Evidence map›Paper›PMID 38900164›Full record

ArticleOsteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA2024

Prior fragility fractures are associated with a higher risk of 8-year complications following total shoulder arthroplasty.

Amy Y Zhao, Samantha Ferraro, Amil Agarwal, Jacob D Mikula, Frederick Mun, Rachel Ranson, Matthew Best, Uma Srikumaran

Abstract read
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In one paragraph

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, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
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

2 citing papers in PubMed.

  1. Article
  2. Patients with periprosthetic femoral fractures are older adults who are commonly diagnosed with osteoporosis.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2025
    Observational
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

8 authors.

Amy Y ZhaoDepartment of Orthopaedic Surgery, District of Columbia, George Washington Hospital, Washington, DC, USA. zhaoa@gwmail.gwu.edu.ORCID http://orcid.org/0000-0002-0494-4223
Samantha FerraroDepartment of Orthopaedic Surgery, District of Columbia, George Washington Hospital, Washington, DC, USA.
Amil AgarwalDepartment of Orthopaedic Surgery, District of Columbia, George Washington Hospital, Washington, DC, USA.
Jacob D MikulaDepartment of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD, USA.
Frederick MunDepartment of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD, USA.
Rachel RansonDepartment of Orthopaedic Surgery, District of Columbia, George Washington Hospital, Washington, DC, USA.
Matthew BestDepartment of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD, USA.
Uma SrikumaranDepartment of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Patients who sustain fragility fractures prior to total shoulder arthroplasty have significantly higher risk for bone health-related complications within 8 years of procedure. Identification of these high-risk patients with an emphasis on preoperative, intraoperative, and postoperative bone health optimization may help minimize these preventable complications. PURPOSE: As the population ages, more patients with osteoporosis are undergoing total shoulder arthroplasty (TSA), including those who have sustained a prior fragility fracture. Sustaining a fragility fracture before TSA has been associated with increased risk of short-term revision rates, periprosthetic fracture (PPF), and secondary fragility fractures but long-term implant survivorship in this patient population is unknown. Therefore, the purpose of this study was to characterize the association of prior fragility fractures with 8-year risks of revision TSA, periprosthetic fracture, and secondary fragility fracture.

methodsPatients aged 50 years and older who underwent TSA were identified in a large national database. Patients were stratified based on whether they sustained a fragility fracture within 3 years prior to TSA. Patients who had a prior fragility fracture (7631) were matched 1:1 to patients who did not based on age, gender, Charlson Comorbidity Index (CCI), smoking, obesity, diabetes mellitus, and alcohol use. Kaplan-Meier and Cox Proportional Hazards analyses were used to observe the cumulative incidences of all-cause revision, periprosthetic fracture, and secondary fragility fracture within 8 years of index surgery.

resultsThe 8-year cumulative incidence of revision TSA (5.7% vs. 4.1%), periprosthetic fracture (3.8% vs. 1.4%), and secondary fragility fracture (46.5% vs. 10.1%) were significantly higher for those who had a prior fragility fracture when compared to those who did not. On multivariable analysis, a prior fragility fracture was associated with higher risks of revision (hazard ratio [HR], 1.48; 95% confidence interval [CI], 1.24-1.74; p < 0.001), periprosthetic fracture (HR, 2.98; 95% CI, 2.18-4.07; p < 0.001) and secondary fragility fracture (HR, 8.39; 95% CI, 7.62-9.24; p < 0.001).

conclusionsPrior fragility fracture was a significant risk factor for revision, periprosthetic fracture, and secondary fragility fracture within 8 years of primary TSA. Identification of these high-risk patients with an emphasis on preoperative and postoperative bone health optimization may help minimize these complications. LEVEL OF EVIDENCE: III.

Indexed as

Arthroplasty, Replacement, ShoulderOsteoporotic FracturesPeriprosthetic FracturesReoperationAgedAged, 80 and overDatabases, FactualFemaleHumansMaleMiddle AgedPostoperative ComplicationsRecurrenceRisk AssessmentRisk FactorsBone healthFragility fractureOsteoporosisPeriprosthetic fractureTotal shoulder arthroplasty

Identifiers

PMID38900164

What OpenQuestion holds

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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.