OF-Score reliable tool to aid treatment decision in Osteoporotic Vertebral Compression Fractures: study

Although conservative therapy is successful in most cases, clear indications for treatment of acute OVCF are still missing.

The Working Group “Osteoporotic Fractures” (AG-OF) of the Spine Section of the German Society of Orthopaedics and Trauma (DGOU) has developed a new reliable and reproducible classification system for osteoporotic fractures (OF classification).The development process of the OF classification followed the concept for validation of fracture classifications according to Audige et al. In the next step a score for therapeutic decision making based on the OF classification was developed. To evaluate the score prospectively, the AG-OF designed the “Evaluation of the Osteoporotic Fracture classification, Treatment score and Therapy recommendations” (EOFTT) study.

This study by Ullrich et al aims to validate the recently developed OF score for treatment decisions in patients with osteoporotic vertebral compression fractures (OVCF). The study has been published in ‘Global spine journal.’

It is a prospective multicenter cohort study (EOFTT) in 17 spine centers. All consecutive patients with OVCF were included. The decision for conservative or surgical therapy was made by the treating physician independent of the OF score recommendation. Final decisions were compared to the recommendations given by the OF score. Outcome parameters were complications, Visual Analogue Scale, Oswestry Disability Questionnaire, Timed Up & Go test, EQ-5D 5 L, and Barthel Index.

Key findings of the study were:

• In total, 518 patients (75.3% female, age 75 ± 10) years were included.

• 344 (66%) patients received surgical treatment.

• 71% of patients were treated following the score recommendations.

• For an OF score cut-off value of 6.5, the sensitivity and specificity to predict actual treatment were 60% and 68% (AUC .684, P < .001).

• During hospitalization overall 76 (14.7%) complications occurred.

• The mean follow-up rate and time were 92% and 5 ± 3.5 months, respectively.

• While all patients in the study cohort improved in clinical outcome parameters, the effect size was significantly less in the patients not treated in line with the OF score’s recommendation.

• Eight (3%) patients needed revision surgery.

The authors concluded – “This study evaluated the OF score for treatment decisions in OVCF. Patients treated according to the score’s recommendations showed favorable short-term clinical results. Non compliance with the score’s recommendations was associated with more pain and impaired functional outcome and quality of life. The OF score is a reliable and save tool to aid treatment decision in OVCF. Further adjustment of the score may increase compliance in the future.”

Further reading:

Clinical Evaluation of the Osteoporotic Fracture Treatment Score (OF-Score): Results of the Evaluation of the Osteoporotic Fracture Classification, Treatment Score and Therapy Recommendations (EOFTT) Study Bernhard W. Ullrich, Klaus John Schnake et al Study Design: Multicenter prospective cohort study. Global Spine Journal 2023, Vol. 13(1S) 29S–35S DOI: 10.1177/21925682221148133