Detection of vertebral fractures

Abstract

Despite the importance of vertebral compression fractures, there is much that remains uncertain. There is no "gold standard" for the definition which has led to epidemiologic and study differences. Height loss is a way to suspect vertebral fractures but it has its own issues. There are multiple radiographic systems for defining vertebral fractures, both prevalent and incident; risk factors for prevalent fractures have already been delineated. Recent studies have elucidated the risk factors for incident vertebral fractures including age, low weight, late menarche, lower bone mineral density, history of vertebral and nonvertebral fractures, smoking, and use of a walking aid. Fan beam densitometers have had improving ability to image the spine, a procedure now known as vertebral fracture assessment (VFA). Recently (in the United States) a CPT code and reimbursement was established. Yet, many vertebral fractures go undiagnosed, diagnosed but unreported, or reported but not utilized in patient care. Because of this, the International Osteoporosis Foundation developed a Vertebral Fracture Initiative for radiologists and the International Society for Clinical Densitometry began a VFA course. Both teaching programs use the semi-quantitative assessment of Genant to aid the radiologists and clinicians in detecting vertebral fractures.

Quantitative imaging techniques for the assessment of osteoporosis and sarcopenia

“…In clinical trials, prevalent VFs are typically defined as a reduction of 3 SD or more (below the normative reference values for that particular vertebra) in any of the ratios of anterior, middle and posterior heights. In serial radiographs an incident fracture (i.e., a new VF) is defined both as an absolute change in vertebral height of at least 4 mm or as a percentage of reduction (15% or 20% reduction, depending on different studies) in the anterior, middle, or posterior heights from the baseline measurements (203,205).…”

“…Vertebrae from T4 to L4 are graded as normal/not fractured (grade 0), mildly deformed (grade 1: 20-25% reduction in height; 10-20% reduction of projected vertebral area), moderately deformed (grade 2: 25-40% reduction in height and 20-40% reduction of projected vertebral area) and severely deformed (grade 3: >40% reduction in any height and projected vertebral area) (206). However over time, the area reduction requirement was excluded from the examination (205). Since a linear relationship exists between the number and severity of prevalent VFs and the risk of future VFs, a spinal deformity index (SDI) can be derived from this scoring system, resulting from the sum of all grades assigned to the vertebrae divided by the number of evaluated vertebrae (38,197).…”

Vertebral fractures in women aged 50 years and older with clinical risk factors for fractures in primary care

“…Sensitivity increased with a higher prevalence of VFs [10]. Based on these findings, and the fact that moderate and severe VFs show the best predictive value for future fractures [10,16,17], we only considered moderate and severe VFs in this study. Mild vertebral compression was not considered a VF.…”

Quantitative vertebral compression fracture evaluation using a height compass

“…Nearly one-in-a-thousand people experience a compression fracture at some point in their life, though the level of damage varies greatly. Compression fractures vary greatly in appearance and extent [2]. Due to the collapse, height loss of the vertebra body is often observed.…”