Evidence map›Paper›PMID 35967749›Full record

ArticleGeriatric orthopaedic surgery & rehabilitation2022

A Novel Osteoporosis Screening Protocol to Identify Orthopedic Surgery Patients for Preoperative Bone Health Optimization.

Elliot Chang, Brian Nickel, Neil Binkley, James Bernatz, Diane Krueger, Alec Winzenried, Paul A Anderson

Open access · goldAbstract read
In one paragraph

Article in Geriatric orthopaedic surgery & rehabilitation, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed
3.1field-weighted citation impact, top 8% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 14 citations in OpenAlex.

  1. Review
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  3. Perioperative denosumab exposure and risk of revision after total hip and knee arthroplasty in osteoarthritis: a registry-based data linkage study.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2026
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 1 institution in 1 country.

Elliot ChangDepartment of Orthopedics Surgery and Rehabilitation, University of Wisconsin UWMF Centennial Bldg, Madison, WI, USA.ORCID https://orcid.org/0000-0002-9715-8212
Brian NickelDepartment of Orthopedics Surgery and Rehabilitation, University of Wisconsin UWMF Centennial Bldg, Madison, WI, USA.
Neil BinkleyUniversity of Wisconsin School of Medicine and Public Health Osteoporosis Clinical Research Program, Madison, WI, USA.
James BernatzDepartment of Orthopedics Surgery and Rehabilitation, University of Wisconsin UWMF Centennial Bldg, Madison, WI, USA.
Diane KruegerUniversity of Wisconsin School of Medicine and Public Health Osteoporosis Clinical Research Program, Madison, WI, USA.
Alec WinzenriedDepartment of Orthopedics Surgery and Rehabilitation, University of Wisconsin UWMF Centennial Bldg, Madison, WI, USA.
Paul A AndersonDepartment of Orthopedics Surgery and Rehabilitation, University of Wisconsin UWMF Centennial Bldg, Madison, WI, USA.
University of Wisconsin–Madison · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Introduction: Osteoporosis is highly prevalent in elective orthopedic surgery. While preoperative bone health optimization decreases osteoporosis-related complications, there is an unmet need to establish who may benefit from preoperative dual-energy x-ray absorptiometry (DXA). This study assesses a novel, simple screening protocol to identify orthopedic surgical patients for preoperative DXA. Materials/Methods: This retrospective cohort study included 628 patients undergoing total knee, hip, or shoulder arthroplasty or thoracolumbar spine fusion. Inclusion criteria were ≥40 years undergoing primary elective surgery. Screening criteria defining who should obtain DXA due to high osteoporosis risk included: female ≥65, male ≥70, fracture history when ≥50 years, or FRAX major osteoporotic fracture risk (without bone mineral density [BMD]-adjustments) ≥8.4%. Osteoporosis was defined by World Health Organization criteria [T-score ≤ -2.5], clinical National Osteoporosis Foundation (NOF) criteria [T-score ≤ -2.5, elevated BMD-adjusted FRAX risk, or prior hip/spine fracture], and modified clinical criteria [NOF criteria simplified to include any non-traumatic prior fracture and FRAX without BMD]. Results: The study included 100 TKAs, 100 THAs, 251 TSAs, and 177 spine fusions, average age 65.6 ± 9.8. DXA was available for 209 patients. Screening criteria recommending DXA was met by 362 patients. For those with DXA, screening sensitivity was .96 (CI: .78 to .99) and specificity was .19 (CI: .14 to .25) for identifying T-score osteoporosis. Similar sensitivity of .99 (CI: .91 to .99) and specificity of .61 (CI: .56 to .66) were found for modified clinical osteoporosis. For modified clinical osteoporosis, 192 patients with osteoporosis met criteria (true pos.), 1 patient with osteoporosis did not meet criteria (false neg.), 170 patients without osteoporosis met criteria (false pos.), and 265 patients without osteoporosis did not meet criteria (true neg.). Discussion/Conclusion: A simple screening protocol identifies orthopedic surgical candidates at risk of T-score or clinical osteoporosis for preoperative DXA with high sensitivity.

Indexed as

adult reconstructive surgerybone health optimizationbone health screeningbone mineral densityfragility fracturesmetabolic bone disordersosteoporosisspine surgery

Identifiers

PMID35967749
PMCPMC9364193
OpenAlexW4290239756

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.