Nationwide trends and demographic projections of hospitalisations for vertebral fractures and postmenopausal osteoporosis in Germany: a 24-year registry-based study

Hospitalisations for vertebral fractures increased in Germany over the past two decades. Although hospitalisation rates have recently stabilised or declined, demographic projections indicate that the absolute inpatient hospitalisation burden may remain substantial through 2050. These findings highlight the need for better osteoporosis prevention and long-term healthcare planning. BACKGROUND: Vertebral fractures represent one of the most common manifestations of skeletal fragility and contribute substantially to morbidity, disability, and healthcare utilisation in ageing populations. However, nationwide long-term hospitalisation trends and the impact of demographic ageing on future inpatient burden remain insufficiently characterised. This study investigated inpatient hospitalisation trends for vertebral fractures and postmenopausal osteoporosis in Germany over a 24-year period and estimated the future inpatient burden through 2050. METHODS: Nationwide inpatient data from the German Federal Health Monitoring (GBE) database were analysed between 2000 and 2023. Hospitalisations were identified using ICD-10-GM codes for thoracic vertebral fractures (S22.0), lumbar vertebral fractures (S32.0), and postmenopausal osteoporosis with osteoporotic fracture (M80.0). Absolute hospitalisations, age-standardised hospitalisation rates, sex-specific trends, in-hospital mortality, and length of hospital stay were evaluated. Temporal trends were assessed using joinpoint regression. Future hospitalisations were projected by applying age-specific hospitalisation rates observed during 2021-2023 to the official German population projections (Destatis main scenario G2L2W2). RESULTS: Between 2000 and 2023, annual hospitalisations increased from 14,057 to 27,563 for thoracic vertebral fractures, from 27,683 to 45,280 for lumbar vertebral fractures, and from 2,617 to 11,800 for postmenopausal osteoporosis with osteoporotic fracture. In contrast, age-standardised hospitalisation rates increased until the mid-to-late 2010s before stabilising or declining across all three diagnoses. Joinpoint regression identified significant trend reversals for thoracic vertebral fractures (2016), lumbar vertebral fractures (2018), and postmenopausal osteoporosis with osteoporotic fracture (2015). Overall, lumbar vertebral fractures (AAPC - 0.65%, p = 0.01) and postmenopausal osteoporosis with osteoporotic fracture (AAPC - 1.17%, p < 0.001) demonstrated significant long-term declines, whereas thoracic vertebral fractures remained stable (AAPC - 0.44%, p = 0.10). Assuming stable age-specific hospitalisation rates, the demographic projection indicated an approximately 10% increase in annual inpatient hospitalisations for thoracic and lumbar vertebral fractures by 2050. CONCLUSIONS: Although age-standardised hospitalisation rates have stabilised or declined in recent years, demographic projections indicate that the inpatient hospitalisation burden associated with vertebral fractures may remain substantial in Germany. These findings underscore the need for timely osteoporosis diagnosis, systematic secondary fracture prevention, and long-term healthcare planning for an ageing population.