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Open Access 25-04-2024 | Osteoporosis | Review Article

Radiological diagnosis of prevalent osteoporotic vertebral fracture on radiographs: an interim consensus from a group of experts of the ESSR osteoporosis and metabolism subcommittee

Authors: Yì Xiáng J. Wáng, Daniele Diacinti, Maria Pilar Aparisi Gómez, Fernando Ruiz Santiago, Fabio Becce, Alberto Stefano Tagliafico, Mahesh Prakash, Amanda Isaac, Danoob Dalili, James F. Griffith, Giuseppe Guglielmi, Alberto Bazzocchi

Published in: Skeletal Radiology

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Abstract

When a low-energy trauma induces an acute vertebral fracture (VF) with clinical symptoms, a definitive diagnosis of osteoporotic vertebral fracture (OVF) can be made. Beyond that, a “gold” radiographic standard to distinguish osteoporotic from non-osteoporotic VFs does not exist. Fracture-shaped vertebral deformity (FSVD) is defined as a deformity radiographically indistinguishable from vertebral fracture according to the best of the reading radiologist’s knowledge. FSVD is not uncommon among young populations with normal bone strength. FSVD among an older population is called osteoporotic-like vertebral fracture (OLVF) when the FSVD is likely to be associated with compromised bone strength. In more severe grade deformities or when a vertebra is collapsed, OVF diagnosis can be made with a relatively high degree of certainty by experienced readers. In “milder” cases, OVF is often diagnosed based on a high probability rather than an absolute diagnosis. After excluding known mimickers, singular vertebral wedging in older women is statistically most likely an OLVF. For older women, three non-adjacent minimal grade OLVF (< 20% height loss), one minimal grade OLVF and one mild OLVF (20–25% height loss), or one OLVF with ≥ 25% height loss, meet the diagnosis of osteoporosis. For older men, a single OLVF with < 40% height loss may be insufficient to suggest the subject is osteoporotic. Common OLVF differential diagnoses include X-ray projection artifacts and scoliosis, acquired and developmental short vertebrae, osteoarthritic wedging, oncological deformities, deformity due to high-energy trauma VF, lateral hyperosteogeny of a vertebral body, Cupid’s bow, and expansive endplate, among others.
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Metadata
Title
Radiological diagnosis of prevalent osteoporotic vertebral fracture on radiographs: an interim consensus from a group of experts of the ESSR osteoporosis and metabolism subcommittee
Authors
Yì Xiáng J. Wáng
Daniele Diacinti
Maria Pilar Aparisi Gómez
Fernando Ruiz Santiago
Fabio Becce
Alberto Stefano Tagliafico
Mahesh Prakash
Amanda Isaac
Danoob Dalili
James F. Griffith
Giuseppe Guglielmi
Alberto Bazzocchi
Publication date
25-04-2024
Publisher
Springer Berlin Heidelberg
Published in
Skeletal Radiology
Print ISSN: 0364-2348
Electronic ISSN: 1432-2161
DOI
https://doi.org/10.1007/s00256-024-04678-4