Perioperative Denosumab Versus Bisphosphonates for MIDLF Surgery in Patients With Osteopenia: A Short-Term Prospective Cohort Study

Study Design Prospective Cohort Study. Objective To compare the effectiveness and safety of perioperative denosumab, bisphosphonates, and a control group in promoting lumbar fusion after midline lumbar fusion (MIDLF) surgery in patients with osteopenia or osteoporosis. Methods This prospective cohort study enrolled 54 patients with osteopenia or osteoporosis undergoing MIDLF surgery. Patients were divided into 3 groups: denosumab (60 mg subcutaneous injection), bisphosphonates (5 mg zoledronic acid intravenous infusion), and control (no anti-osteoporotic drugs, only calcium + vitamin D). Outcomes included fusion rates, clinical scores, bone metabolism markers, and adverse events. Results 54 patients were included in the study. Among them, 50 patients completed the 6-month postoperative follow-up. Due to the impact of the COVID-19 pandemic, only 29 patients completed the final follow-up. At 6 months, fusion rates were significantly higher in the denosumab (25% complete, 68.6% partial) and bisphosphonate (25% complete, 75% partial) groups compared to the control group (10.5% complete, 57.9% partial, P < 0.001). No significant difference was found between the 2 drug groups. Postoperative fever was more common in the bisphosphonate group (71.4%) than in the denosumab group (11.8%, P =0.004) and control (23.5%, P = 0.011) groups. Conclusions In the short-term follow-up, both denosumab and bisphosphonates significantly improved the early bone fusion rate after MIDLF surgery, with no significant difference observed between the two. Denosumab was associated with a lower incidence of postoperative fever, making it a recommended choice for perioperative anti-osteoporosis therapy.