Consensus-Based Guidance for Bone Health Optimization in Spine Surgery
Author(s)
Weerasak Singhatanadgige, MD, MS1, Sirinthip Petcharapiruch, BSc, MSc2, Supitchaya Changsatja, PharmD, MA2, Thanut Valleenukul, MD3, Wicharn Yingsakmongkol, MD1.
1Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand, 2Real World Solutions, IQVIA, Bangkok, Thailand, 3Department of Orthopedic Surgery, Bhumibol Adulyadej Hospital, Bangkok, Thailand.
1Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand, 2Real World Solutions, IQVIA, Bangkok, Thailand, 3Department of Orthopedic Surgery, Bhumibol Adulyadej Hospital, Bangkok, Thailand.
OBJECTIVES: To develop consensus-based guidance for bone health optimization (BHO) in instrumented spine surgery, aimed at promoting optimal postoperative outcomes and reducing osteoporosis-related complications (ORCs).
METHODS: The study utilized a modified Delphi technique, engaging ten orthopedic surgeons from Thailand with expertise in complex spine surgery and osteoporosis management. A targeted literature review was conducted followed by two online surveys, and a face-to-face consensus meeting to develop and refine the statements. 25 main statements and 45 sub-statements, focusing on patient evaluation, assessment tools, and risk stratification were drafted for the panel’s deliberation.
RESULTS: There was unanimous agreement on the necessity of evaluating bone health before instrumented spine surgery in patients aged ≥60 years, while evaluation was considered optional for those aged 50-59 years. The panelists supported using the FRAX score for clinical evaluation and recommended using several assessment tools, including DXA scans for specific age groups, CT-HU, TBS, and VFA for bone health evaluation if available. Treatment recommendations included bone-forming agents as the first-line therapy for high-risk and very high-risk patients and specialized surgical techniques for very high-risk patients. Surgical delay of at least 3 months should also be considered for very high-risk/severe osteoporosis patients who had been scheduled for instrumented spine surgery.
CONCLUSIONS: This guidance includes patient screening, evaluation, and treatment of the patient with poor bone health based on risk stratification, including normal/low-risk, osteopenia/intermediate-risk, osteoporosis/high-risk, and severe osteoporosis/very high-risk. Spine surgeons should be aware of poor bone health and consider BHO to improve surgical outcomes and prevent ORCs.
METHODS: The study utilized a modified Delphi technique, engaging ten orthopedic surgeons from Thailand with expertise in complex spine surgery and osteoporosis management. A targeted literature review was conducted followed by two online surveys, and a face-to-face consensus meeting to develop and refine the statements. 25 main statements and 45 sub-statements, focusing on patient evaluation, assessment tools, and risk stratification were drafted for the panel’s deliberation.
RESULTS: There was unanimous agreement on the necessity of evaluating bone health before instrumented spine surgery in patients aged ≥60 years, while evaluation was considered optional for those aged 50-59 years. The panelists supported using the FRAX score for clinical evaluation and recommended using several assessment tools, including DXA scans for specific age groups, CT-HU, TBS, and VFA for bone health evaluation if available. Treatment recommendations included bone-forming agents as the first-line therapy for high-risk and very high-risk patients and specialized surgical techniques for very high-risk patients. Surgical delay of at least 3 months should also be considered for very high-risk/severe osteoporosis patients who had been scheduled for instrumented spine surgery.
CONCLUSIONS: This guidance includes patient screening, evaluation, and treatment of the patient with poor bone health based on risk stratification, including normal/low-risk, osteopenia/intermediate-risk, osteoporosis/high-risk, and severe osteoporosis/very high-risk. Spine surgeons should be aware of poor bone health and consider BHO to improve surgical outcomes and prevent ORCs.
Conference/Value in Health Info
2025-09, ISPOR Real-World Evidence Summit 2025, Tokyo, Japan
Value in Health Regional, Volume 49S (September 2025)
Code
RWD51
Topic Subcategory
Distributed Data & Research Networks
Disease
SDC: Musculoskeletal Disorders (Arthritis, Bone Disorders, Osteoporosis, Other Musculoskeletal)