{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T04:10:57Z","timestamp":1792987857358,"version":"4.5.0"},"reference-count":98,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2024,8,19]],"date-time":"2024-08-19T00:00:00Z","timestamp":1724025600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Qatar National Library","award":["8747d094e2af9e15"],"award-info":[{"award-number":["8747d094e2af9e15"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Osteoporosis and low bone mineral density (BMD) pose significant challenges in adult spinal deformity surgery, increasing the risks of complications such as vertebral compression fractures, hardware failure, proximal junctional kyphosis\/failure, and pseudoarthrosis. This narrative review examines the current evidence on bone health optimization strategies for spinal deformity patients. Preoperative screening and medical optimization are crucial, with vitamin D supplementation showing particular benefit. Among the pharmacologic agents, bisphosphonates demonstrate efficacy in improving fusion rates and reducing hardware-related complications, though the effects may be delayed. Teriparatide, a parathyroid hormone analog, shows promise in accelerating fusion and enhancing pedicle screw fixation. Newer anabolic agents like abaloparatide and romosozumab require further study but show potential. Romosozumab, in particular, has demonstrated significant improvements in lumbar spine BMD over a shorter duration compared to other treatments. Surgical techniques like cement augmentation and the use of larger interbody cages can mitigate the risks in osteoporotic patients. Overall, a multifaceted approach incorporating medical optimization, appropriate pharmacologic treatment, and tailored surgical techniques is recommended to improve outcomes in adult spinal deformity patients with compromised bone quality. Future research should focus on optimizing the treatment protocols, assessing the long-term outcomes of newer agents in the spine surgery population, and developing cost-effective strategies to improve access to these promising therapies.<\/jats:p>","DOI":"10.3390\/jcm13164891","type":"journal-article","created":{"date-parts":[[2024,8,19]],"date-time":"2024-08-19T10:11:28Z","timestamp":1724062288000},"page":"4891","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Bone Health Optimization in Adult Spinal Deformity Patients: A Narrative Review"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1639-7199","authenticated-orcid":false,"given":"Yousef A.","family":"Al-Najjar","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, Och Spine at New York Presbyterian at the Weill Cornell Medical Center, 525 East 68th Street, New York, NY 10065, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4180-6049","authenticated-orcid":false,"given":"Danyal A.","family":"Quraishi","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Och Spine at New York Presbyterian at the Weill Cornell Medical Center, 525 East 68th Street, New York, NY 10065, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2824-6059","authenticated-orcid":false,"given":"Neerav","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Och Spine at New York Presbyterian at the Weill Cornell Medical Center, 525 East 68th Street, New York, NY 10065, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibrahim","family":"Hussain","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Och Spine at New York Presbyterian at the Weill Cornell Medical Center, 525 East 68th Street, New York, NY 10065, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,8,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1093\/neuros\/nyz454","article-title":"Epidemiology and Socioeconomic Trends in Adult Spinal Deformity Care","volume":"87","author":"Safaee","year":"2020","journal-title":"Neurosurgery"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"886","DOI":"10.31616\/asj.2020.0568","article-title":"Adult Spinal Deformity: Current Concepts and Decision-Making Strategies for Management","volume":"14","author":"Kim","year":"2020","journal-title":"Asian Spine J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1016\/j.jspd.2015.12.009","article-title":"Adult Spinal Deformity: Epidemiology, Health Impact, Evaluation, and Management","volume":"4","author":"Ames","year":"2016","journal-title":"Spine Deform."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1302\/2633-1462.13.BJO-2020-0001.R1","article-title":"Incidence of Spinal Deformity Surgery in a National Health Service from 2005 to 2018: An Analysis of 2,205 Children and Adolescents","volume":"1","author":"Tsirikos","year":"2020","journal-title":"Bone Jt. 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