Bone Health Optimization (BHO) in Spine Surgery : Spine

Secondary Logo

Journal Logo

Literature Review

Bone Health Optimization (BHO) in Spine Surgery

Anderson, Paul A. MD, MSa; Binkley, Neil C. MDb; Bernatz, James T. MDa

Author Information
Spine 48(11):p 782-790, June 1, 2023. | DOI: 10.1097/BRS.0000000000004618


Study Design. 

Literature review


To educate spine surgeons on the importance of bone health optimization in surgical patients.

Summary of Background Data. 

Osteoporosis is common and underdiagnosed in spine surgery patients. Poor bone health has been linked to worse outcomes and complications after spine surgery. Guidelines are available to inform decision making on screening and treatment in this population.


Available literature is reviewed regarding bone health screening and treatment. Studies reporting outcomes related to osteoporosis, bone density, and vitamin D status are summarized. Pharmacologic treatment and nutritional considerations are discussed. Bone health optimization practice models and outcomes are also reviewed.


Bone health screening should be considered in all adults over age 50. Gender-specific guidelines are available to determine which patients need dual-energy x-ray absorptiometry. Osteoporosis can be diagnosed by dual-energy x-ray absorptiometry T-score, fracture risk calculator or by history of low-energy fracture. Advanced imaging including computed tomography and magnetic resonance imaging can be used to opportunistically assess bone health. If diagnosed, osteoporosis can be treated with either antiresorptive or anabolic agents. These medications can be started preoperatively or postoperatively and, in high-risk patients, surgical delay can be considered. The implementation of bone health optimization programs has been shown to greatly increasing screening and treatment rates.


Bone health assessment and optimization are important for decreasing surgical risks and improving outcomes in spine surgery patients.

© 2023 Wolters Kluwer Health, Inc. All rights reserved.

You can read the full text of this article if you:

Access through Ovid