A surgical procedure to deliver a triphasic calcium-based implant material to address local bone loss and strengthen an osteoporotic proximal femur: a case report

Abstract

Bone loss associated with the systemic skeletal disease osteoporosis results in weakened or fragile bone, the most serious consequence of which is fracture. A 67-year-old post-menopausal Caucasian woman presented with a diagnosis of osteoporosis by FRAX and DXA and a history of a fragility hip fracture. The patient was classified according to the latest guidance document for treating patients with post-menopausal osteoporosis from the International Osteoporosis Foundation and European Society for Clinical and Economic Aspects of Osteoporosis. The patient was at very high risk for major osteoporotic fracture, including hip fracture. This case report describes the use of a minimally invasive surgical procedure to address bone loss in the proximal femur associated with osteoporosis. Local osteo-enhancement procedure (LOEP), a minimally invasive surgical procedure, was performed using a triphasic calcium-based implant material, AGN1. LOEP was carried out under general anesthesia and fluoroscopic navigation. The area of bone loss in the proximal femur, the enhancement site, was identified, debrided, and irrigated to prepare it for low-pressure filling with AGN1 implant material. The patient recovered from the procedure without incident and was discharged without activity limitations after an overnight stay. X-ray imaging and DXA scans were used to evaluate implant material resorption and replacement with bone over a 3.25-year follow up. A significant and sustained increase in femoral neck and total hip BMD was observed (pre vs 3.25 years post-procedure: 0.546 vs 1.031 gm/cm2 and 0.628 vs 0.96 gm/cm2, respectively), which corresponded to a change in the patient’s T-score from the osteoporosis range to normal. Based on the use of T-scores to measure the risk of fragility fractures, and acknowledging the well-published limitations of doing so, the hip fracture risk of this patient was reduced from very high to low. This case report documents the use of this minimally invasive, targeted procedure to address hip fragility fracture (the most serious issue in the systemic disease osteoporosis), with AGN1 implant material used to replace bone lost in the proximal femur.