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Objectives and questions: Osteoporosis and osteoarthritis are two common conditions frequently observed in older adults. Both skeletal disorders represent a major public health challenge due to their substantial morbidity and mortality. The aim of this study was to evaluate the relationship between the anatomical location of osteoarthritis and the presence of osteoporosis.

Material and methods: We conducted a descriptive, cross-sectional, and analytical study with prospective recruitment of patients presenting with severe primary knee or hip osteoarthritis who were candidates for total joint arthroplasty. All patients underwent a detailed interview and a comprehensive clinical examination. Bone status was assessed using dual-energy X-ray absorptiometry (DXA) at the hip and lumbar spine. Results were interpreted according to the WHO classification.

Results: Over a 2-year period, 300 patients were included: 65 with severe hip osteoarthritis and 235 with severe knee osteoarthritis. The sex ratio was 0.45, the mean age was 67.97 ± 6.78 years, and the mean BMI was 30.81 ± 5.37 kg/m². Overall, 26.7% (95% CI: 21.7%–32.1%) of patients were osteoporotic, 43.7% (95% CI: 38.0%–49.5%) were osteopenic, and 29.7% (95% CI: 24.6%–65.2%) had normal bone density. Among patients with hip osteoarthritis, 28.5% were osteoporotic, while 20% of those with knee osteoarthritis were also osteoporotic. No association was found between bone status and the site of osteoarthritis.

Discussion and conclusions: In this cohort of arthroplasty candidates, osteoporosis and osteopenia were highly prevalent, confirming the frequent coexistence of altered bone density in patients with advanced osteoarthritis. However, bone status did not differ between hip and knee osteoarthritis, indicating that the anatomical site of OA is not influenced by bone mineral density. These findings align with literature showing a complex and variable relationship between OA and osteoporosis, driven by mechanical, metabolic, and age-related factors. The uniform severity of OA in our sample may also explain the absence of an association. Given the high rate of low bone density, systematic DXA assessment remains essential in all arthroplasty candidates to optimize perioperative care and reduce fracture risk.