Association of Osteoporosis and Bone-Strengthening Medications with Postoperative Outcomes Following Transforaminal Lumbar Interbody Fusion.

BACKGROUND

Osteoporosis increases the risk of postoperative complications and reoperation following spinal fusion due to reduced bone quality. Bone-strengthening medications are frequently employed to mitigate these risks. This study evaluates the impact of osteoporosis and osteoporosis medications on the incidence of additional spine surgeries and postoperative complications following lumbar fusion.

METHODS

We conducted a retrospective cohort study using a national database of patients who underwent transforaminal lumbar interbody fusion between 2010 and April 2023. Patients were exactly matched 1:1 for age, gender, and comorbidities. Osteoporosis medications included bisphosphonates (alendronate, ibandronate, and risedronate), parathyroid hormone analogs (teriparatide and abaloparatide), and monoclonal antibodies (denosumab and romosozumab). Logistic regression and Kaplan-Meier survival compared rates of additional spine surgeries and postoperative complications and assessed the effect of osteoporosis medications.

RESULTS

After matching, 24,145 patients with and without osteoporosis were identified. Osteoporosis patients had a higher incidence of all-cause need for additional spine surgery (odds ratio [OR] = 1.40; 95% confidence interval [CI]: 1.28-1.53). Although medication effects did not reach statistical significance, teriparatide (OR = 1.06; 95% CI: 0.41-2.21), abaloparatide (OR = 3.04; 95% CI: 0.71-8.95), and denosumab (OR = 1.35; 95% CI: 0.33-3.70) demonstrated moderate change in risk for reoperation. Osteoporosis patients had higher rates of urinary tract infections (OR = 1.18; 95% CI: 1.08-1.29), pneumonia (OR = 1.25; 95% CI: 1.07-1.45), and deep vein thrombosis (OR = 1.40; 95% CI: 1.16-1.69).

CONCLUSIONS

Osteoporosis is linked to higher reoperation and medical complications following lumbar fusion. Although osteoporosis medications did not significantly alter reoperation risk, their potential role in perioperative optimization requires further investigation.