Journal of General Internal Medicine

, Volume 21, Issue 4, pp 352–356

Incidental vertebral fractures on chest radiographs

Recognition, documentation, and treatment


    • Division of Pharmacoepidemiology and PharmacoeconomicsBrigham and Women’s Hospital
  • John A. Carrino
    • Department of RadiologyBrigham and Women’s Hospital
  • Philipp Lang
    • Department of RadiologyBrigham and Women’s Hospital
  • Daniel H. Solomon
    • Division of Pharmacoepidemiology and PharmacoeconomicsBrigham and Women’s Hospital
    • Division of Rheumatology, Immunology, and Allergy, Department of MedicineBrigham and Women’s Hospital
Original Articles

DOI: 10.1111/j.1525-1497.2006.00395.x

Cite this article as:
Morris, C.A., Carrino, J.A., Lang, P. et al. J Gen Intern Med (2006) 21: 352. doi:10.1111/j.1525-1497.2006.00395.x


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.

Key words

diagnosisosteoporosishealth service researchwomen’s healthhospital medicine

Copyright information

© Society of General Internal Medicine 2006