Why osteoporosis may be driving joint replacement failures

A new expert position statement reframes complications after joint replacement and spinal fusion as a single outcome, implant fixation failure, and recommends routine bone health optimization before orthopedic procedures.

The statement, published June 18 in Osteoporosis International, comes from the Fracture Working Group of the International Osteoporosis Foundation’s Council of Scientific Advisors.

Here are five things to know:

1. Osteoporosis affects more than fracture risk. The statement argues osteoporosis also contributes to implant fixation failure, including periprosthetic fractures, implant loosening, subsidence, pseudarthrosis and junctional failure.
2. Low bone mineral density increases complication risk. Evidence reviewed by the authors found low bone mineral density is associated with implant fixation failure after both joint replacement and spinal fusion procedures.
3. Bone-building drugs may improve spinal fusion outcomes. The strongest evidence favored anabolic therapies, particularly teriparatide, which was associated with earlier fusion and improved fusion mass. In joint replacement, bisphosphonates preserved periprosthetic bone mineral density in randomized trials, with registry data suggesting improved implant survival.
4. Better screening is recommended before surgery. The authors recommend routine perioperative bone health assessments using bone mineral density testing and, when available, opportunistic CT imaging to identify patients at higher risk of implant-related complications.
5. More outcome-focused research is needed. The statement calls for clinical trials that measure revision surgery and implant failure rather than relying primarily on imaging or biomechanical markers.

At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.