最大限度地减少全关节置换术（TJA）后假体周围骨折（PFF）的发病率和死亡率仍然是一个令人感兴趣的结果。在接受 TJA 作为降低 PFF 风险的手段的患者中，患者和手术风险因素（包括骨质疏松症和固定类型）尚未真正得到优化。因此，我们检查了：（1）接受全膝关节置换术和全膝关节置换术（TKA）的患者中符合骨质疏松症筛查标准的百分比是多少？ (2) 骨水泥组和非骨水泥组中骨质疏松症高风险组和低风险组的 5 年 PFF 和脆性骨折发生率有何不同？ (3) 上述患者中有多少比例在 THA 或 TKA 之前接受了双 X 射线吸收测量 (DEXA) 扫描？我们查询了 2016 年 4 月 1 日至 2021 年 12 月 31 日期间的全付费国家数据库，以确定高风险以及接受非骨水泥或骨水泥固定 TJA 的低风险患者。高风险患者至少满足以下标准之一：男性至少 70 岁，女性至少 65 岁，或至少 60 岁且具有以下条件的患者：吸烟、酗酒、体重指数 <18.5 、既往脆性骨折、慢性全身性皮质类固醇或影响性激素或骨矿物质密度的遗传状况。排除标准是诊断为恶性肿瘤、高能量事件（机动车碰撞）、因骨折而接受 TJA 的患者、年龄小于 50 岁的患者、先前诊断或治疗过骨质疏松症的患者以及最低随访时间不到2年。有384,783名患者（67.1%）接受了非骨水泥TKA，67,774名患者（11.8%）接受了非骨水泥TKA，这些患者被认为是高风险。此外，还有 62,505 名患者（10.9%）接受了骨水泥型 THA，58,667 名患者（10.2%）接受了非骨水泥型 THA，被认为是高风险。无骨水泥组 TKA 后 5 年假体周围骨折风险为 7.8%（95% CI，5.56 至 10.98），而骨水泥组为 4.30%（85% CI，3.98 至 4.65），P < 0.0001。高风险非骨水泥队列的全髋关节置换术后 5 年假体周围骨折风险为 7.9%（95% 置信区间 (CI)，6.87 至 9.19），而骨水泥队列中的这一风险为 7.78%（85% CI，6.77 至 8.94） , P < 0.0001。与骨水泥固定相比，骨质疏松症高危患者接受非骨水泥固定时，TKA 后 5 年发生 PFF 的风险增加。对于骨质疏松高危患者，无论是非骨水泥固定还是骨水泥固定，THA 后 5 年发生 PFF 的风险都会增加，但两组之间没有临床意义的差异。解决骨密度扫描未充分利用的缺点，并根据骨质量和骨折风险更好地选择合适的 TJA 患者，有助于加快改善当前实践状态的进程。© 2024 P K Surendran 教授纪念教育基金会。由 Elsevier B.V 出版。保留所有权利，包括文本和数据挖掘、人工智能培训和类似技术的权利。

Minimizing the burden of periprosthetic fractures (PFF) following total joint arthroplasty (TJA) with regard to morbidity and mortality remains an outcome of interest. Patient and surgical risk factors, including osteoporosis and fixation type, have not truly been optimized in patients undergoing TJA as a means to reduce the risk of PFF. As such, we examined: (1) What percentage of patients who underwent THA and total knee arthroplasty (TKA) met the criteria for osteoporosis screening? (2) How did the 5-year rate of PFF and fragility fracture differ in the high-risk and low-risk groups for osteoporosis between the cemented and cementless cohorts? (3) What percentage of the aforementioned patients received a dual x-ray absorptiometry (DEXA) scan before THA or TKA?We queried an all-payer, national database from April 1, 2016 to December 31, 2021, to identify high-risk and low-risk patients who underwent TJA with a cementless or cemented fixation. High-risk patients met at least one of the following criteria: men at least 70 years old, women at least 65 years old, or patients at least 60 years old who have the following: tobacco use, alcohol abuse, body mass index <18.5, prior fragility fracture, chronic systemic corticosteroids, or genetic condition affecting sex hormones or bone mineral density. Exclusion criteria were a diagnosis of malignancy, high-energy events (motor vehicle collision), those who underwent TJA indicated for fracture, patients less than 50 years old, those who had a prior diagnosis of or treatment for osteoporosis, and a minimum follow-up of less than 2 years.There were 384,783 patients (67.1 %) who underwent cementless TKA and 67,774 patients (11.8 %) who underwent cementless TKA who were considered high risk. Additionally, there were 62,505 patients (10.9 %) who underwent cemented THA and 58,667 patients (10.2 %) who underwent cementless THA and were considered high risk. The cementless cohort had a 5-year periprosthetic fracture risk following TKA of 7.8 % (95 % CI, 5.56 to 10.98) in comparison to 4.30 % in the cemented cohort (85 % CI, 3.98 to 4.65), P < 0.0001. The high-risk cementless cohort had a 5-year periprosthetic fracture risk following THA of 7.9 % (95 % confidence interval (CI), 6.87 to 9.19) in comparison to 7.78 % in the cemented cohort (85 % CI, 6.77 to 8.94), P < 0.0001.There is an increased risk of PFF at 5 years following TKA in patients at high risk for osteoporosis undergoing cementless fixation in comparison to cemented fixation. There is an increased risk of PFF at 5 years following THA in patients at high risk for osteoporosis for both cementless fixation and cemented fixation, but no clinically meaningful difference between the two groups. Addressing the shortcomings of the underutilization of bone density scans and better selecting appropriate patients for TJA based on bone quality and fracture risk can help expedite the process of improving the current state of practice.© 2024 Professor P K Surendran Memorial Education Foundation. Published by Elsevier B.V. All rights are reserved, including those for text and data mining, AI training, and similar technologies.