The relationship of thromboembolic complications after arthroplasty of joints with low bone density in the context of pathogenesis and pharmacoprophylaxis

postoperative venous thromboembolic complications remain one of the main causes of death and disability in patients undergoing total knee and hip replacement in the Russian Federation. At the same time, the high prevalence of osteoporosis and osteopenia in this cohort forms an intersection of pathogenetic mechanisms that combine bone remodeling disorders and activation of the hemostasis system. The purpose of this literature review is to systematize domestic and foreign data on the association of low bone mineral density with the risk of thromboembolic events, characterize the molecular and cellular processes responsible for this interaction, and critically analyze pharmacoprophylactic strategies recommended by Russian clinical guidelines. To prepare the article, we conducted an extended search for publications from 2005-2025 in the databases of eLibrary, RSCI, PubMed and Web of Science, as well as an analysis of the national recommendations of the Association of Orthopedic Traumatologists of Russia, the Association of Phlebologists of Russia and the Russian Association for Osteoporosis. The results demonstrate that the presence of osteoporosis increases the relative risk of symptomatic venous thrombosis after joint replacement by 60-80% in the absence of an adapted anticoagulant regimen, and direct factor Xa inhibitors are comparable in effectiveness to low-molecular-weight heparins, but safer for bone metabolism. Comprehensive consideration of densitometric parameters when choosing thromboprophylaxis is a promising area of personalized orthopedic care.

joint replacement, low bone mineral density, venous thromboembolism, osteoporosis, pharmacoprophylaxis, Russian clinical guidelines