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Osteoporosis and osteoarthritis share common risk factors such as age and female gender; hence they can be present concomitantly, especially in patients with chronic osteoarthritis Open Access Original Article DOI: 10.7759/cureus.27275 How to cite this article Dave D, Bhattacharjee S K, Shah D D, et al. (July 26, 2022) Osteoporosis in Indian Patients Undergoing Elective Arthroplasty and Spinal Procedures: An Observational Study. Cureus 14(7): e27275. DOI 10.7759/cureus.27275 common in patients undergoing total joint arthroplasty (including total knee replacement {TKR}/total hip replacement {THR}) and spinal procedures [15,16]. Traditionally, it was believed that osteoporosis and osteoarthritis have an inverse relationship and patients with advanced osteoarthritis are less likely to develop osteoporosis [12,17-20]. However, newer studies on the association between osteoarthritis and osteoporosis with subsequent fracture risk show conflicting results [21,22]. While some studies show a low prevalence of osteoporosis and increased bone mass in patients with osteoarthritis undergoing TKR/THR [13,22,23], others show a prevalence roughly equal to that in the general population [12,24], while yet others show an increased risk of fractures in these patients [25-28]. Joint replacements and arthroplasty are known to lower bone mineral density (BMD) and increase fracture risk post-surgery [21,28-31]. Moreover, osteoporosis increases the risk of complications, such as aseptic loosening (which leads to nearly half of the indications for the revision of primary arthroplasties), periprosthetic fracture [22, 32], and the complications secondary to implant or bone union failure (including proximal junctional failure and pseudoarthrosis) [16]. In arthroplasty, the bone-implant interface needs to endure high shear stress of physiological loading. Hence, poor quality of peri-implant bone may jeopardize the initial stability of cementless stems and also the long-term success of osseointegration worsening postsurgical outcomes [33,34]. BMD is one of the main determinants of postsurgical outcomes in patients undergoing spine fusion operations with instrumentation [3,35]. Osteopenia and osteoporosis can adversely impact outcomes in elective spine surgery by affecting screw pull-out to fusion rates [36]. As the ability of screws to resist pullout from bone is directly related to BMD [3,37] an osteoporotic spine considerably lengthens fusion rates, resulting in longer operative time and increased postoperative time for recovery [3,38]. Thus, the consequences of untreated osteoporosis in patients undergoing joint arthroplasty and spinal procedures can be dire, ranging from poor surgical outcomes to increased mortality rates following a fracture [22,36].