Disparities in management of symptomatic osteoporotic vertebral compression fractures: a nationwide multidisciplinary survey

Abstract

This nationwide multidisciplinary survey found dissatisfaction among physicians with current osteoporotic vertebral compression fracture care, revealing significant disparities in diagnosis, treatment, and follow-up practices. Issues include poor communication and differing guidelines. Improving interdisciplinary collaboration and standardized care strategies is essential for better patient outcomes.

Purpose: This survey aims to assess current preferred care practices for symptomatic osteoporotic vertebral compression fractures (OVCF) in the Netherlands, focusing on guideline adherence, identifying knowledge gaps, and clarifying consensus and collaboration across medical disciplines in OVCF treatment.

Methods: This cross-sectional study was conducted via Qualtrics (Provo, UT) using a self-administered online survey distributed to 238 general practitioners and physicians in orthopedics, traumatology, internal medicine, rheumatology, and geriatrics working at 51 hospitals in the Netherlands. The survey, conducted in Dutch, included 36 multiple-choice and two open questions and was accessible via an anonymous email link or QR code. General practitioners received additional questions specific to their role. Data was anonymized, stored securely, and analyzed using descriptive statistics in Microsoft Excel and SPSS (Version 24). Open-ended responses were coded and categorized. The survey was conducted prior to the publication of the updated Federation of Medical Specialists guidelines in 2024.

Results: Physicians across various disciplines uniformly expressed dissatisfaction with current OVCF care. The survey highlighted significant disparities in diagnosis, treatment, and follow-up practices. A lack of communication between primary and secondary care providers and differing guidelines further complicate OVCF management. These issues point to considerable variation in clinical practice and gaps in interdisciplinary collaboration.

Conclusion: Addressing the identified issues requires fostering interdisciplinary collaboration and creating cohesive care strategies. Ensuring access to diagnostic resources in both primary and secondary care and establishing coordinated care models promises more structured and standardized treatment. These steps are crucial for enhancing patient outcomes in OVCF management.

Keywords: Dissatisfaction; OVCF management; Osteoporosis; Osteoporosis treatment; Osteoporotic vertebral compression fracture; Survey.

Fig. 1

Pie chart displaying whether medical specialists make a diagnosis of an osteoporotic vertebral fracture depending on degree of collapse. The question respondents received was “From what degree of collapse do you diagnose an osteoporotic vertebral fracture?”

Fig. 2

Actual use of classification systems by respondents and preferred classification systems. Respondents were asked “Do you use a classification system to characterize the osteoporotic fracture?” If response was “Yes,” respondents were asked “What classification system do you use?” Responses to use of classification systems can be seen on the left hand sides of the graphs and answers to which specific classification systems can be seen on the left. Responses were analyzed and are shown based on medical specialty

Fig. 3

a Infographic on treatment likelihood based on patient presentation and primary caregiver. Patients with acute OVCF either visit the emergency department, where they are treated by an internal medicine specialist or surgeon, or they see their general practitioner. Respondents were asked about standard treatment components in their practice. b Infographic on treatment likelihood based on patient presentation and primary caregiver. Respondents indicating they prescribed physical therapy, a brace, or planned follow-up outpatient visits were asked several follow-ups concerning physical therapy initiation, type of brace, and type of outpatient consultation with or without additional imaging

Fig. 3

a Infographic on treatment likelihood based on patient presentation and primary caregiver. Patients with acute OVCF either visit the emergency department, where they are treated by an internal medicine specialist or surgeon, or they see their general practitioner. Respondents were asked about standard treatment components in their practice. b Infographic on treatment likelihood based on patient presentation and primary caregiver. Respondents indicating they prescribed physical therapy, a brace, or planned follow-up outpatient visits were asked several follow-ups concerning physical therapy initiation, type of brace, and type of outpatient consultation with or without additional imaging

Fig. 4

Bar graph showing the answers to questions regarding potential additions to care. Internal medicine specialists indicated they would be most interested (42%) in “More detailed reporting of radiographic images,” whereas general practitioners expressed more interest (44%) in “Low-threshold consultation 1st and 2nd line care.” Both general practitioners (46%) and internal medicine specialists (42%) would consider having a “Specialized network of physiotherapists” a valuable addition to care

Fig. 5

Bar graph showing the categorized answers on an open question regarding bottlenecks surrounding the care of patients with OVCF. Diverse responses were provided, which were categorized into five themes: Diagnosis and treatment, Referral and multidisciplinary approach, Financial aspects, Lack of guidelines and evidence, Education and awareness. The answers are presented per specialization of physicians. General practitioners mainly mentioned issues concerning education and treatment, whereas surgeons mainly mentioned bottlenecks in the field of diagnosis and treatment