Published 1/1/2008

Second Look: Clinical

If you missed these news items the first time around, AAOS Now gives you a second chance to review them. Links are available online at www.aaos.org/now. Headline News Now, the AAOS thrice-weekly, online update of news of interest to orthopaedic surgeons, brings you the latest on clinical, socioeconomic, and political issues, as well as important announcements from AAOS.

Delayed TKAs for women may result in poorer outcomes

A study published in the November 2007 issue of the Journal of Bone and Joint Surgery finds that women with osteoarthritis of the knee are more likely than men to delay pursuing total knee arthroplasty (TKA), potentially resulting in poorer outcomes. Researchers examined 221 TKA candidates and 44 healthy subjects matched for gender, age, and body-mass index and found that healthy men generally had better strength and function than women in most areas, although the healthy women had better scores in voluntary-muscle activation than men. Among candidates for TKA, women scored lower than men in all areas, and the differences were more pronounced than in the healthy group. This suggests that some women are not getting knee surgery soon enough, either because physicians wait too long to suggest it, or the women wait too long to access appropriate care.

Mortality increasing after hip fracture

A European study published in the November 2007 issue of the Journal of the American Geriatrics Society finds that mortality after hip fracture is increasing among elderly people, and more men are sustaining hip fractures. Researchers in Denmark reviewed the records of 163,313 patients who had a hip fracture between 1981 and 2001, along with 505,960 age- and sex-matched controls. During the study period, the mean age of patients with hip fracture increased from 75.8 years to 78.1 years, and the proportion of men who had hip fractures increased from 25.5 percent to 29.8 percent. Mortality was significantly higher among hip-fracture patients who underwent hip arthroplasty than among those who had osteosynthesis (relative risk = 1.05; 95 percent confidence interval (CI) = 1.03-1.07).

Simple test to determine male osteoporosis risk

According to a report in the Annals of Family Medicine, a simple test can be used to identify men at risk for osteoporosis and subsequent hip fracture. Researchers at the University of Texas Medical Branch, Galveston, developed a simplified scoring algorithm—the Male Osteoporosis Risk Estimation Score (MORES)—using only three variables: age (three categories), weight (three categories), and history of chronic obstructive pulmonary disease (yes or no). According to their study, a score of 6 or greater out of a possible 13 yielded an overall sensitivity of 0.93 (95 percent CI, 0.85-0.97) and a specificity of 0.59 (95 percent CI, 0.56-0.62). For men age 60 years and older, MORES can be a simple approach to identify those at risk for osteoporosis. The test can also identify men with osteopenia, which would give patients the opportunity to modify lifestyles and diets to prevent progression to osteoporosis.

Teriparatide may be effective for glucocorticoid-associated bone loss

A study published in the November 15 issue of the New England Journal of Medicine finds that the drug teriparatide may be effective at reducing bone loss associated with glucocorticoids, which are often prescribed to patients suffering from asthma, autoimmune disorders, and skin allergies. Researchers followed 428 patients over the course of 18 months in a randomized, double-blind, controlled trial. An experimental group of 214 patients was given 20 µg of teriparatide once daily, while the remaining 214 patients were given 10 mg of alendronate once per day. At the last measurement, the mean (± SE) bone-mineral density at the lumbar spine had increased more in the teriparatide group than in the alendronate group (7.2 ± 0.7 percent vs. 3.4 ± 0.7 percent, P < 0.001), and fewer new vertebral fractures occurred in the teriparatide group than in the alendronate group (0.6 percent vs. 6.1 percent, P = 0.004). The incidence of nonvertebral fractures was similar in the two groups (5.6 percent vs. 3.7 percent, P = 0.36). The study was funded by the manufacturer of teriparatide.