Vitamin D and Bisphosphonate Therapy for Optimizing Outcomes in Spinal Fusion: A Systematic Review and Meta-Analysis.

Abstract

Systematic Review and Meta-Analysis. To systematically evaluate the impact of perioperative vitamin D supplementation and bisphosphonate therapy on spinal fusion outcomes, patient-reported disability and pain, postural stability, and vertebral fracture risk. Bone health optimization is critical for successful spinal fusion. While vitamin D, and bisphosphonate supplementation have been studied individually, their comparative and combined effects remain unclear. A PRISMA-compliant systematic review and meta-analysis was performed (PubMed, Embase, Google Scholar; through January 2025). Eligible randomized controlled and prospective comparative trials evaluated: (1) vitamin D vs placebo/no supplement and (2) bisphosphonates vs vitamin D. Primary outcomes were fusion rates and vertebral compression fractures (VCFs). Secondary outcomes included functional scores (ODI), and VAS, postural stability, bone turnover markers (P1NP), and BMD. Risk ratios (RR) and mean differences (MD/SMD) with 95% CI were pooled. For Vitamin D vs placebo analysis, increased fusion at 1 year (RR ~1.25), improved ODI at 6M and 1Y (MD ~ 6.90, 8.56), and provided a small early VAS benefit (MD 1.14). OSI improved significantly (SMD 0.93). For Bisphosphonates vs vitamin D analysis, Bisphosphonate therapy accelerated early fusion, but by 1Y outcomes were similar. ODI favored vitamin D at 1Y, while VAS showed no difference. Bisphosphonates suppressed P1NP and reduced fracture risk (RR 0.10). Vitamin D accelerates early fusion and modestly improves long-term function and bisphosphonates provide fracture protection and turnover suppression. These findings support a tailored, multimodal approach to perioperative bone health optimization in spinal fusion. II.