JAAOS - 2026-09-15 - Journal Article
Global Patterns of Bone Health Screening and Treatment in Spine Surgery: An AO Spine Survey.
Shen Y, Malka MS, Hassan FM, Coury JR, Shi T, Ortega DA, Lombardi JM, Lenke LG, Wetzel FT, Reyes JL, Sardar ZM
Topics
Key Takeaway
Only 61.1% of spine surgeons globally screen with DXA before instrumented fusion, with North America highest at 89.5% and Africa lowest at 36.6%.
Summary Depth
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Summary
This AO Spine survey assessed global patterns of osteoporosis screening and treatment optimization before spine surgery using a 34-item questionnaire distributed to AO Spine subscribers across six world regions. Of respondents, 61.1% routinely obtain DXA before instrumented fusion; when osteoporosis is detected, 65.1% alter their surgical plan and 64.7% refer for treatment first. Fellowship-trained surgeons screened more frequently than non-fellowship-trained surgeons (67.9% vs. 52.5%, P=0.002), and significant regional variation existed (North America 89.5% vs. Africa 36.6%, P<0.001).
Key Limitation
A 3.4% response rate renders the findings ungeneralizable and almost certainly overestimates screening rates, as non-respondents are disproportionately likely to be surgeons with less structured bone health protocols.
Original Abstract
INTRODUCTION
Bone health is critical to spine surgery. Studies have demonstrated the role and benefit of optimizing bone health before spinal surgery. However, bone health screening and treatment patterns vary considerably among spine surgeons. The purpose of this study was to assess the global screening, prevention, and treatment of osteoporosis and bone health in spine surgery.
METHODS
A 34-item questionnaire was created and distributed anonymously, globally to AO Spine subscribers. The word responses were analyzed manually and categorized. Each participant was assigned a region: Asia, Africa, Central America, Europe, North America, or South America. Quantitative outcomes include the frequency and proportion of respondents who selected each answer. Qualitative outcomes include written responses to select prompts. Chi-squared tests was performed to compare proportions based on categories.
RESULTS
The response rate was 3.4%; 36.2% of respondents were from Asia, 28.7% Europe, 12.8% South America, 9.8% North America, 9.6% Africa, and 2.9% Central America. 69.8% finished residency in orthopaedic surgery, 24.5% in neurosurgery, and 5.7% in others; 58.6% completed a spine fellowship. Before instrumented fusion, 61.1% routinely checked dual-energy radiograph absorptiometry (DXA). If osteoporosis is detected on DXA before an instrumented fusion, 65.1% would alter their treatment plan; 64.7% refer the patient to treatment first. The rate of DXA screening before instrumented fusion differed based on the region ( P < 0.001): the highest was in North America at 89.5%, and the lowest was in Africa at 36.6%. Before instrumented fusion, fellowship-trained surgeons screened DXA more routinely than those without a fellowship, at 67.9% and 52.5%, respectively ( P = 0.002).
CONCLUSIONS
Globally, bone health screening before spine surgery has increased. However, large regional variations in practice patterns exist regarding the screening of bone health pre- and perioperatively.