Abstract
Osteoporotic vertebral fracture is associated with increased morbidity and mortality. As a powerful predictor of future fracture risk, the identification of vertebral fracture helps target individuals who will benefit from anti-fracture therapy. The identification of vertebral fractures is problematic because (1) “normal” radiological appearances in the spine vary greatly both among and within individuals; (2) “normal” vertebrae may exhibit misleading radiological appearances due to radiographic projection error; and (3) “abnormal” appearances due to non-fracture deformities and normal variants are common, but can be difficult to differentiate from true vertebral fracture. Various methods of vertebral fracture definition have been proposed, but there is no agreed gold standard. Quantitative methods of vertebral fracture definition are objective and reproducible, but the major limitation of these methods is their inability to differentiate between vertebral deformity and vertebral fracture. The qualitative visual approach draws on the expertise of the reader, but it is a subjective method with poor interobserver agreement. Semiquantitative assessment of vertebral fracture is a standardized visual method, which is commonly applied in research studies as a surrogate gold standard. This method is more objective and reproducible than a purely qualitative approach, but can be difficult to apply. The established methods focus primarily on the identification of “reduced” or short vertebral height as an indication of vertebral fracture, but this is also a feature of some non-fracture deformities and normal variants. A modified visual approach known as algorithm-based qualitative assessment of vertebral fracture (ABQ) has recently been introduced, and this focuses on radiological evidence of change at the vertebral endplate as the primary indicator of fracture. Preliminary testing of the ABQ method has produced promising results, but the method requires further evaluation. Vertebral imaging by means of dual energy X-ray absorptiometry (DXA) scanner produces images of near-radiographic quality at a fraction of the radiation dose incurred by conventional radiography. There is growing interest in vertebral fracture assessment using this technique as a means of assessing a patient’s fracture risk. Given the increasing availability of new technology and the importance of accurate diagnosis of vertebral fracture, there is an urgent need for better awareness of and training in the definition of vertebral fracture. Methods of vertebral fracture definition should be validated by testing the association with clinical outcomes of vertebral fracture, in particular the prediction of incident fractures.
Similar content being viewed by others
References
Schlaich C, Minne HW, Bruckner T, Wagner G, Gebest HJ, Grunze M, Ziegler R, Leidig-Bruckner G (1998) Reduced pulmonary function in patients with spinal osteoporotic fractures. Osteoporos Int 8:261–267
Scane AC, Francis RM, Sutcliffe AM, Francis MJ, Rawlings DJ, Chapple CL (1999) Case-control study of the pathogenesis and sequelae of symptomatic vertebral fractures in men. Osteoporos Int 9:91–97
Adachi JD, Loannidis G, Berger C, Joseph L, Papaioannou A, Pickard L, Papadimitropoulos EA, Hopman W, Poliquin S, Prior JC, Hanley DA, Olszynski WP, Anastassiades T, Brown JP, Murray T, Jackson SA, Tenenhouse A (2001) The influence of osteoporotic fractures on health-related quality of life in community-dwelling men and women across Canada. Osteoporos Int 12:903–908
Tosteson AN, Gabriel SE, Grove MR, Moncur MM, Kneeland TS, Melton LJ III (2001) Impact of hip and vertebral fractures on quality-adjusted life years. Osteoporos Int 12:042–49
Nevitt MC, Thompson DE, Black DM, Rubin SR, Ensrud K, Yates AJ, Cummings SR (2000) Effect of alendronate on limited-activity days and bed-disability days caused by back pain in postmenopausal women with existing vertebral fractures. Arch Intern Med 160:77–85
Oleksik A, Lips P, Dawson A, Minshall ME, Shen W, Cooper C, Kanis J (2000) Health-related quality of life in postmenopausal women with low BMD with or without prevalent vertebral fractures. J Bone Miner Res 15:1384–1392
Pluijm SM, Tromp AM, Smit JH, Deeg DJ, Lips P (2000) Consequences of vertebral deformities in older men and women. J Bone Miner Res 15:1564–1572
Hall SE, Criddle RA, Comito TL, Prince RL (1999) A case-control study of quality of life and functional impairment in women with long-standing vertebral osteoporotic fracture. Osteoporos Int 9:508–515
Burger H, Van Daele PL, Grashuis K, Hofman A, Grobbee DE, Schutte HE, Birkenhager JC, Pols HA (1997) Vertebral deformities and functional impairment in men and women. J Bone Miner Res 12:152–157
Cook DJ, Guyatt GH, Adachi JD, Clifton J, Griffith LE, Epstein RS, Juniper EF (1993) Quality of life issues in women with vertebral fractures due to osteoporosis. Arthritis Rheum 36:750–756
Leidig-Bruckner G, Minne HW, Schlaich C, Wagner G, Scheidt-Nave C, Bruckner T, Gebest HJ, Ziegler R (1997) Clinical grading of spinal osteoporosis: quality of life components and spinal deformity in women with chronic low back pain and women with vertebral osteoporosis. J Bone Miner Res 12:663–675
Jalava T, Sarna S, Pylkkanen L, Mawer B, Kanis JA, Selby P, Davies M, Adams J, Francis RM, Robinson J, McCloskey E (2003) Association between vertebral fracture and increased mortality in osteoporotic patients. J Bone Miner Res 18:1254–1260
Cooper C, Atkinson EJ, Jacobsen SJ, O’Fallon WM, Melton LJ III (1993) Population-based study of survival after osteoporotic fractures. Am J Epidemiol 137:1001–1005
Kanis JA, Oden A, Johnell O, De Laet C, Jonsson B (2004) Excess mortality after hospitalization for vertebral fracture. Osteoporos Int 15:108–112
Hasserius R, Karlsson MK, Nilsson BE, Redlund-Johnell I, Johnell O (2003) Prevalent vertebral deformities predict increased mortality and increased fracture rate in both men and women: A 10-year population-based study of 598 individuals from the Swedish cohort in the European Vertebral Osteoporosis Study. Osteoporos Int 14:61–68
Kado DM, Duong T, Stone KL, Ensrud KE, Nevitt MC, Greendale GA, Cummings SR (2000) Incident vertebral fractures and mortality in older women: a prospective study. Osteoporos Int 10:89–94
Gehlbach SH, Bigelow C, Heimisdottir M, May S, Walker M, Kirkwood JR (2000) Recognition of vertebral fracture in a clinical setting. Osteoporos Int 11:577–582
Ross PD, Genant HK, Davis JW, Miller PD, Wasnich RD (1993) Predicting vertebral fracture incidence from prevalent fractures and bone density among non-black, osteoporotic women. Osteoporos Int 3:120–126
Ross PD, Davis JW, Epstein RS, Wasnich RD (1991) Pre-existing fractures and bone mass predict vertebral fracture incidence in women. Ann Intern Med 114:919–923
Black DM, Arden NK, Palermo L, Pearson J, Cummings SR (1999) Prevalent vertebral deformities predict hip fractures and new vertebral deformities but not wrist fractures. J Bone Miner Res 14:821–828
Melton LJ III, Atkinson EJ, Cooper C, O’Fallon WM, Riggs BL (1999) Vertebral fractures predict subsequent fractures. Osteoporos Int 10:214–221
Delmas PD, Genant HK, Crans GG, Stock JL, Wong M, Siris E, Adachi JD (2003) Severity of prevalent vertebral fractures and the risk of subsequent vertebral and nonvertebral fractures: results from the MORE trial. Bone 33(4):522–532
Klotzbuecher CM, Ross PD, Landsman PB, Abbott TA III, Berger M (2000) Patients with prior fractures have an increased risk of future fractures: A summary of the literature and statistical synthesis. J Bone Miner Res 15:721–739
Group for the Respect of Ethics and Excellence in Science (1995) Recommendations for the registration of new chemical entities used in the prevention and treatment of osteoporosis. Calcif Tissue Int 57:247–250
Hurxthal LM (1968) Measurement of anterior vertebral compressions and biconcave vertebrae. AJR Am J Roentgenol 103:635–644
Smith-Bindman R, Cummings SR, Steiger P, Genant HK (1991) A comparison of morphometric definitions of vertebral fracture. J Bone Miner Res 6:25–34
Cooper C, Melton LJ III (1992) Vertebral fractures. BMJ 304:1634–1635
Nielsen HAV, Podenphant J, Martens S, Gotfredsen A, Riis BJ (1991) Precision in assessment of osteoporosis from spine radiographs. Eur J Radiol 13:11–14
Jensen GF, McNair P, Boesen J, Hegedus V (1984) Validity in diagnosing osteoporosis. Eur J Radiol 4:1–3
Hedlund LR, Gallagher JC (1988) Vertebral morphometry in diagnosis of spinal fractures. Bone Miner 5:59–67
Harma M, Heliovaara M, Aromaa A, Knet P (1986) Thoracic spine compression fractures in Finland. Clin Orthop 205:188–194
Barnett E, Nordin BEC (1960) The radiological diagnosis of osteoporosis: a new approach. Clin Radiol 11:166–174
Reshef A, Schwartz A, Ben Menachem Y, Menczel J, Guggenheim K (1971) Radiological osteoporosis: correlation with dietary and biochemical findings. J Am Geriatr Soc 19:391–402
Horsman A (1976) Measurements of the skeleton in vivo. In: Nordin BEC (ed) Calcium phosphate and magnesium metabolism. Churchill Livingstone, New York, pp 375–377
Jensen GF, Tougaard L (1981) A simple X-ray method for monitoring progress of osteoporosis. Lancet 2:19–20
Riggs BL, Seeman E, Hodgson SF, Taves DR, O’Fallon WM (1982) Effect of the fluoride/calcium regimen on vertebral fracture occurrence in postmenopausal osteoporosis: Comparison with conventional therapy. N Eng J Med 306:446–450
Kleerekoper M, Parfitt AM, Ellis BI (1984) Measurement of vertebral fracture rates in osteoporosis. In: Christiansen C, Arnaud CD, Nordin BEC, Parfitt AM, Peck WA, Riggs BL (eds) Proceeding of the Copenhagen International Symposium on Osteoporosis. Glostrup Hospital, Copenhagen, pp 103–109
Gallagher JC, Hedlund LR, Stoner S, Meeger C (1988) Vertebral morphometry: normative data. Bone Miner 4:189–196
Ott SM, Kilcoyne RF, Chesnut CH III (1988) Comparisons among methods of measuring bone mass and relationship to severity of vertebral fractures in osteoporosis. J Clin Endocrinol Metab 66:501–507
Minne HW, Leidig G, Wuster C, Siromachkostov L, Baldauf G, Bickel R, Sauer P, Lojen M, Ziegler R (1988) A newly developed spine deformity index (SDI) to quantitate vertebral crush fractures in patients with osteoporosis. Bone Miner 3:335–349
Davies KM, Recker RR, Heaney RP (1989) Normal vertebral dimensions and normal variation in serial measurements of vertebrae. J Bone Miner Res 4:341–349
Melton LJ III, Kan SH, Frye MA, Wahner HW, O’Fallon WM, Riggs BL (1989) Epidemiology of vertebral fractures in women. Am J Epidemiol 129:1001–1011
Ross PD, Yhee YK, He YF, Davis JW, Kamimoto C, Epstein RS, Wasnich RD (1993) A new method for vertebral fracture diagnosis. J Bone Miner Res 8:167–174
Smith-Bindman R, Steiger P, Cummings SR, Genant HK (1991) The index of radiographic area (IRA): a new approach to estimating the severity of vertebral deformity. Bone Miner 15:137–149
Eastell R, Cedel SL, Wahner HW, Riggs BL, Melton LJ III (1991) Classification of vertebral fractures. J Bone Miner Res 6:207–215
McCloskey EV, Spector TD, Eyres KS, Fern ED, O’Rourke N, Vasikaran S, Kanis JA (1993) The assessment of vertebral deformity: a method for use in population studies and clinical trials. Osteoporos Int 3:138–147
Black DM, Palermo L, Nevitt MC, Genant HK, Epstein R, San Valentin R, Cummings SR (1995) Comparison of methods for defining prevalent vertebral deformities: the Study of Osteoporotic Fractures. J Bone Miner Res 10:890–902
Sauer P, Leidig G, Minne HW, Duckeck G, Schwarz W, Siromachkostov L, Ziegler R (1001) Spine deformity index (SDI) versus other objective procedures of vertebral fracture identification in patients with osteoporosis: a comparative study. J Bone Miner Res 6:227–238
Leidig-Bruckner G, Limberg B, Felsenberg D, Bruckner T, Holder S, Kather A, Miksch J, Wuster C, Ziegler R, Scheidt-Nave C (2000) Sex difference in the validity of vertebral deformities as an index of prevalent vertebral osteoporotic fractures: a population survey of older men and women. Osteoporos Int 11:102–119
Grados F, Roux C, De Vernejoul MC, Utard G, Sebert JL, Fardellone P (2001) Comparison of four morphometric definitions and a semiquantitative consensus reading for assessing prevalent vertebral fractures. Osteoporosis Int 12:716–722
Kleerekoper M, Nelson DA (1992) Vertebral fracture or vertebral deformity? Calcif Tissue Int 50:5–6
Ziegler R, Scheidt-Nave C, Leidig-Bruckner G (1996) What is a vertebral fracture? Bone 18:169S–177S
Sone T, Tomomitsu T, Miyake M, Takeda N, Fukunaga M (1997) Age-related changes in vertebral height ratios and vertebral fracture. Osteoporos Int 7:113–118
Antoniou J, Nguyen C, Lander P, Hadjipavlou A (2000) Osteoporosis of the spine: correlation between vertebral deformity and bone mineral density in postmenopausal women. Am J Orthop 29 (12): 956–959
Melton LJ III Atkinson EJ, Khosla S, O’Fallon WM, Riggs BL (1999) Secondary osteoporosis and the risk of vertebral deformities in women. Bone 24:49–55
Nicholson PH, Haddaway MJ, Davie MW, Evans SF (1993) Vertebral deformity, bone mineral density, back pain and height loss in unscreened women over 50 years. Osteoporos Int 3:300–307
Spector TD, McCloskey EV, Doyle DV, Kanis JA (1993) Prevalence of vertebral fracture in women and the relationship with bone density and symptoms: the Chingford Study. J Bone Miner Res 8:817–822
Matthis C, Weber U, O’Neill TW, Raspe H (1998) Health impact associated with vertebral deformities: results from the European Vertebral Osteoporosis Study (EVOS). Osteoporos Int 8:364–372
Ettinger B, Black DM, Nevitt MC, Rundle AC, Cauley JA, Cummings SR, Genant HK (1992) Contribution of vertebral deformities to chronic back pain and disability. J Bone Miner Res 7:449–456
Lyritis GP, Mayasis B, Tsakalakos N, Lambropoulos A, Gazi S, Karachalios T, Tsekoura M, Yiatzides A (1989) The natural history of the osteoporotic vertebral fracture. Clin Rheumatol 8 [Suppl 2]:66–69
Vernon-Roberts B, Pirie GJ (1973) Healing trabecular microfractures in the bodies of lumbar vertebrae. Ann Rheum Dis 32:406–412
Puche RC, Morosano M, Masoni A, Perez Jimeno N, Bertoluzzo SM, Podadera JC, Podadera MA, Bocanera R, Tozzini R (1995) The natural history of kyphosis in postmenopausal women. Bone 17:239–246
Ferrar L, Jiang G, Eastell R (2001) Vertebral wedge angle measured by morphometric X-ray absorptiometry. Osteoporos Int 12:914–921
Ling X, Cummings SR, Mingwei Q, Xihe Z, Xioashu C, Nevitt M, Stone K (2000) Vertebral fractures in Beijing, China: the Beijing Osteoporosis Project. J Bone Miner Res 15:2019–2025
Bianco AC, Malvestiti LF, Gouveia CH, Wehba S, Lewin S, Marone MM (1999) Morphometric dual-energy X-ray absorptiometry of the spine: report of a large series and correlation with axial bone mineral density. J Bone Miner Res 14:1605–1613
O’Neill TW, Varlow J, Felsenberg D, Johnell O, Weber K, Marchant F, Delmas PD, Cooper C, Kanis J, Silman AJ (1994) Variation in vertebral height ratios in population studies. J Bone Miner Res 9:1895–1907
Szulc P, Munoz F, Sornay-Rendu E, Paris E, Souhami E, Zanchetta J, Bagur A, van der Mooren MJ, Young S, Delmas PD (2000) Comparison of morphometric assessment of prevalent vertebral deformities in women using different reference data. Bone 27:841–846
Jackson SA, Tenenhouse A, Robertson L (2000) Vertebral fracture definition from population-based data: preliminary results from the Canadian Multicenter Osteoporosis Study (CaMos). Osteoporos Int 11:680–687
Bagur A, Solis F, Di Gregorio S, Mautalen C (2000) Reference data of vertebral morphometry by X-ray absorptiometry (MXA) in Argentine women. Calcif Tissue Int 66:259–262
O’Neill TW, White J, Eastell R, Silman AJ (1993) The influence of sex on morphometric indices of vertebral deformity. J Orthop Rheum 6:29–32
Cheng XG, Sun Y, Boonen S, Nicholson PH, Brys P, Dequeker J, Felsenberg D (1998) Measurements of vertebral shape by radiographic morphometry: sex differences and relationships with vertebral level and lumbar lordosis. Skeletal Radiol 27:380–384
Ferrar L, Eastell R (1999) Identification of vertebral deformities in men: comparison of morphometric radiography and morphometric X-ray absorptiometry. Osteoporos Int 10:167–174
Ferrar L, Jiang G, Barrington NA, Eastell R (2000) Identification of vertebral deformities in women: comparison of radiological assessment and quantitative morphometry using morphometric radiography and morphometric X-ray absorptiometry. J Bone Miner Res 15:575–585
Rea JA, Steiger P, Blake GM, Potts E, Smith IG, Fogelman I (1998) Morphometric X-ray absorptiometry: reference data for vertebral dimensions. J Bone Miner Res 13:464–474
Chappard C, Kolta S, Fechtenbaum J, Dougados M, Roux C (1998) Clinical evaluation of spine morphometric X-ray absorptiometry. Br J Rheumatol 37:496–501
Melton LJ III, Egan KS, O’Fallon WM, Riggs BL (1998) Influence of fracture criteria on the outcome of a randomized trial of therapy. Osteoporos Int 8:184–191
Nelson DA, Kleerekoper M, Peterson EL (1994) Reversal of vertebral deformities in osteoporosis: measurement error or “rebound”? J Bone Miner Res 9:977–982
Mann T, Oviatt SK, Wilson D, Nelson D, Orwoll ES (1992) Vertebral deformity in men. J Bone Miner Res 7:1259–1265
Hansen SE, Christensen TH, Kryger P (1992) Osteoporotic fractures of the spine in elderly women. Risk factors, inducing factors and course. Ugeskr Laeger 154:563–567
Kanis JA, McCloskey EV (1992) Epidemiology of vertebral osteoporosis. Bone 13 [Suppl 2]:S1–10
Cummings SR, Black DM, Nevitt MC, Browner WS, Cauley JA, Genant HK, Mascioli SR, Scott JC, Seeley DG, Steiger P et al (1990) Appendicular bone density and age predict hip fracture in women. JAMA 263:665–668
Weber K, Lunt M, Gowin W, Lauermann T, Armbrecht G, Wieland E, Leb G, O’Neill T, Felsenberg D, Reeve J (1999) Measurement imprecision in vertebral morphometry of spinal radiographs obtained in the European Prospective Osteoporosis Study: consequences for the identification of prevalent and incident deformities. Br J Radiol 72:957–966
Jergas MD, San Valentin R (1995) Techniques for the assessment of vertebral dimensions in quantitative morphometry. In: Genant HK, Jergas M, van Kuijk C (eds) (1995) Vertebral fracture in osteoporosis. Radiology and Research Education Foundation, California, USA, pp 163–88
Ferrar L, Jiang G, Eastell R (2001) Longitudinal evaluation of morphometric X-ray absorptiometry for the identification of vertebral deformities. Osteoporos Int 12:661–671
Rea JA, Chen MB, Li J, Marsh E, Fan B, Blake GM, Steiger P, Smith IG, Genant HK, Fogelman I (2001) Vertebral morphometry: a comparison of long-term precision of morphometric X-ray absorptiometry and morphometric radiography in normal and osteoporotic subjects. Osteoporos Int 12:158–166
Pak CY, Ho A, Poindexter J, Peterson R, Sakhaee K (1996) Quantitation of incident spinal fractures: comparison of visual detection with quantitative morphometry. Bone 18:349–353
Genant HK, Wu CY, van Kuijk C, Nevitt MC (1993) Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 8:1137–1148
Black DM, Reiss TF, Nevitt MC, Cauley J, Karpf D, Cummings SR (1993) Design of the Fracture Intervention Trial. Osteoporos Int 3 [Suppl 3]:S29–S39
Harris ST, Watts NB, Genant HK, McKeever CD, Hangartner T, Keller M, Chesnut CH III, Brown J, Eriksen EF, Hoseyni MS, Axelrod, DW, Miller PD (1999) Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. JAMA 282:1344–1352
Siris E, Adachi JD, Lu Y, Fuerst T, Crans GG, Wong M, Harper KD, Genant HK (2002) Effects of raloxifene on fracture severity in postmenopausal women with osteoporosis: results from the MORE study. Osteoporos Int 13:907–913
Genant HK, Jergas M (2003) Assessment of prevalent and incident vertebral fractures in osteoporosis research. Osteoporos Int 14 [Suppl 3]:S43–S55
Wu CY, Li J, Jergas M, Genant HK (1995) Comparison of semiquantitative and quantitative techniques for the assessment of prevalent and incident vertebral fractures. Osteoporos Int 5:354–370
Szulc P, Munoz F, Marchand F, Delmas PD (2001) Semiquantitative evaluation of prevalent vertebral deformities in men and their relationship with osteoporosis: the MINOS study. Osteoporos Int 12 (4):302–310
Jiang G, Eastell R, Barrington NA, Ferrar L (2004) Comparison of methods for the visual identification of prevalent vertebral fracture in osteoporosis. Osteoporos Int Nov 15:887–896
Abdel-Hamid Osman A, Bassiouni H, Koutri R, Nijs J, Geusens P, Dequeker J (1994) Aging of the thoracic spine: distinction between wedging in osteoarthritis and fracture in osteoporosis: a cross-sectional and longitudinal study. Bone 15:437–442
Ismail AA, Cooper C, Felsenberg D, Varlow J, Kanis JA, Silman AJ, O’Neill TW (1999) Number and type of vertebral deformities: epidemiological characteristics and relation to back pain and height loss. Osteoporos Int 9:206–213
Jones G, White C, Nguyen T, Sambrook PN, Kelly PJ, Eisman JA (1996) Prevalent vertebral deformities: relationship to bone mineral density and spinal osteophytosis in elderly men and women. Osteoporos Int 6:233–239
Ito M, Hayashi K, Yamada M, Nakamura T (1994) Vertebral measurements for assessment of osteoporosis. Br J Radiol 67:759–763
Schmorl G, Junghans H (1971) The human spine in health and disease. Grune and Stratton, New York
Quek ST, Peh WC (2002) Radiology of osteoporosis. Semin Musculoskelet Radiol 6:197–206
Baur A, Dietrich O, Reiser M (2003) Diffusion-weighted imaging of bone marrow: current status. Eur Radiol 13:1699–1708
Hain SF, Fogelman I (2002) Nuclear medicine studies in metabolic bone disease. Semin Musculoskelet Radiol 6:323–329
Guermazi A, Mohr A, Grigorian M, Taouli B, Genant HK (2002) Identification of vertebral fracture in osteoporosis. Semin Musculoskelet Radiol 6:241–252
National Osteoporosis Foundation Working Group on Vertebral Fractures (1995) Report assessing vertebral fracture. J Bone Miner Res 10:518–523
Lunt M, Gowin W, Johnell, Armbrecht G, Felsenberg D (2001) A statistical method to minimize magnification errors in serial vertebral radiographs. Osteoporos Int 12:909–913
Jiang G, Barrington NA, Eastell R (2000) Identification of incident vertebral fractures using a new quantitative approach. J Bone Miner Res 15 [Suppl 1]:1123
Ross PD, Huang C, Karpf D, Lydick E, Coel M, Hirsch L, Wasnich RD (1996) Blinded reading of radiographs increases the frequency of errors in vertebral fracture detection. J Bone Miner Res 11:1793–1800
Reeve J, Lunt M, Felsenberg D, Silman AJ, Scheidt-Nave C, Poor G, Gennari C, Weber K, Lorenc R, Masaryk P, Cannata JB, Dequeker J, Reid DM, Pols HA, Benevolenskaya LI, Stepan JJ, Miazgowski T, Bhalla A, Bruges Armas J, Eastell R, Lopes-Vaz A, Lyritis G, Jajic I, Woolf AD, Banzer D, Reisinger W, Todd CJ, Felsch B, Havelka S, Hoszowski K, Janott J, Johnell O, Raspe HH, Yershova OB, Kanis JA, Armbrecht G, Finn JD, Gowin W, O’Neill TW (2003) Determinants of the size of incident vertebral deformities in European men and women in the sixth to ninth decades of age: the European Prospective Osteoporosis Study (EPOS). J Bone Miner Res 18:166–173
Kleerekoper M, Peterson EL, Nelson DA, Phillips E, Schork MA, Tilley BC, Parfitt AM (1991) A randomized trial of sodium fluoride as a treatment for postmenopausal osteoporosis. Osteoporos Int 1:155–161
Genant HK, Jergas M, van Kuijk C (eds) (1995) Vertebral fracture in osteoporosis. Radiology and Research Education Foundation, California, USA
International Osteoporosis Foundation and European Society of Musculoskeletal Radiology (2003) Vertebral Fracture Initiative 2003 (compact disc). http://www.osteofound.org
International Osteoporosis Foundation and European Society of Musculoskeletal Radiology (2003) Vertebral fracture initiative resource document
Smyth PP, Taylor CJ, Adams JE (1999) Vertebral shape: automatic measurement with active shape models. Radiology 211:571–578
Rea JA, Chen MB, Li J, Blake GM, Steiger P, Genant HK, Fogelman I (2000) Morphometric X-ray absorptiometry and morphometric radiography of the spine: a comparison of prevalent vertebral deformity identification. J Bone Miner Res 15:564–574
Steiger P, Cummings SR, Genant HK, Weiss H (1994) Morphometric X-ray absorptiometry of the spine: correlation in vivo with morphometric radiography. Osteoporos Int 4:238–244
Ferrar L, Jiang G, Eastell R, Peel NF (2003) Visual identification of vertebral fractures in osteoporosis using morphometric X-ray absorptiometry. J Bone Miner Res 18:933–938
Greenspan SL, von Stetten E, Emond SK, Jones L, Parker RA (2001) Instant vertebral assessment: a noninvasive dual X-ray absorptiometry technique to avoid misclassification and clinical mismanagement of osteoporosis. J Clin Densitom 4:373–380
Rea JA, Li J, Blake GM, Steiger P, Genant HK, Fogelman I (2000) Visual assessment of vertebral deformity by X-ray absorptiometry: a highly predictive method to exclude vertebral deformity. Osteoporos Int 11:660–668
Vokes TJ, Dixon LB, Favus MJ (2003) Clinical utility of dual-energy vertebral assessment (DVA). Osteoporos Int. 14(11):871–888
Schousboe JT, DeBold CR, Bowles C, Glickstein S, Rubino RK (2002) Prevalence of vertebral compression fracture deformity by X-ray absorptiometry of lateral thoracic and lumbar spines in a population referred for bone densitometry. J Clin Densitom 5(3):239–246
Blake GM, Rea JA, Fogelman I (1997) Vertebral morphometry studies using dual-energy X-ray absorptiometry. Semin Nucl Med 27 (3):276–290
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ferrar, L., Jiang, G., Adams, J. et al. Identification of vertebral fractures: An update. Osteoporos Int 16, 717–728 (2005). https://doi.org/10.1007/s00198-005-1880-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00198-005-1880-x