Introduction: Osteoporosis medications are commonly used in spine surgery to enhance bone mineral density (BMD) and prevent post-operative complications. This study aims to identify factors that influence the effectiveness of osteoporosis treatments.
Methods: Data were retrospectively collected from three tertiary care centers on patients who received osteoporosis treatment. Variables included Hounsfield Unit (HU) measurements, patient demographics including frailty scores and treatment details. Patients were considered improved if their final HU increased ≥ 5 points compared to baseline. Survival analysis was used to assess factors influencing treatment response.
Results: A total of 306 patients were included, with 159 (52%) showing improvement and 147 (48%) not. Those who improved were younger (median 72 vs. 75 years, p=0.02), had lower pre-treatment HU (median 98 vs. 109 HU, p=0.02), and had shorter treatment durations (median 17 vs. 20 months, p=0.01). Distribution of medications differed significantly (p=0.004): Alendronate (35.8% vs. 44.9%), Denosumab (35.8% vs. 44.9%), Romosozumab (15.7% vs. 4.8%), and Teriparatide (19.5% vs. 30.6%). Univariate analysis revealed that older age (HR 0.99, p=0.05), higher mFI score (HR 0.83, p=0.04), higher baseline HU (HR 0.99, p=0.003) reduced the likelihood of improvement. Though, Female (HR 1.49, p=0.03) had a higher chance of HU improvement. In multivariate analysis after control of treatment type patient-related factors were no longer statistically significant. In contrast, the type of medication received was a strong predictor of the outcome in both univariate and multivariate analyses. Patients treated with Denosumab (HR 2.32, p< 0.001), Romosozumab (HR 24.06, p< 0.001), and Teriparatide (HR 6.61, p< 0.001) were more likely to show improvement. Except, Alendronate was associated with reduction of improvement (HR 0.43, p< 0.001).
Conclusion : Response to osteoporosis treatment is primarily driven by the type of medication, independent of patient-related factors, with Romosozumab showing the greatest effect on increasing bone density
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