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Osteoporosis Screening Gaps Among Patients Undergoing Lumbar Fusion Surgery
Eric Mao1, Krystell E Ceballos-Alvarez, Sydney Thai
1From the Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD.
Background:
Osteoporosis is associated with elevated complication rates after lumbar fusion surgery. Despite this, osteoporosis remains both underscreened and undertreated in the United States. Currently, rates of dual-energy radiograph absorptiometry (DEXA) screening before lumbar fusion surgery are unknown, as is the proportion of patients who, after being diagnosed with osteoporosis, receive appropriate treatment. Therefore, the aim of this study was to assess osteoporosis screening and treatment rates among patients undergoing lumbar fusion surgery.
Methods:
Patients older than 50 years undergoing lumbar fusion for lumbar stenosis with degenerative spondylolisthesis were identified using the TriNetX database. Patients receiving surgery for indications of malignancy or infection, as well as those with diagnoses of osteoporosis before the screening window, were excluded. The prevalence of DEXA scans in the 2 years before fusion was calculated for the overall cohort and for high-risk cohorts defined by Endocrinology Society guidelines. A secondary analysis assessed rates of osteoporosis treatment among patients receiving preoperative DEXA scans.
Results:
Of 46,104 patients who underwent lumbar fusion surgery, only 4.5% of men and 15.6% of women received a preoperative DEXA scan in the 2 years before their fusion. Women were more likely to receive DEXA scans than men (OR, 3.93; 95% CI, 3.64 to 4.23; P < 0.001). Only 5.6% of high-risk men and 17.5% of high-risk women received preoperative DEXA screening. Among patients diagnosed with osteoporosis after DEXA screening, only 11.0% received anabolic therapy and 23.1% received antiresorptive therapy.
Conclusion:
Despite most patients undergoing lumbar fusion being at risk of osteoporosis (and eligible for screening), a small minority were screened using DEXA in the 2 years before surgery. Efforts are warranted to increase the prevalence of DEXA screening so that osteoporosis is appropriately diagnosed and treated before lumbar fusion surgery.