Prevalence of Poor Bone Quality in Patients Undergoing Spine Surgery: A Comprehensive Approach

Area of Science:

• Orthopedics and Spine Surgery
• Metabolic Bone Disease

Background:

• Osteoporosis and osteopenia are prevalent in patients undergoing spine surgery.
• Assessing bone quality preoperatively is critical for surgical outcomes.
• Vitamin D deficiency is common in this patient population.

Purpose of the Study:

• To determine the prevalence of poor bone quality in patients over 50 scheduled for spine surgery.
• To evaluate the utility of bone mass density (BMD), trabecular bone score (TBS), FRAX, and vitamin D status in assessing bone quality.

Main Methods:

• A cross-sectional study involving 104 patients aged over 50 undergoing lumbar or cervical spine fusion.
• Data collected included demographics, BMI, osteoporosis risk factors, calcium intake, FRAX score, disability indices, and pain scores (VAS).
• Bone quality was assessed using BMD (DXA), TBS, and serum 25 OH vitamin D levels.

Main Results:

• Osteoporosis was detected in 9.6% and osteopenia in 34.6% of patients by BMD.
• 79.8% of patients had low vitamin D levels.
• Combining BMD and TBS identified 33.7% of patients with poor bone quality; BMD, TBS, and FRAX identified 37.5%.

Conclusions:

• Poor bone quality and vitamin D deficiency are highly prevalent in older adults undergoing spine surgery.
• Dual-energy X-ray absorptiometry (DXA) alone is insufficient for preoperative assessment of bone quality.
• TBS is a valuable tool to complement DXA, and FRAX aids in identifying high-risk individuals.