The prevention of osteoporotic vertebral fractures in eastern and in western countries

Fjorda Koromani; Jiawei Li; Hiroshi Hagino; Richard Eastell; Annegreet Vlug; Ling Wang; Hua Yue; Yong-Chan Ha; Steven Cummings; Salvatore Minisola; Claus-C Glüer; Ling Oei; East Meets West Action Group of the European Calcified Tissue Society

doi:10.1016/j.bonr.2025.101851

The prevention of osteoporotic vertebral fractures in eastern and in western countries

Bone Rep. 2025 May 15:25:101851. doi: 10.1016/j.bonr.2025.101851. eCollection 2025 Jun.

Authors

Fjorda Koromani^{1

2}, Jiawei Li¹, Hiroshi Hagino², Richard Eastell³, Annegreet Vlug^{4

5}, Ling Wang⁶, Hua Yue⁷, Yong-Chan Ha⁸, Steven Cummings^{9

10

11}, Salvatore Minisola¹², Claus-C Glüer¹³, Ling Oei^{1

4

5

14}; East Meets West Action Group of the European Calcified Tissue Society

Affiliations

¹ Department of Internal Medicine, Erasmus MC, Rotterdam, the Netherlands.
² Faculty of Medicine, School of Health Science, Tottori University, Japan.
³ Division of Clinical Medicine, University of Sheffield, Sheffield, UK.
⁴ Department of Internal Medicine, Jan van Goyen Medical Center, Amsterdam, the Netherlands.
⁵ Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands.
⁶ Department of Radiology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China.
⁷ Department of Osteoporosis and Bone Diseases, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
⁸ Department of Orthopaedic Surgery, Seoul Bumin, Hospital, Seoul, South Korea.
⁹ San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, CA, USA.
¹⁰ Departments of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
¹¹ Department of Radiology, Peking University Jishuitan Hospital, Beijing, China.
¹² Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy.
¹³ Section Biomedical Imaging, Department of Radiology and Neurology, University Hospital Schleswig-Holstein, Kiel, Germany.
¹⁴ Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands.

Abstract

Osteoporotic vertebral fractures (VFs) are among the most common and clinically significant manifestations of skeletal fragility, contributing substantially to morbidity, disability, and future fracture risk worldwide. Yet, their recognition and management remain inconsistent across regions. To explore differences and similarities in the prevalence, diagnosis, management, and prevention of vertebral fractures, the East Meets West (EmW) Action Group of the European Calcified Tissue Society convened a multi-country exchange among clinical and research experts from Europe, the USA, and East Asia. This report summarizes the discussions and synthesizes current knowledge on the topic. Evidence from China, South Korea, Japan, and Germany shows a wide range in reported VF prevalence and incidence, largely influenced by differences in population aging, imaging access, and diagnostic adjudication methods. While lateral spine radiographs remain the standard for detection in both research and clinical care, variable use of quantitative morphometry (QM), semi-quantitative (SQ), and algorithm-based qualitative (ABQ) methods limits comparability. MRI remains the gold standard for assessing fracture acuity, but is not feasible for widespread screening. VFA via DXA is gaining popularity, although underutilized in several settings. Despite the availability of effective pharmacologic treatments, including bisphosphonates, denosumab, and anabolic agents, treatment rates following VF remain suboptimal across all countries studied. None of the countries currently has a nationwide vertebral fracture screening program, although fracture liaison services (FLS) and AI-assisted imaging offer promising pathways forward. The lack of a universally accepted definition and gold standard for VF adjudication continues to hamper clinical decision-making and data harmonization. This report highlights the need for greater international consensus on diagnostic criteria, improved integration of vertebral fracture screening into clinical workflows, and the development of targeted strategies to close treatment gaps and reduce the global burden of vertebral fractures.

Publication types

Review