Prevalence of Osteoporosis Treatment After Multi-Level Spina
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The aim was to study the prevalence of pre-operative osteoporosis treatment, and its effect on risk of osteoporosis related complications (ORC), revision surgery and costs in osteoporotic patients undergoing more than 3-level spinal fusion for degenerative pathology.

Patients and procedures of concern were coded using the International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) coding schemes. Instrumentation complications, pathological fractures, and revision surgery were all assessed using osteoporosis related complications (ORC) one year after surgery. Kaplan-Meier survival curves and Cox proportional hazards analysis were used to examine the impact of osteoporosis treatment on the risk of ORC.

--A total of 849 patients were included with documented osteoporosis undergoing more than 3-level spinal fusion.

--White (85.6%), female (82.7%), and 60-79 years of age was the most common demographic. Of entire cohort, 121 were on osteoporosis treatment prior to spinal fusion.

--Of treated patients, 52/121 had continued prescriptions at 1 year post-operatively.

--Treated patients and not-treated patients had 1-year ORC incidence of 9.1% and 15.0%, respectively.

--The average 1-year reimbursement/patient for managing ORC was dollar 3,053 (treated) and dollar 21,147 (not-treated). On adjusted cox analysis, pre-operative osteoporosis treatment was associated with a lower risk of ORC (HR: 0.53).

Finally, pre-operative osteoporosis therapy is linked to a lower risk of ORC and revision surgery after a 3-level spinal fusion at 1-year. Prior to spinal fusion, there is a low rate of osteoporosis care and, as a result, a low rate of treatment continuation following surgery. These results demonstrate the importance of increased osteoporosis awareness, patient education, and management prior to elective multi-level spinal fusion.