背景：骨质疏松症是一种代谢性骨病，通常影响老年人。可能需要手术干预的退行性脊柱疾病在这种易感人群中也很普遍。如果脊柱手术前未确诊或未治疗，骨质疏松可能导致术后不良事件的风险增加.术前不治疗骨质疏松症可能与对骨骼生理学的了解不足有关。缺乏标准化的治疗算法，有限的成本效益干预措施，脊柱外科医生不愿成为骨质疏松症管理的主要提供者。
目的：本循证综述的目的是制定脊柱手术患者骨质疏松的术前评估和治疗指南。
方法：使用美国国家医学图书馆/PubMed数据库和Embase对相关的术前诊断研究进行了文献系统综述，这些研究预测骨质疏松症相关术后不良事件的风险增加，以及骨质疏松症患者术前治疗低骨密度（BMD）是否能改善预后。
结果：在281项研究中，17人符合纳入标准，被纳入系统评价。工作组确认了B级建议，即术前使用双能X线骨密度仪扫描进行骨质疏松症测试（T评分<-2.5），计算机断层扫描（Hounsfield单位<97.9），血清维生素D3水平(<20ng/mL)可预测脊柱手术后骨质疏松相关不良事件的风险增加。专责小组确定了B级建议，即术前使用特立帕肽治疗骨质疏松症可增加BMD，诱导更早和更强大的融合，并可能改善选定患者的预后。关于术前单独使用双膦酸盐治疗和术后结果的证据不足。
结论：本循证临床指南建议怀疑有骨质疏松的患者接受术前评估，如果骨质疏松被证实，应就术后不良事件的风险给予适当建议。此外,术前优化BMD并选择治疗可改善某些患者的预后.可以在https://www上访问完整的指南。cns.org/guidelines/browse-guidelines-detail/3-术前-骨质疏松-评估。
BACKGROUND: Osteoporosis is a metabolic bone disease that commonly affects the elderly. Degenerative spinal disease that may require surgical intervention is also prevalent in this susceptible population. If undiagnosed or untreated before spine surgery, osteoporosis may result in an increased risk of postoperative adverse events. Nontreatment of osteoporosis preoperatively may be related to a poor understanding of bone physiology, a lack of standardized treatment algorithms, limited cost-effective interventions, and reluctance by spine surgeons to be the primary provider of osteoporosis management.
OBJECTIVE: The objective of this evidence-based review is to develop
guidelines for the preoperative assessment and treatment of osteoporosis in patients undergoing spine surgery.
METHODS: A systematic review of the literature was performed using the National Library of Medicine/PubMed database and Embase for studies relevant to preoperative diagnostic studies that predict increased risk of osteoporosis-related postoperative adverse events and whether the preoperative treatment of low bone mineral density (BMD) in patients with osteoporosis improves outcome.
RESULTS: Out of 281 studies, 17 met the inclusion criteria and were included for systematic review. The task force affirmed a Grade B recommendation that preoperative osteoporosis testing with a dual-energy X-ray absorptiometry scan (T-score < -2.5), a computed tomography scan (Hounsfield units <97.9), and serum vitamin D3 level (<20 ng/mL) predict an increased risk of osteoporosis-related adverse events after spine surgery. The task force determined a Grade B recommendation that preoperative osteoporosis treatment with teriparatide increases BMD, induces earlier and more robust fusion, and may improve select patient outcomes. There is insufficient evidence regarding preoperative treatment with bisphosphonates alone and postoperative outcome.
CONCLUSIONS: This evidence-based clinical
guideline provides a recommendation that patients with suspected osteoporosis undergo preoperative assessment and be appropriately counseled about the risk of postoperative adverse events if osteoporosis is confirmed. In addition, preoperative optimization of BMD with select treatments improves certain patient outcomes.The full
guidelines can be accessed at https://www.cns.org/
guidelines/browse-
guidelines-detail/3-preoperative-osteoporosis-assessment.
