Changes in Periprosthetic Bone Mineral Density Following Arthroplasty: An In-Depth Review and Current Perspectives

Abstract

Purpose of review: Arthroplasty (e.g., TKA, UKA, THA) is a gold-standard treatment for end-stage joint diseases, yet it often leads to periprosthetic bone mineral density (BMD) loss, increasing risks of implant loosening and fractures. This review aims to (1) evaluate current methods for measuring periprosthetic BMD, (2) analyze factors contributing to BMD reduction, and (3) discuss pharmacological interventions to mitigate bone loss, thereby improving postoperative outcomes.

Recent findings: Recent studies highlight three primary BMD assessment tools: DEXA (widely used but limited by artifact interference), QCT (3D precision but higher cost/radiation), and HRpQCT (high-resolution yet restricted to peripheral sites). Key contributors to BMD loss include stress shielding, surgical technique, patient-specific factors (e.g., age, osteoporosis), and postoperative management gaps. Pharmacological agents like teriparatide (anabolic), denosumab (anti-resorptive), and TCM (e.g., Epimedium-derived compounds) show efficacy in preserving periprosthetic BMD. Periprosthetic BMD loss remains a critical challenge post-arthroplasty. While current monitoring tools and pharmacological strategies offer promising solutions, limitations in accessibility and standardization persist. Future research should focus on personalized BMD management protocols, cost-effective monitoring technologies, and long-term outcomes of combined therapies to optimize implant longevity and patient quality of life.

Keywords: Bone Mineral Density (BMD); Periprosthetic bone loss; Total hip arthroplasty (THA); Total knee arthroplasty (TKA); Unicompartmental knee arthroplasty (UKA).