Gender disparities in the treatment and outcome of osteoporotic thoracolumbar vertebral fractures - results from the prospective EOFTT multicenter study.
Aug 2026· European spine journal· 0 citations· 13 references
Medicine
TL;DR
Although gender had minimal influence on pain and functional recovery, marked differences in surgical strategies and the administration of anti-osteoporotic therapy underscore potential disparities in the surgical treatment of women and the management of osteoporosis in men.
Abstract
INTRODUCTION
Osteoporotic vertebral fractures (OVF) present varying treatment challenges depending on fracture severity, stability, and patient characteristics. While the OF classification system guides treatment decisions, gender differences in OVF management and outcomes remain underexplored.
RESEARCH QUESTION
How do treatment strategies and clinical outcomes differ between genders?
Methods
This secondary analysis utilized prospective data from the German multicenter EOFTT study, including 518 patients (390 females, 128 males) treated for thoracolumbar OVF. Outcomes assessed included adherence to OF score recommendations, pain levels, functional performance (Timed Up & Go test, Barthel Index, Oswestry Disability Index), and rates of anti-osteoporotic therapy (aoTh). Statistical analyses included generalized linear mixed models and repeated-measures general linear models, with therapy type as a covariate.
Results
Gender did not influence overall treatment choice; however, men more frequently underwent instrumentation, while women received augmentation procedures. AoTh administration was significantly lower in men at discharge (72% vs. 82%, p = 0.017) and follow-up (71% vs. 89%, p < 0.001). Both genders showed significant improvements in pain, mobility, and functional outcomes over time (p < 0.001), with no gender-specific differences. Adherence to OF score recommendations was 61% with no gender disparity.
Discussion
AND
Conclusion
Although gender had minimal influence on pain and functional recovery, marked differences in surgical strategies and the administration of anti-osteoporotic therapy underscore potential disparities in the surgical treatment of women and the management of osteoporosis in men. Addressing these disparities through tailored screening, optimized adherence to guidelines, and individualized treatment strategies may improve outcomes in OVF management.
Thoracic and lumbar vertebroplasty yielded comparable 2-year PROMs with no statistically significant differences detected between cohorts, suggesting that the vertebral region may not be a major determinant of patient-reported recovery following vertebroplasty for OVCFs.
Yong Ng, Jeremy Tze En Lim, Lei Jiang et al.· Asian Spine Journal· 0 citations
PURPOSE
Treatment decisions for osteoporotic thoracolumbar vertebral fractures (OVF) in elderly patients are challenging. The AO Spine-DGOU Osteoporotic Fracture (OF) classification and OF-score support treatment allocation but do not explicitly account for chronological age, despite its known prognostic relevance. In addition, determinants of length of hospital stay (LOS) in older and very old patients with OVF remain incompletely defined.
METHODS
In this prospective single-centre cohort study, patients aged ≥ 65 years with low-energy OVF were systematically classified using the OF system and treated conservatively or surgically. Multivariable logistic regression was used to identify determinants of surgical treatment, including age-dependent effects. Determinants of LOS were analysed using linear regression of log-transformed LOS, including interaction analyses between age group and treatment.
RESULTS
A total of 171 patients were included. Higher OF grades and neurological deficits strongly favoured surgical treatment (OF 3: OR 11.53, 95% CI 2.60-51.23; OF 4-5: OR 31.54, 95% CI 7.21-137.97), whereas increasing age was independently associated with a lower likelihood of surgery (OR 0.85 per year, 95% CI 0.79-0.91). While OF 5 fractures were allocated to surgery irrespective of age, a pronounced age-dependent difference in treatment allocation was observed in OF 4 fractures, with surgical treatment rates of 82.8% in patients aged 65-79 years compared with 43.2% in patients aged ≥ 80 years. Surgical treatment was associated with longer LOS (median 17.5 vs. 7.0 days). Higher OF grade, poor pre-fracture mobility, greater comorbidity burden and neurological deficit independently prolonged LOS. Interaction analysis showed that surgery prolonged LOS to a similar extent in both age groups, with no significant interaction between treatment and age group (p = 0.41).
CONCLUSIONS
Age was independently associated with treatment allocation in osteoporotic thoracolumbar fractures, particularly for OF 4 fractures. Surgical treatment was associated with longer hospital stay irrespective of age. No significant interaction between treatment and age group was observed, although smaller interaction effects cannot be excluded because of limited statistical power. Incorporating age- and frailty-related parameters into OF-based decision algorithms may improve treatment guidance in very elderly patients.
D. Wiersbicki, J. Neumann, T. Stelzner et al.· European spine journal· 0 citations
INTRODUCTION
Osteoporotic vertebral fractures (OVFs) are a major cause of morbidity in older adults, leading to pain, disability, and decreased quality of life. Although osteoporosis is traditionally associated with women, men also experience substantial morbidity and mortality after fractures. However, the mechanisms underlying sex differences in OVF remain unclear. This study aimed to investigate sex differences in comorbidities, bone mineral density (BMD), nutritional status, and MRI findings in patients with OVF.
METHODS
We retrospectively analyzed 492 patients (126 men and 366 women) hospitalized for OVF between 2015 and 2021. Clinical data, including comorbidities, BMD, Prognostic Nutritional Index (PNI), and MRI signal patterns, were collected. MRI patterns were classified into low- and high-risk groups for delayed bone union. Multivariate logistic regression analysis was performed to identify independent factors associated with high-risk MRI patterns.
RESULTS
Men had a significantly higher prevalence of cardiac, renal, and brain disorders, as well as malignancy, compared with women. Men also had significantly higher BMD but lower PNI values. High-risk MRI patterns were more frequent in men in univariate analysis (41.3% vs. 30.0%, p = 0.039). However, multivariate logistic regression analysis revealed that PNI was independently associated with high-risk MRI patterns (OR 0.943 per point increase, 95% CI 0.902-0.986, p = 0.0098), whereas sex was not.
CONCLUSIONS
Poor nutritional status was independently associated with high-risk MRI patterns in patients with OVF. The observed sex differences in acute radiological risk may be partially explained or mediated by differences in baseline nutritional status rather than biological sex itself.
Tatsuya Yasuda, Junichiro Sarukawa, Kaoru Yamazaki et al.· Journal of Orthopaedic Scien...· 0 citations
Proximal humerus fractures (PHFs) are common in the elderly population, but the optimal treatment strategy remains controversial. This study evaluated the long-term functional outcomes of non-surgically treated PHFs and assessed whether retrospective treatment recommendations made by experienced shoulder surgeons were associated with differences in clinical outcomes. This retrospective cohort study included 150 PHFs in 149 patients treated nonoperatively between 2020 and 2021. Two-, three-, and four-part fractures with a minimum 12-month follow-up were analyzed. Outcome measures included QuickDASH, Oxford Shoulder Score (OSS), Subjective Shoulder Value (SSV), and SF-12. Demographic characteristics and radiographic fracture features were analyzed. In a second phase, five shoulder surgeons independently reviewed anonymized cases and retrospectively recommended surgical or conservative treatment while blinded to patient outcomes. At a mean follow-up of 32.1 months, younger age, absence of comorbidities, better pre-injury physical status, and dominant limb involvement were independently associated with superior outcomes, whereas the number of fracture fragments did not. Displaced fractures showed worse outcomes than non-displaced fractures. However, among displaced fractures, no significant differences in SSV, OSS, QuickDASH, or SF-12 scores were found between fractures retrospectively considered surgical candidates and those deemed suitable for conservative management. Functional recovery following conservative treatment of PHFs appears to be influenced more by patient-related factors than by fracture morphology or surgeon experience. These findings suggest that carefully selected patients with displaced PHFs can achieve satisfactory outcomes with nonoperative treatment. IV.
Andrea Pautasso, Chiara Bernardi, M. Assom et al.· European Journal of Orthopae...· 0 citations
STUDY DESIGN
Retrospective cohort study.
OBJECTIVE
To evaluate the impact of prior fragility fractures on complications following anterior cervical discectomy and fusion (ACDF).
SUMMARY OF BACKGROUND DATA
Fragility fractures indicate poor bone quality and increased comorbidities, potentially elevating surgical risks. Understanding the risks is critical for optimizing outcomes in ACDF patients.
METHODS
Patients undergoing a primary ACDF within 3 years of a fragility fracture were identified from 2013 to 2022. A control cohort without prior fragility fractures was matched 1:1. Exclusion criteria included traumatic fractures, prior revision ACDFs, and active spine infections. Outcomes assessed included 90-day medical and surgical complications, 30-day and 90-day emergency visits and readmission rates, and 2-year complications, including mortality. Statistical analyses included the Pearson χ² test, the Welch t test, and the multivariate logistic regression.
RESULTS
A total of 1236 patients were matched in each cohort. Prior fragility fractures were associated with higher risks of medical complications, such as atelectasis (4.4% vs. 1.7%, OR: 2.83, P<0.001), respiratory failure (5.0% vs. 2.3%, OR: 2.36, P<0.001), pleural effusion (3.6% vs. 0.9%, OR: 4.35, P<0.001), and urinary tract infections (9.3% vs. 4.5%, OR: 2.20, P<0.001). Surgical complications were also more frequent, including dysphagia (7.0% vs. 4.0%, OR: 1.81, P=0.001), spinal cord deficit (5.0% vs. 2.1%, OR: 27.46, P<0.001), and deep wound infection (1.2% vs. 0.4%, OR: 3.07, P<0.031). Subsequent fragility fractures at 2 years were significantly higher in patients who had a history of fragility fracture (29.0% vs. 4.4%, OR: 10.18, P<0.001), as were 30-day (12.5% vs. 7.3%, OR: 1.87, P<0.001) and 90-day (16.8% vs. 10.3%, OR: 1.82, P<0.001) readmission rates.
CONCLUSIONS
Patients with a history of fragility fractures undergoing ACDF experience significantly higher rates of postoperative complications and readmission rates.
Muhammad Zulfiqar, Ved A. Vengsarkar, Elizabeth K. Driskill et al.· Clinical Spine Surgery· 0 citations
ABSTRACT Background and Aims Lumbar disc herniation (LDH), a leading cause of low back pain, necessitates effective conservative management to mitigate surgical interventions. This retrospective observational study evaluated the short‐term (6 months–2 years) and long‐term (3–6 years) efficacy of conservative therapies in 194 LDH patients from Iran. Methods Data were collected via medical records, demographic questionnaires, and the numerical rating scale (NRS) for pain, with analyses adjusting for covariates such as body mass index (BMI), comorbidities, and treatment modalities. Data were analyzed using SPSS 24 (Kolmogorov–Smirnov normality test), including descriptive (frequencies, means/SDs) and inferential statistics (t‐tests, ANOVA, chi‐square, Fisher's exact); ANCOVA and multivariate logistic regression (adjusted for confounders, 95% confidence interval CI) modeled pain/paresthesia outcomes. Results The significant pain reduction after treatment (mean NRS: 7.3 to 3.7, p < 0.001) was demonstrated with home exercise programs showing the largest improvement (adjusted β: −0.74, p = 0.010). Short‐term pharmacological therapy (≤ 24 months) also reduced pain (β = −0.96, p = 0.02), while long‐term use lacked efficacy. Higher BMI correlated with higher pain (p = 0.03) and paresthesia risk (p = 0.01), and water therapy unexpectedly increased paresthesia odds (odds ratio (OR) = 4.14, p = 0.03) compared to other treatments. Females reported higher paresthesia rates (52.7% vs. 33.3%, p = 0.03), and comorbidities like hypertension were associated with a higher rate of paresthesia. Satisfaction rates exceeded 66% across therapies, though adherence to acupuncture, yoga, and injections was low. Conclusion The findings suggest that home‐based exercise and short‐term pharmacological therapy were associated with more favorable pain outcomes in this cohort. However, due to the observational design, these findings should be interpreted as associations rather than evidence of causal treatment effectiveness.
Bina Eftekharsadat, Shadi Khodaei, Raha Markazi-Movaghar et al.· Health Science Reports· 0 citations
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