Medical management of bone loss from a spinal surgeon's perspective

Osteoporosis is a common metabolic disorder in which the mineral and structural properties of the bone are compromised as a result of multiple, often endocrine, factors. Osteoporosis and other bone loss disorders will impact all spine surgeons. With the aging of the population, surgeons caring for adults will no doubt treat patients sustaining spinal fragility fractures from the dens to the sacrum. Moreover, all spine surgeons, even pediatric deformity specialists, will encounter challenges in successful spinal fixation related to poor bone quality. To adequately care for these patients, the physician requires a reasonable familiarity with the disease state and its implications on the spine. The surgeon must be able to identify at-risk patients, assess their bone mineral density, and, increasingly, initiate treatment.