Osteoporosis and osteomalacia are significant risk factors for fracture and spine
instrumentation failure. Low-energy fractures are becoming increasingly more common
because of an increase in life expectancy and age of the population. Decreased bone
density is an independent risk factor for instrumentation failure in spinal fusion
operations.
To assess the awareness and practice patterns of spine surgeons regarding metabolic
bone disorders and osteoporosis with emphasis on fracture care and arthrodesis.
Questionnaire study.
Spine surgeons attending the "Disorders of the Spine" conference (January 2007, Whistler,
British Columbia, Canada).
Respondent reported frequencies of diagnostics, screening, and treatment methods for
patients with low-energy spine fractures, pseudoarthrosis, and those undergoing spinal
arthrodesis.
A ten-question survey was administered to orthopedic surgeons and neurosurgeons who
treated spine fractures and degenerative spine conditions in their practice. The survey
was given to those who were attending a continuing medical education spinal disorders
conference. The survey asked about treatment patterns with respect to osteoporosis
and osteomalacia workup and treatment for patients with low-energy spine fractures,
pseudoarthrosis, and those undergoing spinal arthrodesis.
Of the 133 surgeons to whom the questionnaire was distributed at this meeting, 114
questionnaires were returned that corresponds to a response rate of 86%. Twenty-one
surveys were excluded because of incomplete biographical information, resulting in
a total of 93 completed questionnaires that were available for analysis. When treating
patients with low-energy spine fractures, 60% checked dual-energy X-ray absorptiometry
(DEXA) and 39% checked metabolic laboratories (of those who did not order laboratories
and DEXA about 63% refer for treatment). Before instrumented fusion, 44% of those
queried checked DEXA and 12% checked metabolic laboratories (vitamin D, parathyroid
hormone [PTH], and calcium [Ca]). Before noninstrumented fusion, 22% checked DEXA
and 11% checked metabolic laboratories. Before addressing pseudoarthrosis, 19% checked
DEXA and 20% checked metabolic laboratories.
Despite of the large number of elderly patients undergoing spine care and the high
incidence of osteoporosis and/or osteomalacia in this population, a large portion
of the spine surgeons who responded to the survey reported that they do not perform
routine osteoporosis/osteomalacia workups. Of those who do perform workups, some commented
that it will change their surgical plan or preoperative treatment. It appears that
there is a need for increased awareness among spine specialists regarding osteoporosis
screening and treatment. Osteoporosis practice patterns may also be affected with
newly evolving government quality reporting regulations.