Prevalence of Vertebral Fractures in CTPA’s in Adults Aged 75 and Older and Their Association with Subsequent Fractures and Mortality

Abstract

Identifying vertebral fractures is prudent in the management of osteoporosis and the current literature suggests that less than one-third of incidental vertebral fractures are reported. The aim of this study is to determine the prevalence of reported and unreported vertebral fractures in computerized tomography pulmonary angiograms (CTPA) and their relevance to clinical outcomes. All acutely unwell patients aged 75 or older who underwent CTPAs were reviewed retrospectively. 179 CTPAs were reviewed to identify any unreported vertebral fractures. A total of 161 were included for further analysis. Of which, 14.3% (23/161) were reported to have a vertebral fracture, however, only 8.7% (14/161) of reports used the correct terminology of ‘fracture’. On subsequent review, an additional 19.3% (31/161) were noted to have vertebral fractures. Therefore, the overall prevalence of vertebral fractures was 33.5% (54/161). A total of 22.2% (12/54) of patients with a vertebral fracture on CTPA sustained a new fragility fracture during the follow-up period (4.5 years). In comparison, a significantly lower 10.3% (11/107) of patients without a vertebral fracture developed a subsequent fragility fracture during the same period (p = 0.04). Overall mortality during the follow-up period was significantly higher for patients with vertebral fractures (68.5%, 37/54) as compared to those without (45.8%, 49/107, p = 0.006). Vertebral fractures within the elderly population are underreported on CTPAs. The significance of detecting incidental vertebral fractures is clear given the increased rates of subsequent fractures and mortality. Radiologists and physicians alike must be made aware of the importance of identifying and treating incidental, vertebral fragility fractures.

The Impact of Prior Fragility Fractures on Complications After Total Hip Arthroplasty: A Propensity Score–Matched Cohort Study

“…Between 2013 and 2014, fragility fractures were responsible for more than 540,600 hospitalizations and 935,700 visits to an emergency department by Americans aged 50 and older [5]. Notably, these rates are likely a significant underestimate, and the true incidence of fragility fractures is likely much higher given the frequency of incidental diagnoses, asymptomatic fractures, and increasing prevalence of osteoporosis in an expanding elderly population [3,[7][8][9].…”

Opportunistic diagnosis of osteoporosis, fragile bone strength and vertebral fractures from routine CT scans; a review of approved technology systems and pathways to implementation

“…This is particularly true for opportunistic evaluation of CT; many routinely acquired CT scans are for patients with cancer or cancer-monitoring in whom mortality is higher than the general public. Indeed, the ancillary finding of a vertebral fracture in CT reduces survival markedly; from around 60% 4-year survival to about 30% 4-year survival (in adults 75 years or older undergoing chest CT) 81 . Here, there is a large research gap.…”

Fracture Risk in Men and Women With Vertebral Fractures Identified Opportunistically on Routine Computed Tomography Scans and Not Treated for Osteoporosis: An Observational Cohort Study

“…Unfortunately, a number of studies have documented that a large proportion of patients with VF available on such imaging are not identified as fractured in radiology reports. ( 14 , 15 , 16 , 17 , 18 , 19 ) Suggested causes include—among others—a lack of routine examination of bone health when the imaging is performed for another indication, ( 15 ) use of ambiguous terminology to describe the VF, ( 15 , 16 , 20 ) and a lack of awareness about VFs among radiologists. ( 19 ) In addition, although a number of studies have described an increased fracture risk in subjects with clinical VF as well as in subjects with VF identified purposively on baseline radiological imaging, ( 21 , 22 , 23 , 24 ) real‐world patient cohorts with opportunistically identified VF will likely differ substantially from the well‐defined cohorts of such observational studies.…”

“…Few studies have investigated fracture risk in real‐world populations with opportunistically identified VF, and they are limited by assessing hip fracture risk only and not reporting relative risk estimates, respectively. ( 14 , 25 ) Hence it seems prudent to suggest that this lack of evidence plays a role in the aforementioned underreporting. To address this issue, the objective of this study is to evaluate the risk of subsequent fractures in subjects with VF identified opportunistically on CT scans performed as part of routine clinical practice.…”