Diagnosis of Osteoporotic Vertebral Fractures: Importance of Recognition and Description by Radiologists

Leon Lenchik; Lee F. Rogers; Pierre D. Delmas; Harry K. Genant

Disclosures

Am J Roentgenol. 2004;183(4) 

In This Article

Frequency of Vertebral Fractures

Osteoporosis is a major public health concern. Recent evidence from clinical and epidemiologic trials on osteoporosis has increased the urgency for accurate diagnosis of vertebral fractures. Despite the fact that vertebral fractures are very common[1–8] and are associated with decreased quality of life,[9–16] they are frequently undetected by clinicians[17,18] and underdiagnosed by radiologists.[19,20] We review the clinical consequences of vertebral fractures and explore the reasons why these fractures often evade diagnosis. More important, we urge radiologists to play a more active role in the diagnosis of vertebral fractures. Because many of the clinical consequences of vertebral fractures are preventable with prompt pharmacologic intervention, there is increasing rationale for accurate and unambiguous diagnosis of these fractures by radiologists. With an unambiguous approach to reporting of vertebral fractures, radiologists can make a significant contribution to the appropriate care of patients with osteoporosis.

According to the National Osteoporosis Foundation, 30 million American women and 14 million men are affected by osteopenia or osteoporosis.[21] All are at an increased risk for fracture, and some have already experienced fracture.[22,23] In the United Sates, the lifetime risk of osteoporotic fracture is 40% in white women and 13% in white men.[7,8] Patients with osteoporosis commonly fracture their vertebrae, proximal femur, distal radius, or proximal humerus; the most common site is the vertebral body.[6,8] With approximately 700,000 cases each year in the United States, vertebral fractures account for nearly half of all osteoporotic fractures and are at least twice as common as hip fractures.[6]

As with most other osteoporotic fractures, the incidence of vertebral fractures increases with age. In the United States, the incidence rate for symptomatic vertebral fractures in white women under 45 years old is 0.2 per 1,000 person-years compared with 1.2 per 1,000 person-years after 85 years old.[24] Because many vertebral fractures are asymptomatic, these rates grossly underestimate the scope of the problem. More important, vertebral fractures generally occur earlier in life than hip fractures. In a large cross-sectional study in Europe, on the basis of standardized radiologic evaluation, the prevalence of vertebral fractures in men and women age 50 and older varied from 10% to 24%.[1] In both sexes, the prevalence of vertebral fractures increases dramatically with age.[1,2] In one study,[2] the prevalence in women increased from 5% to 50% between 50 and 85 years old. The epidemiology of vertebral fracture in nonwhites has not been thoroughly studied, but it appears that Hispanic and African American women have lower fracture rates than whites.[25,26] Yet, the impact of vertebral fractures is best measured, not on the basis of their frequency, but rather on their effect on the patient's quality of life.

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