Preoperative Evaluation of Osteoporosis in Spinal Fusion Surgery: A Survey of Argentine and Latin American Surgeons

DOI: https://doi.org/10.15417/issn.1852-7434.2026.91.2.2214
Keywords: Osteoporosis, preoperative evaluation, spine surgery, arthrodesis, spinal fusion

Abstract

Objective: To analyze the preoperative evaluation of osteoporosis during surgical planning for adult patients undergoing spinal fusion surgery, from the perspective of spine surgeons in Argentina and Latin America. Materials and Methods: A descriptive, cross-sectional study was conducted among orthopedic spine surgeons practicing in Argentina and other Latin American countries. A structured questionnaire based on a simulated clinical case was developed to explore preoperative management of a 70-year-old patient scheduled for elective spinal fusion surgery. Results: A total of 154 spine surgeons from Argentina, Brazil, Paraguay, and Uruguay were surveyed. Significant differences were found in the use of full-length spine radiographs (p < 0.001), dynamic radiographs (p = 0.001), computed tomography (p = 0.002), magnetic resonance imaging (p < 0.001), and Hounsfield unit assessment (p = 0.014). The use of bone density scans showed a marginal statistical trend (p = 0.058), with higher rates in Uruguay (52.4%) and Argentina (42.9%). Vitamin D testing was requested in 40.3% of cases, with no significant differences between countries (p = 0.803), highlighting the limited assessment of this marker related to bone metabolism. Conclusions: There is a clear trend toward underestimation of osteoporosis screening in the preoperative evaluation for spinal fusion surgery. Fewer than 50% of surgeons considered requesting a DEXA scan, Hounsfield unit assessment, or vitamin D measurement.

Downloads

Download data is not yet available.

Author Biographies

Pedro Luis Bazán, Spinal Pathology Unit, Department of Orthopedics and Traumatology, Hospital Interzonal General de Agudos San Martín, La Plata, Buenos Aires, Argentina
Spinal Pathology Unit, Department of Orthopedics and Traumatology, Hospital Interzonal General de Agudos San Martín, La Plata, Buenos Aires, Argentina Study Group of the Argentine Society of Spinal Pathology (SAPCV)
Guillermo Alejandro Ricciardi, Department of Orthopedics and Traumatology, Hospital General de Agudos “Dr. Teodoro Álvarez”, Autonomous City of Buenos Aires, Argentina
Servicio de Ortopedia y Traumatología, Hospital General de Agudos “Dr. Teodoro Álvarez”, Ciudad Autónoma de Buenos Aires, Argentina Study Group of the Argentine Society of Spinal Pathology (SAPCV)      
Esteban Calcagni, Centro Artro, Autonomous City of Buenos Aires, Argentina
Centro Artro, Autonomous City of Buenos Aires, Argentina Study Group of the Argentine Society of Spinal Pathology (SAPCV)
Enrique Alcides Casco, Department of Orthopedics and Traumatology, Hospital de Trauma, Asunción, Paraguay
Department of Orthopedics and Traumatology, Hospital de Trauma, Asunción, Paraguay
Nicolás Galli, CEDEFCO, Montevideo, Uruguay
CEDEFCO, Montevideo, Uruguay
Alexandre Fogaça Cristante, Institute of Orthopedics and Traumatology, School of Medicine, University of São Paulo, Brazil
Institute of Orthopedics and Traumatology, School of Medicine, University of São Paulo, Brazil
José Antonio Rosado Pardo, Department of Orthopedics and Traumatology, Hospital General de Agudos “Dr. Teodoro Álvarez”, Autonomous City of Buenos Aires, Argentina
Department of Orthopedics and Traumatology, Hospital General de Agudos “Dr. Teodoro Álvarez”, Autonomous City of Buenos Aires, Argentina Study Group of the Argentine Society of Spinal Pathology (SAPCV)
Enrique Gobbi, CEMIC, Buenos Aires, Argentina
CEMIC, Buenos Aires, Argentina Study Group of the Argentine Society of Spinal Pathology (SAPCV)

References

Albergaria BH, Chalem M, Clark P, Messina OD, Pereira RMR, Vidal LF. Consensus statement: osteoporosis

prevention and treatment in Latin America-current structure and future directions. Arch Osteoporos 2018;13(1):90. https://doi.org/10.1007/s11657-018-0505-x

Etxebarria-Foronda I, Caeiro-Rey JR, Larrainzar-Garijo R, Vaquero-Cervino E, Roca-Ruiz L, Mesa-Ramos M, et al. Guía SECOT-GEIOS en osteoporosis y fractura por fragilidad. Actualización. Rev Esp Cir Ortop Traumatol 2015;59(6):373-93. https://doi.org/10.1016/j.recot.2015.05.007

Singer A, Exuzides A, Spangler L, O’Malley C, Colby C, Johnston K, et al. Burden of illness for osteoporotic fractures compared with other serious diseases among postmenopausal women in the United States. Mayo Clin Proc 2015;90(1):53-62. https://doi.org/10.1016/j.mayocp.2014.09.011

Fan ZQ, Yan XA, Li BF, Shen E, Xu X, Wang H, et al. Prevalence of osteoporosis in spinal surgery patients older than 50 years: A systematic review and meta-analysis. PLoS One 2023;18(5). https://doi.org/10.1371/journal.pone.0286110

Diebo BG, Sheikh B, Freilich M, Shah NV, Redfern JAI, Tarabichi S, et al. Osteoporosis and spine surgery: A critical analysis review. JBJS Rev 2020;8(6):e0160. https://doi.org/10.2106/JBJS.RVW.19.00160

Gupta A, Cha T, Schwab J, Fogel H, Tobert D, Razi AE, et al. Osteoporosis increases the likelihood of revision surgery following a long spinal fusion for adult spinal deformity. Spine J 2021;21(1):134-40. https://doi.org/10.1016/j.spinee.2020.08.002

Shen T, Shahzad H, Sierra F, Wick JB, Pina D, Van BW, et al. Osteoporosis treatment and outcomes in patients undergoing adult spinal deformity surgery. World Neurosurg 2024;190:e1018-e1024. https://doi.org/10.1016/j.wneu.2024.08.053

Diebo BG, Scheer R, Rompala A, Veenema RJ, Shah NV, Beyer GA, et al. The impact of osteoporosis on 2-year outcomes in patients undergoing long cervical fusion. J Am Acad Orthop Surg 2023;31(1):e44-e50. https://doi.org/10.5435/JAAOS-D-22-00361

Karikari IO, Metz LN. Preventing pseudoarthrosis and proximal junctional kyphosis: How to deal with the osteoporotic spine. Neurosurg Clin N Am 2018;29(3):365-74. https://doi.org/10.1016/j.nec.2018.03.005

Daniels AH, Singh M, Knebel A, Thomson C, Kuharski MJ, De Varona A, et al. Preoperative optimization strategies in elective spine surgery. JBJS Rev 2025;13(2). https://doi.org/10.2106/JBJS.RVW.24.00210

Bernatz JT, Winzenried AE, Hare KJ, Mikula AL, Williams SK, Binkley NC, et al. Effect of bone health optimization on osteoporosis screening and treatment before thoracolumbar fusion. J Am Acad Orthop Surg Glob Res Rev 2022;6(3):e21.00253. https://doi.org/10.5435/JAAOSGlobal-D-21-00253

Dimar J, Bisson EF, Dhall S, Harrop JS, Hoh DJ, Mohamed B, et al. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines for Perioperative Spine: Preoperative Osteoporosis Assessment. Neurosurgery 2021;89(Suppl 1):S19-S25. https://doi.org/10.1093/neuros/nyab317

Kato S, Rocos B, Yoshida G, Sardar Z, Jones KE, Oe S, et al. AO Spine Clinical Practice Recommendations: Evaluation, implications and management of osteoporosis in adult spinal deformity. Global Spine 2025;14:21925682251357200. https://doi.org/10.1177/21925682251357200

Dipaola CP, Bible JE, Biswas D, Dipaola M, Grauer JN, Rechtine GR. Survey of spine surgeons on attitudes regarding osteoporosis and osteomalacia screening and treatment for fractures, fusion surgery, and pseudoarthrosis. Spine J 2009;9(7):537-44. https://doi.org/10.1016/j.spinee.2009.02.005

Díaz-Romero R, Henríquez MS, Melián KA, Balhen-Martin C. Practice patterns of spine surgeons regarding osteoporosis: An international survey. Int J Spine Surg 2021;15(2):376-85. https://doi.org/10.14444/8049

Pantoja S, Molina M. Surgeon management of osteoporosis in instrumented spine surgery: AOSpine Latin America survey. Global Spine J 2019;9(2):169-72. https://doi.org/10.1177/2192568218785369

Sociedad Internacional de Densitometría Clínica. Posiciones Oficiales para Adultos 2019. Disponible en: https://iscd.org/learn/official-positions/adult-positions/

St Jeor JD, Jackson TJ, Xiong AE, Kadri A, Freedman BA, Sebastian AS, et al. Osteoporosis in spine surgery patients: what is the best way to diagnose osteoporosis in this population? Neurosurg Focus 2020;49(2):E4. https://doi.org/10.3171/2020.5.FOCUS20277

St Jeor JD, Jackson TJ, Xiong AE, Freedman BA, Sebastian AS, Currier BL, et al. Average lumbar Hounsfield units predict osteoporosis-related complications following lumbar spine fusion. Global Spine J 2022;12(5):851-7. https://doi.org/10.1177/2192568220975365

Bazán PL, Jordan RC, Cevallos JRM, Adaro AOG, Adaro JCS. Uso de unidades Hounsfield en la planificación de cirugía de columna: revisión sistemática y metanálisis. Coluna/Columna 2022;21:e264579. https://doi.org/10.1590/S1808-185120222103264579

Lehman RA Jr, Kang DG, Wagner SC. Management of osteoporosis in spine surgery. J Am Acad Orthop Surg 2015;23(4):253-63. https://doi.org/10.5435/JAAOS-D-14-00042

Stoker GE, Buchowski JM, Bridwell KH, Lenke LG, Riew KD, Zebala LP. Preoperative vitamin D status of adults undergoing surgical spinal fusion. Spine (Phila Pa 1976) 2013;38(6):507-15. https://doi.org/10.1097/BRS.0b013e3182739ad1

Kerezoudis P, Rinaldo L, Drazin D, Kallmes D, Krauss W, Hassoon A, et al. Association between vitamin D deficiency and outcomes following spinal fusion surgery: A systematic review. World Neurosurg 2016;95:71-6. https://doi.org/10.1016/j.wneu.2016.07.074

Bajaj A, Shah RM, Goodwin AM, Kurapaty S, Patel AA, Divi SN. The role of preoperative vitamin D in spine surgery. Curr Rev Musculoskelet Med 2023;16(2):48-54. https://doi.org/10.1007/s12178-022-09813-z

Published
2026-04-30
How to Cite
Bazán, P. L., Ricciardi, G. A., Calcagni, E., Casco, E. A., Galli, N., Fogaça Cristante, A., Rosado Pardo, J. A., & Gobbi, E. (2026). Preoperative Evaluation of Osteoporosis in Spinal Fusion Surgery: A Survey of Argentine and Latin American Surgeons. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 91(2), 118-125. https://doi.org/10.15417/issn.1852-7434.2026.91.2.2214
Issue
Vol 91 No 2 (2026)
Section
Clinical Research
Copyright (c) 2026 Revista de la Asociación Argentina de Ortopedia y Traumatología

Manuscript acceptance by the Journal implies the simultaneous non-submission to any other journal or publishing house. The RAAOT is under the Licencia Creative Commnos Atribución-NoComercial-Compartir Obras Derivadas Igual 4.0 Internacional (CC-BY-NC.SA 4.0) (http://creativecommons.org/licences/by-nc-sa/4.0/deed.es). Articles can be shared, copied, distributed, modified, altered, transformed into a derivative work, executed and publicly communicated, provided a) the authors and the original publication (Journal, Publisher and URL) are mentioned, b) they are not used for commercial purposes, c) the same terms of the license are maintained.

In the event that the manuscript is approved for its next publication, the authors retain the copyright and will assign to the journal the rights of publication, edition, reproduction, distribution, exhibition and communication at a national and international level in the different databases. data, repositories and portals.

It is hereby stated that the mentioned manuscript has not been published and that it is not being printed in any other national or foreign journal.

The authors hereby accept the necessary modifications, suggested by the reviewers, in order to adapt the manuscript to the style and publication rules of this Journal.