What are the Optimal Age Thresholds for qCT-Based Osteoporosis and Osteopenia Screening in Patients Undergoing Lumbar Fusion Surgery?
Abstract
STUDY DESIGN: Secondary analysis of two prospective single-center studies.
OBJECTIVE: To evaluate the effectiveness of guideline-recommended osteoporosis screening age cutoffs in lumbar fusion surgery (LFS) patients and identify optimized thresholds for osteoporosis and osteopenia detection.
BACKGROUND: Poor bone quality impacts lumbar fusion surgery (LFS) outcomes. Current general population screening guidelines recommend starting at 65 years for women and 70 years for men in the absence of other risk factors. This study evaluates their effectiveness and refines age-based screening strategies for LFS patients.
MATERIALS AND METHODS: This post hoc analysis included patients aged 50 years or older from two prospective studies enrolling patients undergoing LFS for degenerative conditions. Patients with unsuitable imaging for quantitative CT (qCT) bone mineral density measurements were excluded. Osteoporosis and osteopenia status were determined by medical history and qCT in all patients. Univariable and multivariable logistic regression and ROC analysis to optimize age cutoffs for BMD screening were performed. The number needed to screen (NNS) for age cutoffs to detect one case was calculated.
RESULTS: Among 515 patients (56% female, median age: 66 yr), impaired bone quality was present in 70%. Osteoporosis was found in 34%, with 38% of cases previously undiagnosed. Age was the only significant risk factor for low BMD for both sexes. Guideline age cutoffs yielded a sensitivity…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 515 participants or records.
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