Spine - 2026-07-15 - Journal Article; Systematic Review; Meta-Analysis
Vitamin D and Bisphosphonate Therapy for Optimizing Outcomes in Spinal Fusion: A Systematic Review and Meta-Analysis.
Sadh P, Kim J, Furlong C, Perez-Albela A, Suleman Y, Basques BA
Topics
Key Takeaway
Vitamin D supplementation improves one-year fusion rates by approximately 25% (RR ~1.25) over placebo, while bisphosphonates reduce vertebral compression fracture risk by 90% (RR 0.10) compared to vitamin D alone in spinal fusion patients.
Summary Depth
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Summary
This PRISMA-compliant meta-analysis compared vitamin D vs. placebo and bisphosphonates vs. vitamin D on fusion rates, VCF risk, ODI, VAS, postural stability, and bone turnover markers in spinal fusion patients. Vitamin D vs. placebo showed RR ~1.25 for fusion at one year, ODI improvement of ~8.56 points at one year, and OSI SMD of 0.93. Bisphosphonates accelerated early fusion but converged with vitamin D by one year, suppressed P1NP, and dramatically reduced fracture risk (RR 0.10), though ODI favored vitamin D at one year.
Key Limitation
Approximate rather than exact pooled effect sizes and absence of reported heterogeneity statistics (I²) prevent reliable assessment of result precision and cross-study consistency.
Original Abstract
STUDY DESIGN
Systematic review and meta-analysis.
OBJECTIVE
To systematically evaluate the impact of perioperative vitamin D supplementation and bisphosphonate therapy on spinal fusion outcomes, patient-reported disability and pain, postural stability, and vertebral fracture risk.
BACKGROUND
Bone health optimization is critical for successful spinal fusion. While vitamin D and bisphosphonate supplementation have been studied individually, their comparative and combined effects remain unclear.
METHODS
A PRISMA-compliant systematic review and meta-analysis were performed (PubMed, Embase, and Google Scholar; through January 2025). Eligible randomized controlled and prospective comparative trials evaluated: (1) vitamin D versus placebo/no supplement and (2) bisphosphonates versus vitamin D. Primary outcomes were fusion rates and vertebral compression fractures (VCFs). Secondary outcomes included functional scores (ODI), VAS, postural stability, bone turnover markers (P1NP), and BMD. Risk ratios (RR) and mean differences (MD/SMD) with 95% CI were pooled.
RESULTS
For the vitamin D versus placebo analysis, increased fusion at one year (RR: ∼1.25), improved ODI at six months and one year (MD: ∼6.90, 8.56), and provided a small early VAS benefit (MD: 1.14). OSI improved significantly (SMD: 0.93). For Bisphosphonates versus vitamin D analysis, bisphosphonate therapy accelerated early fusion, but by one year, outcomes were similar. ODI favored vitamin D at one year, while VAS showed no difference. Bisphosphonates suppressed P1NP and reduced fracture risk (RR: 0.10).
CONCLUSIONS
Vitamin D accelerates early fusion and modestly improves long-term function and bisphosphonates provide fracture protection and turnover suppression. These findings support a tailored, multimodal approach to perioperative bone health optimization in spinal fusion.
LEVEL OF EVIDENCE
Level II.