ABSTRACT
Osteoporosis is associated with a capacious humeral canal with poor structural quality of the trabecular bone of the metaphysis. This reduces the hod of press-fit components and at the same time the risk of periprosthetic fracture during insertion is increased. Osteoporosis also increases the risk of proximal humeral fracture and in cases of fracture dislocation and head-splitting fracture, shoulder replacement may be indicated. However anatomic total shoulder in cases of trauma has poor result, often related to early glenoid loosening. These issues can be managed in many individuals by using a reverse geometry total shoulder replacement, which is now the commonest form of shoulder replacement carried out worldwide. Although osteoporosis affects proximal humeral structure, it has much less effect on the glenoid, this being one reason why reverse geometry total shoulder replacement is becoming the procedure of choice in the elderly with osteoporosis and/or rotator cuff disease.
