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Purpose <p>Though the use of anabolic bone agents has proven effective in adult spinal deformity (ASD) surgery, prescription and approval of these medications remains a challenge. In osteopenic/osteoporotic patients undergoing ASD surgery, we sought to determine the impact of a bone optimization clinic on: (1) prescription patterns of anabolic agents, (2) mechanical complications, and (3) reoperation.</p> Methods <p>A retrospective cohort study (2009–23) was performed for osteopenic/osteoporotic patients undergoing ASD surgery with ≥ 2-year follow-up. The study period was binarized into before/after a bone optimization clinic was established (2009–19 vs. 2020–23). The primary outcomes were: (1) use of anabolic agents prior to surgery (Teriparatide, Abaloparatide, and Romosozumab-aqqg), (2) mechanical complications, and (3) reoperation. Multivariable regression controlling for age, sex, body mass index, and operative time was performed.</p> Results <p>Of 126 patients (mean age 68 ± 10yrs; 86% female) undergoing ASD surgery with osteopenia (80%) or osteoporosis (20%), 91 (72%) were before the bone optimization clinic and 35 (28%) were after. Similar rates of osteoporosis in both groups were seen (pre-21% vs. post-17%, <i>p</i> = 0.638). After the bone optimization clinic, more patients received preoperative anabolic therapy (54% vs. 23%, <i>p</i> &lt; 0.001) and for a longer duration (98 ± 156 vs. 40 ± 109&#xa0;days, <i>p</i> = 0.027). Overall mechanical complications decreased significantly (49% vs 81%, <i>p</i> &lt; 0.001) as did reoperation for mechanical complications (6% vs. 44%, <i>p</i> &lt; 0.001). Multivariable regression showed that a bone optimization clinic independently improved the use of preoperative anabolic agents (OR = 5.3, 95%CI:2.1–13.4, <i>p</i> &lt; 0.001) and reduced the risk of mechanical complications (OR = 0.2 95%CI:0.1–0.5, <i>p</i> &lt; 0.001) and reoperation for mechanical complications (OR = 0.1, 95%CI:0.1–0.4, <i>p</i> &lt; 0.001).</p> Conclusion <p>In osteopenic/osteoporotic patients undergoing ASD surgery, a bone optimization clinic was independently associated with increased prescription rates and duration of anabolic bone agents, reduced mechanical complications, and reduced reoperation for mechanical complications.</p>

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A bone optimization rheumatology clinic increases anabolic bone agent use and reduces mechanical complications in adult spinal deformity surgery

  • 期刊论文

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  • 发表日期：

    2026年2月14日

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  • Harsh Jain,
  • Advith Sarikonda,
  • Ranbir Ahluwalia,
  • Omar Zakieh,
  • Austin Montgomery,
  • Walter Navid,
  • Philip Raj,
  • Clayton R. Baker,
  • Hani Chanbour,
  • Iyan Younus,
  • Tyler Zeoli,
  • Soren Jonzzon,
  • Autumn Zuckerman,
  • S. Bobo Tanner,
  • Julian G. Lugo-Pico,
  • Amir M. Abtahi,
  • Byron F. Stephens,
  • Scott L. Zuckerman

摘要

Purpose

Though the use of anabolic bone agents has proven effective in adult spinal deformity (ASD) surgery, prescription and approval of these medications remains a challenge. In osteopenic/osteoporotic patients undergoing ASD surgery, we sought to determine the impact of a bone optimization clinic on: (1) prescription patterns of anabolic agents, (2) mechanical complications, and (3) reoperation.

Methods

A retrospective cohort study (2009–23) was performed for osteopenic/osteoporotic patients undergoing ASD surgery with ≥ 2-year follow-up. The study period was binarized into before/after a bone optimization clinic was established (2009–19 vs. 2020–23). The primary outcomes were: (1) use of anabolic agents prior to surgery (Teriparatide, Abaloparatide, and Romosozumab-aqqg), (2) mechanical complications, and (3) reoperation. Multivariable regression controlling for age, sex, body mass index, and operative time was performed.

Results

Of 126 patients (mean age 68 ± 10yrs; 86% female) undergoing ASD surgery with osteopenia (80%) or osteoporosis (20%), 91 (72%) were before the bone optimization clinic and 35 (28%) were after. Similar rates of osteoporosis in both groups were seen (pre-21% vs. post-17%, p = 0.638). After the bone optimization clinic, more patients received preoperative anabolic therapy (54% vs. 23%, p < 0.001) and for a longer duration (98 ± 156 vs. 40 ± 109 days, p = 0.027). Overall mechanical complications decreased significantly (49% vs 81%, p < 0.001) as did reoperation for mechanical complications (6% vs. 44%, p < 0.001). Multivariable regression showed that a bone optimization clinic independently improved the use of preoperative anabolic agents (OR = 5.3, 95%CI:2.1–13.4, p < 0.001) and reduced the risk of mechanical complications (OR = 0.2 95%CI:0.1–0.5, p < 0.001) and reoperation for mechanical complications (OR = 0.1, 95%CI:0.1–0.4, p < 0.001).

Conclusion

In osteopenic/osteoporotic patients undergoing ASD surgery, a bone optimization clinic was independently associated with increased prescription rates and duration of anabolic bone agents, reduced mechanical complications, and reduced reoperation for mechanical complications.