Osteoporotic Thoracolumbar Fractures: Age-Modified Osteoporotic Fracture–based Treatment Decisions and Length of Hospital Stay in Elderly Patients – a Prospective Single-Centre Cohort Study

Treatment decisions for osteoporotic thoracolumbar vertebral fractures (OVF) in elderly patients are challenging. The AO Spine–DGOU Osteoporotic Fracture (OF) classification and OF-score support treatment allocation but do not explicitly account for chronological age, despite its known prognostic relevance. In addition, determinants of length of hospital stay (LOS) in older and very old patients with OVF remain incompletely defined. In this prospective single-centre cohort study, patients aged ≥ 65 years with low-energy OVF were systematically classified using the OF system and treated conservatively or surgically. Multivariable logistic regression was used to identify determinants of surgical treatment, including age-dependent effects. Determinants of LOS were analysed using linear regression of log-transformed LOS, including interaction analyses between age group and treatment. A total of 171 patients were included. Higher OF grades and neurological deficits strongly favoured surgical treatment (OF 3: OR 11.53, 95