In this study, we compared the current status of management trend and attitude in practice pattern between orthopedic surgeons and internists who treat OVCF. We found no difference between the two groups regarding obtaining DEXA scan, performing laboratory examination, and team collaboration. However, the two groups significantly differed in obtaining additional T2-weighted image with fat suppression, attitude on management choice, and the most important concern in the management of OVCF. We also found that the rates of collaboration and image-based diagnosis were lower for physicians from nontertiary hospitals, and the collaboration rate was lower for students and residents. This study analyzed the management trend and attitude of orthopedic surgeons and internists regarding the treatment of patients with OVCF, which, to our knowledge, has not been studied before.
The DEXA scanning rates in previous studies ranged from 1.4% in a retrospective cohort study by Barton et al  to 32.0% in Hawaii in a study by Nguyen et al  and to 52.9% in South Korea in a study by Park et al , which differ from the results of our study, as most of the physicians in our study agreed to performing DEXA bone mineral density (BMD) scan to middle-aged and elderly patients with suspected OVCF. The results of previous studies and our results suggest that the rate of BMD measurement has increased over the years; however, doctors’ knowledge and attitude may not translate into action in diagnosis. Our result also indicated that the type of hospitals may be an influencing factor.
An additional T2-weighted image with fat suppression is necessary to identify abnormalities in regions with abundant fat, which is the only way to determine the potentially painful vertebrae in old-aged patients who have more fat at the vertebrae . It is better in identifying acute and hidden lesions before cement augmentation than plain radiographs and computed tomography scans. Similar to a nationwide population-based study in South Korea that found that the rate of magnetic resonance imaging (MRI) was only 35% for patients with OVCF , our study found that the rates of T2-weighted imaging with fat suppression were 67.74% for surgeons and 36.17% for internists. It indicates that the importance of MRI scanning has been ignored by different physicians in the diagnosis of OVCF, and a difference existed between surgeons and internists.
The issue of choosing nonsurgical management, vertebroplasty, or balloon kyphoplasty in the treatment of OVCF remains complicated . The heterogeneity of the patient population, including those with negative manifestation in MRI, varied symptoms, insufficient response to conservative treatment, etc., was found be the reason behind the management choices . However, the influence of differences in discipline has rarely been studied. Schupfner et al  found that surgeons tend to choose balloon kyphoplasty as their main treatment, whereas more nonsurgeons chose vertebroplasty. On the contrary, our result showed that nonsurgical management was the first-line treatment for both groups, but more surgeons chose surgical treatment, whereas more internists insist on conservative treatment. Except for the diversity of respondents between Schupfner et al’s study and ours, we note that Schupfner et al investigated only three nonsurgeons (two radiologists and one internist) and five surgeons. The results of Schupfner et al and our results suggest that a difference in management choice indeed exists between surgeons and internists, as surgeons and radiologists tends to choose surgical management, whereas internists prefers nonsurgical management.
For patients with OVCF, the rate of osteoporosis diagnosis after fractures has significantly increased, whereas the rate of osteoporosis treatment has only increased minimally . Barton et al  found that only 15% of patients had calcium or vitamin D supplementation or had FDA-approved osteoporosis medication following vertebral fractures. Unsurprisingly, 38% had another vertebral fracture within 2 years following the first one. Previous studies found that osteoporosis treatment after fragility fractures might be influenced by factors such as BMD measurement, fracture history, and hospitalization, which might lead to a higher prescribing rate . Our study investigated whether the differences in discipline are an influencing factor and found significant difference between the two groups. We found that most internists were more concerned with osteoporosis treatment, whereas the proportion of surgeons with the same concern was only two thirds. The result of previous studies and our result suggest that the hospital medical staff play an important role in the management of osteoporosis after fragility spinal fractures, and a difference might exist between different disciplines, in which internists might contribute more.
The collaboration among disciplines in osteoporosis was globally initiated, and its advantages have been reported in previous studies, including increased efficiency and better treatment coordination [22, 23]. Correspondingly, our study showed that most physicians were willing to collaborate with different disciplines. Hjalmarso et al  found that a practice pattern with a horizontal structure would trigger free action of the professionals and would encourage a changeable leadership, which would balance the top-down structure and improve the outcome of interprofessional collaboration. In our study, we also found the feasibility of a horizontal structure in collaboration and that both surgeons and internists were willing to subjectively take leadership of the team. The results of the study of Hjalmarso et al and our results suggest that physicians are willing to take the leadership in a team, and a horizontal practice pattern with changeable leadership is feasible. We also noted that the sense of collaboration might be disparate among physicians from different grades of hospitals and physicians with different job titles.
Our study is the first to compare the management trend and practice pattern for patients with OVCF between orthopedic surgeons and internists. However, our study has some limitations. First, a significant difference in sex ratio was found between the two groups. Although only a few surgeons in our study were women, it conforms to a previous report that female surgeons dominated only 10–20% of the surgical workforce ; thus, we believe that it may not be a bias. Second, compared with internists, more surgeons were from teaching hospitals, which might bias the estimation. Besides, in our study, most physicians were from tertiary hospitals, and doctors with senior professional titles had the highest proportion among the respondents, which indicates that our result may be more optimistic than the reality. Third, this is a self-assessment study, and deviation might exist compared with the real condition. Further studies are needed to demonstrate the result more conclusively. Although our study has some deficiencies, they are not cofounders to the conclusion.