Gender disparities in the treatment and outcome of osteoporotic thoracolumbar vertebral fractures – results from the prospective EOFTT multicentre study
European Spine Journal · 13 Aug 2026
† Impact is the editorial-priority score. All scores are out of 100. Clinical is a stored clinical-importance score from the earlier method; it has not been recalculated.
Why it matters
Highlights a real-world undertreatment gap for osteoporosis in men after vertebral fractures, and a difference in surgical technique choice between genders that could affect future fracture risk or reoperation, both relevant to surgeons managing these patients.
The evidence
This secondary analysis of the German EOFTT multicentre cohort compared 128 men and 390 women treated for osteoporotic thoracolumbar vertebral fractures to see if treatment and outcomes differed by gender. Men underwent instrumentation more often while women more often had augmentation-only procedures, and men received anti-osteoporotic therapy less often than women both at discharge (72% vs 82%, p=0.017) and follow-up (71% vs 89%, p<0.001), even though pain and functional recovery (ODI, TUG, Barthel) improved similarly in both groups over time.
Anti-osteoporotic therapy administration at follow-up: Risk difference 18 (95% CI unavailable; units not reported). Interpret in the study's stated comparison; this alone does not establish a treatment's causal effect.
Why this rigour score?
Prospective cohortDesign starting point: 40
Raised the score
- Aligned time zero+2.5
- 0% loss to follow-up+1.7
Lowered the score
- 7-month follow-up−4.1
Score capped at 40. The conclusions are not supported by the reported results.
Methods at a glance
Recorded assessment- Confounding adjustmentMultivariable regression
- Covariate balance confirmedNot applicable
- Outcome assessors blindedNot reported
- Comparable start of follow-upMet
- Adequate statistical powerCalculation absent
- Prospective registrationNot reported
Not reported does not mean not done. Checks have different weights; this is not a count of boxes ticked.
See the full score breakdown
- Study design starting point
- 40
- Aligned time zero
- +2.5
- 7-month follow-up
- −4.1
- 0% loss to follow-up
- +1.7
- Journal prior (not an observed method)
- +1
- Methodological cap
- −1.1
- Final rigour score rounded
- 40 / 100
Study design sets the starting point and a ceiling of 82. Recorded methods then adjust the score. Points are shown to one decimal place; the final score uses unrounded values.
Checklist from the stored appraisal. “Not met” describes the recorded criterion; it does not always produce a deduction. This overview supports reading the full study.
For journal club
1.Should men presenting with osteoporotic vertebral fractures be flagged for more aggressive osteoporosis screening and treatment initiation given this persistent gap in anti-osteoporotic therapy uptake?
2.Does the finding that women more often receive augmentation-only rather than instrumentation despite similar fracture severity and bone quality warrant reconsideration of how surgical technique is selected, independent of gender?
Original publication title
Gender disparities in the treatment and outcome of osteoporotic thoracolumbar vertebral fractures – results from the prospective EOFTT multicenter study