Osteosynthetic improvement of osteoporotic bone: prevention surgery

Abstract

A prior osteoporotic femoral neck fracture (FNF) doubles the risk of a second, contralateral hip fracture. Pharmacological prevention of osteoporotic fractures is cost-effective but medication compliance and persistence rates are suboptimal.The aim of our study was to evaluate the safety and effectiveness of a device developed for the surgical prevention of an additional contralateral FNF in elderly osteoporotic patients.Only patients with a T score ≤ -2.5 were enrolled and randomized either to receive (Group A) or not receive (Group B) surgical prevention. Sixty-seven patients were enrolled. The mean follow-up was 16 months (range 1 to 22). To date, no contralateral FNF has been reported in either group. In Group A, no device-related complications were recorded. Twelve patients reported one or more falls and in four cases a non-femoral fragility fracture occurred.The main problem with pharmacological prevention is therapy adherence and the extensive period needed for only a slight improvement in bone strength.Surgical prevention is a potential solution for avoiding the occurrence of a second contralateral FNF. Nevertheless, a longer follow-up and a larger cohort of patients is necessary in order to verify the true effectiveness of the surgical prevention in elderly osteoporotic patients.

Keywords: femoral neck fractures; osteoporosis; surgical prevention..

Figure 1

- - A: X rays of an 83 year old female with a right FNF; B: Post operative X rays; in the injured hip, a hemiarthroplasty was performed while a PNS was used in the contralateral hip. C: 3 months FU X-rays. D: 3 months CT scan of the reinforced hip shows good osteointegration. E: 12 months FU Xrays. F: The CT scan performed at 12 months confirms the osteointegration.