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. 2023 Jan 12;7(3):200–210. doi: 10.22603/ssrr.2022-0198

Table 3.

Studies Reporting Implant-related Complications, Including Screw Loosening by Osteoporosis/osteopenia Status.

Study Study Groups Implant-related Complications
n/N (%)
Additional Analysis
Loffler et al. (2021) 28) Osteoporosis 11/13 (84.6) (screw loosening) NR
Osteopenia 9/20 (45.0) (screw loosening)
No Osteoporosis/Osteopenia 3/13 (23.1) (screw loosening)
Roberts et al. (2021) 16) Osteoporosis
No Osteoporosis
192/3,162 (6.1) (instrumentation failure)
76/1,581 (4.8) (instrumentation failure)
Osteoporosis w/ bisphosphonate vs.
No Osteoporosis,
OR 1.20 (95% CI 0.88–1.65);
Osteoporosis w/out bisphosphonate vs.
No Osteoporosis, OR 1.35 (1.00–1.84)
Sumiya et al. (2021) 29) Osteoporosis
No Osteoporosis
17/33 (51.5) (screw pull-out)
9/43 (20.9) (screw pull-out)
NR
St Jeor et al. (2020) 31) Osteoporosis 5/14 (35.7) (pooled rate of ORCs*) Osteoporosis vs. No Osteoporosis/
Osteopenia, p=0.138
Osteopenia vs. No Osteoporosis/
Osteopenia, p=0.005
Osteopenia 33/82 (40.2) (pooled rate of ORCs*)
No Osteoporosis/Osteopenia 7/44 (15.9) (pooled rate of ORCs*)
Park et al. (2019) 30) Osteoporosis
(T-score≤−2.5) #
7/72 lumbar levels (9.7%) (CM w/o subsidence)
13/72 lumbar levels (18.1%) (CM w/ subsidence),
9/72 lumbar levels (12.5%) (CR)
Osteoporosis was a risk factor for:
CM w/out subsidence, OR 8.73,
p<0.001; CM w/ subsidence, OR 5.77,
p<0.001; CR, OR 7.86, p<0.001
No Osteoporosis/Osteopenia
(T-score≤−2.5) ǂ
13/809 lumbar levels (1.6%) (CM w/o subsidence),
23/809 (0.1%) (CM w/ subsidence),
8/809 lumbar levels (1.0%) (CR)
Cho et al. (2018) 15) Osteoporosis
(T-score≤−2.5) #
No Osteoporosis
(T-score≥−1.0) #
10/31 (32.3) (screw loosening)
17/24 (70.8) (cage subsidence)
7/55 (12.7) (screw loosening)
9/39 (23.1) (cage subsidence)
Osteoporosis vs. No Osteoporosis,
screw loosening, p=0.029;
cage subsidence, p<0.001
Formby et al. (2016) 27) Osteoporosis
No Osteoporosis
4/18 (22.2) (pedicle screw loosening)
6/70 (8.6) (pedicle screw loosening)
Osteoporosis vs. No Osteoporosis
p=0.14

*Osteoporosis-related complications (ORCs) were defined as one of the following categories: revision surgery, compression fracture, proximal junctional kyphosis, pseudarthrosis, accelerated adjacent segment disease, or instrumentation failure (including screw loosening).

#T-score, a measure of bone density measured in standard deviations from the average bone density of healthy same-sex young adults.

ǂT-score between 1 and 2.5 standard deviations below the young adult mean is considered low bone density, or osteopenia.

CI, confidence interval; CM, cage migration; CR, cage retropulsion; OR, odds ratio; ORC, osteoporosis-related complications; NR, not reported

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