Diagnosis of vertebral fractures on lateral chest X-ray: Intraobserver agreement of semi-quantitative vertebral fracture assessment

Willems, Hanna C.; Munster, Barbara C. Van; Leeflang, Mariska; Beuerle, E. Y.; Tulner, C.R.; Lems, Willem F.

doi:10.1016/j.ejrad.2014.09.005

Cited by 6 publications

(4 citation statements)

References 23 publications

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“…Our results should be interpreted within certain limitations. We used lateral chest radiographs and not spine radiographs, which may have complicated vertebral fracture diagnosis, although lateral chest radiographs have excellent agreement and reliability compared with spine radiographs [22]. Also, lateral chest radiographs did not allow for fracture assessment of the lower lumbar spine, as we could only evaluate the spine down to the first lumbar vertebra in most patients.…”

Section: Discussionmentioning

confidence: 99%

“…This method allows to exclude other possible causes of vertebral deformity, such as Scheuermann's disease, remodeling of vertebral bodies due to degenerative disk disease, or scoliosis. Lateral chest radiographs are reliable for the diagnosis of vertebral fractures, with excellent agreement and reliability compared with lateral spine radiographs (95-98% and 0.88-0.91, respectively) [22]. Fractures were graded by type (wedge, biconcave, or crush deformity) and severity: grade 1 (20-25% height loss), grade 2 (25-40% height loss), or grade 3 (> 40% height loss).…”

Section: Vertebral Fracture Assessmentmentioning

confidence: 99%

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The prevalence and incidence of vertebral fractures in end-stage renal disease and the role of parathyroid hormone

et al. 2019

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The risk of vertebral fracture is unclear in end-stage renal disease. We report a high vertebral fracture prevalence and incidence in transplantation-eligible patients on dialysis, suggesting that these patients may benefit from radiographic screening for vertebral fractures. Parathyroid hormone had a U-shaped association with vertebral fracture risk. Introduction Vertebral fractures are often overlooked, but even undiagnosed vertebral fractures negatively impact physical functioning, quality of life, and mortality. The risk of vertebral fractures in end-stage renal disease (ESRD) patients is unclear, and parathyroid hormone (PTH) might play a role in the development of vertebral fractures. We therefore determined vertebral fracture prevalence and incidence in ESRD patients and assessed associations of vertebral trabecular bone mineral density (BMD) and PTH with vertebral fracture. Methods In 146 transplantation-eligible patients on dialysis, we determined vertebral fractures on lateral chest radiographs, which image the thoracic and upper lumbar spine. We determined incident vertebral fractures in 70 patients with follow-up radiographs (23 received a kidney transplant) after median 1.8 years. Vertebral trabecular BMD was measured with computed tomography, and PTH measured with 2-site immunoassays, categorized in tertiles with the middle tertile as reference. We used Poisson regression to assess associations of vertebral trabecular BMD and PTH with vertebral fracture. Results Mean age of the study population was 52 ± 13 years, and 98 (67%) were male. Median dialysis duration was 26 (IQR 13-55) months. Vertebral fractures were present in 50/146 patients (34%) and incident vertebral fractures occurred in 20/70 patients (29%). Vertebral trabecular BMD was not associated with vertebral fracture prevalence (relative risk 0.97, 95% CI 0.89 to 1.04). For the lowest PTH tertile (< 11 pmol/L), the relative risk of vertebral fracture was greater although not significant (2.28, 95% CI 0.97 to 5.97) and was significantly greater for the highest PTH tertile (≥ 30 pmol/L; 2.82, 95% CI 1.22 to 7.27) after adjustment for potential confounders. Conclusions The prevalence and incidence of vertebral fractures is high even in relatively young and healthy ESRD patients. Vertebral trabecular BMD is not associated with vertebral fracture, and the association of PTH with vertebral fracture risk appears U-shaped. Nevertheless, our study did not measure vertebral BMD using DXA and assessed vertebral fractures using lateral chest radiographs and not spine radiographs.

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Section: Discussionmentioning

confidence: 99%

Section: Vertebral Fracture Assessmentmentioning

confidence: 99%

The prevalence and incidence of vertebral fractures in end-stage renal disease and the role of parathyroid hormone

et al. 2019

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“…The prevalence of vertebral fractures was assessed on standing upright lateral X-rays of the thoracic and lumbar vertebral spine. Vertebral fractures were scored by the semi-quantitative technique of Genant [ 22 , 23 ]. All radiographs were scored by two observers (MG and HJ).…”

Section: Methodsmentioning

confidence: 99%

Associations between vertebral fractures, increased thoracic kyphosis, a flexed posture and falls in older adults: a prospective cohort study

et al. 2015

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BackgroundVertebral fractures, an increased thoracic kyphosis and a flexed posture are associated with falls. However, this was not confirmed in prospective studies. We performed a prospective cohort study to investigate the association between vertebral fractures, increased thoracic kyphosis and/or flexed posture with future fall incidents in older adults within the next year.MethodsPatients were recruited at a geriatric outpatient clinic. Vertebral fractures were evaluated on lateral radiographs of the spine with the semi-quantitative method of Genant; the degree of thoracic kyphosis was assessed with the Cobb angle. The occiput-to-wall distance was used to determine a flexed posture. Self-reported falls were prospectively registered by monthly phone contact for the duration of 12 months.ResultsFifty-one older adults were included; mean age was 79 years (SD = 4.8). An increased thoracic kyphosis was independently associated with future falls (OR 2.13; 95% CI 1.10-4.51). Prevalent vertebral fractures had a trend towards significancy (OR 3.67; 95% CI 0.85-15.9). A flexed posture was not significantly associated with future falls.ConclusionOlder adults with an increased thoracic kyphosis are more likely to fall within the next year. We suggest clinical attention for underlying causes. Because patients with increased thoracic curvature of the spine might have underlying osteoporotic vertebral fractures, clinicians should be aware of the risk of a new fracture.

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“…VCFs are diagnosed by lateral thoracic and lumbar X-rays or by lateral vertebral fracture assessment on DXA scan [131]. VCFs can often be picked up on chest X-rays, and should actively be looked for when reviewing chest imaging of COPD patients [12,132]. A decrease in height by more than 4 cm from age 25, should alert the physician to the possibility of a VCF [133].…”

Section: Diagnosismentioning

confidence: 99%

COPD: osteoporosis and sarcopenia

2016

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Systemic involvement and comorbidities are common in chronic obstructive pulmonary disease (COPD). They add to the burden of disease and are associated with significant disability and mortality. These include cardiovascular disease, mood disorders, anemia, cachexia, skeletal muscle dysfunction and bone pathology. In this article, we review the pathophysiology, diagnosis and treatment of two such comorbidities, osteoporosis and sarcopenia, as they relate to patients with COPD.

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Diagnosis of vertebral fractures on lateral chest X-ray: Intraobserver agreement of semi-quantitative vertebral fracture assessment

Cited by 6 publications

References 23 publications

The prevalence and incidence of vertebral fractures in end-stage renal disease and the role of parathyroid hormone

The prevalence and incidence of vertebral fractures in end-stage renal disease and the role of parathyroid hormone

Associations between vertebral fractures, increased thoracic kyphosis, a flexed posture and falls in older adults: a prospective cohort study

COPD: osteoporosis and sarcopenia

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