ArticleJournal of shoulder and elbow arthroplasty2026
Lower Geriatric Nutritional Risk Index is associated with increased risk of acromial stress fracture following reverse total shoulder arthroplasty.
Article in Journal of shoulder and elbow arthroplasty, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Acromial and scapular spine stress fractures are serious complications following reverse total shoulder arthroplasty (rTSA), and patient-level risk factors may contribute to their development. The Geriatric Nutritional Risk Index (GNRI) is a validated marker of physiologic reserve. The purpose of this study was to evaluate the association between GNRI and post-operative stress fracture after rTSA. We hypothesized that lower GNRI would be associated with increased fracture risk. Methods: We performed a retrospective 1:2 age- and sex-matched case-control study of patients undergoing primary rTSA. Forty-five patients who developed post-operative acromial or scapular spine stress fracture were matched to 90 controls without fracture. Demographic variables collected included age, sex, body mass index, diagnosis, and comorbidities. GNRI was calculated pre-operatively and post-operatively and analyzed as a continuous variable and using predefined thresholds (<98, <103, <109). Conditional logistic regression adjusted for diagnosis and comorbidities. Receiver-operating characteristic analysis assessed discriminatory ability. Results: A total of 135 patients were included (mean age, 72.8 years; 53% female). Patients with stress fracture had lower pre-operative GNRI (107.4 ± 12.4 vs. 114.0 ± 13.9; Conclusion: In this matched case-control analysis, lower post-operative GNRI was independently associated with increased risk of acromial and scapular spine stress fracture following rTSA. GNRI may serve as a practical perioperative risk stratification tool in patients undergoing reverse shoulder arthroplasty.
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