Best Practice Guidelines for Assessment and Management of Osteoporosis in Adult Patients Undergoing Elective Spinal Reconstruction

Zeeshan M. Sardar, Och Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY.
Josephine R. Coury, Och Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY.
Meghan Cerpa, Och Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY.
Christopher J. DeWald, Rush University Medical Center, Chicago, IL.
Christopher P. Ames, University of California, San Francisco, CA.
Christopher Shuhart, Swedish Physicians Bone Health and Osteoporosis Center, Seattle, WA.
Colleen Watkins, West Virginia University School of Medicine, J.W. Ruby Memorial Hospital, WV.
David W. Polly, University of Minnesota, MN.
Douglas R. Dirschl, University of Chicago, Chicago, IL.
Eric O. Klineberg, University of California, Davis, CA.
John R. Dimar, Norton Leatherman Spine, University of Louisville, Louisville, KY.
Kelly D. Krohn, The CORE Institute, University of Arizona, AZ.
Khaled M. Kebaish, Johns Hopkins University, Baltimore, MD.
Laura L. Tosi, Children's National Hospital, George Washington University, WA.
Michael Kelly, Washington University in St. Louis, St. Louis, MO.
Nancy E. Lane, University of California, Davis, CA.
Neil C. Binkley, University of Wisconsin-Madison, Madison, WI.
Sigurd H. Berven, University of California, San Francisco, CA.
Nathan J. Lee, Och Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY.
Paul Anderson, University of Wisconsin, WI.
Peter D. Angevine, Och Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY.
Ronald A. Lehman, Och Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY.
Lawrence G. Lenke, Och Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY.

Document Type

Journal Article

Publication Date

1-15-2022

Journal

Spine

Volume

47

Issue

2

DOI

10.1097/BRS.0000000000004268

Abstract

STUDY DESIGN: Expert consensus study. OBJECTIVE: This expert panel was created to establish best practice guidelines to identify and treat patients with poor bone health prior to elective spinal reconstruction. SUMMARY OF BACKGROUND DATA: Currently, no guidelines exist for the management of osteoporosis and osteopenia in patients undergoing spinal reconstructive surgery. Untreated osteoporosis in spine reconstruction surgery is associated with higher complications and worse outcomes. METHODS: A multidisciplinary panel with 18 experts was assembled including orthopedic and neurological surgeons, endocrinologists, and rheumatologists. Surveys and discussions regarding the current literature were held according to Delphi method until a final set of guidelines was created with over 70% consensus. RESULTS: Panelists agreed that bone health should be considered in every patient prior to elective spinal reconstruction. All patients above 65 and those under 65 with particular risk factors (chronic glucocorticoid use, high fracture risk or previous fracture, limited mobility, and eight other key factors) should have a formal bone health evaluation prior to undergoing surgery. DXA scans of the hip are preferable due to their wide availability. Opportunistic CT Hounsfield Units of the vertebrae can be useful in identifying poor bone health. In the absence of contraindications, anabolic agents are considered first line therapy due to their bone building properties as compared with antiresorptive medications. Medications should be administered preoperatively for at least 2 months and postoperatively for minimum 8 months. CONCLUSION: Based on the consensus of a multidisciplinary panel of experts, we propose best practice guidelines for assessment and treatment of poor bone health prior to elective spinal reconstructive surgery. Patients above age 65 and those with particular risk factors under 65 should undergo formal bone health evaluation. We also established guidelines on perioperative optimization, utility of various diagnostic modalities, and the optimal medical management of bone health in this population.Level of Evidence: 5.

Department

Pediatrics

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