{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T04:18:59Z","timestamp":1790741939296,"version":"4.1.0"},"reference-count":82,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,8]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Pyogenic spondylodiscitis affects a fragile patient population. Surgical treatment in cases of instability entails instrumentation, and loosening of this instrumentation is a frequent occurrence in pyogenic spondylodiscitis. The authors therefore attempted to investigate whether low bone mineral density (BMD)\u2014which is compatible with the diagnosis of osteoporosis\u2014is underdiagnosed in patients with pyogenic spondylodiscitis. How osteoporosis was treated and how it affected implant stability were further analyzed.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n Charts of patients who underwent operations for pyogenic spondylodiscitis were retrospectively reviewed for clinical data, prior medical history of osteoporosis, and preoperative CT scans of the thoracolumbar spine. In accordance with a previously validated high-fidelity opportunistic CT assessment, average Hounsfield units (HUs) in vertebral bodies of L1 and L4 were measured. Based on the validation study, the authors opted for a conservative cutoff value for low BMD, being compatible with osteoporosis \u2264 110 HUs. Baseline and outcome variables, including implant failure and osteoporosis interventions, were entered into a multivariate logistic model for statistical analysis.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n Of 200 consecutive patients who underwent fusion surgery for pyogenic spondylodiscitis, 64% (n = 127) were male and 66% (n = 132) were older than 65 years. Seven percent (n = 14) had previously been diagnosed with osteoporosis. The attenuation analysis revealed HU values compatible with osteoporosis in 48% (95\/200). The need for subsequent revision surgery due to implant failure showed a trend toward an association with estimated low BMD (OR 2.11, 95% CI 0.95\u20134.68, p = 0.067). Estimated low BMD was associated with subsequent implant loosening (p < 0.001). Only 5% of the patients with estimated low BMD received a diagnosis and pharmacological treatment of osteoporosis within 1 year after spinal instrumentation.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n Relying on past medical history of osteoporosis is insufficient in the management of patients with pyogenic spondylodiscitis. This is the first study to identify a substantially missed opportunity to detect osteoporosis and to start pharmacological treatment after surgery for prevention of implant failure. The authors advocate for routine opportunistic CT evaluation for a better estimation of bone quality to initiate diagnosis and treatment for osteoporosis in these patients.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2020.5.focus20267","type":"journal-article","created":{"date-parts":[[2020,8,1]],"date-time":"2020-08-01T09:30:46Z","timestamp":1596274246000},"page":"E16","source":"Crossref","is-referenced-by-count":18,"title":["Do we underdiagnose osteoporosis in patients with pyogenic spondylodiscitis?"],"prefix":"10.3171","volume":"49","author":[{"given":"Christoph","family":"Bettag","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Georg-August University of G\u00f6ttingen; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tammam","family":"Abboud","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Georg-August University of G\u00f6ttingen; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"von der Brelie","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Georg-August University of G\u00f6ttingen; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Melich","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Georg-August University of G\u00f6ttingen; and"},{"name":"Department of Neurosurgery, University Hospital Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veit","family":"Rohde","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Georg-August University of G\u00f6ttingen; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bawarjan","family":"Schatlo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Georg-August University of G\u00f6ttingen; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"4","key":"b1","series-title":"Eur Spine J","doi-asserted-by":"publisher","first-page":"983","DOI":"10.1007\/s00586-015-4318-y","article-title":"Outcome of conservative and surgical treatment of pyogenic spondylodiscitis: a systematic literature review","volume":"25","author":"Rutges JP","year":"2016","unstructured":"Rutges JP, Kempen DH, van Dijk M, Oner FC. 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