Osteoporosis Management in Spine Surgery: Strategies for Optimizing Bone Health

Osteoporosis, which causes decreased bone mass and micro-architectural disorganization, greatly elevates the rate of complications in spine surgery, such as screw loosening, implant failure, compromised fusion, and revision surgery. With more than 200 million people suffering from it across the globe, immediate diagnosis and treatment are necessary to help lessen the disease’s global burden. New evidence indicates that focused pharmacologic treatments like bisphosphonates, denosumab, and anabolic drugs (teriparatide, abaloparatide, and romosozumab) increase bone mineral density, augment implant stability, and decrease the risk of vertebral fractures. Acute fracture pain may be relieved in the short term by calcitonin, while procedures like vertebral augmentation or kyphoplasty are helpful to some patients. Preoperative diagnosis and treatment of low bone mass using medical therapy, vitamin D and calcium supplementation, and multidisciplinary management enhance outcomes from surgery. Recent evidence indicates that combining anti-osteoporotic treatment with minimally invasive fixation methods and cement augmentation approaches lowers hardware failure and hastens fusion. This chapter summarizes contemporary evidence favoring active osteoporosis treatment to maximize outcomes following spinal surgery and reduce rates of complications.