Recognition of Vertebral Fracture in a Clinical Setting

Abstract

Osteoporosis-related vertebral fractures have important health consequences for older individuals, including disability and increased mortality. Because these fractures can be prevented with appropriate medications, recognition and treatment of high-risk patients is warranted. A cross-sectional survey was carried out in a large, regional hospital in New England to examine the frequency with which vertebral fractures are identified and treated by clinicians in a population of hospitalized older women who have radiographic evidence of fractures. The study population consisted of 934 women aged 60 years and older who were hospitalized between October 1, 1995 and March 31, 1997, and who had a chest radiograph obtained. Vertebral fractures in the thoracic region were identified by two radiologists. Discharge diagnoses, medical record notes and radiology reports were compared with the results of the radiologists' readings to determine the frequency with which fractures were identified and appropriate, osteoporosis-preventing medications prescribed. Moderate or severe vertebral fractures were identified for 132 (14.1%) study subjects, but only 17 (1.8%) of the 934 participants had a discharge diagnosis of vertebral fracture. Of these 132, only 17% had fracture noted in the medical record or discharge summary; 50% of contemporaneous radiology reports identified a fracture as present; and 23% of the time it was found in the radiologist's summary impression. Only 18% of medical records indicated that fracture patients had been prescribed calcium, vitamin D, estrogen replacement or an antiresorptive agent. Relatively few hospitalized older women with radiographically demonstrated vertebral fractures were thus identified or treated by clinicians, suggesting a need for improved recognition.

Reliability and accuracy of scout CT in the detection of vertebral fractures

“…In the past few years, several imaging techniques have been proposed for the detection of VFs [7,8]. Spine assessment with the aim of VF detection has been performed on the main basis of spine radiographs and dual-energy X-ray absorptiometry scans [9].…”

“…Results show that detection is still low when VFs are not the intent of the study [13,14]. Radiographs of the chest and abdomen, as well as CT sagittal multiplanar reconstructions (MPRs), have been considered [7,8,15,16] following the widespread use of CT imaging. In recent years, the opportunity to screen for VFs on ancillary sequences of advanced imaging techniques, such as localisation scans of CT and MRI, were also investigated [17][18][19].…”

Tomosynthesis of the thoracic spine: added value in diagnosing vertebral fractures in the elderly

“…In particular, tomosynthesis may have a value in diagnosing osteoporotic fractures of the thoracic spine, which often are under-recognized and underreported [1]. The reason for under-recognizing fractures in the thoracic spine is often reduced image quality due to disturbing anatomic noise from the lung structures, which becomes more apparent with age concomitantly with a reduction of bone mineral density.…”

“…This makes it difficult to evaluate the thoracic spine for osteoporotic compression fractures [1] as well as for destructions and other lesions, which may require the use of other imaging modalities. Thoracic spine tomography [2,3] was frequently used before the advent of computed tomography (CT).…”

The Value of X-ray Compared with Magnetic Resonance Imaging in the Diagnosis of Traumatic Vertebral Fractures

“…Most of the existing studies on diagnosis of vertebral fractures are limited to non-traumatic pathologic fractures and few studies have been conducted on traumatic fractures. Despite standardization of radiographic reading, in approximately half of hospitalized elderly patients, moderate to severe vertebral fracture could not be diagnosed [9], according to a retrospective study. In a similar multinational prospective study, diagnostic accuracy of X-rays for vertebral fractures was poor with 34% of false negative rating, but all of these studies were conducted on patients with osteoporotic vertebral fractures [10].…”