A Clinical Prospective Observational Cohort Study on the Prevalence and Primary Diagnostic Accuracy of Occult Vertebral Fractures in Aged Women with Acute Lower Back Pain Using Magnetic Resonance Imaging

Abstract

Background Elderly female patients complaints of acute low back pain (LBP) may involve vertebral fracture (VF), among which occult VF (OVF: early-stage VF without any morphological change) is often missed to be detected by primary X-ray examination. The current study aimed to investigate the prevalence of VF and OVF and the diagnostic accuracy of the initial X-ray in detecting OVF. Method Subjects were elderly women (>70 years old) complaining of acute LBP with an accurate onset date. Subjects underwent lumbar X-ray, magnetic resonance imaging (MRI), and bone mineral density (BMD) measurement at their first visit. The distribution of radiological findings from X-ray and magnetic resonance imaging (MRI) as well as the calculation of the prevalence of VF and OVF are investigated. Results The prevalence of VF among elderly women with LBP was 76.5% and L1 was the most commonly injured level. Among VF cases, the prevalence of OVF was 33.3%. Furthermore, osteoporotic patients tend to show increased prevalence of VF (87.5%). The predictive values in detecting VF on the initial plain X-ray were as follows: sensitivity, 51.3%; specificity, 75.0%; and accuracy rate, 56.7%. Conclusions Acute LBP patients may suffer vertebral injury with almost no morphologic change in X-ray, which can be detected using MRI.

Comparison of the Characteristics of Back Pain in Women with Postmenopausal Osteoporosis with and without Vertebral Compression Fracture: A Retrospective Study at a Single Osteoporosis Center in Poland

“…Researchers have reported many features that distinguish the character of back pain of patients with compression fracture from that of patients without this type of injury. A seemingly simple assessment of the intensity of pain on NRS performed among women with vertebral fractures due to osteoporosis [ 25 , 26 ] demonstrated that patients with vertebral fractures experience much more severe pain compared with patients without fractures. This finding leads to the conclusion that osteoporotic fractures of the spine are in fact not asymptomatic [ 27 , 28 ].…”

Whole spine localizers of magnetic resonance imaging detect unexpected vertebral fractures

“…The exclusion criteria were: (i) missing WS-locs; (ii) missing information on the referral reason; and (iii) metal hardware resulting in non-evaluable image quality. To investigate a representative patient population, the study was performed on all consecutive patients aged >65 years and not only >70 years as previously described (4).…”

“…In patients aged > 70 years with low back pain (LBP), radiographs are initially performed, even if the radiographic detection of the vertebral fractures is rather poor (4). To exclude some rather rare reasons for LBP such as infection, tumor, or metastases, magnetic resonance imaging (MRI) can be additionally obtained (5).…”

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

“…It is important not to dismiss patient symptoms based on normal radiographs since many patients with normal plain films may only have acute changes detectable on MRI. 26 Loss of vertebral height may not be evident at time of acute symptoms but can be evident on subsequent follow-up radiograph.…”