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