Osteoporosis weakens the bone–implant interface by reducing bone mass, disrupting trabecular microarchitecture, and impairing bone remodeling. In spinal surgery, these changes increase the risk of pedicle-screw loosening, inadequate osseointegration, delayed fusion, and construct failure. Although conventional mechanical approaches can improve immediate fixation, they do not fully address the impaired osteogenic, angiogenic, inflammatory, and antimicrobial microenvironment of osteoporotic bone.

Nanomedicine offers interface-targeted strategies to enhance fixation and regeneration. Nanoengineered implant surfaces, nanotube-based delivery systems, bioactive nanocoatings, nanocarriers, and nanocomposite scaffolds can provide osteogenic cues, localized drug or ion delivery, immunomodulation, angiogenic support, and antimicrobial protection. These functions may improve peri-implant bone formation while limiting systemic exposure to therapeutic agents.

This review examines nanomedicine approaches for osteoporotic spinal fixation, osseointegration, and regeneration, with emphasis on nanoengineered interfaces, local therapeutic delivery, and multifunctional fixation systems. It also discusses key translational barriers, including nanomaterial toxicity, particle or ion release, coating durability, manufacturing reproducibility, and limited long-term clinical evidence. Nanomedicine may complement established surgical and pharmacological treatment by enabling more biologically active and personalized strategies for compromised bone–implant interfaces.