Radiographic and functional outcomes of bisphosphonate use in lumbar fusion: a systematic review and meta-analysis of comparative studies

  • Nickolas Fretes
  • Evan Vellios
  • Akshay Sharma
  • Remi M. AjiboyeEmail author
Review Article



To date, there are conflicting reports with no consensus on the influence of bisphosphonates on lumbar fusion. The goal of this study was to compare the radiographic and functional outcomes of patients that had lumbar fusion with and without bisphosphonates.


A systematic search of multiple medical reference databases was conducted for studies comparing bisphosphonate use to controls following spinal fusion. Meta-analysis was performed using the random-effects model for heterogeneity. Radiographic outcome measures included fusion rates and risk of screw loosening, cage subsidence and vertebral fracture. Functional outcomes measures included Oswestry Disability Index and visual analog scale score for back and leg pain.


Bisphosphonate use was statistically suggestive of a higher fusion rate compared to controls (OR 2.2, 95% CI 0.87–5.56, p = 0.09). There was no difference in screw loosening rates between the bisphosphonate group and controls (OR 0.45, 95% CI 0.14–1.48, p = 0.19). However, bisphosphonate use was associated with decreased odds of cage subsidence and vertebral fractures compared to controls (cage subsidence: OR 0.29, 95% CI 0.11–0.75, p = 0.01; vertebral fracture: OR 0.18, 95% CI 0.07–0.48, p = 0.0007).


Bisphosphonate use does not appear to impair successful lumbar fusion compared to controls. Additionally, bisphosphonate use was associated with decreased odds of cage subsidence and vertebral fractures compared to controls that had lumbar fusion.

Graphic abstract

These slides can be retrieved under Electronic Supplementary Material.


Bisphosphonate Osteoporosis Fusion Screw loosening Cage subsidence Vertebral fracture 



No funds were received in support of this work.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

586_2019_6090_MOESM1_ESM.pptx (175 kb)
Supplementary file1 (PPTX 175 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.UCLA Medical CenterLos AngelesUSA
  2. 2.Case Western Reserve School of MedicineClevelandUSA
  3. 3.Sports and Spine OrthopedicsTorranceUSA
  4. 4.Department of Orthopedic Surgery, Stanford Medical CenterRedwood CityUSA

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