Osteoporosis

Description

Osteoporosis is viewed not merely as a silent metabolic disease, but as a severe structural challenge that compromises spinal biomechanics, implant stability, and surgical outcomes. When spine specialists approach an osteoporotic patient, their perspective focuses on several critical clinical pillars: 1. Surgical Planning and Complication Risks Low bone mineral density (BMD) directly impairs a surgeon's ability to achieve stable spinal fixation. In elective spine surgeries (like spinal fusions), osteoporosis increases the risk of: • Screw Pullout and Loosening • Cage Subsidence • Proximal Junctional Kyphosis (PJK) • Pseudarthrosis 2. Preoperative Optimization (The Structural Runway) Modern spinal guidelines strongly emphasize preoperative optimization. Spine surgeons increasingly order DXA scans or opportunistic quantitative CT (QCT) scans before elective procedures. 3. Intraoperative Adaptations When operating on osteoporotic bone, spine surgeons alter their technical approaches to mitigate risks: • Cement Augmentation: Injecting polymethylmethacrylate (PMMA) bone cement directly through or around pedicle screws to anchor them safely. • Load-Sharing Constructs: Extending the length of the hardware fixation over more segments to distribute mechanical stress across multiple vertebrae. • Alternative Hooks and Wires: Combining pedicle screws with laminar hooks to maximize structural support. 4. Fragility Fracture Management Vertebral compression fractures (VCFs) are the most common osteoporotic fragility fractures. Orthospinal management follows a tiered approach: • Conservative: Brief bracing (e.g., ASH brace) combined with early mobilization to prevent further bone loss caused by bed rest. • Minimally Invasive Interventions: If severe pain persists, procedures like vertebroplasty or balloon kyphoplasty (injecting bone cement directly into the fractured vertebra) are used to rapidly stabilize the bone, relieve debilitating pain, and prevent progressive forward-stooping deformities (kyphosis). 5. The "Sentinel Event" and Secondary Prevention Focus heavily on Fracture Liaison Services (FLS) to coordinate long-term medical care, ensuring patients are properly transitioned to medical management (such as bisphosphonates, Denosumab, calcium, and Vitamin D) immediately following an injury.

Objectives

Presenters

1. Dr. Oliver Mugambi
   MCS COSECSA YR 2 Resident at Meru Teaching and Referral Hospital
   Resident Orthopedics Meru Teaching and Referral Hospital