Australian surgeon Munjed al Muderis uncovers bone density changes after five years following unilateral lower extremity osseointegration

This month, Professor Munjed Al Muderis, principal investigator of a research team formed of Jason Shih Hoellwarth, Atiya Oomatia, Elisabeth Vrasas, and Kevin Tetsworth, published an article in Bone Reports magazine confirming bone density changes after five or more years of unilateral lower extremity osseointegration.

The team was concerned as amputees with traditional socket prostheses lose local bone density leading to the development of osteopenia or osteoporosis. This process happens as traditional sockets do not load the bones through the amputated limb, so patients lose bone density over time. Consequently, some of these patients can be at a higher risk of suffering from bone fractures during daily activities.

Osseointegration is an alternative to socket-prosthesis in which an implant is anchored to the patient´s skeleton, allowing them to have a more physiological weight bearing. In this study, the team wanted to elucidate whether osseointegration improved the patient´s bone density.

To answer to this question several transfemoral and transtibial unilateral amputees had a dual x-ray absorptiometry (DXA) performed preoperatively and after at least five years. This technique uses X-rays to show bone density.

The research team found that over a period of five years, osseointegration improves bone density in unilateral lower limb amputees who suffered from previous local disuse osteoporosis. The study also indicated that bone density tends to be worse in transfemoral than in transtibial amputees.

Prof. Munjed Al Muderis commented: “This research emphasises bone quality is important. We know that with socket-mounted prosthesis loading is distributed around the bone eventually leading to an osteoporotic bone. We also know that with osseointegration as the bone is loaded it restores the natural biomechanics and the loading forces, thereby reducing the rate of osteoporosis. This paper validates that having undergone an osseointegration procedure may facilitate improvements in bone mineral density.”

The team pointed to the need of continuing with the research on this field with the use of other advanced techniques such as QCT (Quantitative computed tomography). Further studies would help to understand with greater accuracy the long-term bone density changes of patients using osseointegration and sockets.

The findings of the study are a relevant source of information for the medical community, as it may help physicians to better assess which patients could benefit the most from osseointegration.

The full report entitled: Bone density changes after five or more years of unilateral lower extremity osseointegration: Observational cohort study can be found here