Clinical and Economic Burden of Poor Bone Health in Adult Spinal Deformity Surgery: A Multicenter Cohort Study.

Authors

Peter G Passias, Mohammad Daher, Kyriakos D Chatzis, Virginie Lafage, Renaud Lafage, Pratibha Nayak, Andrew Schoenfeld, Marc Khalife, Sleiman Haddad, Emmanuelle Ferrero, Breton Line, Bassel Diebo, Alan H Daniels, Jeffrey P Mullin, D Kojo Hamilton, Thomas Buell, David O Okonkwo, Jeffrey Gum, Alekos Theologis, Praveen Mummaneni, Dean Chou, Gregory Mundis, Darryl Lau, Joshua Bunch, Brandon Carlson, Stephen Lewis, Justin Scheer, Robert Eastlack, Khaled Kebaish, Munish Gupta, Han Jo Kim, Alex Soroceanu, Anthony Mikula, Themistocles Protopsaltis, Mitsuru Yagi, Naobumi Hosogane, Lawrence Lenke, Richard Hostin, Justin Smith, Eric Klineberg, Christopher Ames, Frank Schwab, Shay Bess, Christopher Shaffrey, International Spine Study Group

Published in

Spine. Jun 26, 2026. Epub Jun 26, 2026.

Abstract

Retrospective review of the prospectively enrolled, multicenter ASD database.
We sought to compare clinical and economic outcomes for ASD patients with poor-bone-health versus those with normal-bone-health.
Osteoporosis is a common comorbidity in the adult spinal deformity (ASD) population, with a reported prevalence of 14-29%.
Patients were categorized into five guideline-concordant cohorts: Confirmed-Osteoporosis (COP: patients with osteopenia or osteoporosis based on DEXA values or a formal preoperative diagnosis); Fracture Osteoporosis (Fx: patients with fragility fractures); Fracture-without-confirmed-Osteoporosis (FXNO: patients with fragility fractures but no osteopenia/osteoporosis diagnosis based on DEXA/formal documentation); Confirmed/fracture-osteoporosis (COP/FX: patients with fragility fractures and/or osteopenia/osteoporosis by DEXA/diagnosis); and the Normal cohort (Nm: patients with normal bone health and no fragility fractures). Cost analyses were performed using multivariate linear regression controlling for BMI, diabetes, baseline deformity (T1PA), and levels fused. Multivariate logistic regression assessed risk of reoperation/complications between groups while controlling for BMI, diabetes, baseline deformity (T1PA), and levels fused.
Overall, 205 patients were included in the Fx-cohort, 136 patients in the COP-cohort, 115 patients in the FXNO-cohort, and 71 patients Nm-cohort. Compared with the Nm-cohort, osteoporotic-cohorts demonstrated significantly worse baseline spinopelvic alignment and higher comorbidity burden. Fx and FXNO cohorts had higher rates of PJF (Fx: 11.2% vs 1.4%, aOR 7.8; FXNO: 10.4% vs 1.4%, aOR 9.0) and revision surgery (Fx: 19.5% vs 7.0%, aOR 2.8; FXNO: 22.6% vs 7.0%, aOR 3.6). Osteoporotic cohorts demonstrated significantly higher short-term QALYs at 6 weeks (P<0.05) with no difference in the long term. Revision surgery averaged $95,117 per case, translating into an estimated $4.0 million potential-cost-savings.
Our findings highlight the clinical and economic burden of untreated poor bone quality in the setting of ASD surgery. Proactive medical management is crucial to mitigate complications, reduce revisions, and significantly lower healthcare costs in ASD surgery.

PMID:
42430752
Bibliographic data and abstract were imported from PubMed on 11 Jul 2026.

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