Diagnosing vertebral fractures: missed opportunities

Borges, João Lindolfo Cunha; Maia, Julianne Lira; Silva, Renata Faria; Lewiecki, Edward Michael

doi:10.1016/j.rbr.2014.12.008

ABSTRACT

Vertebral fractures are the single most common type of osteoporotic fracture. Postmenopausal women are at increased risk for osteoporotic vertebral fractures compared with women of childbearing age. Vertebral fractures are associated with an increase in morbidity, mortality, and high risk of a subsequent vertebral fracture, regardless of bone mineral density. Despite the common occurrence and serious consequences of vertebral fractures, they are often unrecognized or misdiagnosed by radiologists. Moreover, vertebral fractures may be described by variable terminology that can confuse rather than enlighten referring physicians. We conducted a survey of spine X-ray reports from a group of postmenopausal women screened for participation in a study of osteoporosis at Centro de Pesquisa Clínica do Brasil. A descriptive analysis evaluated the variability of reports in 7 patients. Four independent general radiologists issued reports assessing vertebral fractures through a blinded analysis. The objective of this study was to evaluate for consistency in these reports. The analysis found marked variability in the diagnosis of vertebral fractures and the terminology used to describe them. In community medical practices, such variability could lead to differences in the management of patients with osteoporosis, with the potential for undertreatment or overtreatment depending on clinical circumstances. Accurate and unambiguous reporting of vertebral fractures is likely to be associated with improved clinical outcomes.

Keywords:
Vertebral fractures; Osteoporotic fractures; Osteoporosis

[1] *Corresponding author. E-mail: jlborges@metabolismo.com.br (J.L.C. Borges).

	Report 1	Report 2	Report 3	Report 4
Patient 1	Slight reduction of the heights of vertebral bodies.	Anterior wedging of T5.	Mild fractures at L2 and L3. Moreover, moderate reduction of the height of the thoracic vertebral bodies, more pronounced at T5.	Fracture/Crush fracture in T5 vertebral body, and less evident in L3.
Patient 2	Absence of fractures.	Discreet anterior wedging of T11 depression of the upper plateau.	Biconcave insufficiency vertebral body fractures in several thoracic vertebras. Anterior mild wedging in T11.	Fracture/wedging of vertebral bodies of T10, T11, T13 and T14.
Patient 3	Absence of fractures.	Absence of fractures.	Biconcave aspect of vertebral bodies of thoracic and upper lumbar vertebra, mainly in T11 and T12. No significant vertebral collapse.	Absence of fractures.
Patient 4	Absence of fractures.	Absence of fractures.	Absence of fractures.	Absence of fractures.
Patient 5	Absence of fractures.	Absence of fractures.	Absence of fractures.	Absence of fractures.
Patient 6	Absence of fractures.	Discrete wedging of L2 vertebral body	Absence of fractures.	Diminished height of the vertebral body of L2.
Patient 7	Wedging of the L4 vertebral body around 15%.	Anterior wedging of T11 and T12. Superior plateau fracture of L4	Discreet anterior wedging L4.	Discrete fracture/wedging in the upper plateau of L4.