Gender disparities in the treatment and outcome of osteoporotic thoracolumbar vertebral fractures – results from the prospective EOFTT multicenter study
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.
Authors
- Michael Scherer (ORCID: https://orcid.org/0000-0003-3211-9180)
- Falko Schwarz (ORCID: https://orcid.org/0000-0003-0821-193X)
- Kai Sprengel (ORCID: https://orcid.org/0000-0001-5921-8272)
- Georg Osterhoff (ORCID: https://orcid.org/0000-0001-5051-0998)
- Martin Bäumlein (ORCID: https://orcid.org/0000-0003-3010-5156)
- B. Ullrich
- Christopher Baron
- S. Katscher
- Gregor Schmeiser (ORCID: https://orcid.org/0000-0002-2432-8276)
- Katja Liepold
- Holger Siekmann
- Helena Arias
- Philipp Schenk (ORCID: https://orcid.org/0000-0002-3610-2469)
- Volker Zimmermann
- Alexander Franck
- Ulrich J. A. Spiegl
- Klaus J. Schnake
- Max J. Scheyerer
- Simon Schramm
- Working Group Osteoporotic Fractures Spine Section
- Michael Müller
Institutions
- University of Lucerne (CH)
- Universitätsklinikum Gießen und Marburg (DE)
- Klinikum St. Georg (DE)
- BG Klinik Tübingen (DE)
- Universitätsklinikum Erlangen (DE)
- Düsseldorf University Hospital (DE)
- Sana Kliniken Duisburg (DE)
- Schön Klinik Hamburg Eilbek (DE)
- Malteser Waldkrankenhaus Erlangen (DE)
- University Hospital Schleswig-Holstein (DE)
- Paracelsus Medizinische Privatuniversität (DE)
- Klinikum Ingolstadt (DE)
- University Hospital Leipzig (DE)
- Technische Hochschule Georg Agricola (DE)
- München Klinik Harlaching (DE)
- Jena University Hospital (DE)
- Sana Kliniken Leipziger Land (DE)
- Berufsgenossenschaftliche Unfallklinik Frankfurt am Main (DE)
- BG Klinikum Bergmannstrost Halle (DE)
- University Hospital Cologne (DE)
- Heinrich Heine University Düsseldorf (DE)
- Technical University of Munich (DE)
- Praxis (EE)
- University of Lübeck (DE)
Publication Details
- Journal
- European Spine Journal
- Published
- 2026-08-13
- DOI
- https://doi.org/10.1007/s00586-026-10247-1
- Primary Topic
- Spinal Fractures and Fixation Techniques
- Type
- article
- Field-Weighted Citation Impact
- 0.00