A Review and Clinical Perspective of the Impact of Osteoporosis on the Spine

Abstract

Introduction: Osteopenia and osteoporosis are common conditions in the United States. The health consequences of low bone density can be dire, from poor surgical outcomes to increased mortality rates following a fracture. Significance: This article highlights the impact low bone density has on spine health in terms of vertebral fragility fractures and its adverse effects on elective spine surgery. It also reviews the clinical importance of bone health assessment and optimization. Results: Vertebral fractures are the most common fragility fractures with significant consequences related to patient morbidity and mortality. Additionally, a vertebral fracture is the best predictor of a subsequent fracture. These fractures constitute sentinel events in osteoporosis that require further evaluation and treatment of the patient’s underlying bone disease. In addition to fractures, osteopenia and osteoporosis have deleterious effects on elective spine surgery from screw pullout to fusion rates. Adequate evaluation and treatment of a patient’s underlying bone disease in these situations have been shown to improve patient outcomes. Conclusion: With an increased understanding of the prevalence of low bone mass and its consequences as well an understanding of how to identify these patients and appropriately intervene, spine surgeons can effectively decrease the rates of adverse health outcomes related to low bone mass.

Factors affecting postoperative mortality of patients with insufficient union following osteoporotic vertebral fractures and impact of preoperative serum albumin on mortality

“…Despite conservative treatment, the prevalence of an insufficient bone union among elderly patients with OVF reportedly ranges from 10.0 to 13.5%. The quality of life and activities of daily living of these patients may be reduced severely [ 6 , 7 ]. Despite the various surgical procedures proposed for the management of an insufficient bone union following OVF, optimal surgical procedures have not yet been clearly established.…”

Strategies to Achieve Spinal Fusion in Multilevel Anterior Cervical Spine Surgery: An Overview

“…Appropriate pre-operative bone health studies in patients at high risk of osteoporosis include metabolic bone health panels (vitamin D, parathyroid hormone, thyroid-stimulating hormone, albumin, and pre-albumin levels) and dual-energy X-ray absorptiometry (DEXA) scans to evaluate bone mineral density. Quantitative computed tomography (qCT) can be used as an alternative [9]. In the setting of multilevel anterior cervical fusion, optimizing bone health can pay dividends as some of these metabolic abnormalities, such as vitamin D deficiency, can be reversed, promoting higher fusion rates [1, 33].…”

Factors affecting postoperative survival of patients with insufficient union following osteoporotic vertebral fractures and impact of preoperative serum albumin on mortality

“…The quality of life and activities of daily living of these patients are reduced severely. [6,7] Despite the various surgical procedures proposed for the management of an insufficient bone union following OVF, optimal surgical procedures have not yet been clearly established. This is because of the poor general condition and frequent instrumentation failure resulting from low bone quality in elderly patients.…”