Work

A bone optimization rheumatology clinic increases anabolic bone agent use and reduces mechanical complications in adult spinal deformity surgery

Year: 2026

Type: article

Abstract: PURPOSE: Though the use of anabolic bone agents has proven effective in adult spinal deformity (ASD) surgery, prescription and approval of these medications remains a challenge. In osteopenic/osteoporotic patients undergoing ASD surgery, we sought to determine the impact of a bone optimization clinic on: (1) prescription patterns of anabolic agents, (2) mechanical complications, and (3) reoperation. METHODS: A retrospective cohort study (2009-23) was performed for osteopenic/osteoporotic patients undergoing ASD surgery with ≥ 2-year follow-up. The study period was binarized into before/after a bone optimization clinic was established (2009-19 vs. 2020-23). The primary outcomes were: (1) use of anabolic agents prior to surgery (Teriparatide, Abaloparatide, and Romosozumab-aqqg), (2) mechanical complications, and (3) reoperation. Multivariable regression controlling for age, sex, body mass index, and operative time was performed. RESULTS: Of 126 patients (mean age 68 ± 10yrs; 86% female) undergoing ASD surgery with osteopenia (80%) or osteoporosis (20%), 91 (72%) were before the bone optimization clinic and 35 (28%) were after. Similar rates of osteoporosis in both groups were seen (pre-21% vs. post-17%, p = 0.638). After the bone optimization clinic, more patients received preoperative anabolic therapy (54% vs. 23%, p < 0.001) and for a longer duration (98 ± 156 vs. 40 ± 109 days, p = 0.027). Overall mechanical complications decreased significantly (49% vs 81%, p < 0.001) as did reoperation for mechanical complications (6% vs. 44%, p < 0.001). Multivariable regression showed that a bone optimization clinic independently improved the use of preoperative anabolic agents (OR = 5.3, 95%CI:2.1-13.4, p < 0.001) and reduced the risk of mechanical complications (OR = 0.2 95%CI:0.1-0.5, p < 0.001) and reoperation for mechanical complications (OR = 0.1, 95%CI:0.1-0.4, p < 0.001). CONCLUSION: In osteopenic/osteoporotic patients undergoing ASD surgery, a bone optimization clinic was independently associated with increased prescription rates and duration of anabolic bone agents, reduced mechanical complications, and reduced reoperation for mechanical complications.

Source: Spine Deformity

DOI: 10.1007/s43390-026-01307-z