Spinal Fusion and Osteoporosis – Antiresorptive and Anabolic Bone Building Medications

Bone Health Therapy and Spinal Fusion: Abaloparatide, Teriparatide, Denosumab, and Romosozumab

In a past blog, we talked about arthroplasty and bone health. We touched upon how the effects of osteoporosis on arthroplasty is like trying to patch a threadbare favorite cashmere sweater or favorite pair of jeans. The fabric of the sweater is so threadbare that it cannot hold the new patch. The patches do not fail, but rather the sweater around the patch disintegrates. The same effect with patched jeans, where the patch is stronger than the threadbare fabric it is meant to hold together.

This is analogous to how osteoporosis affects joint replacements and surgical procedures that repair or replace joints. Let’s extrapolate this idea a bit further. The spine and spinal column are commonly spoken of as a singular unit, but in reality is made up of 33 vertebrae, with 364 joints shared amongst the 33 vertebrae. In spinal fusion surgery, surgeons install fixating hardware into the vertebrae of your spine, immobilizing the joints between the fused vertebrae. For those patients who have osteoporosis, this means that each vertebral connection and hardware installation is anchored into a weak or compromised bone matrix.

What should we do?

Current bone health treatments fall into a few categories: anti-resorptive medications like denosumab and bisphosphonates, and the osteoanabolic bone builders like abaloparatide, teriparatide, and Romosozumab.
Anti-resorptive medications like bisphosphonates and denosumab decrease the activity of osteoclasts – cells that break down bone in preparation for new growth – thereby preventing further breakdown and reduction of bone mass.
Osteoanabolic medications like abaloparatide and teriparatide act as bone builders by increasing the activity of osteoblasts – bone-forming cells responsible for synthesizing and depositing the organic bone matrix (osteoid) and coordinating its mineralization.

Publications and studies released in 2020 report the successful incorporation of teriparatide prior to lumbar fusion surgery in lowering the two-year complication rate for patients with poor bone health. What does this mean? It means that patients who are in need of spinal fusion, should also consider pre-operative bone health therapy.

If you are awaiting spinal fusion surgery, or any other joint replacement operation, speak with your surgeon about prepping your bones with a year or more of bone therapy to rebuild a solid foundation upon which to anchor your new replacements.