ArticleOsteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA2019
DXA evaluation of femoral bone mineral density and cortical width in patients with prior total knee arthroplasty.
Article in Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04167163 (An Open-Label Phase 2 Study of Abaloparatide to Mitigate Distal Femoral Bone Loss Following Total Knee Arthroplasty), which is not on this map. Cited by 8 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
An Open-Label Phase 2 Study of Abaloparatide to Mitigate Distal Femoral Bone Loss Following Total Knee Arthroplasty
Who cites it
8 citing papers in PubMed, 16 citations in OpenAlex.
- The effect of preoperative rehabilitation exercises on postoperative bone mineral density, tendon-bone healing, and physical function after anterior cruciate ligament reconstruction: a multi-center randomized controlled clinical trial.BMC sports science, medicine & rehabilitation · 2026Article
- Osteoporosis and osteoporosis therapies as determinants of implant fixation failure in arthroplasty and spinal fusion constructs: a position statement from the Fracture Working Group of the Council of Scientific Advisors of the International Osteoporosis Foundation.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2026Review
- The effect of exercise rehabilitation on bone mineral density, muscle strength, and physical function outcomes in ACL ruptures: A randomized controlled clinical trial.Sports medicine and health science · 2026Article
- Patellar Dislocation Patients Had Lower Bone Mineral Density and Hounsfield Unit Values in the Knee Joint Compared to Patients with Anterior Cruciate Ligament Ruptures: A Focus on Cortical Bone in the Tibia.Bioengineering (Basel, Switzerland) · 2025Article
- Unraveling the relationship between serum parathyroid hormone levels and trabecular bone score: a cross-sectional study.Scientific reports · 2024Article
- Correlation of CT Values and Bone Mineral Density in Elderly Chinese Patients with Proximal Humeral Fractures.Orthopaedic surgery · 2021Article
- Current Applications and Selected Technical Details of Dual-Energy X-Ray Absorptiometry.Medical science monitor : international medical journal of experimental and clinical research · 2021Review
- Abaloparatide Increases Distal Femur Bone Mineral Density Post-Total Knee Arthroplasty.JB & JS open accessArticle
Corrections and comments
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Authors and funding
7 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Periprosthetic fractures after total knee arthroplasty (TKA) have devastating consequences. Osteoporosis increases periprosthetic fracture risk, but distal femur bone mineral density (BMD) is not measured post-TKA. This study measured distal femur BMD and cortical width; both were lower in the TKA compared to the non-operated leg. BMD measurement reproducibility was good. Standardized DXA regions of interest are proposed.
introductionPeriprosthetic fractures following total knee arthroplasty (TKA) are not rare. We hypothesized that TKA is associated with low BMD, potentially increasing periprosthetic fracture risk. However, distal femur dual energy x-ray (DXA) measurement is virtually never performed after TKA due to lack of standardized approaches. Thus, this study's aims were to develop standard DXA femur regions of interest (ROIs), assess cortical width, and determine measurement reproducibility in TKA patients.
methodsThirty adults (15 M/15 F) age 59-80 years with unilateral, primary TKA within 2-5 years had femoral DXA scans performed in duplicate using a Lunar iDXA densitometer. In prior work, we established that femur BMD was lowest in the distal metaphysis and highest in mid-shaft. Thus, BMD and cortical width were measured at 15%, 25%, and 60% of the femur length measured from the distal notch. Femur BMD and cortical width were compared between limbs (TKA vs. non-operated side) by paired t test.
resultsBMD was 3.2-9.9% lower (p < 0.001) in the operated femur at all custom ROIs; substantial between individual differences existed with some up to 30% lower. Cortical width was lower (p < 0.05) at the 25% ROI on the TKA side. BMD reproducibility was excellent; CV 0.85-1.33%.
conclusionsDistal femur BMD can be reproducibly measured using DXA and is ~ 10% lower on the TKA leg. Similarly, medial and lateral cortices are thinner at the 25% ROI. These bone changes likely increase periprosthetic fracture risk. Further work to define and mitigate periprosthetic fracture risk after TKA is needed.
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