{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T20:08:15Z","timestamp":1772827695549,"version":"3.50.1"},"reference-count":62,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,11,21]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Glucagon-like peptide-1 (GLP-1) agonists are established therapeutics for weight loss that are increasingly used for BMI optimization prior to spine surgery. However, emerging evidence has suggested that GLP-1 agonists might reduce bone mineral density (BMD), increasing the risk of postoperative biomechanical complications. CT-based Hounsfield units (HUs) have gained popularity as a method for measuring spinal BMD. The aim of this study was to evaluate the effects of GLP-1 agonist\u2013induced weight loss on spinal BMD as measured by opportunistic CT-based HUs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>Patients who were treated with any GLP-1 agonist (2017\u20132022) for &gt; 3 months were retrospectively identified. Patient body weight (BW), BMI, and HU measurements in the L1 vertebral body were measured before and after GLP-1 therapy. Patients were grouped according to the percentage of weight loss during GLP-1 therapy. One-way ANOVA was used to compare the mean changes in spinal HUs across the groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Among the 102 included patients, the mean \u00b1 standard error of the mean BW reduction was 14.5 \u00b1 2.5 kg over 15.9 \u00b1 1.2 months of GLP-1 agonist therapy. Of these, 7 patients (6.9%) lost &gt; 20% BW (mean decrease of 31.9 \u00b1 7.0 HU, p = 0.011), 14 (13.7%) lost 15%\u201320% BW (mean decrease of 19.1 \u00b1 8.3 HU, p = 0.038), 14 (13.7%) lost 10%\u201315% BW (mean decrease of 12.2 \u00b1 5.1 HU, p = 0.036), 24 (23.5%) lost 5%\u201310% BW (mean decrease of 15.7 \u00b1 3.3 HU, p &lt; 0.0001), 26 (25.5%) lost &lt; 5% BW (mean decrease of 14.7 \u00b1 6.0 HU, p = 0.022), and 17 (16.7%) gained BW during GLP-1 therapy (mean decrease of 6.3 \u00b1 5.0 HU, p = 0.229). One-way ANOVA testing did not show a significant difference in HU reduction across the weight loss groups (F = 1.12, p = 0.355). In addition, there was a significant correlation between the decrease in L1 HUs and the duration of GLP-1 therapy (r = \u22120.38, p = 0.0001) but not the amount of weight loss (r = \u22120.18, p = 0.070). In the multivariate analysis, the duration of GLP-1 therapy (p = 0.032) was a significant independent predictor of vertebral HU reduction, but the amount of weight loss (p = 0.664) was not.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Despite similar pretreatment BW and HU measurements, all weight loss groups had significant decreases in vertebral HUs following GLP-1 agonist therapy, with a significant correlation observed between HU reduction and treatment duration. This suggests that long-term GLP-1 agonist therapy can significantly diminish spinal BMD regardless of the amount of weight loss achieved.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.7.spine25791","type":"journal-article","created":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T17:41:01Z","timestamp":1765215661000},"page":"188-194","source":"Crossref","is-referenced-by-count":0,"title":["Effects of glucagon-like peptide-1 agonist therapy on vertebral bone mineral density as measured by CT-based Hounsfield units"],"prefix":"10.3171","volume":"44","author":[{"given":"Michael L.","family":"Martini","sequence":"first","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdelraman M.","family":"Hamouda","sequence":"additional","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zach","family":"Pennington","sequence":"additional","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julian S.","family":"Rechberger","sequence":"additional","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anthony L.","family":"Mikula","sequence":"additional","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nikita","family":"Lakomkin","sequence":"additional","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer","family":"Perez","sequence":"additional","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick","family":"Flanigan","sequence":"additional","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arjun","family":"Sebastian","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Rochester; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brett","family":"Freedman","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Rochester; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melvin D.","family":"Helgeson","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Rochester; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmad","family":"Nassr","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Rochester; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William E.","family":"Krauss","sequence":"additional","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michelle J.","family":"Clarke","sequence":"additional","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeremy L.","family":"Fogelson","sequence":"additional","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kurt","family":"Kennel","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Mayo Clinic, Rochester, Minnesota"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benjamin D.","family":"Elder","sequence":"additional","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"12","key":"b1","series-title":"J Bone Miner Res","first-page":"1885","article-title":"Structural determinants of vertebral fracture risk","volume":"22","author":"Melton LJ","year":"2007","unstructured":"Melton LJ, Riggs BL, Keaveny TM,  Structural determinants of vertebral fracture risk. 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