DOS Kongressen 2014 ·
209
Evaluation of bone mineral density and bone
markers in femoral amputees prior to
osseointegrated implant surgery
Rehne Lessmann Hansen, Peter Holmberg Jørgensen, Kjeld Søballe,
Klaus Kjær Petersen, Maiken Stilling
Department of orthopaedic research, University Hospital of Aarhus;
Department of orthopaedic surgery, University Hospital of Aarhus
Background:
Amputees often have radiological halisteretic bone in the residual
femur. The status of periimplant bone mineral density (BMD) and general skel-
etal bone activity may offer important information prior to osseointegration
(OI) surgery.
Purpose / Aim of Study:
Evaluation of preoperative data of the first 20 pa-
tients.
Materials and Methods:
20 patients (13 male) with mean age 48 (range 30-
66) years, and mean 10.5 (range 0-39) years since amputation, were sched-
uled for surgery with an OI-implant. Preoperative assessment included AP and
LA radiographs of the femur, DXA scans with measurement of systemic and
femoral/pelvic bone mineral density (BMD) and thigh muscle mass, and bio-
markers (BASP bone-type, Ca2+, PTH, D2+D3, creatinine).
Findings / Results:
Mean length of the residual femur was 20.3cm (range
4.7–41cm). 9 patients had a normal systemic BMD (T>-1), 9 were osteopenic
((T ≤ -1), and 2 patients were osteoporotic ((T < -2.5) (male:30 yr, male:45yr).
The BMD of the femur, hip and pelvis on the amputated leg was decreased by
40%, 35% and 21%, and the muscle mass in the gluteal region and femur was
decreased by 9,5% and 47,5%, compared to the healthy leg (p<0.001). The
BMD in the distal 12 cm of the amputated femur correlated positively with the
length of the femur (spearman’s rho 0.64, p=0.002) and negatively with the
years since amputation (spearman’s rho -0.71, p=0.0004). 7 patients had vita-
min D insufficiency, 5 patients had elevated PTH-levels, 5 patients had elevated
BASP and all had normal Ca2+ and BASP bone-type.
Conclusions:
Femoral amputees have an almost 50% reduced BMD and muscle
mass in the affected leg and the degree depends on the years since amputation
and the length of the residual femur. Low systemic BMD and vitamin D insuf-
ficiency with sec. hyperparathyroidism was seen in 1/3 of patients indicating a
general need for screening.
156.
