Paz Ricardo Díaz-Romero, Henríquez Manuel Sosa, Melián Kevin Armas, Martin Claudia Balhen
Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.
Department of Neurosurgery of Hospital Insular of Las Palmas, Las Palmas de Gran Canaria, Spain.
Global Spine J. 2022 Sep;12(7):1412-1419. doi: 10.1177/2192568221989684. Epub 2021 Jan 25.
A cross-sectional study.
To investigate the prevalence of poor bone quality in patients requiring spine surgery through comprehensive evaluation with bone mass density (BMD), trabecular bone score (TBS), FRAX, and vitamin D status.
we prospectively recruited patients of > 50 years old candidates for lumbar or cervical spine fusion surgery at our institution. Recorded data were: demographic, body mass index (BMI), risk factors for osteoporosis, daily calcium intake, FRAX score, disability index for lumbar and cervical spine, and VAS for pain. Serum 25 OH vitamin D, BMD using DXA, and TBS was also evaluated.
A total of 104 patients were recruited, osteoporosis by BMD was detected in 9.6%, and osteopenia in 34.6% of patients. 69.4% of patients with osteopenia had a degraded or partially degraded bone microarchitecture by TBS.Low levels of vitamin D were detected in 79.8% of patients. Increased pain was associated with low BMD levels. Adding TBS to BMD for the determination of bone strength resulted in 33.7% of patients with poor bone quality. Lastly, the combination of BMD, TBS, and FRAX revealed 37,5% of patients with poor bone quality.
Poor bone quality and low vitamin D levels are quite common among patients aged ≥ 50 years undergoing spine surgery. DXA alone seems not enough for preoperative identification of impaired bone quality cases. FRAX is useful for identifying high-risk patients and TBS is a valuable complement to DXA by adding the dimension of bone quality.
横断面研究。
通过骨密度（BMD）、小梁骨评分（TBS）、FRAX和维生素D状态的综合评估，调查需要脊柱手术的患者中骨质量差的患病率。
我们前瞻性招募了我院年龄大于50岁的腰椎或颈椎融合手术候选患者。记录的数据包括：人口统计学资料、体重指数（BMI）、骨质疏松症危险因素、每日钙摄入量、FRAX评分、腰椎和颈椎残疾指数以及疼痛视觉模拟评分（VAS）。还评估了血清25羟维生素D、使用双能X线吸收法（DXA）测定的骨密度和小梁骨评分。
共招募了104例患者，根据骨密度检测出9.6%的患者患有骨质疏松症，34.6%的患者患有骨量减少。69.4%骨量减少的患者通过小梁骨评分显示骨微结构退化或部分退化。79.8%的患者检测出维生素D水平低。疼痛加剧与低骨密度水平相关。将小梁骨评分添加到骨密度中以确定骨强度，结果显示33.7%的患者骨质量差。最后，骨密度、小梁骨评分和FRAX的联合评估显示37.5%的患者骨质量差。
在接受脊柱手术的50岁及以上患者中，骨质量差和维生素D水平低相当常见。仅靠双能X线吸收法似乎不足以在术前识别骨质量受损的病例。FRAX有助于识别高危患者，小梁骨评分通过增加骨质量维度，是对双能X线吸收法的有价值补充。
