Incidental Vertebral Fractures Discovered With Chest Radiography in the Emergency Department

Abstract

One in 6 elderly patients who underwent chest radiography in our emergency department had clinically important vertebral fractures. Nevertheless, only 43 (60%) of these fractures were reported, and only 25% of patients with fractures received a diagnosis of or treatment for osteoporosis.

Identifying osteoporotic vertebral endplate and cortex fractures

“…The majority are morphometric (75%), that is, clinically silent without an incident of back pain, rather than with clinical symptoms (25%) (6). Incidental osteoporotic VFs are usually under-reported on radiograph and CT (7)(8)(9)(10). The sensitivity of axial CT images in detecting these fractures is poor, sagittal reformation is recommended to improve the detection rate (10).…”

A team approach: implementing a model of care for preventing osteoporosis related fractures

“…The presence of osteoporosis on X-ray is very rarely mentioned in reports unless it is specifically requested and rarely documented in patient records [13,14] and patients themselves have very little knowledge or understanding of the impact of osteoporosis and their increased risk of future fractures [15]. Further delays occur when the treating orthopaedic surgeons fail to identify patients with osteoporosis or to commence treatment [13] and rely instead on general practitioners (GPs) for follow-up [13,16].…”

“…Treatment for osteoporosis is more likely to be initiated if the fracture is located in the spine [12], and although compression vertebral fractures have been identified as the most common fracture associated with osteoporosis, only 25% of patients with this type of fracture received a diagnosis of osteoporosis or treatment for osteoporosis [14].…”

Detection of vertebral fractures

“…Majumdar et al [37] reviewed prevalent vertebral fractures discovered on chest radiographs taken in an emergency room setting. They selected an approximate 10% (500) sample of the 5083 people older than 60 years who had chest x-rays taken.…”