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Published in: Archives of Osteoporosis 1/2019

01-12-2019 | Fracture Healing | Original Article

Bone union after spinal fusion surgery using local bone in long-term bisphosphonate users: a prospective comparative study

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

Published in: Archives of Osteoporosis | Issue 1/2019

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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.
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Metadata
Title
Bone union after spinal fusion surgery using local bone in long-term bisphosphonate users: a prospective comparative study
Authors
Taewook Kang
Si Young Park
Seok Ha Hong
Jin Hyeok Lee
Soon Hyuck Lee
Jong Hoon Park
Publication date
01-12-2019
Publisher
Springer London
Published in
Archives of Osteoporosis / Issue 1/2019
Print ISSN: 1862-3522
Electronic ISSN: 1862-3514
DOI
https://doi.org/10.1007/s11657-019-0628-8

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