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Incidental vertebral fractures on chest radiographs

Recognition, documentation, and treatment

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Abstract

BACKGROUND: Recognition of incidental vertebral fractures may be an important opportunity for identifying and treating osteoporosis.

OBJECTIVE: To assess osteoporosis documentation rates in patients with vertebral fractures, and to define patient and hospitalization characteristics associated with osteoporosis management.

DESIGN: Hospital and outpatient records were abstracted for patients with vertebral fractures on inpatient radiograph reports. The primary outcome of interest was discharge summary fracture documentation. Covariates associated with fracture documentation and treatment were examined with multivariate regression models. Secondary outcomes included osteoporosis documentation and management 6 months following discharge.

PATIENTS: Women ≥ 50 years hospitalized at an academic medical center.

RESULTS: Among 10.291 women with chest radiographs, 142 (1.4%) had vertebral fractures reported. Among patients with a reported fracture, 58 (41%) had their fracture noted in the findings section but not in the final impression. Only 23 (16%) discharge summaries documented a vertebral fracture. Factors associated with documentation of the fracture in the discharge summary included notation of the fracture in the impression section (odds ratio [OR] 3.7, 95% confidence interval [CI] 1.0 to 13.1), tobacco use (OR 3.7; 95% CI 1.1 to 12.2), discharge from a medical service (OR 7.6; 95% CI 0.9 to 66.2) and glucocorticoid use (OR 3.7; 95% CI 0.8 to 17.0). Only 36% of patients were using any osteoporosis medications at discharge. Fracture notation in the impression section was associated with fracture documentation in subsequent outpatient notes (OR 3.6, 95% CI 0.9 to 13.8). Discharge summary fracture documentation was associated with an increased likelihood of starting an osteoporosis medication by 6 months (OR 2.8; 95% CI 0.8 to 9.2).

CONCLUSIONS: Incidental vertebral fractures from inpatient chest radiographs may represent a missed opportunity for osteoporosis management.

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Authors and Affiliations

  1. Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital, Boston, MA, USA

    Charles A Morris MD, MPH & Daniel H. Solomon MD, MPH

  2. Department of Radiology, Brigham and Women’s Hospital, Boston, MA, USA

    John A. Carrino MD, MPH & Philipp Lang MD, MBA

  3. Division of Rheumatology, Immunology, and Allergy, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA

    Daniel H. Solomon MD, MPH

Authors
  1. Charles A Morris MD, MPH
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  2. John A. Carrino MD, MPH
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  3. Philipp Lang MD, MBA
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  4. Daniel H. Solomon MD, MPH
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Corresponding author

Correspondence to Charles A Morris MD, MPH.

Additional information

The authors have no conflicts of interest to report.

This work was supported in part by Arthritis Foundation (Atlanta, GA), NIH DA 15507, NIH AR48264, NIH AR48616 (Bethesda, MD)

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Morris, C.A., Carrino, J.A., Lang, P. et al. Incidental vertebral fractures on chest radiographs. J Gen Intern Med 21, 352–356 (2006). https://doi.org/10.1111/j.1525-1497.2006.00395.x

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  • DOI: https://doi.org/10.1111/j.1525-1497.2006.00395.x

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