Osteoporosis International

, Volume 16, Issue 12, pp 1823–1826 | Cite as

Reporting of vertebral fractures on spine X-rays

  • J. Fechtenbaum
  • C. Cropet
  • S. Kolta
  • B. Verdoncq
  • P. Orcel
  • C. Roux
Original Article

Abstract

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.

Keywords

Diagnosis of osteoporosis Osteoporosis Vertebral fracture 

References

  1. 1.
    Eastell R, Cedel SL, Wahner HW, Riggs BL, Melton LJ 3rd (1991) Classification of vertebral fractures. J Bone Miner Res 6:207–215Google Scholar
  2. 2.
    O’Neill TW, Felsenberg D, Varlow J, Cooper C, Kanis JA, Silman AJ (1996) The prevalence of vertebral deformity in European men and women: the European Vertebral Osteoporosis Study. J Bone Miner Res 11:1010–1018Google Scholar
  3. 3.
    Klotzbuecher CM, Ross PD, Landsman PB, Abbott TA 3rd, 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 15:721–739Google Scholar
  4. 4.
    Kotowicz MA, Melton LJ, Cooper C, Atkinson EJ, O’Fallon WM, Riggs BL (1994) Risk of hip fracture in women with vertebral fracture. J Bone Miner Res 9:599–605Google Scholar
  5. 5.
    Nevitt MC, Ettinger B, Black DM, Stone K, Jamal SA, Ensrud K, Segal M, Genant HK, Cummings SR (1998) The association of radiographically detected vertebral fractures with back pain and function: a prospective study. Ann Intern Med 128:793–800Google Scholar
  6. 6.
    Kanis JA, Minne HW, Meunier PJ, Ziegler R, Allender E (1992) Quality of life and vertebral osteoporosis. Osteoporos Int 2:161–163Google Scholar
  7. 7.
    Oleksik A, Lips P, Dawson A, Minshall ME, Shen W, Cooper C, Kanis J (2000) Health related quality of life in post menopausal women with low BMD with or without prevalent vertebral fractures. J Bone Miner Res 15:1384–1392Google Scholar
  8. 8.
    Cockerill W, Lunt M, Silman AJ, Cooper C, Lips P, Bhalla AK et al (2004) Health-related quality of life and radiographic vertebral fracture. Osteoporos Int 15:113–119Google Scholar
  9. 9.
    Huang C, Ross PD, Washnich RD (1996). Vertebral fracture and other predictors of physical impairment and health care utilization. Arch Intern Med 156:2469–2475Google Scholar
  10. 10.
    Ensrud KE, Thompson DE, Cauley JA, Nevitt MC, Kado DM, Hochberg MC, Santora AC 2nd, Black DM (2000). Prevalent vertebral deformities predict mortality and hopsitalization in older women with low bone mass. J Am Geriatr Soc 48:241–249Google Scholar
  11. 11.
    Cauley JA, Thompson DE, Ensrud KC et al (2000) Risk of mortality following clinical fractures. Osteoporos Int 11:556–561Google Scholar
  12. 12.
    Ross PD, Genant HK, Davis JW, Miller PD, Wasnich RD (1993) Predicting vertebral fractures incidence from prevalent fractures and bone density among non-black, osteoporotic women. Osteoporos Int 3:120–126Google Scholar
  13. 13.
    Gehlbach SH, Bigelow C, Heimisdottir M, May S, Walker M, Kirkwood JR (2000) Recognition of vertebral fracture in a clinical setting. Osteoporos Int 11:577–582Google Scholar
  14. 14.
    Kim N (2004) Underreporting of vertebral fractures on routine chest radiography. Am J Roentgen 182:297–300Google Scholar
  15. 15.
    Genant HK, Wu CY, van Kuijk C, Nevitt MC (1993) Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 8:1137–1148Google Scholar
  16. 16.
    Lindsay R, Silverman SL, Cooper C, Hanley DA, Barton I, Broy SB et al (2001) Risk of new vertebral fracture in the year following a fracture. JAMA 285:320–323Google Scholar
  17. 17.
    Kado DM, Browner WS, Palermo L et al (1999) Vertebral fractures and mortality in older women. A prospective study. Arch Intern Med 159:1215–1220Google Scholar
  18. 18.
    Delmas PD, Genant HK, Crans GG, Stock JL, Wong M, Siris E et al (2003) Severity of prevalent vertebral fractures and the risk of subsequent vertebral and non vertebral fractures: results from the MORE trial. Bone 33:522–532Google Scholar
  19. 19.
    Torgeson DJ, Sykes D, Puffer S, Brown P, Cooper C (2004) Pharmaceutical treatment of symptomatic vertebral fractures in primary care. Ann Rheum Dis 63:853–856Google Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2005

Authors and Affiliations

  • J. Fechtenbaum
    • 1
  • C. Cropet
    • 2
  • S. Kolta
    • 1
  • B. Verdoncq
    • 3
  • P. Orcel
    • 4
  • C. Roux
    • 1
  1. 1.Department of RheumatologyParis 5 University AP-HP Cochin HospitalParisFrance
  2. 2.MAPILyonFrance
  3. 3.AventisParisFrance
  4. 4.Rheumatology DepartmentAP-HP Lariboisière Hospital, Paris 7 UniversityParisFrance

Personalised recommendations