Preoperative treatment and postoperative outcomes in osteoporotic patients with vertebral fractures: a longitudinal database study.

INTRODUCTION

This study aimed to investigate perioperative treatment and postoperative outcomes in osteoporotic patients with vertebral fractures (VFs), categorized by the type of spine surgery.

MATERIALS AND METHODS

Patients aged ≥ 40, diagnosed with VFs and osteoporosis, with initial spine surgery between April 2015 and February 2021, were analyzed using a Japanese claims database. Time-to-event analysis was conducted for postoperative outcome. Outcome-related factors were explored with a multivariable Cox proportional hazards model.

RESULTS

The study population (n = 4870) consisted of 2675 patients in the percutaneous vertebroplasty (PVP) group and 2195 in the spine fusion surgery (SFS) group. Most patients had lumbar VFs, and posterior spinal fusion was common in the SFS group. Approximately 20% of patients did not receive prescriptions for osteoporosis medications during the perioperative period. Most reoperations and subsequent fractures occurred within 90 days after PVP or SFS. In the PVP group, degenerative spine disease (adjusted hazard ratio 1.34 [95% CI, 1.03-1.76]), psychotropic drugs (1.34 [1.03-1.76]), and glucocorticoid prescriptions with a mean dose of ≥ 5 to < 7.5 mg/day (2.35 [1.04-5.34]) (vs. < 1 mg/day) were associated with reoperation. In post hoc subgroup analysis by year of spine surgery, anabolic agents were associated with a lower risk of reoperation (0.48 [0.30-0.75]) in 2019 and later. In the SFS group, hyperparathyroidism and Parkinson's disease were associated with reoperation (2.14 [1.03-4.44] and 2.10 [1.31-3.37], respectively).

CONCLUSION

Perioperative osteoporosis medication may be suboptimal. Factors associated with postoperative outcomes must be considered, with the strategic goal of improving patient outcomes.