The growing blind spot in osteoporosis care: A survey of spine surgeons in German-speaking countries.

INTRODUCTION

The incidence of osteoporotic vertebral fractures is steadily increasing due to demographic changes and a growing treatment gap. The OF-Classification and OF-Score provide a standardized framework for classifying and treating these fractures.

RESEARCH QUESTION: This study aimed to assess treatment practices and the use of these classifications among spine surgeons through an online survey.

METHODS

An anonymized electronic questionnaire consisting of 36 questions was distributed to all members of the German Spine Society (DWG), the Austrian Spine Society (Spine.at), and German-speaking hospitals in Switzerland. The responses were stratified by specialty and analyzed comparatively.

RESULTS

Out of 2981 physicians contacted, 300 completed the survey (response rate: 18.6 %); 40.3 % were neurosurgeons, 36.3 % orthopedic surgeons, and 22.3 % trauma surgeons. The OF-Classification was routinely used by 70.3 % of participants. Factors considered most important for clinical decision-making were clinical presentation (95 %), imaging (90.7 %), and general condition of the patient (78.7 %). Only 44 % used the OF-Score for clinical decision-making. Bone mineral density measurements were performed regularly by 60.3 %, primarily using DEXA scans (57.3 %) followed by CT-based Hounsfield Unit (HU; 19 %) and quantitative computed tomography (QCT). Anti-osteoporotic therapy compliant to national guidelines was prescribed only by 48 % of participants and 34.7 % did not routinely monitor bone mineral density during treatment.

CONCLUSION

The OF-Classification is widely implemented, whereas the OF-Score plays a minor role in clinical decision-making. There is a significant deficit in the diagnosis and treatment of osteoporosis, as evidenced by low diagnostic rates, under prescription of anti-osteoporotic therapy, lack of follow-up, and inadequate outpatient care.