3 Osteoporosis Bone health Diagnosis and Treatment of Osteoporosis in the Aging Spine Patient

Vitamin DSecondary fracturesprevention ofSecondary fracturesFracture Liaison ServicesOsteoporotic-related fracturessecondaryprevention ofOsteoporotic-related fracturessecondaryprevention ofOsteoporotic-related fracturessecondaryFracture Liaison ServicesOsteoporotic-related fracturessecondaryFracture Liaison ServicesOsteoporosisvitamin D andOsteoporosistreatment ofOsteoporosisantiresorptive medications forOsteoporosisanabolic medications forOsteopeniaLow bone massFracture(s)osteoporotic-related, secondaryprevention ofFracture(s)osteoporotic-related, secondaryprevention ofFracture(s)osteoporotic-related, secondaryprevention ofFracture(s)osteoporotic-related, secondaryFracture Liaison ServicesFracture(s)osteoporotic-related, secondaryFracture Liaison ServicesFracture Liaison Services (FLS)Dual-energy X-ray absorptiometry (DXA)Bone healthvitamin D andBisphosphonatesAntiresorptive medicationsAnabolic medicationsLow bone mass (osteopenia and osteoporosis) is a common condition that is poorly managed in our current health care system. Poor bone health can increase fragility and fracture risk and also adversely affect outcomes following spinal surgery. The spine practitioner can help patients by taking ownership of bone health. Secondary fracture prevention is aimed at making the first fracture the last fracture by diagnosing and treating poor bone health and intervening to reduce fall risk. Unfortunately, less than 20% of patients who have an osteoporosis-related fracture receive treatment for osteoporosis. Fracture liaison services are becoming increasingly available and provide a comprehensive approach to reduce the risk of subsequent fracture. These programs reduce secondary fractures by 40%. Preoperative bone health optimization is a newer approach aimed at optimizing bone health prior to surgery. Recent investigations show a link between poor surgical outcomes with vitamin D deficiency and osteoporosis. Conversely, as might be expected, treatment with bisphosphonates or bone anabolic medications improves surgical outcomes. The critical components of these programs are assessing the risk of poor bone health, identifying and correcting vitamin D deficiency, eliminating toxins that adversely affect bone (e.g., smoking and excess alcohol intake) recommending fall prevention as required, practicing weight bearing exercises, and maintaining proper nutrition. Dual-energy X-ray absorptiometry (DXA) is an essential part of evaluation, as it classifies bone status and can be ordered and interpreted by all spine practitioners. Advances in DXA testing include vertebral fracture assessment and trabecular bone scoring that may aid in identification of patients with occult fracture and patients with poor quality. Since bone is fundamental to the function of the spine, practitioners should include diagnostic and treatment of bone health when evaluating patients with spinal diseases.