Opportunistic diagnosis of osteoporotic vertebral fractures on standard imaging performed for alternative indications

Abstract

Osteoporotic vertebral fractures (VF) are the most common type of osteoporotic fracture. Patients with VF are at increased risk of hip fractures or additional VFs, both of which contribute to patient morbidity and mortality. Early diagnosis of VFs is essential so patients can be prescribed appropriate medical therapy. Most patients with clinical suspicion for VF have an X-ray of the spine. Many VFs are invisible on X-ray and require further imaging. CT can provide excellent bony detail but uses high doses of ionising radiation. MRI provides excellent soft tissue detail and can distinguish old from new fractures in addition to differentiating osteoporotic VFs from other causes of back pain. Bone scans have a limited role due to poor specificity. The literature suggests that radiologists frequently miss or do not report VFs when imaging is requested for an alternative clinical indication and when there is no clinical suspicion of VF. Common examples include failure to identify VFs on lateral chest x-rays, sagittal reformats of CT thorax and abdomen, lateral localizers on MRI and scout views on CT. Failure to diagnose a VF is a missed opportunity to improve management of osteoporosis and reduce risk of further fractures. This article discusses the role of radiographs, CT, MRI and Bone Scintigraphy in the assessment and recognition of osteoporotic fractures. This article focuses on opportunistic diagnosis of vertebral fractures on imaging studies that are performed for other clinical indications. It does not discuss use of DXA which is a specific imaging modality for osteoporosis.

Towards the diagnosis of osteoporosis – contributions from coincidental diagnostic imaging findings in chiropractors' practice

“…Hence, in some cases, the chiropractors will evaluate X-ray images that, most often by coincidence, show signs of osteopenia and/or osteoporotic fractures in the absence of a diagnosis or suspicion of osteoporosis. The inherent possibility of identifying these signs of osteoporosis on conventional X-rays, irrespective that the reasons for obtaining the images, provides a unique opportunistic opportunity, which given the chiropractor's awareness, could likely contribute to earlier diagnosis of osteoporosis in some individuals [ 7 , 16 – 21 ].…”