXA) scan results within the past 2 years, perform DXA scan in all women aged 65 years and older, all men aged 70 years and older, and women younger than 65 years or men younger than 70 years with concurrent risk factors for poor bone health. All women and men presenting with a fracture secondary to low-energy trauma should receive DXA scan and bone health workup; for fractures secondary to high-energy trauma, perform DXA scan and further workup in women aged 65 years and older and men aged 70 years and older.» Failure to recognize and treat poor bone health can result in poor surgical outcomes including implant failure, periprosthetic infection, and nonunion after fracture fixation. However, collaborative healthcare teams can create personalized care plans involving nutritional supplements, antiresorptive or anabolic treatment, and weight-bearing exercise programs, resulting in BHO before surgery. Ultimately, this coordinated approach can enhance the success rate of surgical interventions, minimize complications, and improve patients' overall quality of life.
Keyphrases
- bone mineral density
- healthcare
- public health
- primary care
- dual energy
- soft tissue
- mental health
- bone loss
- postmenopausal women
- body composition
- body mass index
- bone regeneration
- health information
- physical activity
- minimally invasive
- computed tomography
- risk factors
- middle aged
- polycystic ovary syndrome
- type diabetes
- social media
- magnetic resonance
- adipose tissue
- quality improvement
- magnetic resonance imaging
- coronary artery disease
- rheumatoid arthritis
- newly diagnosed
- palliative care
- metabolic syndrome
- ejection fraction
- patient reported outcomes
- pulmonary embolism
- skeletal muscle
- radiation therapy
- pregnancy outcomes
- peritoneal dialysis
- acute coronary syndrome
- weight loss
- percutaneous coronary intervention