Osteoporosis represents the most common metabolic disease of the bone, with an estimated 10% of adults aged 50 years or older affected in the United States. This patient population is at increased risk for spine fracture and instrumentation-related complications after spine surgery. Surgeon knowledge of the available treatments for patients with low bone mineral density (BMD) and how they impact biology of fusion may help mitigate negative effects in the postoperative period. Recombinant parathyroid hormone, which is sold under the name teriparatide, is the most extensively studied bone-protecting agent in humans. Additionally, the success of the monoclonal antibody denosumab has led to further clinical investigations of human patients undergoing spine surgery. Another monoclonal antibody, romosozumab, was recently approved by the US FDA for human use in patients with osteoporosis. Although studies of romosozumab in patients undergoing spine surgery have not been conducted, this is a promising potential therapeutic agent based on its early success in preclinical and clinical trials. Here, the authors aimed to review the mechanisms of action and evidence of use of antiresorptive and anabolic agents in patients with osteoporosis undergoing spine surgery.

In accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic review was conducted to explore the antiresorptive and anabolic agents used in the perioperative period in patients with osteoporosis undergoing spinal surgery. The search was performed by using the PubMed, Embase, and Cochrane Library databases. Titles and abstracts were screened and subsequently selected for full review.

The initial search returned 330 articles. Of these articles, 23 final articles were included and reviewed. Many of these articles reported that use of adjuvant agents in the perioperative period improved radiographic evidence of bony fusion and bone fusion rates. These agents tended to improve BMD postoperatively.

Although antiosteoporosis agents are effective to varying degrees as treatments of patients with low BMD, teriparatide and bisphosphonates have been the most extensively studied with respect to spinal instrumentation. The advent of newer agents represents an area for further exploration, especially due to the current paucity of controlled investigations. It is imperative for spine surgeons to understand the mechanisms of action of these drugs and their effects on biology of fusion.

骨质疏松症是最常见的骨骼代谢疾病，在美国估计有 10% 的 50 岁或以上的成年人受到影响。该患者群体在脊柱手术后发生脊柱骨折和器械相关并发症的风险增加。外科医生对低骨密度 (BMD) 患者可用治疗的了解以及它们如何影响融合生物学可能有助于减轻术后期间的负面影响。重组甲状旁腺激素以特立帕肽的名义出售，是人类研究最广泛的骨骼保护剂。此外，单克隆抗体狄诺塞麦的成功导致了对接受脊柱手术的人类患者的进一步临床研究。另一种单克隆抗体 romosozumab，最近被美国 FDA 批准用于骨质疏松症患者。尽管尚未对接受脊柱手术的患者进行 romosozumab 的研究，但基于其在临床前和临床试验中的早期成功，这是一种很有前景的潜在治疗剂。在这里，作者旨在回顾抗吸收和合成代谢药物在接受脊柱手术的骨质疏松患者中的作用机制和证据。

根据 PRISMA（系统评价和荟萃分析的首选报告项目）指南，进行了系统评价，以探讨接受脊柱手术的骨质疏松症患者围手术期使用的抗吸收和合成代谢药物。使用 PubMed、Embase 和 Cochrane 图书馆数据库进行检索。标题和摘要经过筛选，随后被选中进行全面审查。

最初的搜索返回了 330 篇文章。在这些文章中，最终收录并审查了 23 篇文章。这些文章中有许多报道说，在围手术期使用辅助药物可以改善骨融合和骨融合率的影像学证据。这些药物倾向于在术后改善 BMD。

尽管抗骨质疏松药物在治疗低 BMD 患者时在不同程度上有效，但特立帕肽和双膦酸盐在脊柱器械方面的研究最为广泛。新代理的出现代表了进一步探索的领域，特别是由于目前缺乏受控调查。脊柱外科医生必须了解这些药物的作用机制及其对融合生物学的影响。