Radiographic and functional outcomes of bisphosphonate use in lumbar fusion: a systematic review and meta-analysis of comparative studies
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.
These slides can be retrieved under Electronic Supplementary Material.
KeywordsBisphosphonate 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.
- 2.Etebar S, Cahill DW (1999) Risk factors for adjacent-segment failure following lumbar fixation with rigid instrumentation for degenerative instability. J Neurosurg 90:163–169Google Scholar
- 5.Ohtori S, Inoue G, Orita S, Yamauchi K, Eguchi Y, Ochiai N, Kishida S, Kuniyoshi K, Aoki Y, Nakamura J, Ishikawa T, Miyagi M, Kamoda H, Suzuki M, Kubota G, Sakuma Y, Oikawa Y, Inage K, Sainoh T, Takaso M, Toyone T, Takahashi K (2013) Comparison of teriparatide and bisphosphonate treatment to reduce pedicle screw loosening after lumbar spinal fusion surgery in postmenopausal women with osteoporosis from a bone quality perspective. Spine 38:E487–E492. https://doi.org/10.1097/BRS.0b013e31828826dd CrossRefGoogle Scholar
- 19.Stone MA, Jakoi AM, Iorio JA, Pham MH, Patel NN, Hsieh PC, Liu JC, Acosta FL, Hah R, Wang JC (2017) Bisphosphonate's and intermittent parathyroid hormone's effect on human spinal fusion: a systematic review of the literature. Asian Spine J 11:484–493. https://doi.org/10.4184/asj.2017.11.3.484 CrossRefGoogle Scholar
- 25.Grey A, Reid IR (2006) Differences between the bisphosphonates for the prevention and treatment of osteoporosis. Ther Clin Risk Manag 2:77–86Google Scholar
- 26.Chen LX, Zhou ZR, Li YL, Ning GZ, Zhang TS, Zhang D, Feng SQ (2015) Comparison of bone mineral density in lumbar spine and fracture rate among eight drugs in treatments of osteoporosis in men: a network meta-analysis. PLoS ONE 10:e0128032. https://doi.org/10.1371/journal.pone.0128032 CrossRefGoogle Scholar
- 28.Migliore A, Broccoli S, Massafra U, Cassol M, Frediani B (2013) Ranking antireabsorptive agents to prevent vertebral fractures in postmenopausal osteoporosis by mixed treatment comparison meta-analysis. Eur Rev Med Pharmacol Sci 17:658–667Google Scholar