How to define an osteoporotic vertebral fracture?

Diacinti, Daniele; Guglielmi, Giuseppe

doi:10.21037/qims.2019.09.10

Cited by 31 publications

(27 citation statements)

References 87 publications

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“…A fracture was defined as a case in which the anterior or median height of the vertebra was decreased by more than 20% compared to the posterior height. [ 15 , 16 ] When it was difficult to differentiate from old fracture, it was diagnosed after magnetic resonance imaging evaluation. The OVCFs were properly treated based on current treatment principles including conservative treatment and surgical treatment.…”

Section: Methodsmentioning

confidence: 99%

Prevalence and Risk Factors of T-Score Spine-Hip Discordance in Patients with Osteoporotic Vertebral Compression Fracture

Yoon¹,

Kang²,

Kim

et al. 2022

J Bone Metab

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Background: T-score discordance between the spine and hip is commonly observed when dual energy X-ray absorptiometry (DXA) is used to diagnose osteoporosis. However, information is scarce regarding the prevalence and risk factors for this problem in Korea. This study evaluated the prevalence of major/minor discordance and associated risk factors in elderly Korean patients with osteoporotic vertebral compression fractures (OVCFs).Methods: This study included 200 patients (37 men, 163 women) treated for thoracic or lumbar compression fractures between January 2015 and August 2021. DXA was performed to examine T‐scores and determine the prevalence of discordance, defined as a difference between the T-score categories of the femur and spine in the same individual. The t-tests, χ2 tests, and regression analyses were used to assess the associated risk factors of T-score discordance among the subjects.Results: T-score concordance, minor discordance, and major discordance were observed in 137 (68.5%), 59 (29.5%), and 4 (2%) patients with OVCFs, respectively. The spinal T-score was lower than the femoral T-score in all major discordance and 81.3% (48/59) of minor discordant cases. Overall, the only factor related to T-score discordance was the age at fracture (odds ratio, -0.01; P=0.014).Conclusions: The results of this study showed that a significant number of subjects (31.5%) showed spine-hip discordance, even with a mean age in their 80s. More attention should be paid to the appropriate evaluation and management of elderly patients with OVCFs. Moreover, a longitudinal study is necessary to verify the clinical importance of T-score discordance in this population.

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Section: Methodsmentioning

confidence: 99%

Prevalence and Risk Factors of T-Score Spine-Hip Discordance in Patients with Osteoporotic Vertebral Compression Fracture

Yoon¹,

Kang²,

Kim

et al. 2022

J Bone Metab

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“…Perhaps it is time to build upon this. Especially so given that the increasing agreement that radiological over-diagnosis of low-grade vertebral fractures is a persisting clinical problem that threatens the credibility of the use of radiology in risk assessment (28,(34)(35)(36)42).…”

Section: Taxonomymentioning

confidence: 99%

Gender and the recognition of vertebral fractures

Lentle

2020

Quant Imaging Med Surg

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“…For acute patients with acute pain, it should be also noted that VB with VCF may appear only as minimal deformity or to be ‘normal’ during initial X-ray [ 31 ]. In these cases, reporting minimal VCD deformity may alert further investigations such as fat-suppressed T2-weighted magnetic resonance (MR) imaging [ 23 , 32 ]. If patients' results of other tests (e.g., BMD) do not warrant antiresorptive therapy, it would be advisable to consider them to be at high risk of fracture and further tests should be carried out again in 1–2 years.…”

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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How to define an osteoporotic vertebral fracture?

Cited by 31 publications

References 87 publications

Prevalence and Risk Factors of T-Score Spine-Hip Discordance in Patients with Osteoporotic Vertebral Compression Fracture

Prevalence and Risk Factors of T-Score Spine-Hip Discordance in Patients with Osteoporotic Vertebral Compression Fracture

Gender and the recognition of vertebral fractures

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

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