After Spinal Fusion, Vitamin D is better than Bisphosphonate Therapy at 1 year - meta-analysis
@@@@Vitamin D and Bisphosphonate Therapy for Optimizing Outcomes in Spinal Fusion A Systematic Review and Meta-Analysis Spine Feb, 23, 2026. | DOI: 10.1097/BRS.0000000000005655 PDF behind paywall
Sadh, Puru BSa; Kim, Jinseong MDa; Furlong, Charles BAb; Perez-Albela, Alejandro MDa; Suleman, Yousufa; Basques, Bryce A. MD, MHSa
Objective. 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.
Background. 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.
Methods. 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.
Results. 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).
Conclusions. 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.
Level of Evidence. II
Vitamin D dose is not in the abstract
- probably in the PDF, which is behind a paywall
Claude AI suspects that the dose sizes ranged from 800 to 2,000 IU daily
Risk of a spinal fracture reduced 25% by a good level of Vitamin D
Related in VitaminDWiki
- Spinal fusion and Vitamin D - several studies
- Spinal non fusion 3.5 X more likely if low vitamin D
- Pain after spinal cord injury 4.8 X more likely if low Vitamin D
- Vitamin D before surgery improves outcome (spinal in this case)
- Spinal Fusion complications 2.2 X more likely if low Vitamin D
It appears that Vitamin D in 5 ways:
- 1) Reduces the risk of spinal fracture in the first place
- 2) Reduces Spinal Fusion complications
- 3) Increases the chance of fusion
- 4) Will provide 100+ other benefits to the body
- 5) Reduces the pain after spinal cord injury