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P60. Bone health optimization improves osteoporosis screening and treatment prior to thoracolumbar fusion

P60. Bone health optimization improves osteoporosis screening and treatment prior to thoracolumbar fusion

Authors :
Anthony L. Mikula
James T. Bernatz
Paul A. Anderson
Alec E. Winzenried
Seth K. Williams
Neil Binkley
Source :
The Spine Journal. 21:S169
Publication Year :
2021
Publisher :
Elsevier BV, 2021.

Abstract

BACKGROUND CONTEXT Osteoporosis is not rare in thoracolumbar spine fusion patients and may portend poorer surgical outcomes. Implementation of a bone health optimization (BHO) clinic improves osteoporosis screening and treatment in the total joint arthroplasty population. We hypothesize that preoperative osteoporosis is common, under-recognized and undertreated in thoracolumbar fusion patients and that a BHO clinic will increase preoperative osteoporosis screening rates and pharmacologic osteoporosis treatment in this population. PURPOSE The purpose of the study is to determine the proportion of patients receiving appropriate osteoporosis screening and treatment before and after initiation of a BHO clinic. STUDY DESIGN/SETTING Retrospective case series. PATIENT SAMPLE Adults age 30+ who underwent elective thoracolumbar spine fusion at a single tertiary care center prior to and after creation of a BHO referral clinic OUTCOME MEASURES Osteoporosis screening rates (ie, dual-energy X-ray absorptiometry (DXA) testing). METHODS Preoperative osteoporosis risk factors, prior DXA testing, and prior osteoporosis pharmacotherapy were collected from the electronic medical record. Fracture risk was estimated using the Fracture Risk Assessment Tool (FRAX) with and without bone mineral density (BMD) and the U.S. National Osteoporosis Foundation (NOF) criteria for screening and treatment were applied. RESULTS Ninety patients were included in the pre-BHO group; 53 met criteria for BMD measurement but only 10 were tested within two years preoperatively. Sixteen (18%) met criteria for osteoporosis pharmacotherapy but only 5 of the 16 (31%) received osteoporosis medication within six months of surgery. There were 87 patients in the postBHO group and 19 were referred to the BHO clinic. BMD measurement was performed in 17 (89%) of patients referred to BHO clinic compared to 10% for those not referred. All patients (n=7) referred to the BHO clinic meeting treatment criteria received treatment within 6 months before surgery, whereas only 25% of patients not referred received treatment. CONCLUSIONS Osteoporosis is not rare in adults undergoing thoracolumbar spine fusion with ∼13-18% meeting criteria for pharmacotherapy. Preoperative BHO referral increases screening and treatment. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Details

ISSN :
15299430
Volume :
21
Database :
OpenAIRE
Journal :
The Spine Journal
Accession number :
edsair.doi...........d9ec4d93cffb86d774f743a7e15c08e5
Full Text :
https://doi.org/10.1016/j.spinee.2021.05.268