Treating Osteoporosis in Spine Surgery Patients

Peer Reviewed

Patients presenting for spine surgery evaluation at a spine center had a high level of osteoporosis knowledge and were willing to see an osteoporosis specialist should they require osteoporosis treatment, according to survey findings published in the December 21 issue of the International Journal of Spine Surgery. Given that osteoporosis is associated with poor outcomes and an increased risk for complications in spinal surgery, the findings suggest that pre- or post-operative osteoporosis treatment may be well-accepted in patients undergoing spine surgery.
Illustration of osteoporosis bone structure magnified.The increasing population raises the issue of osteoporosis, understanding bone health, metabolic conditions and their effects on spinal surgery. Photo Source:“This study brings to light the fact that there is more knowledge and understanding of osteoporosis in the population especially when compared to the original study of the Facts on Osteoporosis Quiz (FOOQ) in 1998,” said senior author Ronald A. Lehman, Jr, MD, who is Professor of Orthopaedic Surgery with Tenure, Co-Director of Spinal Deformity and Scoliosis Surgery, and Chief of Degenerative, Robotic and Minimally Invasive Spine Surgery. “With the increasing population in the world, the issue of osteoporosis and bone health is increasing in importance. There have been many published studies on the treatment and understanding of bone metabolic conditions, and their effects on spinal surgery.”

Osteoporosis is present in nearly 50% of women and 14% of men undergoing lumbar spinal fusion, and increases the risk for complications in patients undergoing spinal instrumentation (eg, fractures and loosening of screws), according to previous research.1,2

Study Design

To evaluate the level of osteoporosis knowledge among patients presenting for initial surgical evaluation, researchers surveyed 63 patients presenting to a large multi-provider academic spine hospital on their level of osteoporosis knowledge using the FOOQ. Approximately half of the patients (n=29) were given patient education prior to the survey consisting of an information packet by the International Osteoporosis Foundation that provided basic information about bone health and osteoporosis. The other 34 patients were not given an educational intervention (nonintervention group).

The average age of the overall group was 54 years, 33 (52%) were female, and 59 (82%) had a college or advanced degree. Approximately half of the patients in the overall group (51%) were seeking consultation for lower back/lumbar spine issues. No significant demographic differences were found between the two groups.

Mean FOOQ scores were slightly higher in the intervention group than the nonintervention group (16.37 versus 15.62), but the difference was not statistically significant (P=.12). These scores equated to 82% and 78% correct answers in the intervention and nonintervention groups, respectively.

A majority of the overall group (60%) was “definitely” or “probably” interested in seeing an osteoporosis specialist, and 61% thought they could benefit from seeing an osteoporosis specialist. Reponses to these questions were similar in the intervention and nonintervention group.

When asked whether the findings might be different in a less educated population, Dr. Lehman said “It is quite possible that the level of understanding of osteoporosis would be less in lower education demographic, however, the number of commercials and marketing from the pharmaceutical companies for medications and the increased awareness and surveys among primary care physicians continues to expand the populations’ understanding. It appears that for people who seek routine and preventive Medicare care, the awareness of osteoporosis is quite high.”

Experts Weigh in on Pre-operative Osteoporosis Treatment

“There is no absolute timing for the treatment of osteoporosis for spine surgery, however, we have published several studies outlining the treatment for osteopenia and osteoporosis over the past decade,” Dr. Lehman told SpineUniverse.3-7 “These papers provide us with good overall guidelines to help our patients navigate their bone health. We recommend consultation with an endocrinologist for anyone undergoing a major spinal reconstruction, and generally prefer them to be placed on one of the anabolic osteoporosis medications for 3 to 6 months prior to undergoing these large, elective surgeries.”

Commenting on the findings, Isador H. Lieberman, MD, MBA, FRCSC, said that all at-risk patients or patients older than age 65 years who present to Texas Back Institute are evaluated for osteoporosis. “If we diagnose osteoporosis, we initiate treatment prior to any surgical intervention,” he told SpineUniverse.

“The treatment is dependent on the etiology of their osteoporosis and their bone metabolic state,” said Dr. Lieberman, who is an Orthopaedic and Spinal Surgeon at Texas Back Institute in Plano, Texas. “Patients undergo a series of evaluations, including blood work, to determine the best intervention and the length of time prior to surgery that is needed for adequate treatment.”

Despite the high rate of patient knowledge of osteoporosis found in this study, Dr. Lieberman suggests that clinicians should still assume that their patients’ knowledge is limited and should explain osteoporosis to all patients presenting for spine surgery.

He encouraged spine surgeons to “take osteoporosis seriously, treat appropriately. It is the correct thing to do.”

Dr. Lieberman has no relevant disclosures.
Dr. Lehman is a consultant for Medtronic, is on the Medical Advisory Board for DePuy Synthes Spine, and is on the Speakers Bureau for Medtronic, Stryker, and DePuy Synthes Spine

Updated on: 03/13/19
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Ronald A. Lehman, Jr., MD
Professor of Orthopaedic Surgery, Tenure
Columbia University
Isador H. Lieberman, MD, MBA, FRCSC
Orthopaedic and Spinal Surgeon
Texas Back Institute

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