In Reply

The data from the German Federal Statistical Office, on which our analysis is based, is limited to hospitalized cases (1). This was noted accordingly in the description of the methods. As Prof. Scherer rightly points out, a significant proportion of osteoporotic fractures are treated on an outpatient basis and could therefore not be included in our analysis.

We also agree with his second comment, that there is a high probability of undercoding and miscoding for the very elderly. The diagnostic code “M80. Osteoporosis with pathologic fracture” distinguishes different etiologies of osteoporosis (postmenopausal, post-ovariectomy, inactive osteoporosis, post-surgical malabsorption, drug-induced, idiopathic, other, or unspecified). This also summarizes fractures, for example under “other fractures” “[neck, head, ribs, torso, skull, spine]”. Due to the associated heterogeneity of coding, we decided not to include the additional dataset of the M80 diagnoses (which has a dubious robustness) in our analysis, in order to avoid any unnecessary complexity of the derived statements. Based on the available data, the statement that osteoporotic vertebral fractures are among the ten most common injuries of the skeletal system is still unfounded, although clinical practice could suggest this.

The internal evaluation in Prof. Scherer’s clinic for the period 1 February, 2006, to 30 September, 2021, which showed that the incidence of fractures in women over 80 years of age increases by a factor of 10 to 30, is very interesting. We will soon be able to publish a detailed analysis of nationwide incidence rates of vertebral fractures, which shows a clear trend of increasing incidence of fractures of the thoracic and lumbar spine and the sacrum in patients older than 70 years. With this, we hope to highlight the growing importance of osteoporosis in vertebral body fractures.