Original Article

Osteoporosis International

, Volume 20, Issue 8, pp 1347-1352

First online:

Spine radiographs to improve the identification of women at high risk for fractures

  • J. C. NetelenbosAffiliated withDepartment of Endocrinology, VU University Medical Center Email author 
  • , W. F. LemsAffiliated withDepartment of Rheumatology, VU University Medical Center
  • , P. P. GeusensAffiliated withDepartment of Internal Medicine/Rheumatology, University HospitalUniversity Hasselt
  • , H. J. VerhaarAffiliated withMobility Laboratory, Department of Geriatric Medicine, University Medical Center
  • , A. J. M. BoermansAffiliated with
  • , M. M. BoomsmaAffiliated withMedical department, GlaxoSmithKline
  • , P. G. H. MulderAffiliated withErasmus University Medical Center
  • , S. E. PapapoulosAffiliated withDepartment of Endocrinology and Metabolic Diseases, University Medical Center

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In women older than 60 years with clinical risk factors for osteoporosis but without osteoporosis based on bone mineral density (T-score ≥ −2.5), a systematic survey with X-rays of the spine identified previously unknown vertebral deformities in 21% of women.


This study determines the prevalence of vertebral deformities in elderly women with clinical risk factors for osteoporosis but with BMD values above the threshold for osteoporosis (T-score ≥ −2.5).


Bisphosphonate naïve women older than 60 years attending 35 general practices in the Netherlands with ≥2 clinical risk factors for osteoporosis were invited for BMD measurement (DXA). In women with T-score ≥ −2.5 at both spine and the hips, lateral radiographs of the thoracic and lumbar spine were performed.


Of 631 women with a DXA measurement, 187 (30%) had osteoporosis (T-score < −2.5 at the spine or the hip). Of the remaining 444 women with T-score ≥ −2.5 at both spine and hip, 387 had additional spine radiographs, of whom 80 (21%) had at least one vertebral deformity.


In elderly women with clinical risk factors for osteoporosis but BMD T-score ≥ −2.5, addition of spine radiographs identified vertebral deformities in 21% (95% CI: 17–25). Since these women are at risk of future fractures, antiosteoporotic treatment should be considered.


Bone mineral density Case finding Dual-energy X-ray absorptiometry Spine radiographs