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The potential effect of romosozumab on perioperative management for instrumentation surgery
Koji Ishikawa1,2, Soji Tani1, Tomoaki Toyone1
1Department of Orthopaedic Surgery, School of Medicine Showa University Tokyo Japan.
Background:
Age-related changes in bone health increase the risk for complications in elderly patients undergoing orthopedic surgery. Osteoporosis is a key therapeutic target that needs to be addressed to ensure successful instrumentation surgery. The effectiveness of pharmacological interventions in orthopedic surgery, particularly the new drug romosozumab, is still unknown. We aim to evaluate the effect of 3-month romosozumab treatment on biomechanical parameters related to spinal instrumentation surgery, using the Quantitative Computed Tomography (QCT)-based Finite Element Method (FEM).
Methods:
This open-labeled, prospective study included 81 patients aged 60 to 90 years, who met the osteoporosis criteria and were scheduled for either romosozumab or eldecalcitol treatment. Patients were assessed using blood samples, dual-energy absorptiometry (DXA), and QCT. Biomechanical parameters were evaluated using FEM at baseline and 3 months post-treatment. The primary endpoints were biomechanical parameters at 3 months, while secondary endpoints included changes in regional volumetric bone mineral density around the pedicle (P-vBMD) and vertebral body (V-vBMD).
Results:
Romosozumab treatment led to significant gains in P-vBMD, and V-vBMD compared to eldecalcitol at 3 months. Notably, the romosozumab group showed greater improvements in all biomechanical parameters estimated by FEM at 3 months compared to the eldecalcitol group.
Conclusion:
Romosozumab significantly increased the regional vBMD as well as biomechanical parameters, potentially offering clinical benefits in reducing post-operative complications in patients with osteoporosis undergoing orthopedic instrumentation surgery. This study highlights the novel advantages of romosozumab treatment and advocates further research on its effectiveness in perioperative management.
Insights
Romosozumab significantly improved bone density and biomechanical strength in osteoporosis patients undergoing spinal surgery compared to eldecalcitol. This suggests potential benefits for reducing post-operative complications in orthopedic instrumentation surgery.
Area of Science:
- Orthopedics
- Bone Metabolism
- Pharmacology
Background:
- Osteoporosis increases risks in elderly patients undergoing orthopedic surgery.
- Effective interventions are crucial for successful spinal instrumentation.
- The efficacy of romosozumab in this context requires investigation.
Purpose of the Study:
- To evaluate romosozumab's effect on biomechanical parameters for spinal instrumentation surgery.
- To compare romosozumab with eldecalcitol in osteoporosis patients.
- To assess changes using Quantitative Computed Tomography (QCT) and Finite Element Method (FEM).
Main Methods:
- Open-labeled, prospective study of 81 patients (60-90 years) with osteoporosis.
- Treatment groups: romosozumab or eldecalcitol.
- Assessments included DXA, QCT, and FEM analysis at baseline and 3 months.
Main Results:
- Romosozumab significantly increased pedicle (P-vBMD) and vertebral body (V-vBMD) bone mineral density compared to eldecalcitol.
- FEM analysis showed greater improvements in biomechanical parameters with romosozumab.
Conclusions:
- Romosozumab enhances regional bone density and biomechanical parameters in osteoporosis patients.
- This may reduce post-operative complications in orthopedic instrumentation surgery.
- Further research is recommended for perioperative romosozumab use.
