Schmidt Tobias, Ebert Katharina, Rolvien Tim, Oehler Nicola, Lohmann Jens, Papavero Luca, Kothe Ralph, Amling Michael, Barvencik Florian, Mussawy Haider
Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestraße 59, 22529, Hamburg, Germany.
Department of Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
BMC Musculoskelet Disord. 2018 Feb 13;19(1):53. doi: 10.1186/s12891-018-1970-5.
Impaired 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.
We 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.
Among 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.
This 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.
骨质量受损与脊柱手术的不良预后相关。本研究的目的是评估计划接受脊柱手术患者的骨矿物质状况，并报告骨矿物质紊乱的发生率。
我们回顾性分析了144例需要脊柱手术患者的骨矿物质状况，包括通过双能X线吸收法（DXA）测定骨密度以及检测血清25-羟维生素D（25-OH-D）、甲状旁腺激素、钙、骨特异性碱性磷酸酶、骨钙素和胃泌素水平的实验室数据。另外，对67例T值低于-1.5或有椎体骨折病史的患者亚组进行了高分辨率外周定量计算机断层扫描（HR-pQCT）检查。
144例患者中，126例（87.5%）年龄超过60岁。平均年龄为70.1岁。42例（29.1%）曾发生椎体压缩骨折。通过椎体骨折评估（VFA）在12例患者中检测到12处先前未诊断出的椎体畸形。39例（27.1%）患者患有骨质疏松症，63例（43.8%）患者患有骨量减少。只有16例（11.1%）患者接受了抗骨质疏松治疗，而54例（37.5%）患者有接受特定抗骨质疏松治疗的指征但尚未接受治疗。大多数患者维生素D状态不足（73.6%），34.7%的患者表现出继发性甲状旁腺功能亢进，这是钙稳态严重紊乱的迹象。在67例患者的亚组中，与胫骨远端相比，严重椎体畸形与桡骨远端骨微结构的更严重缺陷相关。
本研究表明，骨代谢紊乱在计划接受脊柱手术的老年患者中非常普遍。椎体畸形与桡骨远端骨微结构的主要恶化相关。由于受损的骨质量可能会影响手术结果，我们强烈建议在手术前评估骨矿物质状况，并在必要时进行抗骨质疏松治疗。
