Is short vertebral height always an osteoporotic fracture? The Osteoporosis and Ultrasound Study (OPUS)

Excess body fat is associated with higher risk of vertebral deformities in older women but not in men: a cross-sectional study

“…Ferrar et al argue that some types of mild deformities are "non-fracture variants" rather than vertebral deformities. These include short vertebral height (SVH), which they report as being more common in older, heavier women, unrelated to osteoporosis [40,41], equally prevalent in preand postmenopausal women [41], and therefore unimportant. However, the limited evidence on the natural history of "mild" vertebral deformities suggests that they do predict subsequent fracture [5] and may even represent an epidemiologically distinct subtype of vertebral "fractures" [42].…”

Early diagnosis of vertebral fractures

“…The correct diagnosis however is only achievable when radiographs and other imaging modalities performed are carefully evaluated and integrated. Vertebral deformities can careful evaluation of the radiographs and other imaging modalities are integrated (19,20). Quantitative morphometry is unable to distinguish osteoporotic vertebral fractures from vertebral deformities from other causes such as degenerative spine and disc disease.…”

Identification of vertebral fractures: a moderately severe solution?

“…Indeed, this was observed in the Cosman study, where one third of those identified as having a fracture were subsequently reclassified as non-fractured; importantly, these mis-called events were reported to be mostly mild wedge deformities [24]. There is good evidence that such fractures are not always associated with low BMD or future non-vertebral fracture risk, unlike moderate (grade 2) or severe (grade 3) vertebral fractures [30,32]. Further evidence suggests that short vertebral height, a common reason for nonexpert definition of mild vertebral fractures, shows little relationship with age [33].…”

“…Such subtleties may be difficult to detect on VFA imaging and, indeed, even on traditional radiographs, and this is particularly true in the setting of grade 1 or mild vertebral fractures. In expert hands such fractures can be identified, but even when images are evaluated by those trained in the technique, there is a significant false positive rate largely due to confusion with non-fracture deformities such as short vertebral height [30,31]. Indeed, this was observed in the Cosman study, where one third of those identified as having a fracture were subsequently reclassified as non-fractured; importantly, these mis-called events were reported to be mostly mild wedge deformities [24].…”