Prophylactic augmentation of the osteoporotic proximal femur-mission impossible?

Published on Dec 7, 2016in bonekey Reports
· DOI :10.1038/bonekey.2016.86
Peter Varga34
Estimated H-index: 34
(AO Research Institute Davos , Davos Platz),
Ladina Hofmann-Fliri9
Estimated H-index: 9
(AO Research Institute Davos , Davos Platz)
+ 1 AuthorsMarkus Windolf30
Estimated H-index: 30
(AO Research Institute Davos , Davos Platz)
The high incidence of secondary hip fractures and the associated markedly increased mortality call for preventive actions that could help to avoid these injuries. By providing immediate strengthening and not relying on patient compliance, internal prophylactic augmentation of the osteoporotic proximal femur may overcome the main limitations of systemic bone drugs and wearable protective pads. However, such a method would have to provide sufficient and reliable strengthening effect with minimal risks and side effects to justify the need of an invasive treatment. The requirements for an internal reinforcement approach are thus strict and include mechanical, biological, clinical, ethical and financial criteria. Here we first attempt to describe the properties of an ideal augmentation method. Previously published methodologies and techniques developed at our research institute, including approaches using cements, metals, other materials or combined approaches, are then reviewed and evaluated according to these aspects. We conclude that none of the discussed methodologies appears to be able to deliver a sufficiently high gain-versus-risk ratio that could justify the clinical application and thus augmentation of the osteoporotic proximal femur remains a challenge. Finally, we provide suggestions for the development and evaluation of future strategies.
Cited By7
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