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Thai Expert Consensus on Bone Health Optimization for Instrumented Spine Surgery
Weerasak Singhatanadgige1,2, Thanut Valleenukul3, Worawat Limthongkul1,2
1Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
International Journal of Spine Surgery
|November 3, 2025
Summary
Optimizing bone health before instrumented spine surgery is crucial for better outcomes. This guidance helps surgeons screen, evaluate, and treat patients with poor bone health to prevent complications.
Area of Science:
- Orthopedics
- Spine Surgery
- Bone Health
Background:
- Limited guidance exists for bone health optimization in instrumented spine surgery, particularly in Thailand.
- Poor bone health can negatively impact surgical outcomes and increase complication rates.
Purpose of the Study:
- To develop consensus-based guidance for optimizing bone health in patients undergoing instrumented spine surgery.
- To address the specific needs and context of the Thai healthcare system.
Main Methods:
- Modified Delphi technique involving 10 Thai orthopedic surgeons.
- Literature review, online surveys, and a face-to-face consensus meeting.
- Development of 25 main statements and 45 substatements on patient evaluation, assessment, and risk stratification.
Main Results:
- Unanimous agreement on bone health evaluation for patients aged ≥60 years; optional for 50-59 years.
- Recommended assessment tools include fracture risk assessment tool, DEXA scans, CT Hounsfield Unit, Trabecular Bone Score, and VFA.
- Treatment strategies include bone-forming agents for high-risk patients and specialized surgical techniques or delays for very high-risk patients.
Conclusions:
- Consensus-based guidance covers screening, evaluation, and treatment for various risk strata of poor bone health.
- Spine surgeons should integrate bone health optimization into pre-operative protocols.
- Optimizing bone health improves surgical outcomes and minimizes osteoporosis-related complications in instrumented spine surgery.
