Global Patterns in Bone Health Screening and Optimization: an AO Spine Survey

Introduction: Poor bone health is associated with numerous postop spine complications. Bone health screening and optimization practices vary amongst spine specialists. Few studies have analyzed spine specialists’ bone health screening/optimization practices.

Methods: A 34-item questionnaire was created and distributed anonymously, globally to AO Spine subscribers via SurveyMonkey. The word responses were analyzed manually and categorized. Each participant was assigned a region: Asia, Africa, Central America, Europe, North America, South America. Chi-squared test was performed to compare proportions based on categories. P-value was significant < 0.05.

Results: The response rate was 3.4% (493/14491). 36.2% (136/376) of respondents were from Asia, 28.7% (108/376) Europe, 12.8% (48/376) South America, 9.8% (37/376) North America, 9.6% (36/376) Africa, and 2.9% (11/376) Central America. 69.8% (344/493) finished residency in orthopaedic surgery, 24.5% (121/493) in neurosurgery, and 5.7% (28/493) in others. 58.6% (289/493) completed a spine fellowship. Before instrumented fusion, 61.1% (280/458) routinely checked DXA. If OPO is detected on DXA before an instrumented fusion, 65.1% (179/275) would alter their treatment plan; 64.7% (178/275) refer the patient to treatment first. 75.3% (283/376) utilized surgical techniques to improve fusion in patients with poor bone health. 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% (34/38), and the lowest was in Africa at 36.6% (15/41). The tendency to employ surgical techniques to enhance fusion differed by geography (p=0.030): 89.6% (43/48) of South Americans did, followed by 81.1% (30/37) of North Americans. 74.3% (84/113) of neurosurgeons routinely screened for bone health, whereas 58.1% (187/322) of orthopaedic surgeons did. The tendency to use surgical techniques to enhance fusion did not differ based on the residency (p=0.39). Before instrumented fusion, fellowship-trained surgeons screened DXA more routinely than those without (67.9% (188/277) vs. 52.5% (83/158), (p=0.002)).

Conclusion : Globally, preop bone health screening has increased. However, large regional variations exist regarding the screening and optimization of bone health pre-/perioperatively.