AO Spine Clinical Practice Recommendations: Evaluation, Implications and Management of Osteoporosis in Adult Spinal Deformity.

Study designLiterature review with clinical recommendation.ObjectivesTo provide the readers with a concise curation of the relevant spine literature regarding the identification and management of osteoporosis in patients with adult spinal deformity (ASD) and set out recommendations for how the practicing clinician should interpret and make use of this evidence.MethodsKey articles from the published literature surrounding osteoporosis in patients being treated for ASD were reviewed and clinical recommendations were formulated by consensus. The recommendations are dichotomously graded into strong and conditional after integrating an assessment of methodological quality and expert opinion. This opinion considers experience and practical issues such as risks, burdens, costs, patient values, and circumstances.Results6 articles were selected by practicing spinal deformity surgeons and each evaluated for the strength of methodology and scientific evidence.ConclusionsThe current evidence suggests that preoperative evaluation of osteoporosis before ASD surgery should be routine. Additionally, there is clinical benefit in using anabolic agents for at least 3 months to improve bone stock and prevent mechanical complications. While high quality, strong evidence is still yet to be reported, all healthcare providers managing patients with ASD should be aware of the importance of bone health for optimizing post-operative outcomes and minimising complications.