title: A Systematic Review of Treatment Strategies for Degenerative Lumbar Spine Fusion Surgery in Patients With Osteoporosis.
abstract: OBJECTIVE
  To evaluate the current evidence in the literature on treatment strategies for degenerative lumbar spine fusion in patients with osteoporosis.
  
  
  METHODS
  A systematic review of the literature from 1950 to 2015.
  
  
  RESULTS
  The review of the literature yielded 15 studies on the effect of treatment options for osteoporosis on lumbar fusion rates. This study evaluated only degenerative lumbar spine conditions and excluded deformity patients. One study demonstrated an association between low bone mass as measured by Hounsfield units and lower fusion rates. Six studies evaluated perioperative medical treatment of osteoporosis and showed higher fusion rates in patients treated with alendronate and teriparatide. The strongest evidence was for perioperative teriparatide. Eight studies evaluated surgical treatment strategies in patients with osteoporosis and showed that cement augmentation of pedicle screws and expandable pedicle screws demonstrated improved fusion rates than traditional pedicle screws. The strongest evidence was for expandable pedicle screws.
  
  
  CONCLUSIONS
  There are 15 articles evaluating osteoporosis in patients undergoing lumbar fusion and the highest level of evidence is for perioperative use of teriparatide.
authors.affiliation: Department of Orthopedic Surgery, The Spine Hospital, Columbia University Medical Center, New York, NY, USA.
authors.forename: Charla R
authors.initials: CR
authors.lastname: Fischer
authors.affiliation: Dartmouth Hitchcock Medical Center, Geisel School of Medicine, Hanover, NH, USA.
authors.forename: Gregory
authors.initials: G
authors.lastname: Hanson
authors.affiliation: Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA.
authors.forename: Melinda
authors.initials: M
authors.lastname: Eller
authors.affiliation: Department of Orthopedic Surgery, The Spine Hospital, Columbia University Medical Center, New York, NY, USA.
authors.forename: Ronald A
authors.initials: RA
authors.lastname: Lehman
keywords: lumbar fusion; metabolic bone disease; osteoporosis; spine instrumentation; spine surgery