Vertebral fractures as a result of untreated osteoporosis are steadily increasing due to demographic change. The OF-classification and score for osteoporotic vertebral fractures provides a standardised basis for determining therapeutic indications. We have collected information on the application and other treatment practices in German-speaking countries.
An anonymous electronic questionnaire with 36 questions was sent to all members of the German Spine Society (DWG), the Austrian Society for Spine Surgery (spine.at) and clinics in Switzerland in October 2023. The responses were stratified according to speciality, level of training and other factors and compared using Fisher's exact test or T-test.
A total of 2981 physicians received the questionnaire, and 300 (10.06% response rate; 18.67% F, 79.33% M, 2% diverse) aged 35-54±10 years, 40.3% from neurosurgery, 36.3% orthopaedics, 22.3% trauma surgery, 1% others completed the survey. With regard to the treatment decision, imaging was decisive for 90.7%, the clinic for 95.0%, the general condition of the patient for 78.7% and the OF score for 44%. Overall, 70.3% of respondents reported using the OF classification as standard (neurosurgery: 67.8%, orthopaedics: 75.2%, trauma surgery: 70.2%). Among general practitioners, standard use was significantly more common at 81.4%, compared to 65.5% of senior consultants (p = 0.013) and 67.6% of chief physicians. There was also a significant difference between practices and clinics: only 30% of practices compared to 75.5% of university clinics used the OF classification as standard (p<0.05). 60.7% of respondents regularly examined bone density, most frequently by DEXA scan (58%) followed by HU on CT (19%) and QCT (14.7%). Antiosteoporotic therapy was regularly prescribed by 26%, with only 17.3% regularly checking bone density during therapy.
The results of the survey provide valuable insights into the current management of osteoporotic vertebral fractures in hospitals and practices. They show that the OF classification is already widely used in clinics, whereas the OF score still plays a less important role in clinical decision-making with regard to other parameters such as clinical findings, imaging and general condition. In long-term care there is a deficit in the form of a lack of follow-up and inadequate outpatient care. Further research is needed to identify specific needs in order to optimise treatment strategies.