Evidence map›Paper›PMID 41790039›Full record

ReviewGlobal spine journal2026

Pre-Operative Bone Health in Elective Spine Surgery, From Risk Assessment to Optimization Strategies: A Narrative Review.

Mitchell K Ng, Morgan Hitchner, Jonathan Dalton, Yulia Lee, William A Green, Gregorio Baek, Joshua Mathew, Yasmine K Eichbaum, Alan S Hilibrand, Alexander R Vaccaro and 2 more

Abstract readReview
In one paragraph

Review in Global spine journal, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Mitchell K NgRothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA.ORCID 0000-0002-5831-055X
Morgan HitchnerRothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Jonathan DaltonRothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA.ORCID 0000-0002-7452-2712
Yulia LeeRothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
William A GreenRothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA.ORCID 0000-0001-7147-0542
Gregorio BaekRothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Joshua MathewRothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Yasmine K EichbaumRothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Alan S HilibrandRothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA.ORCID 0000-0001-8811-9687
Alexander R VaccaroRothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Gregory D SchroederRothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Christopher K KeplerRothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Study DesignNarrative Review.ObjectivesBone health optimization before spine surgery is an important but overlooked determinant of long-term postoperative outcomes. Compromised bone quality is associated with hardware loosening, pseudoarthrosis, proximal junctional failure, and revision surgery. This narrative review aims to highlight the importance of preoperative bone optimization and propose a pragmatic clinical pathway for spine surgeons. Specifically, we aimed to: (1) outline risk assessment and diagnostic strategies, including clinical risk factors, laboratory testing, and imaging such as dual-energy x-ray absorptiometry (DEXA) and opportunistic CT-based Hounsfield Unit (HU) analysis; (2) evaluate therapeutic options, emphasizing pharmacologic agents (teriparatide, romosozumab, denosumab, and bisphosphonates) alongside non-pharmacologic measures including nutrition and lifestyle modification; and (3) explore future directions, including therapy duration and economic barriers to wider adoption of newer agents.MethodsThis narrative review synthesizes the current literature on preoperative bone health management in spine surgery. Risk assessment strategies were discussed including imaging, laboratory testing, and clinical picture analysis. Therapeutic options evaluated emphasize pharmacologic agents alongside non-pharmacologic measures.ResultsDespite the clinical relevance of compromised bone quality to poor surgical outcomes, bone health assessment remains inconsistently incorporated into surgical planning. Current evidence supports a multimodal approach combining targeted assessment and timely intervention to mitigate risk of adverse bone-related events following spine surgery.ConclusionsPreoperative bone health optimization is a crucial opportunity to improve long-term outcomes for patients undergoing spine surgery. Adoption of a standardized clinical pathway for risk stratification, diagnosis, and treatment may provide a valuable framework for improving fixation stability and fusion rates.

Indexed as

bone healthosteoporosispreoperative optimizationspine surgery

Identifiers

PMID41790039
PMCPMC12965892

What Socratic holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.