Vitamin D and Bisphosphonate Therapy for Optimizing Outcomes in Spinal Fusion

STUDY DESIGN: Systematic review and meta-analysis. 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 were performed (PubMed, Embase, and Google Scholar; through January 2025). Eligible randomized controlled and prospective comparative trials evaluated: (1) vitamin D versus placebo/no supplement and (2) bisphosphonates versus vitamin D. Primary outcomes were fusion rates and vertebral compression fractures (VCFs). Secondary outcomes included functional scores (ODI), VAS, postural stability, bone turnover markers (P1NP), and BMD. Risk ratios (RR) and mean differences (MD/SMD) with 95% CI were pooled. RESULTS: For the vitamin D versus placebo analysis, increased fusion at one year (RR: ∼1.25), improved ODI at six months and one year (MD: ∼6.90, 8.56), and provided a small early VAS benefit (MD: 1.14). OSI improved significantly (SMD: 0.93). For Bisphosphonates versus vitamin D analysis, bisphosphonate therapy accelerated early fusion, but by one year, outcomes were similar. ODI favored vitamin D at one year, 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: Level II.