196. Best practice guideline on the assessment and management of osteoporosis in adult patients undergoing elective spinal reconstruction

BACKGROUND CONTEXT Poor bone health in patients undergoing reconstructive spine surgery can lead to complications such as vertebral fractures, pseudarthrosis, proximal junctional kyphosis, and instrumentation failure. No guidelines currently exist for the management of osteoporosis and osteopenia in patients undergoing spinal reconstructive surgery. This expert panel was created to establish best practice guidelines to identify and treat patients with poor bone health prior to undergoing elective spinal reconstruction. PURPOSE An expert panel to define best practice guidelines for the assessment and management of osteoporosis in patients undergoing elective spinal reconstruction. STUDY DESIGN/SETTING Expert panel, consensus study. OUTCOME MEASURES Consensus above 70% on final statements. METHODS A multidisciplinary panel with 20 experts was assembled including orthopedic and neurological surgeons, endocrinologists, and rheumatologists. Three rounds of surveys and discussions regarding the current literature were held until a final set of guidelines was created with over 70% consensus. RESULTS A total of 21 statements were included in the final survey. Bone health should be considered in every patient prior to elective spinal reconstruction. All patients above 65 and those under 65 with particular risk factors (chronic steroid use, high fracture risk or previous fracture, limited mobility, and eight other key factors) should have a formal bone health evaluation prior to undergoing surgery. DEXA scans of the hip are preferable due to their wide availability. Opportunistic CT Hounsfield Units can be useful in identifying poor bone health. Patients with osteoporosis and osteopenia should be appropriately optimized prior to elective surgery. In the absence of contraindications, teriparatide and abaloparatide are considered first-line agents due to their bone building properties as compared to antiresorptive medications such as bisphosphonates. These treatments should be administered preoperatively for at least 2 months and postoperatively for at least 8 months. CONCLUSIONS Based on the consensus of a multidisciplinary panel of experts, we propose best practice guidelines for assessment and treatment of poor bone health prior to elective spinal reconstructive surgery. Patients above age 65 and those with particular risk factors under 65 should undergo formal bone health evaluation. We also reached consensus on perioperative optimization, utility of various diagnostic modalities, and the optimal medical management of bone health in this population. We believe that these guidelines will help reduce adverse postoperative outcomes related to bone health FDA DEVICE/DRUG STATUS Teriparatide, abaloparatide, bisphosphonates: Approved. Poor bone health in patients undergoing reconstructive spine surgery can lead to complications such as vertebral fractures, pseudarthrosis, proximal junctional kyphosis, and instrumentation failure. No guidelines currently exist for the management of osteoporosis and osteopenia in patients undergoing spinal reconstructive surgery. This expert panel was created to establish best practice guidelines to identify and treat patients with poor bone health prior to undergoing elective spinal reconstruction. An expert panel to define best practice guidelines for the assessment and management of osteoporosis in patients undergoing elective spinal reconstruction. Expert panel, consensus study. Consensus above 70% on final statements. A multidisciplinary panel with 20 experts was assembled including orthopedic and neurological surgeons, endocrinologists, and rheumatologists. Three rounds of surveys and discussions regarding the current literature were held until a final set of guidelines was created with over 70% consensus. A total of 21 statements were included in the final survey. Bone health should be considered in every patient prior to elective spinal reconstruction. All patients above 65 and those under 65 with particular risk factors (chronic steroid use, high fracture risk or previous fracture, limited mobility, and eight other key factors) should have a formal bone health evaluation prior to undergoing surgery. DEXA scans of the hip are preferable due to their wide availability. Opportunistic CT Hounsfield Units can be useful in identifying poor bone health. Patients with osteoporosis and osteopenia should be appropriately optimized prior to elective surgery. In the absence of contraindications, teriparatide and abaloparatide are considered first-line agents due to their bone building properties as compared to antiresorptive medications such as bisphosphonates. These treatments should be administered preoperatively for at least 2 months and postoperatively for at least 8 months. Based on the consensus of a multidisciplinary panel of experts, we propose best practice guidelines for assessment and treatment of poor bone health prior to elective spinal reconstructive surgery. Patients above age 65 and those with particular risk factors under 65 should undergo formal bone health evaluation. We also reached consensus on perioperative optimization, utility of various diagnostic modalities, and the optimal medical management of bone health in this population. We believe that these guidelines will help reduce adverse postoperative outcomes related to bone health