Thai Expert Consensus on Bone Health Optimization for Instrumented Spine Surgery
8
Issued Date
2025-12-01
Resource Type
eISSN
22114599
DOI
Scopus ID
2-s2.0-105029086980
Journal Title
International Journal of Spine Surgery
Volume
19
Issue
6
Start Page
722
End Page
733
Rights Holder(s)
SCOPUS
Bibliographic Citation
International Journal of Spine Surgery Vol.19 No.6 (2025) , 722-733
Suggested Citation
Singhatanadgige W., Valleenukul T., Limthongkul W., Ruangchainikom M., Chaiyamongkol W., Chitragran R., Pongmanee S., Siribumrungwong K., Lertudomphonwanit T., Kotheeranurak V., Pluemvitayaporn T., Tanasansomboon T., Petcharapiruch S., Changsatja S., Yingsakmongkol W. Thai Expert Consensus on Bone Health Optimization for Instrumented Spine Surgery. International Journal of Spine Surgery Vol.19 No.6 (2025) , 722-733. 733. doi:10.14444/8818 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/114922
Title
Thai Expert Consensus on Bone Health Optimization for Instrumented Spine Surgery
Author's Affiliation
Chulalongkorn University
Thammasat University
Siriraj Hospital
Faculty of Medicine, Chiang Mai University
Ramathibodi Hospital
Faculty of Medicine, Chulalongkorn University
IQVIA Inc.
Rangsit University
Faculty of Medicine, Prince of Songkla University
Phramongkutklao College of Medicine
Bhumibol Adulyadej Hospital
Samut Sakhon Hospital
Thammasat University
Siriraj Hospital
Faculty of Medicine, Chiang Mai University
Ramathibodi Hospital
Faculty of Medicine, Chulalongkorn University
IQVIA Inc.
Rangsit University
Faculty of Medicine, Prince of Songkla University
Phramongkutklao College of Medicine
Bhumibol Adulyadej Hospital
Samut Sakhon Hospital
Corresponding Author(s)
Other Contributor(s)
Abstract
Objective: To develop consensus-based guidance for bone health optimization in instrumented spine surgery, specifically addressing the limited guidance available in the Thai context. Methods: The study utilized a modified Delphi technique, engaging 10 orthopedic surgeons from Thailand with expertise in complex spine surgery and osteoporosis management. A targeted literature review was conducted, followed by 2 online surveys and a face-to- face consensus meeting to develop and refine the statements. Twenty-five main statements and 45 substatements that focused on patient evaluation, assessment tools, and risk stratification were drafted for the panel’s deliberation. Results: There was unanimous agreement on the necessity of evaluating bone health before instrumented spine surgery in patients aged ≥60 years, while evaluation was considered optional for those aged 50 to 59 years. The panelists supported using the fracture risk assessment tool score for clinical evaluation and recommended using several assessment tools, including dual-energy x-ray absorptiometry scans for specific age groups, Computed Tomography Hounsfield Unit, Trabecular Bone Score, and vertebral fracture assessment for bone health evaluation if available. Treatment recommendations included bone-forming agents as the first-line therapy for patients at high risk and very high risk and specialized surgical techniques for patients at very high risk. Surgical delay of at least 3 months should also be considered for patients at very high risk/with severe osteoporosis who have been scheduled for instrumented spine surgery. Conclusion: This guidance includes patient screening, evaluation, and treatment for patients with poor bone health based on risk stratification, including normal/low risk, osteopenia/intermediate risk, osteoporosis/high risk, and severe osteoporosis/ very high risk. Spine surgeons should be aware of poor bone health and consider bone health optimization to improve surgical outcomes and prevent osteoporosis-related complications. Clinical Relevance: Bone health optimization is crucial for instrumented spine surgery. Spine surgeons should consider bone health optimization guidance, including patient screening for poor bone health, assessment tools for evaluating bone health, and treatment for patients with poor bone health, to improve surgical results and minimize poor bone health-related complications. Level of Evidence: 5.