Objective: The treatment of osteoporotic vertebral compression fractures (OVCF) is based on their severity; however, an efficient prediction tool is lacking. We aimed to evaluate the validity of the osteoporotic fracture classification (OF classification) and scoring system (OF score) in predicting the treatment strategy for patients with OVCF, defined according to the Japanese criteria. 

Methods: We retrospectively investigated 487 consecutive patients diagnosed with vertebral body fractures between January 2018 and December 2022. Only patients with their fresh vertebral fracture episode during the study period were included. Patients were classified into three groups: conservative treatment, balloon kyphoplasty (BKP), and open surgery. OF classification and OF scores were assessed for each patient. 

Results: A total of 237 patients with OVCF were included. There were 127, 81 and 29 patients in the conservative-, BKP, and open surgery groups, respectively. The OF score was significantly higher in the BKP and open surgery groups than in the conservative group (P < 0.001). Multivariate logistic regression analysis showed that anti-osteoporotic drug use, OF classification, progressive deformity, neurological symptoms and mobilization were independent risk factors for operative treatment (all P <0.001). Receiver operating characteristic analysis showed that the cutoff OF score for operative indication was 5.5, with a sensitivity of 91.9%, specificity of 56.5%, and area under the curve of 0.820 (95% confidence interval, 0.769-0.871). 

Conclusion: The OF score identified patients who required operative treatment with a high degree of accuracy. This is especially important for ruling out patients who definitely require operative treatment.

Koki Mitani is a resident of neurosurgery in Kyoto University. He received M.D. from Kyoto University, faculty of medicine in 2019. He completed an internship at Kyoto university in 2019-2021. He trained in spinal surgery at Fujieda Heisei Memorial Hospital in 2023. Interests include spine surgery and clinical research on osteoporosis, aiming to translate research findings into practical applications for the patient care. He has also received a young neurosurgeon award 2023 from Kyoto University.