The items in your link make complete sense to have the same DOI: they are all letters, and the DOI is for the entire 'letters to the editor' section of that journal issue. If you look at the other details, you'll see the different data for each individual letter like titles, PMIDs, etc.
For most of the other DOIs that I quickly checked they look like actual duplicate entries that should be merged into one. Almost all of them have titles that haven't been merged because of the use of characters not used in standard English: I see some German titles with and without umlauts for example, and also titles with mathematical formatting rendered in various ways. This is something that could definitely be improved in the OpenAlex backend by expanding the title-matching functions they use. I dug into those functions a bit in various other conversations in this group earlier this year.
I would recommend letting the OA team know about these duplicates through
their contact form.
Cheers,
Samuel