What is changed in the diagnosis of osteoporosis: the role of radiologists

Guglielmi, Giuseppe; Balzano, Rosario Francesco; Cheng, Xiaoguang

doi:10.21037/qims.2018.02.04

Cited by 7 publications

(5 citation statements)

References 39 publications

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“…We suggest to utilize vertebral morphometry only to graduate more objectively the VFs, once qualitatively diagnosed. In this way the radiologist plays a central role in the management of patients with osteoporosis, but an adequate training is recommended by correctly identifying all of VFs (87).…”

Section: A B C Vertebral Morphometry: Normative Datamentioning

confidence: 99%

How to define an osteoporotic vertebral fracture?

Diacinti

Guglielmi

2019

Quant. Imaging Med. Surg.

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A vertebral deformity (VD) is not always a vertebral fracture (VF). Because of lack of a completely satisfactory "gold standard", there is no consensus on the exact definition of a VF. Therefore, it may sometimes be difficult, especially in mild cases, to discriminate the prevalent VF from a non-fracture deformity or short vertebral height (SVH). A combined standardized approach based on qualitative and semiquantitative (SQ) vertebral assessment may be the most option to correctly identify a VD as a VF. However this visual approach for VF identification is subjective, therefore it is mandatory an adequate training and experience of radiologist to reach a good sensitivity and specificity. Vertebral morphometry, objective and reproducible method, could be used only to evaluate the severity of VFs but requires the availability of reference values of vertebral height ratios. There is actually an evidentiary basis for suggesting that a qualitative approach by expert radiologists to morphological vertebral assessment, combined SQ and morphometric methods seem to be the preferred option for the correct diagnosis of VF as endplate or/and cortex fracture (ECF) or severe vertebral height loss.

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Section: A B C Vertebral Morphometry: Normative Datamentioning

confidence: 99%

How to define an osteoporotic vertebral fracture?

Diacinti

Guglielmi

2019

Quant. Imaging Med. Surg.

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“…Of particular concern is that appropriate grading was not reported for most cases. As the clinical management can be facilitated by precise reporting as to the grade of VCD/VCF and the segmental level or levels involved, radiologists should be trained and sensitized in VCD/VCFs identification; thus, by precise VCD/VCF reporting, radiologist can play an important role in the clinical care of patients with osteoporosis [ 44 , 45 ].…”

Section: Discussionmentioning

confidence: 99%

Underreporting characteristics of osteoporotic vertebral fracture in back pain clinic patients of a tertiary hospital in China

Che-Nordin

et al. 2020

Journal of Orthopaedic Translation

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Aim Osteoporotic vertebral compressive fractures (VCFs) are known to be commonly missed in X-rays indicated for pulmonary or heart diseases. In this study, we investigated the underreporting status of VCF in back pain clinic patients when the spine was the focus of interest. Materials and methods This is a retrospective analysis of 105 female cases (mean: 72 years, range: 55–93 years) from a tertiary hospital in China (facility A, FA). The patients with back and/or leg pain were referred for a spine X-ray. The images were retrieved and transferred to a central reading facility (facility B, FB), where images were double-read by two readers experienced in evaluating osteoporotic vertebral compressive deformity (VCD)/VCF. A qualitative VCD with <20%, 20–25%, 25–40%, and >40% vertebral body height loss was recorded as minimal, mild, moderate, and severe grades, respectively. A VCD coexisted with endplate/cortex fracture (ECF) was VCF. FB readings were considered as the reference. Results There were 34 true negative cases where FA and FB had a consensus. In 7 cases with minimal VCD, 3 cases with ECF, and 7 cases with minimal or mild VCFs, the FA readings were false negative. No standalone singular moderate or severe VCD/VCF in a patient was missed in FA's reports. In 25 FA reading positive cases with multiple VCFs, one VCF was missed in 8 cases, more than one VCF was missed in 15 cases, and one additional ECF was missed in 2 cases. In 14 cases, FA and FB had VCF number agreement, with the term ‘vertebral fracture’ was used appropriately in FA reports. In 15 cases, FA and FB had agreement in VCF number; however, the appropriate term ‘vertebral fracture’ was not used in FA reports; instead the terms of ‘compressive change’ or ‘wedging change’ were used. In most VCFs, severity grading was not given in FA. In 13 VCFs where grading was reported, all were marked as ‘mild’, including seven mild VCFs, five moderate VCFs, and even one severe VCF. Conclusion Among the patients with VCD/VCF, the false negative rate among was 23.9% (17/71), but the missed cases were all minimal or mild grades. One or more VCFs were missed in 32.4% (23/71) of the cases with multiple VCFs. Appropriate severity grading was not reported for most cases. The translational potential of this article The underreporting rate of osteoporotic vertebral compressive fracture in back pain clinic patients in a typical tertiary hospital setting in China compared favorably with literature reports. However, there is a general lack of awareness of vertebral endplate/cortex fracture sign and vertebral fracture severity grading, while minimal and mild VCD with endplate/cortex fracture may have clinical significance. Moreover, after one VCF is spotted in a patient, it is highly advisable to carefully check the whole spine so that multiple VCFs will not be missed.

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“…We suggest to utilize vertebral morphometry only to grade more objectively the VFs, once qualitatively diagnosed. In this way the radiologist plays a central role in the management of patients with osteoporosis, but an adequate training is recommended so to correctly identify all of VFs (87).…”

Section: Vertebral Morphometry: Normative Datamentioning

confidence: 99%

Corrigendum to how to define an osteoporotic vertebral fracture

2019

Quant. Imaging Med. Surg.

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What is changed in the diagnosis of osteoporosis: the role of radiologists

Cited by 7 publications

References 39 publications

How to define an osteoporotic vertebral fracture?

How to define an osteoporotic vertebral fracture?

Underreporting characteristics of osteoporotic vertebral fracture in back pain clinic patients of a tertiary hospital in China

Corrigendum to how to define an osteoporotic vertebral fracture

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