Spondylosis and Osteoporotic Vertebral Fractures

Osteoporosis and spondylosis are the most common age-related conditions affecting the spine. Some of the literature on osteoporosis and spondylosis has demonstrated an inverse relationship between them, though insufficient support for such a relationship has also been documented. Our previous study showed that osteophyte formation and intervertebral disc degeneration were positively correlated with bone mineral density (BMD) for all measurement sites of the lumbar spine and proximal femur. Our most recent study, presented here, showed that, in an early phase of alendronate and/or alfacalcidol therapy (≤6 months), fewer osteophytes were one of the significant factors for incident vertebral fractures. The existence of spondylosis may thus have a protective effect against osteoporotic vertebral fractures. With the increased aging of society, the demand for spine surgery in elderly patients with osteoporosis and spondylosis is increasing. Our surgical strategies for such patients are based on their predominant spinal pathology. If the predominant pathology is in the vertebral bodies, we consider vertebral replacement, and, if it is in the intervertebral space, we consider multilevel posterior lumbar interbody fusion (PLIF).