Systematic Literature Review and Meta-Analysis on the Clinical Outcomes of Spine Surgeries in Patients with Concurrent Osteoporosis

BACKGROUND: Osteoporosis is common among elderly patients and can result in vertebral fractures requiring surgical treatment. This study assessed clinical outcomes associated with spinal surgery in patients with osteoporosis/osteopenia with an additional focus on Asian patients. METHODS: A PRISMA-compliant systematic review and meta-analysis were conducted using the PubMed and ProQuest databases to identify articles published up to May 27, 2021, that included outcomes for patients with osteoporosis or osteopenia undergoing spinal surgery. Statistical analysis was conducted comparing rates of proximal junctional kyphosis (PJK)/proximal junctional failure (PJF), implant loosening, and revision surgery. A qualitative summary of Asian studies was also conducted. RESULTS: A total of 16 studies comprising 133,086 patients were included; among the 15 studies reporting rates of osteoporosis/osteopenia, 12.1% (16,127/132,302) of patients overall and 38.0% (106/279) of Asian patients (n=4 studies) had osteoporosis/osteopenia. The risks of PJK/PJF (relative risk [RR]=1.89; 95% confidence interval [CI]=1.22-2.92, p=0.004), screw loosening (RR=2.59; 95% CI=1.67-4.01, p<0.0001), and revision surgery (RR=1.65; 95% CI=1.13-2.42, p=0.010) were higher in patients with poor bone quality compared with those with healthy bone. In the qualitative review of Asian studies, all studies found that osteoporosis increased the risk of complications and/or revision for spinal surgery patients. CONCLUSIONS: This systematic literature review and meta-analysis indicate that spinal surgery patients with compromised bone quality have more complications and higher healthcare utilization than those with normal bone quality. To our knowledge, this is the first study to focus on the pathophysiology and disease burden among Asian patients. Given the high rate of poor bone quality in this aging population, additional high-quality Asian studies, with uniform definitions and data reporting, are needed.