A retrospective analysis of bone mineral status in patients requiring spinal surgery

Abstract

BackgroundImpaired bone quality is associated with poor outcome of spinal surgery. The aim of the study was to assess the bone mineral status of patients scheduled to undergo spinal surgery and to report frequencies of bone mineral disorders.MethodsWe retrospectively analyzed the bone mineral status of 144 patients requiring spinal surgery including bone mineral density by dual-energy X-ray absorptiometry (DXA) as well as laboratory data with serum levels of 25-hydroxyvitamin D (25-OH-D), parathyroid hormone, calcium, bone specific alkaline phosphate, osteocalcin, and gastrin. High-resolution peripheral quantitative computed tomography (HR-pQCT) was additionally performed in a subgroup of 67 patients with T-Score below − 1.5 or history of vertebral fracture.ResultsAmong 144 patients, 126 patients (87.5%) were older than 60 years. Mean age was 70.1 years. 42 patients (29.1%) had suffered from a vertebral compression fracture. 12 previously undiagnosed vertebral deformities were detected in 12 patients by vertebral fracture assessment (VFA). Osteoporosis was present in 39 patients (27.1%) and osteopenia in 63 patients (43.8%). Only 16 patients (11.1%) had received anti-osteoporotic therapy, while 54 patients (37.5%) had an indication for specific anti-osteoporotic therapy but had not received it yet. The majority of patients had inadequate vitamin D status (73.6%) and 34.7% of patients showed secondary hyperparathyroidism as a sign for a significant disturbed calcium homeostasis. In a subgroup of 67 patients, severe vertebral deformities were associated with stronger deficits in bone microarchitecture at the distal radius compared to the distal tibia.ConclusionsThis study shows that bone metabolism disorders are highly prevalent in elderly patients scheduled for spinal surgery. Vertebral deformities are associated with a predominant deterioration of bone microstructure at the distal radius. As impaired bone quality can compromise surgical outcome, we strongly recommend an evaluation of bone mineral status prior to operation and anti-osteoporotic therapy if necessary.

Human Heterozygous ENPP1 Deficiency Is Associated With Early Onset Osteoporosis, a Phenotype Recapitulated in a Mouse Model of Enpp1 Deficiency

“…To test for disease‐causing genetic variants, DNA was isolated from patients’ peripheral blood and analyzed by a custom‐designed SureSelect XT gene panel (Agilent, Santa Clara, CA, USA) comprising 386 genes associated with changes in bone mass, skeletal dysplasias, dysostoses, or connective tissue diseases as described recently . The pathogenicity of the prioritized variants was judged using PhenIX, which integrates variant scoring by PolyPhen, SIFT, and MutationTaster.…”

“…Bone microstructure of the patients with detected ENPP1 mutation was further analyzed using high-resolution peripheral quantitative computed tomography (HR-pQCT; XtremeCT, Scanco Medical, Bruttisellen, Switzerland) at the nondominant distal radius and tibia in a standardized procedure as previously described using the in vivo protocol. (24,26) Bone geometric parameters included cortical bone area (Ct. bone area, mm 2 ) and trabecular bone area (Tb. bone area, mm 2 ); volumetric bone mineral density (vBMD) measurements included total vBMD (total BMD, mgHA/cm 3 ), cortical BMD (Ct.BMD, mgHA/cm 3 ), and trabecular BMD (Tb.BMD, mgHA/cm 3 ).…”

Should Q-CT Be the Gold Standard for Detecting Spinal Osteoporosis?

“…Low bone mineral density (BMD) associated with conditions requiring surgical intervention has a prevalence ranging from 30% to 70% in the elderly and post-menopausal women. 3 Although the micro-architectural deterioration of bone tissue in osteoporosis is evident in both cortical and cancellous bones, the latter being metabolically more active has higher bone fragility and susceptibility to fracture. 4 Hence, it is more relevant to concentrate on the trabecular component than the integral BMD for spinal osteoporosis.…”

Osteoporosis in Indian Patients Undergoing Elective Arthroplasty and Spinal Procedures: An Observational Study

“…Osteoporosis, a skeletal disorder characterized by reduced bone strength, increased bone fragility, and a greater predisposition to fractures, is a major global public health problem [ 1 , 2 ]. Over 200 million people worldwide suffer from osteoporosis [ 3 , 4 ]. Factors contributing to vitamin D deficiency, such as genetics, darker skin, vegetarianism, and lactose intolerance, have led to a high prevalence of osteoporosis in India [ 5 ].…”