Osteoporosis & bone health

Validation of the AO Spine Osteoporotic Fracture Classification—effect of geographical region on reliability and reproducibility

Osteoporos IntPublished Reliability and reproducibility study

Authors' conclusion

The AO Spine-DGOU Osteoporotic Fracture Classification System demonstrates moderate to substantial reliability and reproducibility, with regional differences influenced by factors such as training and clinical experience.

Study context

Population
Participants from various global regions classifying 27 cases of osteoporotic vertebral fractures with the AO Spine-DGOU system (OF 1-OF 5) after online webinar training27 cases
Participants
320 participants
Comparison
Geographic regions of raters classifying osteoporotic vertebral fractures
Outcome
Reliability and reproducibility of the AO Spine-DGOU Osteoporotic Fracture Classification by geographic region (Fleiss' kappa; agreement with gold standard)
Methodological detailsinternational, interobserver reliability and intraobserver reproducibility, Fleiss' kappa, gold standard committee comparison
  • International
  • Interobserver reliability and intraobserver reproducibility
  • Fleiss' kappa
  • Gold standard committee comparison

Main finding

As reported in the abstract

Agreement with gold standard (kappa)

Global agreement with gold standard, initial kappa (moderate to substantial)

0.58

Global agreement with gold standard, improved kappa

0.61

European participants, highest agreement (kappa)

0.64 and 0.66

Further findings

Kappa

OutcomeGerman-speakingOther EuropeansP value
Reliability, German-speaking vs other European participants (post hoc analysis)Post hoc analysis0.790.70P = 0.0026

Original publication

Validation of the AO Spine Osteoporotic Fracture Classification—effect of geographical region on reliability and reproducibility. Osteoporos Int. Published 13 August 2026. doi:10.1007/s00198-026-08112-4

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