Skip to main content

Advertisement

Log in

Radiologic assessment of osteoporotic vertebral fractures: diagnostic and prognostic implications

  • Musculoskeletal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

As populations age osteoporosis becomes an increasingly important public health issue. Among osteoporotic fractures vertebral fractures are of particular relevance: they are the most common fractures, frequently are asymptomatic but have an important influence on prognosis and morbidity in the osteoporotic patient. Previous studies have suggested that these fractures are frequently not diagnosed and that radiologists miss a high percentage of osteoporotic, vertebral fractures present on lateral chest radiographs. The aims of this review are (1) to emphasize the important role that radiologists play in the accurate and clear reporting of vertebral fractures, (2) to provide guidance in assessing these fractures in radiographs, MRI and computed tomography imaging of the vertebral spine and (3) to sensitize the radiologist in diagnosing fractures in chest radiographs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13
Fig. 14

Similar content being viewed by others

References

  1. Ensrud K, Thompson D, Cauley J, Nevitt M, Kado D, Hochberg M, Santora An, Black D (2000) Prevalent vertebral deformities predict mortality and hospitalization in older women with low bone mass. Fracture Intervention Trial Research Group. J Am Geriatr Soc 48(3):241–249

    Google Scholar 

  2. DeSantis A, Buchman A (2002) Current and emerging therapies in osteoporosis. Expert Opin Pharmacother 3:835–843

    Google Scholar 

  3. Kobayashi K, Shimoyama K, Nakamura K, Murata K (2005) Percutaneous vertebroplasty immediately relieves pain of osteoporotic vertebral compression fractures and prevents prolonged immobilization of patients. Eur Radiol 15:360–367

    Google Scholar 

  4. Theodorou DJ, Theodorou SJ, Sartoris DJ (2002) Treatment of osteoporosis: current status and recent advances. Compr Ther 28:109–122

    Google Scholar 

  5. Gabriel SE, Tosteson AN, Leibson CL, Crowson CS, Pond GR, Hammond CS, Melton LJ III (2002) Direct medical costs attributable to osteoporotic fractures. Osteoporos Int 13:323–330

    Google Scholar 

  6. (2003) Prevention and management of osteoporosis. World Health Organ Tech Rep Ser 921:1–164 (back cover)

  7. Delmas PD, Watts N, Eastell R (2001) Underdiagnosis of vertebral fractures is a world wide problem. J Bone Miner Res 16(suppl):S139

    Google Scholar 

  8. Gehlbach S, Bigelow C, Heimisdottir M, May S, Walker M, Kirkwood J (2000) Recognition of vertebral fracture in a clinical setting. Osteoporos Int 11:577–582

    Google Scholar 

  9. Kim N, Rowe BH, Raymond G, Jen H, Colman I, Jackson SA, Siminoski KG, Chahal AM, Folk D, Majumdar SR (2004) Underreporting of vertebral fractures on routine chest radiography. Am J Roentgenol 182:297–300

    Google Scholar 

  10. Mui LW, Haramati LB, Alterman DD, Haramati N, Zelefsky MN, Hamerman D (2003) Evaluation of vertebral fractures on lateral chest radiographs of inner-city postmenopausal women. Calcif Tissue Int 73:550–554

    Google Scholar 

  11. Mueller D, Isbary M, Boehm H, Bauer J, Rummeny E, Link T (2004) Recognition of osteoporosis-related vertebral fractures on chest radiographs in postmenopausal women. In: RSNA. Chicago, p 305

  12. Lindsay R, Silverman S, Cooper C et al (2001) Risk of new vertebral fracture in the year following a fracture. JAMA 285:320–323

    Google Scholar 

  13. Aloia JF, Vaswani A, Yeh JK, Flaster E (1996) Risk for osteoporosis in black women. Calcif Tissue Int 59:415–423

    Google Scholar 

  14. Bauer RL, Deyo RA (1987) Low risk of vertebral fracture in Mexican American women. Arch Intern Med 147:1437–1439

    Google Scholar 

  15. Davies KM, Stegman MR, Heaney RP, Recker RR (1996) Prevalence and severity of vertebral fracture: the Saunders County Bone Quality Study. Osteoporos Int 6:160–165

    Google Scholar 

  16. Johansson C, Mellstrom D, Rosengren K, Rundgren A (1993) Prevalence of vertebral fractures in 85-year-olds. Radiographic examination of 462 subjects. Acta Orthop Scand 64:25–27

    Google Scholar 

  17. 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 128:793–800

    Google Scholar 

  18. Melton L, Atkinson E, Cooper C, O’Fallon W, Riggs B (1999) Vertebral fractures predict subsequent fractures. Osteoporos Int 10:214–221

    Google Scholar 

  19. O’Neill TW, Cockerill W, Matthis C et al (2004) Back pain, disability, and radiographic vertebral fracture in European women: a prospective study. Osteoporos Int 15:760–765

    Google Scholar 

  20. Cockerill W, Lunt M, Silman AJ et al (2004) Health-related quality of life and radiographic vertebral fracture. Osteoporos Int 15:113–119

    Google Scholar 

  21. Kado DM, Duong T, Stone KL, Ensrud KE, Nevitt MC, Greendale GA, Cummings SR (2003) Incident vertebral fractures and mortality in older women: a prospective study. Osteoporos Int 14:589–594

    Google Scholar 

  22. Lunt M, O’Neill TW, Felsenberg D, Reeve J, Kanis JA, Cooper C, Silman AJ (2003) Characteristics of a prevalent vertebral deformity predict subsequent vertebral fracture: results from the European Prospective Osteoporosis Study (EPOS). Bone 33:505–513

    Google Scholar 

  23. Ismail AA, Cockerill W, Cooper C et al (2001) Prevalent vertebral deformity predicts incident hip though not distal forearm fracture: results from the European Prospective Osteoporosis Study. Osteoporos Int 12:85–90

    Google Scholar 

  24. Lenchik L, Rogers LF, Delmas PD, Genant HK (2004) Diagnosis of osteoporotic vertebral fractures: importance of recognition and description by radiologists. Am J Roentgenol 183:949–958

    Google Scholar 

  25. WHO (1994) Technical Report: assessment of fracture risk and its application to screening for postmenopausal osteoporosis: a report of a WHO study group. In: World Health Organization. Geneva, Switzerland

    Google Scholar 

  26. Black DM, Palermo L, Nevitt MC, Genant HK, Epstein R, San Valentin R, Cummings SR (1995) Comparison of methods for defining prevalent vertebral deformities: the study of osteoporotic fractures. J Bone Miner Res 10:890–902

    Google Scholar 

  27. McCloskey EV, Spector TD, Eyres KS, Fern ED, O’Rourke N, Vasikaran S, Kanis JA (1993) The assessment of vertebral deformity: a method for use in population studies and clinical trials. Osteoporos Int 3:138–147

    Google Scholar 

  28. Eastell R, Cedel SL, Wahner HW, Riggs BL, Melton LJ III (1991) Classification of vertebral fractures. J Bone Miner Res 6:207–215

    Google Scholar 

  29. Smith-Bindman R, Steiger P, Cummings SR, Genant HK (1991) The index of radiographic area (IRA): a new approach to estimating the severity of vertebral deformity. Bone Miner 15:137–149

    Google Scholar 

  30. Jiang G, Eastell R, Barrington NA, Ferrar L (2004) Comparison of methods for the visual identification of prevalent vertebral fracture in osteoporosis. Osteoporos Int 15:887–896

    Google Scholar 

  31. Hurxthal LM (1968) Measurement of anterior vertebral compressions and biconcave vertebrae. Am J Roentgenol Radium Ther Nucl Med 103:635–644

    Google Scholar 

  32. Lunt M, Ismail AA, Felsenberg D, Cooper C, Kanis JA, Reeve J, Silman AJ, O’Neill TW (2002) Defining incident vertebral deformities in population studies: a comparison of morphometric criteria. Osteoporos Int 13:809–815

    Google Scholar 

  33. Genant HK, Wu CY, van Kuijk C, Nevitt MC (1993) Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 8:1137–1148

    Google Scholar 

  34. Storm T, Thamsborg G, Steiniche T, Genant HK, Sorensen OH (1990) Effect of intermittent cyclical etidronate therapy on bone mass and fracture rate in women with postmenopausal osteoporosis. N Engl J Med 322:1265–1271

    Google Scholar 

  35. Ettinger B, Block JE, Smith R, Cummings SR, Harris ST, Genant HK (1988) An examination of the association between vertebral deformities, physical disabilities and psychosocial problems. Maturitas 10:283–296

    Google Scholar 

  36. Wu CY, Li J, Jergas M, Genant HK (1995) Comparison of semiquantitative and quantitative techniques for the assessment of prevalent and incident vertebral fractures. Osteoporos Int 5:354–370

    Google Scholar 

  37. Leidig-Bruckner G, Genant HK, Minne HW, Storm T, Thamsborg G, Bruckner T, Sauer P, Schilling T, Soerensen OH, Ziegler R (1994) Comparison of a semiquantitative and a quantitative method for assessing vertebral fractures in osteoporosis. Bone 15:437–442

    Google Scholar 

  38. Meunier P, Bressot C, Vignon E, Edouard C, Alexandre C, Coupron P, Laurent J (1978) Radiological and histological evolution of post-menopausal osteoporosis treated with sodium fluoride–vitamin D–calcium. Preliminary results. Hans Huber Publishers, Bern

    Google Scholar 

  39. Meunier P, Delmas P, Eastell R, McClung M, Papapoulos S, Rizzoli R, Seeman E, Wasnich R (1999) Diagnosis and management of osteoporosis in postmenopausal women: clinical guidelines. International Committee for Osteoporosis Clinical Guidelines. 21:1025–1044

    Google Scholar 

  40. Minne H, Leidig G, Wüster C, Siromachkostov L, Baldauf G, Bickel R, Sauer P, Lojen M, Ziegler R (1988) A newly developed spine deformity index (SDI) to quantitate vertebral crush fractures in patients with osteoporosis. Bone Miner 3:335–349

    Google Scholar 

  41. Lachmann E, Whelan M (1936) The roentgen diagnosis of osteoporosis and its limitations. Radiology 26:165–177

    Google Scholar 

  42. Guermazi A, Mohr A, Grigorian M, Taouli B, Genant HK (2002) Identification of vertebral fractures in osteoporosis. Semin Musculoskelet Radiol 6:241–252

    Google Scholar 

  43. Jung HS, Jee WH, McCauley TR, Ha KY, Choi KH (2003) Discrimination of metastatic from acute osteoporotic compression spinal fractures with MR imaging. Radiographics 23:179–187

    Google Scholar 

  44. Baur A, Stabler A, Arbogast S, Duerr HR, Bartl R, Reiser M (2002) Acute osteoporotic and neoplastic vertebral compression fractures: fluid sign at MR imaging. Radiology 225:730–735

    Google Scholar 

  45. Daldrup-Link HE, Rummeny EJ, Ihssen B, Kienast J, Link TM (2002) Iron-oxide-enhanced MR imaging of bone marrow in patients with non-Hodgkin’s lymphoma: differentiation between tumor infiltration and hypercellular bone marrow. Eur Radiol 12:1557–1566

    Google Scholar 

  46. Daldrup-Link H, Ihssen B, Link T, Rummeny E (2001) Iron oxides differentiate between hyperplastic hematopoetic marrow and bone marrow neoplasms. Eur Radiol 11:S377

    Google Scholar 

  47. Spuentrup E, Buecker A, Adam G, van Vaals JJ, Guenther RW (2001) Diffusion-weighted MR imaging for differentiation of benign fracture edema and tumor infiltration of the vertebral body. Am J Roentgenol 176:351–358

    Google Scholar 

  48. Baur A, Dietrich O, Reiser M (2003) Diffusion-weighted imaging of bone marrow: current status. Eur Radiol 13:1699–1708

    Google Scholar 

  49. Baur A, Reiser MF (2000) Diffusion-weighted imaging of the musculoskeletal system in humans. Skelet Radiol 29:555–562

    Google Scholar 

  50. Baur A, Stabler A, Bruning R, Bartl R, Krodel A, Reiser M, Deimling M (1998) Diffusion-weighted MR imaging of bone marrow: differentiation of benign versus pathologic compression fractures. Radiology 207:349–356

    Google Scholar 

  51. Baur A, Stabler A, Huber A, Reiser M (2001) Diffusion-weighted magnetic resonance imaging of spinal bone marrow. Semin Musculoskelet Radiol 5:35–42

    Google Scholar 

  52. Blake SP, Connors AM (2004) Sacral insufficiency fracture. Br J Radiol 77:891–896

    Google Scholar 

  53. Baur-Melnyk A, Reiser M (2004) Staging of multiple myeloma with MRI: comparison to MSCT and conventional radiography. Radiologe 44:874–881

    Google Scholar 

  54. Horn EM, Lekovic GP, Feiz-Erfan I, Sonntag VK, Theodore N (2004) Cervical magnetic resonance imaging abnormalities not predictive of cervical spine instability in traumatically injured patients. Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004. J Neurosurg Spine 1:39–42

    Google Scholar 

  55. Laredo JD, Lakhdari K, Bellaiche L, Hamze B, Janklewicz P, Tubiana JM (1995) Acute vertebral collapse: CT findings in benign and malignant nontraumatic cases. Radiology 194:41–48

    Google Scholar 

  56. Stabler A, Schneider P, Link TM, Schops P, Springer OS, Durr HR, Reiser M (1999) Intravertebral vacuum phenomenon following fractures: CT study on frequency and etiology. J Comput Assist Tomogr 23:976–980

    Google Scholar 

  57. Resnick DL (1982) Fish vertebrae. Arthritis Rheum 25:1073–1077

    Google Scholar 

  58. Adams J (2005) Radiology of rickets and osteomalacia. In: Feldman D, Glorieux FH, Pike JW (eds) Vitamin D. Elsevier Academic Press, San Diego, CA, pp 967–994

    Google Scholar 

  59. Adams JE (2002) Dialysis bone disease. Semin Dial 15:277–289

    Google Scholar 

  60. Whitehouse RW (2002) Paget’s disease of bone. Semin Musculoskelet Radiol 6:313–322

    Google Scholar 

  61. Ledermann HP, Schweitzer ME, Morrison WB, Carrino JA (2003) MR imaging findings in spinal infections: rules or myths? Radiology 228:506–514

    Google Scholar 

  62. Assmann H, Montag M, Krzok G, Endert G (1991) Kummell–Verneuil syndrome. Zentralbl Chir 116:185–192

    Google Scholar 

  63. Chan KK, Sartoris DJ, Haghighi P, Sledge P, Barrett-Connor E, Trudell DT, Resnick D (1997) Cupid’s bow contour of the vertebral body: evaluation of pathogenesis with bone densitometry and imaging—histopathologic correlation. Radiology 202:253–256

    Google Scholar 

  64. Neidner F (1932) Zur Kenntnis der normalen und pathologischen Wirbekoerperrandleisten. Fortschr Roentgenstr 46:628

    Google Scholar 

  65. Rea JA, Steiger P, Blake GM, Fogelman I (1998) Optimizing data acquisition and analysis of morphometric X-ray absorptiometry. Osteoporos Int 8:177–183

    Google Scholar 

  66. Rea JA, Li J, Blake GM, Steiger P, Genant HK, Fogelman I (2000) Visual assessment of vertebral deformity by X-ray absorptiometry: a highly predictive method to exclude vertebral deformity. Osteoporos Int 11:660–668

    Google Scholar 

  67. Smyth PP, Taylor CJ, Adams JE (1999) Vertebral shape: automatic measurement with active shape models. Radiology 211:571–578

    Google Scholar 

  68. Nevitt MC, Thompson DE, Black DM, Rubin SR, Ensrud K, Yates AJ, Cummings SR (2000) Effect of alendronate on limited-activity days and bed-disability days caused by back pain in postmenopausal women with existing vertebral fractures. Fracture Intervention Trial Research Group. Arch Intern Med 160:77–85

    Google Scholar 

  69. Siris E, Adachi JD, Lu Y, Fuerst T, Crans GG, Wong M, Harper KD, Genant HK (2002) Effects of raloxifene on fracture severity in postmenopausal women with osteoporosis: results from the MORE study. Multiple Outcomes of Raloxifene Evaluation. Osteoporos Int 13:907–913

    Google Scholar 

  70. Neer RM, Arnaud CD, Zanchetta JR et al (2001) Effect of parathyroid hormone (1–34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med 344:1434–1441

    Google Scholar 

  71. McClung MR, Geusens P, Miller PD et al (2001) Effect of risedronate on the risk of hip fracture in elderly women. Hip Intervention Program Study Group. N Engl J Med 344:333–340

    Google Scholar 

  72. Ohlin A, Johnell O (2004) Vertebroplasty and kyphoplasty in the fractured osteoporotic spine. Clin Calcium 14:65–69

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Thomas M. Link.

Additional information

The authors are members of the Osteoporosis Group of the European Society of Skeletal Radiology (ESSR).

Rights and permissions

Reprints and permissions

About this article

Cite this article

Link, T.M., Guglielmi, G., van Kuijk, C. et al. Radiologic assessment of osteoporotic vertebral fractures: diagnostic and prognostic implications. Eur Radiol 15, 1521–1532 (2005). https://doi.org/10.1007/s00330-005-2773-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-005-2773-2

Keywords

Navigation