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

Zeeshan M Sardar 1, Josephine R Coury 1, Meghan Cerpa 1, Christopher J DeWald 2, Christopher P Ames 3, Christopher Shuhart 4, Colleen Watkins 5, David W Polly 6, Douglas R Dirschl 7, Eric O Klineberg 8, John R Dimar 9, Kelly D Krohn 10, Khaled M Kebaish 11, Laura L Tosi 12, Michael Kelly 13, Nancy E Lane 8, Neil C Binkley 14, Sigurd H Berven 3, Nathan J Lee 1, Paul Anderson 15, Peter D Angevine 1, Ronald A Lehman 1, Lawrence G Lenke 1

Erratum in

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

[No authors listed]
Spine (Phila Pa 1976). 2022 Sep 1;47(17):E581. doi: 10.1097/BRS.0000000000004450. Epub 2022 Aug 11.
PMID: 35960933 No abstract available.


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.

Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

Comment in

Letter to the Editor concerning “Best Practice Guidelines for Assessment and Management of Osteoporosis in Adult Patients Undergoing Elective Spinal Reconstruction”.
Keaveny TM.
Spine (Phila Pa 1976). 2022 May 15;47(10):E466-E467. doi: 10.1097/BRS.0000000000004323. Epub 2022 Jan 19.
PMID: 35066536 No abstract available.
In Response to a Letter to the Editor.
Coury JR, Sardar ZM.
Spine (Phila Pa 1976). 2022 May 15;47(10):E467-E468. doi: 10.1097/BRS.0000000000004321. Epub 2022 Feb 22.
PMID: 35193999 No abstract available.


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