Zhang Andrew S, Khatri Surya, Balmaceno-Criss Mariah, Alsoof Daniel, Daniels Alan H
Department of Orthopaedic Surgery, Louisiana State University, Shreveport, LA, USA.
Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA.
Spine Deform. 2023 May;11(3):579-596. doi: 10.1007/s43390-022-00621-6. Epub 2022 Dec 1.
Osteoporosis is a common, but challenging phenomenon to overcome in adult spinal deformity (ASD) surgery. Several pharmacological agents are at the surgeon's disposal to optimize the osteoporotic patient prior to undergoing extensive reconstruction. Familiarity with these medications will allow the surgeon to make informed decisions on selecting the most appropriate adjuncts for each individual patient.
A comprehensive literature review was conducted in PubMed from September 2021 to April 2022. Studies were selected that contained combinations of various terms including osteoporosis, specific medications, spine surgery, fusion, cage subsidence, screw loosening, pull-out, junctional kyphosis/failure.
Bisphosphonates, denosumab, selective estrogen receptor modulators, teriparatide, abaloparatide and romosozumab are all pharmacological agents currently available for adjunctive use. While these medications have been shown to have beneficial effects on improving bone mineral density in the osteoporotic patient, varying evidence is available on their specific effects in the context of extensive spine surgery. There is still a lack of human studies with use of the newer agents.
Bisphosphonates are first-line agents due to their low cost and robust evidence behind their utility. However, in the absence of contraindications, optimizing bone quality with anabolic medications should be strongly considered in preparation for spinal deformity surgeries due to their beneficial and favorable effects on fusion and hardware compared to the anti-resorptive medications.
骨质疏松症在成人脊柱畸形（ASD）手术中很常见，但难以克服。在进行广泛重建之前，外科医生可使用几种药物来优化骨质疏松患者的状况。熟悉这些药物将使外科医生能够为每位患者选择最合适的辅助药物做出明智的决定。
于2021年9月至2022年4月在PubMed上进行了全面的文献综述。选择的研究包含各种术语的组合，包括骨质疏松症、特定药物、脊柱手术、融合、椎间融合器下沉、螺钉松动、拔出、交界性后凸/失败。
双膦酸盐、地诺单抗、选择性雌激素受体调节剂、特立帕肽、阿巴洛帕肽和罗莫单抗都是目前可用于辅助治疗的药物。虽然这些药物已被证明对改善骨质疏松患者的骨密度有有益作用，但关于它们在广泛脊柱手术中的具体效果的证据各不相同。使用新型药物的人体研究仍然缺乏。
双膦酸盐因其低成本和其效用背后的有力证据而成为一线药物。然而，在没有禁忌症的情况下，由于与抗吸收药物相比，合成代谢药物对融合和内固定器械具有有益和良好的效果，因此在准备脊柱畸形手术时应强烈考虑使用合成代谢药物来优化骨质。
