This Neurosurgical Focus issue topic is lumbar spinal osteoporosis and is a combined effort between the JNS Publishing Group and the Lumbar Spine Research Society (LSRS). Osteoporosis is a common but underappreciated and undertreated chronic disease that is being more frequently recognized as an important predictor of poor outcomes and complications of spinal surgery. Surgeons have little training in the clinical care of metabolic bone disease; therefore, until recently, they have viewed conditions such as osteoporosis as a chronic disease to be managed by primary care physicians. However, observational studies over the last 2 decades have consistently demonstrated that the diagnosis of osteoporosis is often missed, even after fragility fracture, leaving many patients at risk for further fracture or complications following elective spine surgery. Dual-energy x-ray absorptiometry (DXA) is currently considered part of the goldstandard imaging modality for assessing bone quality. Accumulating data are showing better correlation of bone strength/quality to quantitative CT- and, more recently, MRI-derived values. These imaging modalities, commonly performed preoperatively, may prove equivalent, if not superior, to DXA as a means of assessing bone quality. Additional investigation should be focused on the ability of these imaging modalities to predict postoperative osteoporosis-related complications.
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