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Objectives and questions: To assess the applicability of the Osteoporotic Fracture Treatment score (OF-Score) on patients with osteoporotic vertebral compression fractures (OVCF) above the age of 80.

Material and methods: Data was collected in a prospective multicenter cohort study in 17 spine centers (EOFTT study). Only data for patients with an age over 80 years were considered in this analysis. Patients received either an operative or conservative treatment based on the clinician’s decision irrespective of the treatment recommendation by the OF-Score. The Patients were then stratified into 6 groups with respect to whether they received the treatment suggested by the OF-Score. The functional outcome of a treatment was assessed using the following six surveys: pain (VAS-P), Barthel Index, ODI, EQ5D-5L index, EQ5D-VAS. Differences between the functional outcomes between groups was analyzed using a general linear model (GLM) with repeated measurements and post hoc Bonferroni correction for pairwise comparisons.

Results: A total of 180 patients, aged ≥80 years (range 80–97 years, 9% female) were included. Sixty-three patients (35%) were treated conservatively and 117 (65%) surgically. According to the OF-Score, surgery was recommended in 90 (50%) cases, of which 71 were treated concordantly. Conservative treatment was recommended in 62 cases (34%), with concordant treatment in 38 patients. In 28 patients, the OF-Score provided indifferent treatment recommendation, among these, 22 were treated surgically and 6 conservatively. Significant baseline differences were observed only for pain and ODI: patients treated surgically despite a conservative OF-Score recommendation had higher pain (p<0.001), while patients with a surgical recommendation who received conservative treatment had lower pain (p=0.011) and lower ODI scores (p=0.034). All other comparisons between concordant and non-concordant treatment were not significant (p>0.760). Baseline differences showed that patients with higher pain and disability were more likely to receive surgical treatment: pain (conservative p<0.001, surgical p=0.011) and ODI (surgically recommended, conservatively treated p=0.043), whereas other functional measures (Barthel index, EQ5D-5L, EQ5D-VAS) did not differ significantly (p≥0.760).

Discussion and conclusions: In patients aged ≥80 years with OVCF, treatment decisions were guided by both the OF-Score and individual clinical factors such as pain and functional impairment. A substantial proportion of patients were treated in accordance with the score recommendations, and all groups showed significant functional improvement over time. These results indicate that the OF-Score is a valuable tool to support treatment planning in very elderly patients, while clinical judgement remains important to account for patient-specific factors.