Long-Term Outcomes of Bisphosphonate and Parathyroid Hormone Analog Treatment in Osteoporotic Patients Undergoing Lumbar Spine Surgery: A Retrospective Cohort Study

Introduction: Patients with osteoporosis face higher risks of postoperative complications after spinal procedures, though treatment has been shown to improve immediate postoperative outcomes. Despite evidence of perioperative benefits, long-term outcomes after lumbar fusion remain underexplored. This study investigates the five-year impact of bisphosphonate and parathyroid hormone analog treatment on medical and mechanical complications following lumbar spine surgery.

Methods: This retrospective cohort study was performed using medical records from TriNetX, a national de-identified database, to examine patients with osteoporosis undergoing lumbar spine procedures. Those who received bisphosphonate and parathyroid hormone analogs within three months preoperatively were compared to a propensity-matched control group. Propensity score matching (1:1) was utilized to statistically adjust for demographic factors and multiple medical comorbidities, including type I and II diabetes mellitus, metformin use, and body mass index (BMI). This study analyzed 5-year medical and implant complications using Chi-squared tests and univariate regression analyses within a statistically controlled cohort.

Results: Over five years, the treated cohort exhibited significantly higher rates of pneumonia (RR 1.34, p = 0.025), readmissions (RR 1.12, p = 0.028), and opioid use (RR 1.75, p = 0.040) compared to the untreated cohort. Other complications, such as sepsis, infection, wound complications, pulmonary embolism, and surgical issues like pseudoarthrosis and revision surgeries, showed no significant differences between the cohorts.

Conclusion : Osteoporosis treatment in patients undergoing lumbar spine procedures is associated with a higher long-term risk of pneumonia and readmission; however, the benefits of managing osteoporosis and reducing immediate postoperative risks likely outweigh these concerns. These findings suggest that although there may be long-term risks and complications, these should not deter the use of osteoporosis treatment in surgical planning.