gms | German Medical Science

Objectives: Geriatric fractures are increasing in an ageing society, making osteoporotic and low bone quality more common. However, the gold standard of osteoporosis diagnosis, the DXA scan, is not accurate enough to predict fractures in the near future. At the same time, fracture treatment of hip fractures in osteoporotic bones of the elderly is characterized by complications such as the cut out the lag-screw. A more reliable diagnosis of bone quality would provide the opportunity to develop customized osteosynthesis for the appropriate bone quality.

Methods: Studies show that calcium isotope marker (CIM) technology can detect a biochemical imbalance in calcium metabolism and thus an osteoporotic event early and with statistical significance. In this project, we are initiating a confirmatory study that will enroll 40 patients with trochanteric femur fracture who will be evaluated before surgery (V0) with CIM, DXA scan and other routine diagnostics. In addition, 2 different intramedullary force carriers are compared. One and six weeks after surgery (V1 and V2), follow-up diagnostics with CIM will be performed to track the healing process, detect complications such as lag-screw excision and detect subsequent fractures or reoperations during this period that may be related to poor bone quality. In parallel, osteosynthesis concepts for augmentation with suitable bone cement material and a novel design of the lag-screw will be developed to allow for a patient-adapted treatment that meets the requirements of their specific bone quality.

Results: A suitable study design was developed, which was approved by the ethics committee of the UKSH, Campus Kiel, so that the study could finally be initiated. At the time of writing, almost half of the planned number of patients had been enrolled in the study, appropriate urine and blood CIM measurements and DXA measurements were performed and a number of accompanying clinical parameters were collected. Preliminary results at T0 showed a good correlation between bone quality measured by CIM and DXA scan, although the CIM measurement revealed a significantly higher sensitivity. The parallel design process for osteosynthesis devices with low bone quality resulted in a prototype of application device for augmentation of the lag-screw as well as an optimized screw design itself.

Conclusion: The combination of innovative osteoporosis diagnostics with an optimized osteosynthesis device design has the potential to match the appropriate treatment to the corresponding bone quality of each patient, thus enabling tailored care with lower complication rates and reduced health burden for society.