Identification of vertebral fractures: a moderately severe solution?

Excerpt

Vertebral fractures, arguably the most common osteoporotic fracture, have long featured at the heart of the diagnosis and treatment of osteoporosis, with many authorities recommending the presence of a spine fracture as an eligibility criterion for intervention or reimbursement [1‐3]. The visual and quantitative methods involved in their characterization have achieved much attention over the last 25 years [4‐8]. Despite this, and in the face of initiatives by organizations such as the International Osteoporosis Foundation to improve their detection and reporting [9], they frequently remain undiagnosed, with only about one third or even less coming to clinical attention [10]. However, both radiographically detected (incorrectly termed asymptomatic fractures) and clinical vertebral fractures are associated with significant future fracture risk [11], morbidity [12‐14] and mortality [15, 16]. Vertebral fracture assessment (VFA), using lateral spine images acquired with a bone densitometer, is increasingly being advocated for clinical use. It has the advantage of being performed alongside DXA measurement of BMD, thus offering greater convenience for the patient and a substantially lower radiation dose than lateral radiographs [17]. VFA classification of vertebra as normal or fractured shows good concordance with lateral radiograph diagnosis [18‐22]. This technique therefore facilitates improved detection of vertebral fracture. A recent article by Cosman and colleagues in Osteoporosis International reminds us of some important issues that are at least partially independent of the imaging technique used. …