Medical treatment of osteoporosis in osteoporotic vertebral fractures - Results from the prospective EOFTT multicenter study

Introduction: Osteoporotic medication (oTh) is essential for secondary prevention but is often not prescribed after vertebral fractures. Research question: The aim of this analysis was to assess the status of oTh in inpatients with osteoporotic thoracolumbar fractures and to analyze possible supply gaps. Materials and methods: Data were collected as part of the multicenter, prospective EOFTT (Evaluation of the Osteoporotic Fracture Classification, Treatment Score and Therapy Recommendations) study. A total of 518 patients with osteoporotic thoracolumbar fractures in 17 clinics were included. The presence, type, and changes over time of oTh were recorded and evaluated using the Cochrane Q test. Results: Hospitalisation increased oTh with 36% at admission significantly in women to 83%, and in men to 71% (p < 0.001). At admission women received more frequently oTh than men (p = 0.017). At the follow-up after 7 ± 5 months, there was no significant differences between the sexes (p = 0.330). However, the proportion in both groups decreased significantly to 41% (women) and 34% (men), respectively (p < 0.001). In-hospital treatment led to a significant increase in the initiation of anti-osteoporotic medication, with calcium and vitamin D supplementation rising from 13% at admission to 35% at discharge (p < 0.001). However, a substantial and significant decline was observed during follow-up (18%, p < 0.001). Discussion and conclusion: In the inpatient setting, there is a clear improvement in oTh, which is particularly pronounced in female patients. However, the significant decline in therapy rates at follow-up highlights deficits in long-term care. Despite existing recommendations, evidence-based agents such as bisphosphonates or osteoanabolic are still rarely used. This indicates a relevant gap in care in secondary prevention and underscores the need for structured, post-hospitalisation concepts for sustainable osteoporosis therapy.