Bone union after spinal fusion surgery using local bone in long-term bisphosphonate users

a prospective comparative study

Taewook Kang, Si Young Park, Seok Ha Hong, Jin Hyeok Lee, Soon-Hyuck Lee, Jong Hoon Park

Research output: Contribution to journalArticle

Abstract

Summary: Bisphosphonates are the most commonly used drugs for osteoporosis and long-term use of bisphosphonates may affect fusion rate after spinal fusion surgery. There was significant delayed union after 6 months in long-term bisphosphonates users; however, there were no significant difference in fusion rate of long-term bisphosphonate users. Therefore, spinal fusion surgery should not be hesitated in long-term bisphosphonates users. Purpose: Bisphosphonates (BPs) are the most popular class of drugs for treatment of postmenopausal osteoporosis. Long-term use of BPs may also inhibit the spinal fusion process after posterior lumbar interbody fusion (PLIF). We compared bone fusion rates of long-term BPs users and non-users after undergoing spinal fusion surgery. Methods: A total of 97 postmenopausal women who were candidates for single-level PLIF were recruited from 2015 to 2016. Participants were divided into two groups, with 63 patients in a long-term BPs user group and 34 patients in a non-user group. Serum C-terminal cross-linking telopeptide (CTX) levels were checked for bone resorption markers. Bone fusion rates were calculated at 6 months and 1 and 2 years after the surgery. Clinical outcomes were measured using the Oswestry Disability Index (ODI) and visual analog scale (VAS). Results: Serum CTX level was dramatically decreased in the long-term BPs user group (p < 0.05). Fusion rates at 6 months after surgery were 42% in the non-user group and 26% in the long-term BPs user group (p = 0.035). However, fusion rates were 82% in the long-term BPs user group and 87% in the non-user group at 2 years after surgery (p > 0.05). There was no significant difference between the two groups in ODI or VAS. Conclusions: Even though there was significant delayed union after 6 months in long-term BPs users, at the 2-year postoperative follow-up, there was no significant difference in bone fusion rate between the two groups. Long-term BPs users showed fusion rates greater than 80% and clinical outcome improvements that were comparable to those in non-users. No significant effect on fusion rate after PLIF was found in long-term BPs users.

Original languageEnglish
Article number74
JournalArchives of Osteoporosis
Volume14
Issue number1
DOIs
Publication statusPublished - 2019 Dec 1

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Spinal Fusion
Diphosphonates
Prospective Studies
Bone and Bones
Visual Analog Scale
Postmenopausal Osteoporosis
Bone Resorption
Serum
Pharmaceutical Preparations
Osteoporosis

Keywords

  • Bisphosphonates
  • Bone union
  • Long-term user
  • Spinal fusion

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

Bone union after spinal fusion surgery using local bone in long-term bisphosphonate users : a prospective comparative study. / Kang, Taewook; Park, Si Young; Hong, Seok Ha; Lee, Jin Hyeok; Lee, Soon-Hyuck; Park, Jong Hoon.

In: Archives of Osteoporosis, Vol. 14, No. 1, 74, 01.12.2019.

Research output: Contribution to journalArticle

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abstract = "Summary: Bisphosphonates are the most commonly used drugs for osteoporosis and long-term use of bisphosphonates may affect fusion rate after spinal fusion surgery. There was significant delayed union after 6 months in long-term bisphosphonates users; however, there were no significant difference in fusion rate of long-term bisphosphonate users. Therefore, spinal fusion surgery should not be hesitated in long-term bisphosphonates users. Purpose: Bisphosphonates (BPs) are the most popular class of drugs for treatment of postmenopausal osteoporosis. Long-term use of BPs may also inhibit the spinal fusion process after posterior lumbar interbody fusion (PLIF). We compared bone fusion rates of long-term BPs users and non-users after undergoing spinal fusion surgery. Methods: A total of 97 postmenopausal women who were candidates for single-level PLIF were recruited from 2015 to 2016. Participants were divided into two groups, with 63 patients in a long-term BPs user group and 34 patients in a non-user group. Serum C-terminal cross-linking telopeptide (CTX) levels were checked for bone resorption markers. Bone fusion rates were calculated at 6 months and 1 and 2 years after the surgery. Clinical outcomes were measured using the Oswestry Disability Index (ODI) and visual analog scale (VAS). Results: Serum CTX level was dramatically decreased in the long-term BPs user group (p < 0.05). Fusion rates at 6 months after surgery were 42{\%} in the non-user group and 26{\%} in the long-term BPs user group (p = 0.035). However, fusion rates were 82{\%} in the long-term BPs user group and 87{\%} in the non-user group at 2 years after surgery (p > 0.05). There was no significant difference between the two groups in ODI or VAS. Conclusions: Even though there was significant delayed union after 6 months in long-term BPs users, at the 2-year postoperative follow-up, there was no significant difference in bone fusion rate between the two groups. Long-term BPs users showed fusion rates greater than 80{\%} and clinical outcome improvements that were comparable to those in non-users. No significant effect on fusion rate after PLIF was found in long-term BPs users.",
keywords = "Bisphosphonates, Bone union, Long-term user, Spinal fusion",
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AU - Park, Si Young

AU - Hong, Seok Ha

AU - Lee, Jin Hyeok

AU - Lee, Soon-Hyuck

AU - Park, Jong Hoon

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N2 - Summary: Bisphosphonates are the most commonly used drugs for osteoporosis and long-term use of bisphosphonates may affect fusion rate after spinal fusion surgery. There was significant delayed union after 6 months in long-term bisphosphonates users; however, there were no significant difference in fusion rate of long-term bisphosphonate users. Therefore, spinal fusion surgery should not be hesitated in long-term bisphosphonates users. Purpose: Bisphosphonates (BPs) are the most popular class of drugs for treatment of postmenopausal osteoporosis. Long-term use of BPs may also inhibit the spinal fusion process after posterior lumbar interbody fusion (PLIF). We compared bone fusion rates of long-term BPs users and non-users after undergoing spinal fusion surgery. Methods: A total of 97 postmenopausal women who were candidates for single-level PLIF were recruited from 2015 to 2016. Participants were divided into two groups, with 63 patients in a long-term BPs user group and 34 patients in a non-user group. Serum C-terminal cross-linking telopeptide (CTX) levels were checked for bone resorption markers. Bone fusion rates were calculated at 6 months and 1 and 2 years after the surgery. Clinical outcomes were measured using the Oswestry Disability Index (ODI) and visual analog scale (VAS). Results: Serum CTX level was dramatically decreased in the long-term BPs user group (p < 0.05). Fusion rates at 6 months after surgery were 42% in the non-user group and 26% in the long-term BPs user group (p = 0.035). However, fusion rates were 82% in the long-term BPs user group and 87% in the non-user group at 2 years after surgery (p > 0.05). There was no significant difference between the two groups in ODI or VAS. Conclusions: Even though there was significant delayed union after 6 months in long-term BPs users, at the 2-year postoperative follow-up, there was no significant difference in bone fusion rate between the two groups. Long-term BPs users showed fusion rates greater than 80% and clinical outcome improvements that were comparable to those in non-users. No significant effect on fusion rate after PLIF was found in long-term BPs users.

AB - Summary: Bisphosphonates are the most commonly used drugs for osteoporosis and long-term use of bisphosphonates may affect fusion rate after spinal fusion surgery. There was significant delayed union after 6 months in long-term bisphosphonates users; however, there were no significant difference in fusion rate of long-term bisphosphonate users. Therefore, spinal fusion surgery should not be hesitated in long-term bisphosphonates users. Purpose: Bisphosphonates (BPs) are the most popular class of drugs for treatment of postmenopausal osteoporosis. Long-term use of BPs may also inhibit the spinal fusion process after posterior lumbar interbody fusion (PLIF). We compared bone fusion rates of long-term BPs users and non-users after undergoing spinal fusion surgery. Methods: A total of 97 postmenopausal women who were candidates for single-level PLIF were recruited from 2015 to 2016. Participants were divided into two groups, with 63 patients in a long-term BPs user group and 34 patients in a non-user group. Serum C-terminal cross-linking telopeptide (CTX) levels were checked for bone resorption markers. Bone fusion rates were calculated at 6 months and 1 and 2 years after the surgery. Clinical outcomes were measured using the Oswestry Disability Index (ODI) and visual analog scale (VAS). Results: Serum CTX level was dramatically decreased in the long-term BPs user group (p < 0.05). Fusion rates at 6 months after surgery were 42% in the non-user group and 26% in the long-term BPs user group (p = 0.035). However, fusion rates were 82% in the long-term BPs user group and 87% in the non-user group at 2 years after surgery (p > 0.05). There was no significant difference between the two groups in ODI or VAS. Conclusions: Even though there was significant delayed union after 6 months in long-term BPs users, at the 2-year postoperative follow-up, there was no significant difference in bone fusion rate between the two groups. Long-term BPs users showed fusion rates greater than 80% and clinical outcome improvements that were comparable to those in non-users. No significant effect on fusion rate after PLIF was found in long-term BPs users.

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