[Recommendations for the standardized assessment of manifest osteoporosis with vertebral fractures in disability law].

PURPOSE: Osteoporosis is among the most prevalent chronic conditions, affecting millions of individuals and associated with a substantial fracture burden. Osteoporotic vertebral fractures lead to structural damage, functional impairment, pain, loss of mobility, reduced social participation, and increased mortality. Despite the clinical and social-medical relevance of this condition, standardized recommendations for disability assessment within the German Social Compensation Law have been lacking. The aim of this study was to develop nationally uniform, ICF-oriented criteria for determining the degree of disability (GdB) in individuals with manifest osteoporosis and vertebral fractures.

METHODS

Criteria were developed using a modified Delphi process comprising three survey rounds. A national steering committee coordinated data collection and defined consensus thresholds. The expert panel included osteologists, rheumatologists, orthopedic surgeons, geriatricians, social and rehabilitation medicine specialists, and a patient representative. Items from the ICF domains body structures, body functions, and activities and participation were evaluated; consensus was defined as ≥70% agreement.

RESULTS

Clearly defined four-tiered criteria were established that could be matched to the abstract severity categories of the German "Versorgungsmedizin-Verordnung" (VersMedV). These criteria comprehensively capture key structural and functional characteristics of vertebral fractures as well as everyday functional and participation-related aspects. The agreed-upon criteria constitute the first operationalized system for GdB assessment based on valid and reproducible measurement instruments.

CONCLUSION

This work provides the first ICF-oriented, operationalized framework for the social-medical assessment of osteoporosis with vertebral fractures and establishes a foundation for nationwide standardized, objective, and reproducible GdB determination.