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.

Vertebral body fractures of unknown origin in cancer patients receiving MDCT: reporting by radiologists and awareness by clinicians

“…Furthermore, only 35 % of radiographically reported VBFs were shown to be documented in hospital discharge letters (Gehlbach et al 2000 ). Now, one decade after the Vertebral Fracture Initiative (Schwartz and Steinberg 2005 ), we found improved detection rates (61 %), most likely as a result of the routine reading of sagittal reformations. Nevertheless, clinical management rates of pathologic VBFs of unknown origin detected in CT examinations of cancer patients were an inadequate 3 %.…”

“…Over a decade ago the International Osteoporosis Foundation developed a Vertebral Fracture Initiative to educate radiologists and to raise awareness for the relevance of detecting and reporting VBF (Schwartz and Steinberg 2005 ). However, previous investigations concerning radiological reporting of VBFs (Carberry et al 2013 ; Bartalena et al 2009 ; Müller et al 2008 ) excluded patients with known malignancies from their investigations.…”

Traumatic vertebral fractures involve the anterior end plate more than the posterior end plate

“…[ 2 ] The semi-quantitative criteria proposed by Genant et al, [ 3 ] is commonly used in vertebral height reduction, in which the importance of loss of EP integrity is emphasized, but did not make diagnosis on this sign. [ 3 , 4 ] The algorithm-based qualitative (ABQ) approach, described by Jiang et al [ 5 , 6 ] initially, explained that the EP is a 100% sensitive finding in diagnosis VF, while vertebral height loss is not an indispensable indicator for VF. Recently, Wang [ 7 ] proposed a modified semi-quantitative grading, in which the percentage reduction in vertebral height was retained and the percentage reduction in vertebral area was removed.…”

Osteoporotic vertebral endplate and cortex fractures: A pictorial review

“…Genant et al. described the importance of loss of endplate integrity as a characteristic of fractures but did not make diagnosis contingent on this observation [19] .…”

“…Interstudy comparison of epidemiological results is only possible when the methodology of the epidemiological studies is similar/the same (for example, table 6 of reference 32). For ambiguous cases in daily clinical care, in addition to necessary additional investigations such as computed tomography/MRI, radiograph follow-up is also a reasonable choice [8] , [10] , [19] , [29] , [33] .…”