Bone Health Optimization in Adult Spinal Deformity Patients: A Narrative Review
Abstract
:1. Introduction
2. Osteoporosis and Osteopenia
3. Risks and Complications in Osteoporotic Patients
3.1. Vertebral Compression Fractures
3.2. Hardware Failure
3.3. Proximal Junctional Kyphosis and Failure
4. Osteoporosis Treatment and Optimization for Spine Surgery
4.1. Vitamin and Mineral Supplementation
4.2. Antiresorptive Agents
Bisphosphonates
4.3. Anabolic Agents
4.3.1. Denosumab
4.3.2. Romosozumab
4.4. Parathyroid Hormone (PTH) Analogs
4.4.1. Teriparatide
4.4.2. Abaloparatide
5. Future Research Plans
6. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Class | Agent | Brand Name | Mechanism of Action |
---|---|---|---|
Vitamin and mineral supplements | Calcium | N/A | The main mineral component of bone. Forms calcium salts (mostly calcium phosphate) by osteoblasts which harden cartilaginous bone matrices and thus bone building |
Vitamin D | N/A | Activates intestinal absorption of calcium and maintaining calcium homeostasis | |
Antiresorptive agents | Bisphosphonates | Reclast, Boniva, Fosamax, Zoneta, Actonel Aclasta | Inhibits osteoclast function, thus allowing osteoblasts to more efficiently build bone mass |
Anabolic agents | Denosumab | Prolia | Monoclonal antibody that inhibits receptor activator of nuclear factor kappa-B ligand (RANKL), resulting in decreased osteoclast development |
Romosozumab | Evenity | Monoclonal antibody that binds and inhibits sclerostin, a protein secreted by osteocytes that inhibits osteoblast function increases RANKL which activates osteoclasts (PMID: 30775535). Thus, romosozumab is unique in that it increases bone formation and decreases bone resorption | |
Parathyroid hormone (PTH) analogs | Teriparatide | Forteo | Regulates calcium and phosphate metabolism in bone and the kidneys. Counterintuitively increases bone resorption, thus resulting in increased serum calcium levels. However, low-dose and intermittent exposure (i.e., once daily) disproportionately activate osteoblasts with increased serum calcium more than osteoclast function, thus having a net effect of increased bone mineral density |
Abaloparatide | Tymlos | Similar to teriparatide, but with different pharmacokinetics that may confer some advantages in bone mineral density improvements |
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Al-Najjar, Y.A.; Quraishi, D.A.; Kumar, N.; Hussain, I. Bone Health Optimization in Adult Spinal Deformity Patients: A Narrative Review. J. Clin. Med. 2024, 13, 4891. https://doi.org/10.3390/jcm13164891
Al-Najjar YA, Quraishi DA, Kumar N, Hussain I. Bone Health Optimization in Adult Spinal Deformity Patients: A Narrative Review. Journal of Clinical Medicine. 2024; 13(16):4891. https://doi.org/10.3390/jcm13164891
Chicago/Turabian StyleAl-Najjar, Yousef A., Danyal A. Quraishi, Neerav Kumar, and Ibrahim Hussain. 2024. "Bone Health Optimization in Adult Spinal Deformity Patients: A Narrative Review" Journal of Clinical Medicine 13, no. 16: 4891. https://doi.org/10.3390/jcm13164891