Osteoporosis & Spine Surgery in New York City
Dr. Zeeshan Sardar, MD, MSc, F.R.C.S.C
Director, Quality & Patient Safety (QPS) – Och Spine Hospital
Medical Director, Spine Unit – Och Spine Hospital
Co-Chief of Spinal Deformity Surgery • NewYork-Presbyterian / Columbia University
Och Spine Hospital • New York, NY
Osteoporosis — the reduction in bone density that increases fracture risk and impairs the ability of bone to hold surgical implants — is one of the most important and most frequently underaddressed factors in spine surgery. As the population ages and more adults require spinal reconstruction for deformity, stenosis, spondylolisthesis, and adjacent segment disease, the intersection of osteoporosis and spine surgery becomes increasingly central to surgical planning and outcomes. Dr. Sardar evaluates bone density as a standard component of surgical planning for all patients undergoing instrumented spinal fusion and works with endocrinologists and metabolic bone specialists to optimize bone health before elective surgery whenever possible.
WHY BONE DENSITY MATTERS IN SPINE SURGERY
Spinal instrumentation — pedicle screws, interbody cages, rods, and hooks — depends on the surrounding bone for its purchase and stability. In osteoporotic bone, screws can pull out or cut through trabecular bone under the loads imposed by daily activity. Cages can subside into weakened vertebral endplates. Fusion rates are lower. Hardware failure and construct failure rates are higher. These problems translate directly into worse patient outcomes: persistent pain, loss of correction, reoperation, and in severe cases, neurological compromise.
VERTEBRAL COMPRESSION FRACTURES
Osteoporosis also dramatically increases the risk of vertebral compression fractures — fractures of the vertebral body that occur spontaneously or with minimal trauma. These fractures cause sudden, severe back pain and can produce progressive kyphotic deformity as the fractured vertebra collapses. Multiple compression fractures over time cause the characteristic forward rounding of advanced thoracic kyphosis. Vertebral compression fractures are one of the most common causes of acute severe back pain in patients over 65. When identified promptly, minimally invasive treatment (kyphoplasty) can reduce pain and stabilize the fracture. When multiple fractures accumulate, progressive kyphotic deformity may eventually require surgical correction.
EVALUATION
Bone density is evaluated with a DEXA scan, which measures bone mineral density at the hip and lumbar spine. The T-score — the number of standard deviations from peak bone mass in a young healthy adult — is the standard measure. A T-score below -2.5 defines osteoporosis; between -1.0 and -2.5 defines osteopenia. Dr. Sardar uses the DEXA scan result to guide implant selection (including augmented fixation strategies), the extent and design of the instrumentation construct, bone grafting and biological augmentation strategies, and whether elective surgery should be deferred to allow medical treatment first.
MEDICAL TREATMENT BEFORE SURGERY
For patients with significant osteoporosis planning elective spinal fusion, a course of bone-building medical therapy before surgery can meaningfully improve outcomes. Options include teriparatide (Forteo) and abaloparatide (Tymlos) — anabolic agents that stimulate new bone formation; studies suggest they improve fusion rates and reduce hardware failure in osteoporotic spine surgery patients. Bisphosphonates and denosumab are appropriate for long-term management. The decision about which agent to use is made in coordination with an endocrinologist or metabolic bone specialist, whom Dr. Sardar coordinates as part of a pre-surgical optimization pathway.
AUGMENTED FIXATION TECHNIQUES
When surgery cannot be deferred or bone density cannot be adequately improved preoperatively, specialized fixation techniques maximize implant stability: cement augmentation of pedicle screws (injecting bone cement into the pedicle before screw insertion dramatically increases pullout strength); expandable pedicle screws (expanding after insertion to engage more bone surface area); cortical bone trajectory screws (engaging denser cortical bone); and extended constructs that distribute loads over more fixation points.
WHY CHOOSE DR. SARDAR
Dr. Sardar addresses bone density as a standard component of every surgical consultation for instrumented fusion. He works within a multidisciplinary framework at NewYork-Presbyterian / Columbia University that includes endocrinology and metabolic bone specialists, and coordinates preoperative optimization for patients with significant osteoporosis.
This page is for educational purposes only and does not constitute individualized medical advice. Please consult a qualified spine specialist to discuss your specific condition.
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