J Korean Orthop Assoc.  2019 Feb;54(1):18-23. 10.4055/jkoa.2019.54.1.18.

Perioperative Medical Treatment to Improve Surgical Outcomes: Management of Osteoporosis

• Shin HK
• Lee JW
• Song SC

• KMID: 2438953
• DOI: http://doi.org/10.4055/jkoa.2019.54.1.18

Abstract

As the population grows older and medical treatments are advancing, the number of spine surgeries in elderly patients has been increasing. To obtain a successful outcomes of spine surgery in elderly patients, surgeons should prepare meticulously because elderly patients can have osteoporosis and surgery can be more extensive than in younger patients. Therefore, this study reviewed the perioperative medical treatment, particularly for osteoporosis, to improve the surgical outcomes in elderly patients.

Keyword

osteoporosis; elderly; spine surgery; medical treatment; perioperative

MeSH Terms

Aged
Humans
Osteoporosis*
Spine
Surgeons

Reference

1. Manson NA, Phillips FM. Minimally invasive techniques for the treatment of osteoporotic vertebral fractures. J Bone Joint Surg Am. 2006; 88:1862–1872.

2. Malmivaara A, Slätis P, Heliövaara M, et al. Surgical or nonoperative treatment for lumbar spinal stenosis? A randomized controlled trial. Spine (Phila Pa 1976). 2007; 32:1–8.

3. Ritter MA, Albohm MJ, Keating EM, Faris PM, Meding JB. Life expectancy after total hip arthroplasty. J Arthroplasty. 1998; 13:874–875.

4. DeWald CJ, Stanley T. Instrumentation-related complications of multilevel fusions for adult spinal deformity patients over age 65: surgical considerations and treatment options in patients with poor bone quality. Spine (Phila Pa 1976). 2006; 31:S144–S151.

5. Meunier PJ, Delmas PD, Eastell R, et al. Diagnosis and management of osteoporosis in postmenopausal women: clinical guidelines. International Committee for Osteoporosis Clinical Guidelines. Clin Ther. 1999; 21:1025–1044.

6. Cherniack EP, Levis S, Troen BR. Hypovitaminosis D: a widespread epidemic. Geriatrics. 2008; 63:24–30.

7. National Osteoporosis Foundation. Calcium and vitamin D are essential for bone health [Internet]. Arlington (VA): National Osteoporosis Foundation;2015. cited 2015 Oct 29. Available from: https://cdn.nof.org/wp-content/uploads/2016/01/1252.pdf.

8. Cho JH, Cho DC, Yu SH, Jeon YH, Sung JK, Kim KT. Effect of dietary calcium on spinal bone fusion in an ovariectomized rat model. J Korean Neurosurg Soc. 2012; 52:281–287.

9. Tang BM, Eslick GD, Nowson C, Smith C, Bensoussan A. Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: a meta-analysis. Lancet. 2007; 370:657–666.

10. Recker RR, Hinders S, Davies KM, et al. Correcting calcium nutritional deficiency prevents spine fractures in elderly women. J Bone Miner Res. 1996; 11:1961–1966.

11. Fu L, Tang T, Miao Y, Hao Y, Dai K. Effect of 1,25-dihydroxy vitamin D3 on fracture healing and bone remodeling in ovariectomized rat femora. Bone. 2009; 44:893–898.

12. Metzger MF, Kanim LE, Zhao L, Robinson ST, Delamarter RB. The relationship between serum vitamin D levels and spinal fusion success: a quantitative analysis. Spine (Phila Pa 1976). 2015; 40:E458–E468.

13. Kim TH, Yoon JY, Lee BH, et al. Changes in vitamin D status after surgery in female patients with lumbar spinal stenosis and its clinical significance. Spine (Phila Pa 1976). 2012; 37:E1326–E1330.

14. Huang RC, Khan SN, Sandhu HS, et al. Alendronate inhibits spine fusion in a rat model. Spine (Phila Pa 1976). 2005; 30:2516–2522.

15. Nagahama K, Kanayama M, Togawa D, Hashimoto T, Minami A. Does alendronate disturb the healing process of posterior lumbar interbody fusion? A prospective randomized trial. J Neurosurg Spine. 2011; 14:500–507.

16. Varenna M, Bertoldo F, Di Monaco M, Giusti A, Martini G, Rossini M. Safety profile of drugs used in the treatment of osteoporosis: a systematical review of the literature. Reumatismo. 2013; 65:143–166.

17. Lehman RA Jr, Dmitriev AE, Cardoso MJ, et al. Effect of teriparatide [rhPTH(1,34)] and calcitonin on intertransverse process fusion in a rabbit model. Spine (Phila Pa 1976). 2010; 35:146–152.

18. Ohtori S, Inoue G, Orita S, et al. Comparison of teriparatide and bisphosphonate treatment to reduce pedicle screw loosening after lumbar spinal fusion surgery in postmenopausal women with osteoporosis from a bone quality perspective. Spine (Phila Pa 1976). 2013; 38:E487–E492.

19. Ohtori S, Orita S, Yamauchi K, et al. More than 6 months of teriparatide treatment was more effective for bone union than shorter treatment following lumbar posterolateral fusion surgery. Asian Spine J. 2015; 9:573–580.

20. Andrews EB, Gilsenan AW, Midkiff K, et al. The US postmarketing surveillance study of adult osteosarcoma and teriparatide: study design and findings from the first 7 years. J Bone Miner Res. 2012; 27:2429–2437.

21. Miller PD. Safety of parathyroid hormone for the treatment of osteoporosis. Curr Osteoporos Rep. 2008; 6:12–16.

22. Murphy DR, Smolen LJ, Klein TM, Klein RW. The cost effectiveness of teriparatide as a first-line treatment for glucocorticoid-induced and postmenopausal osteoporosis patients in Sweden. BMC Musculoskelet Disord. 2012; 13:213.

23. Eastell R, Christiansen C, Grauer A, et al. Effects of denosumab on bone turnover markers in postmenopausal osteoporosis. J Bone Miner Res. 2011; 26:530–537.

24. Cummings SR, San Martin J, McClung MR, et al. Denosumab for prevention of fractures in postmenopausal women with osteoporosis. N Engl J Med. 2009; 361:756–765.

25. Kamimura M, Nakamura Y, Ikegami S, Uchiyama S, Kato H, Taguchi A. Significant improvement of bone mineral density and bone turnover markers by denosumab therapy in bisphosphonate-unresponsive patients. Osteoporos Int. 2017; 28:559–566.

26. Lane JM. Osteoporosis. Medical prevention and treatment. Spine (Phila Pa 1976). 1997; 22:32S–37S.

27. Lempicki KA, Borchert JS. Cancer risk associated with calcitonin use. J Am Geriatr Soc. 2014; 62:2447–2450.

28. Liu Y, Fan Y, Cao D, Zhang J, Wu Z, Qiu G. Calcitonin enhanced lumbar spinal fusion in a New Zealand rabbit model: a study with morphologic and molecular analysis. Spine (Phila Pa 1976). 2012; 37:E139–E146.