Table.

Recommendation summary for patient optimization to prevent PJK.

Osteoporosis

Medications including bisphosphonates (antiresorptive), teriparatide (anabolic), denosumab (antiresorptive) Calcium + vitamin D supplementation

Frailty

Triage patients using scoring system Prehabilitation Increase protein intake

Neurodegenerative disease

Involve movement disorder specialist Treat Parkinson disease–associated osteoporosis

Obesity

Body mass index <30 ideal, <35 realistic Offer assistance with diet, exercise, and weight loss plans Involve dietitian

Smoking

Smoking cessation; most important postoperatively Nicotine replacement (eg, gum, patches)

Abbreviation: PJK, proximal junctional kyphosis.