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Osteoporos Sarcopenia. 2017 Dec;3(4):164-169. doi: 10.1016/j.afos.2017.11.006. Epub 2017 Dec 18.

Surgical treatment of severe osteoporosis including new concept of advanced severe osteoporosis.

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Department of Orthopedic Surgery, Inje University Ilsan Paik Hospital, Goyang, Korea.
Department of Orthopaedic Surgery, Guri Hospital, Hanyang University College of Medicine, Guri, Korea.
Department of Orthopedic Surgery, SungMin Hospital, Incheon, Korea.
Division of Endocrinology and Metabolism, Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea.


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.


Advanced severe osteoporosis; Fragility fractures; Severe osteoporosis; Surgical treatment

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