Romosozumab Effects on Bone Density, Muscle Mass, and Spine Surgery Outcomes

Exclusion Criteria

• •History of prior spinal surgery.
• •Male sex.
• •Current or prior use of osteoporosis medications within the past 3 years.
• •Current use of anabolic agents other than romosozumab.
• •Current use of androgen receptor (AR) modulators, such as testosterone replacement therapy or selective androgen receptor modulators (SARMs).
• •Severe renal impairment (eGFR \< 30 mL/min/1.73m²).
• •Known hypersensitivity to romosozumab, alendronate or zoledronic acid.
• •Severe spinal deformity.
• •Active malignancy or history of malignancy within the past 5 years.
• •Any secondary cause of decreased BMD (e.g., hyperparathyroidism).
• •Stroke or myocardial infarction in the past year.
• •Planned fusion involving more than 4 levels.
• •Uncorrected hypocalcemia and/or hypovitaminosis D
• •Esophageal abnormalities