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Osteoporosis Screening Is Often Indicated but Overlooked Prior to Rotator Cuff Repair
PURPOSE: To (1) report the percentage of patients undergoing rotator cuff repair (RCR) who were appropriately screened with dual-energy X-ray absorptiometry testing prior to surgery, if indicated, and (2) determine the percentage of patients properly prescribed osteoporosis medications within 6 mont...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8220567/ https://www.ncbi.nlm.nih.gov/pubmed/34195629 http://dx.doi.org/10.1016/j.asmr.2021.01.002 |
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author | Cotter, Eric J. Klosterman, Emma L. Winzenried, Alec E. Greiner, Justin J. Grogan, Brian F. |
author_facet | Cotter, Eric J. Klosterman, Emma L. Winzenried, Alec E. Greiner, Justin J. Grogan, Brian F. |
author_sort | Cotter, Eric J. |
collection | PubMed |
description | PURPOSE: To (1) report the percentage of patients undergoing rotator cuff repair (RCR) who were appropriately screened with dual-energy X-ray absorptiometry testing prior to surgery, if indicated, and (2) determine the percentage of patients properly prescribed osteoporosis medications within 6 months of surgery. METHODS: Consecutive patients aged 50 years or older who underwent elective RCR at a single tertiary-care center over a 1-year period were reviewed. Fracture risk was estimated using the Fracture Risk Assessment Tool (FRAX) with and without bone mineral density. The U.S. National Osteoporosis Foundation (NOF) criteria for screening and treatment were applied. Patients with acute fractures or revision surgery were excluded. RESULTS: Of the 218 patients included, 129 were women (58.1%). The mean age was 61.5 ± 7.2 years. One hundred thirty-one RCRs (60.1%) occurred within 3 months of injury. A total of 69 patients (31.7%) met the NOF criteria for bone mineral density screening. Of these patients, 23 (33.3%) were appropriately screened with a dual-energy X-ray absorptiometry scan. Primary care providers initiated bone health assessment in 18 of the 23 appropriately screened patients, with orthopaedic providers initiating the workup in 3 patients (13.0%). Thirty-two patients (14.7%) met the NOF criteria for pharmacologic management of osteoporosis. Of these patients, 5 (15.6%) were treated. Patients meeting the medication criteria were older (69.1 ± 7.7 years vs 60.2 ± 6.3 years, P < .001), had a lower body mass index (28.8 ± 6.1 vs 31.5 ± 6.5, P = .028), and had chronic rotator cuff tears (P = .015). CONCLUSIONS: Patients aged 50 years or older undergoing RCR are often not appropriately screened for osteoporosis. Even when appropriately screened, only 15.6% of patients meeting the indications for pharmacologic intervention for bone health optimization were prescribed appropriate medications. Although bone health optimization may or may not affect surgical timing, patient encounters related to rotator cuff tears can be used as an opportunity for providers to initiate osteoporosis screening and treatment protocols. LEVEL OF EVIDENCE: Level IV, therapeutic case series. |
format | Online Article Text |
id | pubmed-8220567 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-82205672021-06-29 Osteoporosis Screening Is Often Indicated but Overlooked Prior to Rotator Cuff Repair Cotter, Eric J. Klosterman, Emma L. Winzenried, Alec E. Greiner, Justin J. Grogan, Brian F. Arthrosc Sports Med Rehabil Original Article PURPOSE: To (1) report the percentage of patients undergoing rotator cuff repair (RCR) who were appropriately screened with dual-energy X-ray absorptiometry testing prior to surgery, if indicated, and (2) determine the percentage of patients properly prescribed osteoporosis medications within 6 months of surgery. METHODS: Consecutive patients aged 50 years or older who underwent elective RCR at a single tertiary-care center over a 1-year period were reviewed. Fracture risk was estimated using the Fracture Risk Assessment Tool (FRAX) with and without bone mineral density. The U.S. National Osteoporosis Foundation (NOF) criteria for screening and treatment were applied. Patients with acute fractures or revision surgery were excluded. RESULTS: Of the 218 patients included, 129 were women (58.1%). The mean age was 61.5 ± 7.2 years. One hundred thirty-one RCRs (60.1%) occurred within 3 months of injury. A total of 69 patients (31.7%) met the NOF criteria for bone mineral density screening. Of these patients, 23 (33.3%) were appropriately screened with a dual-energy X-ray absorptiometry scan. Primary care providers initiated bone health assessment in 18 of the 23 appropriately screened patients, with orthopaedic providers initiating the workup in 3 patients (13.0%). Thirty-two patients (14.7%) met the NOF criteria for pharmacologic management of osteoporosis. Of these patients, 5 (15.6%) were treated. Patients meeting the medication criteria were older (69.1 ± 7.7 years vs 60.2 ± 6.3 years, P < .001), had a lower body mass index (28.8 ± 6.1 vs 31.5 ± 6.5, P = .028), and had chronic rotator cuff tears (P = .015). CONCLUSIONS: Patients aged 50 years or older undergoing RCR are often not appropriately screened for osteoporosis. Even when appropriately screened, only 15.6% of patients meeting the indications for pharmacologic intervention for bone health optimization were prescribed appropriate medications. Although bone health optimization may or may not affect surgical timing, patient encounters related to rotator cuff tears can be used as an opportunity for providers to initiate osteoporosis screening and treatment protocols. LEVEL OF EVIDENCE: Level IV, therapeutic case series. Elsevier 2021-03-13 /pmc/articles/PMC8220567/ /pubmed/34195629 http://dx.doi.org/10.1016/j.asmr.2021.01.002 Text en © 2021 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Original Article Cotter, Eric J. Klosterman, Emma L. Winzenried, Alec E. Greiner, Justin J. Grogan, Brian F. Osteoporosis Screening Is Often Indicated but Overlooked Prior to Rotator Cuff Repair |
title | Osteoporosis Screening Is Often Indicated but Overlooked Prior to Rotator Cuff Repair |
title_full | Osteoporosis Screening Is Often Indicated but Overlooked Prior to Rotator Cuff Repair |
title_fullStr | Osteoporosis Screening Is Often Indicated but Overlooked Prior to Rotator Cuff Repair |
title_full_unstemmed | Osteoporosis Screening Is Often Indicated but Overlooked Prior to Rotator Cuff Repair |
title_short | Osteoporosis Screening Is Often Indicated but Overlooked Prior to Rotator Cuff Repair |
title_sort | osteoporosis screening is often indicated but overlooked prior to rotator cuff repair |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8220567/ https://www.ncbi.nlm.nih.gov/pubmed/34195629 http://dx.doi.org/10.1016/j.asmr.2021.01.002 |
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