. 2016 Oct 20;7(4):188–196. doi: 10.1177/2151458516669204

Table 2.

Studies Assessing the Effect of Medical Treatment for Osteoporosis on Lumbar Spinal Fusion.

Study	Patient Population	Medical Intervention	Duration of Treatment	Fusion Rates	Method to Assess Fusion
Alendronate
Kim et al¹⁷	44 patients with osteoporosis who underwent single-level PLIF using cage from April 2007 to March 2009	Alendronate sodium (35 mg/wk)	Does not specify	66.7% in alendronate group	Plain radiographs examined by 2 different neurosurgeons, fusion if there was a bridging bone between the vertebral bodies either within or external to the cage and less than 5° in angular movement in dynamic X-ray
Kim et al¹⁷		Control group	Does not specify	73.9% in control group
Nagahama et al¹⁶	40 patients with osteoporosis who were candidates for single-level PLIF	Alendronate sodium (35 mg/wk)	1 year	95% in alendronate group	Coronal and sagittal CT scans to assess bridging bone formation
Nagahama et al¹⁶		Alfacalcidol (1 mg/d)	1 year	65% in alfacalcidol group; P = .025
Zolendronate
Park et al¹⁸	44 patients with symptomatic degenerative lumbar spinal stenosis who underwent 1- or 2-level posterolateral lumbar fusion	Group 1: bilateral posterolateral fusion with autogenous iliac and local bone grafting and systemic administration of zoledronic acid (5 mg)	2 weeks after surgery as a single IV infusion over 20 minutes	Group 1: 100%	Functional radiography and 3-dimensional CT were assessed by blinded musculoradiologist, defined as continuous intertransverse bony bridging at the target level on the follow-up radiographs and CT scans
		Group 2: bone grafting with allogenous and autogenous local bone and systemic administration of zoledronic acid (5 mg)		Group 2: 100%
		Group 3: bone grafting with autogenous iliac and local bone grafting		Group 3: 100%
		Group 4: allogenous and autogenous local bone grafting		Group 4: 82%
Tu et al¹⁹	64 patients with osteoporosis having degenerative lumbar spondylolisthesis who underwent LIFs	Zoledronate, 5 mg IV infusion (n = 32)	3 days postoperation and once yearly thereafter	75%	X-ray, independent blinded reviewer, defined as the absence of lucency around the graft, evidence of bridging bone between the end plate and the graft, and the absence of movement on dynamic imaging studies
Tu et al¹⁹		Control group (n = 32)	3 days postoperation and once yearly thereafter	56%
Teriparatide
Ohtori et al 2012²⁰	57 women with osteoporosis with degenerative spondylolisthesis underwent decompression and 1- or 2-level instrumented posterolateral fusion with a local bone graft	Teriparatide (20 μg, daily subcutaneous injection)	2 months before and 8 months after surgery (10 months)	84% (radiography) and 82% (CT) in teriparatide group	Radiography and CT images read by 3 blinded surgeons, defined as bridging bone formation across the transverse process between adjacent vertebrae
Ohtori et al 2012²⁰		Risedronate (17.5 mg, weekly oral administration)	2 months before and 8 months after surgery (10 months)	74% (radiography) and 68% (CT) in risedronate group; P < .05
Ohtori et al 2013²¹	62 women with osteoporosis having degenerative spondylolisthesis	Teriparatide (20 μg, daily subcutaneous injection)	2 months before and 10 months after surgery	7%-13% PS loosening; P < .05	Radiography and CT images, 3 blinded surgeons evaluated PS loosening, concurrence of at least 2 of the observers was required
		Risedronate (2.5 mg, daily oral)		13%-26% PS loosening
		Control group		15%-25% PS loosening

Abbreviations: CT, computed tomography; IV, intravenous; LIF, lumbar interbody fusion; PLIF, posterior lumbar interbody fusion; PS, pedicle screw.