ArticleThe spine journal : official journal of the North American Spine Society2025
Is osteoporosis an independent risk factor for sacral fracture after lumbosacral spinal fusion in adults? A retrospective cohort study.
Article in The spine journal : official journal of the North American Spine Society, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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1 citing paper in PubMed.
- Hip Fracture Risk Following Lumbar Fusion: A Retrospective Cohort Study of Construct Length and Age-Stratified Outcomes.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2026Article
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7 authors.
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Abstract
background contextSacral fracture is a rare complication following lumbosacral fusion in adults linked to postsurgical biomechanical changes. There are mixed research results suggesting that osteoporosis may or may not be a contributing factor. PURPOSE: To determine if osteoporosis is an independent risk factor for sacral fracture after lumbosacral fusion. STUDY
designA propensity-matched retrospective cohort study that was preregistered on open science framework. PATIENT SAMPLE: After matching, patients (n=14,302; 82% female) who underwent lumbosacral fusion had a mean age of 64 years and were divided into the osteoporosis cohort (n=7,151) or the no osteoporosis cohort (n=7,151). OUTCOME MEASURES: The primary outcome measure was the risk ratio (RR) of sacral fracture through 2 years after lumbosacral fusion. We secondarily explored the RR for pelvic fixation with instrumentation. We assessed negative control outcomes such as further imaging and major trauma, targeting near-null point estimates.
methodsWe included adults (≥18 years old) in the TriNetX database from 2005 to 2023 who underwent primary lumbosacral fusion, divided into two cohorts depending on the presence or absence of osteoporosis (ie, osteoporosis and no osteoporosis cohorts) and propensity matched via key risk factors.
resultsThere were 261 (1.8%) sacral fractures in the entire patient population (n=14,302). Comparing the osteoporosis cohort to no osteoporosis cohort, there was a statistically significant increase in risk of sacral fracture (RR: 1.75 [1.36, 2.24]; p<.001; 166 [2.3%] vs 95 [1.3%] cases), with a median time to event of 154 and 181 days in each cohort, respectively. There was also a statistically significant increase in risk of pelvic fixation with instrumentation (RR: 1.87 [1.25, 2.78]; p=.002). The likelihood of polytrauma (RR=0.98), subdural hemorrhage (RR=1.24), and diagnostic imaging (RR: 0.93) approximated the null between cohorts, suggesting findings would not be explained by differences in these variables.
conclusionOsteoporosis appears to be independently associated with a statistically and clinically significant risk of sacral fracture through 2 years after lumbosacral fusion. Further research may be warranted for corroboration.
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