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.