Table

Recommendation summary for patient optimization to prevent PJK.

Osteoporosis

  • Medications including bisphosphonates (antiresorptive), teriparatide (anabolic), denosumab (antiresorptive)

  • Calcium + vitamin D supplementation

Frailty

  • Triage patients using scoring system

  • Prehabilitation

  • Increase protein intake

Neurodegenerative disease

  • Involve movement disorder specialist

  • Treat Parkinson disease–associated osteoporosis

Obesity

  • Body mass index <30 ideal, <35 realistic

  • Offer assistance with diet, exercise, and weight loss plans

  • Involve dietitian

Smoking

  • Smoking cessation; most important postoperatively

  • Nicotine replacement (eg, gum, patches)

  • Abbreviation: PJK, proximal junctional kyphosis.