The prevalence and under-diagnosis of vertebral fractures on chest radiograph

Li, Yizhong; Yan, Lisheng; Cai, Sanjun; Wang, Pei‐Wen; Zhuang, Huafeng; Yu, Haiming

doi:10.1186/s12891-018-2171-y

Cited by 51 publications

(35 citation statements)

References 19 publications

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“…Vertebral fractures, in particular, are seldom noted in medical records and reports and, if they are mentioned, are often reported with ambiguous or confusing terminology. (34)(35)(36)(37)(38) Additionally, patients are at highest risk for another fracture in the months immediately after the initial hip or vertebral fracture, (39) and steps need to be taken on an urgent basis to reduce that risk. When unable to determine whether the patient's usual health care provider has been notified, sufficient action might entail calling the provider or sending an email or letter.…”

Section: Fundamental Recommendations and Rationalesmentioning

confidence: 99%

Secondary Fracture Prevention: Consensus Clinical Recommendations from a Multistakeholder Coalition

Conley

Adib²,

Adler

et al. 2019

Journal of Bone and Mineral Research

171

111

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Osteoporosis‐related fractures are undertreated, due in part to misinformation about recommended approaches to patient care and discrepancies among treatment guidelines. To help bridge this gap and improve patient outcomes, the American Society for Bone and Mineral Research assembled a multistakeholder coalition to develop clinical recommendations for the optimal prevention of secondary fracture among people aged 65 years and older with a hip or vertebral fracture. The coalition developed 13 recommendations (7 primary and 6 secondary) strongly supported by the empirical literature. The coalition recommends increased communication with patients regarding fracture risk, mortality and morbidity outcomes, and fracture risk reduction. Risk assessment (including fall history) should occur at regular intervals with referral to physical and/or occupational therapy as appropriate. Oral, intravenous, and subcutaneous pharmacotherapies are efficacious and can reduce risk of future fracture. Patients need education, however, about the benefits and risks of both treatment and not receiving treatment. Oral bisphosphonates alendronate and risedronate are first‐line options and are generally well tolerated; otherwise, intravenous zoledronic acid and subcutaneous denosumab can be considered. Anabolic agents are expensive but may be beneficial for selected patients at high risk. Optimal duration of pharmacotherapy is unknown but because the risk for second fractures is highest in the early post‐fracture period, prompt treatment is recommended. Adequate dietary or supplemental vitamin D and calcium intake should be assured. Individuals being treated for osteoporosis should be reevaluated for fracture risk routinely, including via patient education about osteoporosis and fractures and monitoring for adverse treatment effects. Patients should be strongly encouraged to avoid tobacco, consume alcohol in moderation at most, and engage in regular exercise and fall prevention strategies. Finally, referral to endocrinologists or other osteoporosis specialists may be warranted for individuals who experience repeated fracture or bone loss and those with complicating comorbidities (eg, hyperparathyroidism, chronic kidney disease). © 2019 American Society for Bone and Mineral Research.

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Section: Fundamental Recommendations and Rationalesmentioning

confidence: 99%

Secondary Fracture Prevention: Consensus Clinical Recommendations from a Multistakeholder Coalition

Conley

Adib²,

Adler

et al. 2019

Journal of Bone and Mineral Research

171

111

View full text Add to dashboard Cite

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“…Similarly undiagnosed vertebral fractures have been reported in 9.2% (259) patients following retrospective review of routine 3216 chest radiographs. The prevalence of vertebral fracture was 2.4% in women aged 50-59 years and it increased to 8.9% in women aged 60-69 years and to 21.9% in women aged ≥70 years [20].…”

Section: Discussionmentioning

confidence: 92%

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

et al. 2020

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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.

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“…A diagnosis of OP or previous fragility fracture was reported in around one-third of patients by Ong et al Most patients (75% men and 78% women) had five or more co-pathologies and many of them were more dependent with activities of daily living on discharge compared to their pre-admission level [8]. The incidence of new VCF in female and male aged 50 years and over was 10.7/1000 person years and 5.7/1000 person years respectively, and the prevalence increased from 3% in females under 60 years of age to 20% in females aged over 70 years, and from 7.5 to 20% in males over the same age range [9].…”

Section: Epidemiologymentioning

confidence: 88%

“…In spite of the fact that, BMD assay is considered the best predictor of osteoporotic fragility fracture risks, it is always recommended to perform adequate clinical evaluation [12].Jager et al showed that, combined vertebral fracture assessment (VFA) and BMD method detects previously unknown VCF's in nearly one out of each six patients, with significant impact on management[7]. Radiology-Vertebral compression fractures need radiological confirmation (semiquantitative method of Genant by the conventional spine radiography is traditionally used in the evaluation of VCF's), but are often undiagnosed by radiologists, with a misdiagnosis rate up to 50%[9]. Reasons for this inadequacy are; 1-Vertebral compression fractures frequently do not present as a clinically recognizable event.…”

mentioning

confidence: 99%