Surgical treatment of severe osteoporosis including new concept of advanced severe osteoporosis
Severe osteoporosis is classified as those with a bone mineral density (BMD) T-score of −2.5 or lower, and demonstrate one or more of osteoporotic, low-trauma, fragility fractures. According to the general principle of surgical approach, patients with severe osteoporosis require not only more thorou...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2017-12-01
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| Series: | Osteoporosis and Sarcopenia |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2405525517302029 |
| _version_ | 1811254840729272320 |
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| author | Jin Hwan Kim Ye-Soo Park Kwang Jun Oh Han Seok Choi |
| author_facet | Jin Hwan Kim Ye-Soo Park Kwang Jun Oh Han Seok Choi |
| author_sort | Jin Hwan Kim |
| collection | DOAJ |
| description | Severe osteoporosis is classified as those with a bone mineral density (BMD) T-score of −2.5 or lower, and demonstrate one or more of osteoporotic, low-trauma, fragility fractures. According to the general principle of surgical approach, patients with severe osteoporosis require not only more thorough pre- and postoperative treatment plans, but improvements in surgical fixtures and techniques such as the concept of a locking plate to prevent bone deformity and maximizing the blood flow to the fracture site by using a minimally invasive plate osteosynthesis. Arthroplasty is often performed in cases of displaced femoral neck fracture. Otherwise internal fixation for the goal of bone union is the generally accepted option for intertrochanteric, subtrochanteric, and femoral shaft fractures. Most of osteoporotic spine fracture is stable compression fracture, but vertebroplasty or kyphoplasty may be performed some selective patients. If neurological paralysis, severe spinal instability, or kyphotic deformity occurs, open decompression or fusion surgery may be considered. In order to overcome shortcomings of the World Health Organization definition of osteoporosis, we proposed a concept of ‘advanced severe osteoporosis,’ which is defined by the presence of proximal femur fragility fracture or two or more fragility fractures in addition to BMD T-score of −2.5 or less. In conclusion, we need more meticulous approach for surgical treatment of severe osteoporosis who had fragility fracture. In cases of advanced severe osteoporosis, we recommend more aggressive managements using parathyroid hormone and receptor activator of nuclear factor kappa-B ligand monoclonal antibody. |
| first_indexed | 2024-04-12T17:13:45Z |
| format | Article |
| id | doaj.art-16b5d1fcb67c4389af7fc984efd5acdd |
| institution | Directory Open Access Journal |
| issn | 2405-5255 |
| language | English |
| last_indexed | 2024-04-12T17:13:45Z |
| publishDate | 2017-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Osteoporosis and Sarcopenia |
| spelling | doaj.art-16b5d1fcb67c4389af7fc984efd5acdd2022-12-22T03:23:42ZengElsevierOsteoporosis and Sarcopenia2405-52552017-12-013416416910.1016/j.afos.2017.11.006Surgical treatment of severe osteoporosis including new concept of advanced severe osteoporosisJin Hwan Kim0Ye-Soo Park1Kwang Jun Oh2Han Seok Choi3Department of Orthopedic Surgery, Inje University Ilsan Paik Hospital, Goyang, KoreaDepartment of Orthopaedic Surgery, Guri Hospital, Hanyang University College of Medicine, Guri, KoreaDepartment of Orthopedic Surgery, SungMin Hospital, Incheon, KoreaDivision of Endocrinology and Metabolism, Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, KoreaSevere osteoporosis is classified as those with a bone mineral density (BMD) T-score of −2.5 or lower, and demonstrate one or more of osteoporotic, low-trauma, fragility fractures. According to the general principle of surgical approach, patients with severe osteoporosis require not only more thorough pre- and postoperative treatment plans, but improvements in surgical fixtures and techniques such as the concept of a locking plate to prevent bone deformity and maximizing the blood flow to the fracture site by using a minimally invasive plate osteosynthesis. Arthroplasty is often performed in cases of displaced femoral neck fracture. Otherwise internal fixation for the goal of bone union is the generally accepted option for intertrochanteric, subtrochanteric, and femoral shaft fractures. Most of osteoporotic spine fracture is stable compression fracture, but vertebroplasty or kyphoplasty may be performed some selective patients. If neurological paralysis, severe spinal instability, or kyphotic deformity occurs, open decompression or fusion surgery may be considered. In order to overcome shortcomings of the World Health Organization definition of osteoporosis, we proposed a concept of ‘advanced severe osteoporosis,’ which is defined by the presence of proximal femur fragility fracture or two or more fragility fractures in addition to BMD T-score of −2.5 or less. In conclusion, we need more meticulous approach for surgical treatment of severe osteoporosis who had fragility fracture. In cases of advanced severe osteoporosis, we recommend more aggressive managements using parathyroid hormone and receptor activator of nuclear factor kappa-B ligand monoclonal antibody.http://www.sciencedirect.com/science/article/pii/S2405525517302029Advanced severe osteoporosisFragility fracturesSurgical treatmentSevere osteoporosis |
| spellingShingle | Jin Hwan Kim Ye-Soo Park Kwang Jun Oh Han Seok Choi Surgical treatment of severe osteoporosis including new concept of advanced severe osteoporosis Osteoporosis and Sarcopenia Advanced severe osteoporosis Fragility fractures Surgical treatment Severe osteoporosis |
| title | Surgical treatment of severe osteoporosis including new concept of advanced severe osteoporosis |
| title_full | Surgical treatment of severe osteoporosis including new concept of advanced severe osteoporosis |
| title_fullStr | Surgical treatment of severe osteoporosis including new concept of advanced severe osteoporosis |
| title_full_unstemmed | Surgical treatment of severe osteoporosis including new concept of advanced severe osteoporosis |
| title_short | Surgical treatment of severe osteoporosis including new concept of advanced severe osteoporosis |
| title_sort | surgical treatment of severe osteoporosis including new concept of advanced severe osteoporosis |
| topic | Advanced severe osteoporosis Fragility fractures Surgical treatment Severe osteoporosis |
| url | http://www.sciencedirect.com/science/article/pii/S2405525517302029 |
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