High Prevalence and Underdiagnosis of Osteoporosis in Total Hip Arthroplasty Candidates: A Comprehensive Assessment Using Bone Mineral Density, Trabecular Bone Score, and Bone Turnover Markers

Background Total hip arthroplasty (THA) effectively alleviates symptoms in individuals with hip osteoarthritis; however, many candidates present with undiagnosed osteoporosis. Bone mineral density (BMD) alone may not sufficiently reflect bone fragility. The trabecular bone score (TBS) and bone turnover markers (BTMs) provide additional information on bone quality and metabolism. This study aimed to evaluate osteoporosis prevalence using BMD, TBS, and BTMs, and to assess whether preoperative osteoporosis affects postoperative pain and patient-reported outcome measures (PROMs). Methods This retrospective study included 357 patients who underwent primary THA. Preoperative evaluation involved dual-energy X-ray absorptiometry to assess BMD and lumbar TBS, along with serum levels of tartrate-resistant acid phosphatase 5b (TRACP-5b), total procollagen type 1 amino-terminal propeptide, and 25-hydroxyvitamin D. Patients were classified as having normal bone mass, osteopenia, or osteoporosis based on total hip BMD. Postoperative outcomes were assessed using the Numerical Rating Scale for pain and the Hip Disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS JR) for PROMs at 12 months postoperatively. Results Osteoporosis and osteopenia were identified in 23.8% and 37.5% of patients, respectively. TBS revealed compromised bone microarchitecture in 25.7%, including 42.4% of those without BMD-defined osteoporosis. Elevated TRACP-5b and vitamin D deficiency were observed in 15.6% and 72.3% of patients, respectively. Only 9.2% received osteoporosis treatment. No significant differences in postoperative pain or PROMs were found between groups. Conclusion A multifaceted assessment revealed a high prevalence of unrecognized osteoporosis in THA candidates. Incorporating comprehensive bone health evaluation into preoperative protocols may optimize long-term THA outcomes.