2025 Volume 16 Issue 6 Pages 849-854
Introduction: In Japan, now a super-aging society, the proportion of elderly patients undergoing spinal surgery continues to increase. Reduced bone density has been reported to be a risk factor for postoperative complications such as screw loosening and intervertebral cage subsidence. Recently, preoperative osteoporosis screening and treatment have been emphasized to prevent postoperative complications in spinal fusion surgeries. However, the intervention and screening are often insufficient. This study investigated the prevalence of osteoporosis and the current treatment status in patients with lumbar spinal stenosis (LSS) undergoing surgeries. It also examined the problems of osteoporosis treatment in patients with LSS.
Methods: A total of 145 patients who underwent decompression of up to two levels or single-level fusion for LSS at our institution during the period from January 2016 to December 2023 were included. Preoperative bone density was measured using dual-energy X-ray absorptiometry (DEXA) of the lumbar spine and proximal femur. Existing vertebral fractures were examined by whole-spine X-ray. Osteoporosis was diagnosed according to the Japanese guidelines. The prevalence of osteoporosis was examined. Preoperative and postoperative treatment statuses were compared between male and female patients.
Results: Overall, 21.4% of the patients were diagnosed with osteoporosis (14.6% in men, 28.5% in women). Only 2.1% of patients had a lumbar DEXA value ≤70%. Only a few patients were diagnosed with osteoporosis by lumbar DEXA. The rate of osteoporosis treatment intervention remained low in men both before and after surgery.
Conclusions: Patients with LSS had a higher prevalence of osteoporosis than the general population. In particular, male patients had insufficient treatment, indicating a need for more proactive management of osteoporosis in this population. In addition, the diagnosis of osteoporosis was difficult using only lumbar DEXA in this population due to degeneration.
