Background
• Osteoporosis -- a decreas ed bone density with nor mal bone mineralization
• WHO Definition (1994)
• Bone Mineral Density ≥2.5 S D’s below the mean seen in young normal subjects
Background
• Senile osteoporosis common • Some degree of osteopenia is found in virtually all healthy elderly patients
• Treatable causes should be investigated • Nutritional deficiency • Malabsorption syndromes • Hyperparathyroidism • Cushings disease • Tumors
Epidemiology, Diagnosis Preventi on and Management of Osteopor
otic Fractures
Kenneth A. Egol, MD NYU-Hospital For Joint Diseases
Created March 2004; Revised May 2006
• The goal of treatment is t o restore the pre-injury le vel of function
• Fracture can render an el derly patient unable to fu nction independently --re quiring institutionalized c are
Background
• The most common fractures in the elderl y osteoporotic patient include:
• Hip Fractures • Femoral neck fractures • Intertrochanteric fractures • Subtrochanteric fractures
Background
• Osteopenia complicates both frac ture treatment and healing
• Internal fixation compromised
• Poor screw purchase • Increased risk of screw pull out • ation with methylmethacrylate has been advocated
Pre-injury Status
• American Society of Anesthesiologists (ASA) Classification • ASA I- normal healthy • ASA II- mild systemic disease • ASA III- Severe systemic disease, not incapacitating • ASA IV- severe incapacitating disease • ASA V- moribund patient
• Increased risk of non-union
• Bone augmentation (bone graft, substitutes) may be indicated
Pre-injury Status
• Medical History • Cognitive History • Functional History
• Ankle fractures • Proximal humerus fracture • Distal radius fractures • Vertebral compression fractures
Background
• Fractures in the elderly o steoporotic patient repre sent a challenge to the or thopaedic surgeon
• Ambulatory status • Community Ambulator • Household Ambulator • Non-Functional Ambulator • Non-Ambulator
• Living arrangements
Pre-injury Status
• Systemic disease • Pre-existing cardiac and pulmonary disease is common in the elderly • Diminishes patients ability to tolerate prolonged recumbency • Diabetes increases wound complications and infection • May delay fracture union
Background
• The incidence of osteoporotic fractures is increasing • Estimated that half of all women and one-third of all men will sustain a fragility fracture during t heir lifetime • By 2050 --> 6.3 million hip fractures will occur globally • Enormous cost to society
• Incidence increases with a ge
• 15% of white women age 50 -59
• 70% of white women older t han age 80
Background
• Risk factors for osteoporosis • Female sex • European ancestry • Sedentary lifestyle • Multiple births • Excessive alcohol use