Original Article

Osteoporosis International

, Volume 16, Issue 12, pp 1823-1826

First online:

Reporting of vertebral fractures on spine X-rays

  • J. FechtenbaumAffiliated withDepartment of Rheumatology, Paris 5 University AP-HP Cochin Hospital
  • , C. CropetAffiliated withMAPI
  • , S. KoltaAffiliated withDepartment of Rheumatology, Paris 5 University AP-HP Cochin Hospital
  • , B. VerdoncqAffiliated withAventis
  • , P. OrcelAffiliated withRheumatology Department, AP-HP Lariboisière Hospital, Paris 7 University
  • , C. RouxAffiliated withDepartment of Rheumatology, Paris 5 University AP-HP Cochin Hospital Email author 

Rent the article at a discount

Rent now

* Final gross prices may vary according to local VAT.

Get Access


Vertebral fractures are the hallmark of osteoporosis, responsible for increased morbidity and mortality in post-menopausal women. However, two-thirds of vertebral fractures do not come to clinical attention. The aim of this study was to compare the identification of vertebral fractures on spine X-rays among rheumatologists. Study subjects were women aged 60–80 years having potential signs of vertebral fracture and visiting a rheumatologist. X-rays were performed according to standardized procedures. In 629 patients (among 824 included) at least one vertebral fracture was diagnosed, and the X-rays were then sent to a central facility where a semi-quantitative assessment of vertebral fracture was performed by a single rheumatologist trained for this evaluation. According to the vertebral level, kappa scores were between 0.20 to 0.77, i.e., below 0.6 from T4 to T7, and between 0.6 and 0.77 from T8 to L4. The false-negative fractures rate was 25.8% (and 15.7% of them were related to a numbering discrepancy). The rate of false positive fractures was 6.3%. At the patient level 6.8% had actually no fracture. This study shows that 25% of overall vertebral fractures are not diagnosed among patients considered as having at least one fracture. As a consequence, patients who require treatment to reduce fracture risk are not being properly identified.


Diagnosis of osteoporosis Osteoporosis Vertebral fracture