AO Spine—DGOU Osteoporotic Fracture (OF) Classification System
OF 1
No deformation (vertebral body edema in MRI-STIR)
• Typically not visible on x-rays: chance to find on MRI
OF 2
Deformation of one endplate without or with only minor posterior wall involvement
• With posterior wall <1/5 involvement
OF 3
Deformation of one endplate with distinct posterior wall involvement
• With posterior wall >1/5involved
OF 4
Deformation of both endplates with/without posterior wall involvement
• Loss of vertebral frame structure
• Vertebral body collapse
• Pincer type fracture
OF 5
Deformation of both endplates with/without posterior wall involvement
• Loss of vertebral frame structure
• Vertebral body collapse
• Pincer type fracture
0 points if a parameter is unknown or not determinable;
0–5 points = Conservative therapy;
6 points = Conservative therapy or surgery;
> 6 points = Surgery.
* The severity score system has not been validated yet
and should be used as a reference only.
** According to step II WHO pain ladder.
*** 5-item modified frailty index (mFI) = COPD, or recent
pneumonia; Congestive heart failure; Functional
status (not independent); Hypertension requiring
medication; Diabetes mellitus.
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