La radiologia medica

, Volume 115, Issue 5, pp 815–825 | Cite as

Incidence of new fractures in women with osteoporosis-induced vertebral fractures detected on routine lateral chest radiographs

  • F. Occhicone
  • C.C. Quattrocchi
  • N. Napoli
  • P. Dell’Aia
  • F. D’Agostino
  • P. Pozzilli
  • B. Beomonte Zobel
Musculoskeletal Radiology/Radiologia Muscolo-Scheletrica

Abstract

Purpose

Vertebral fractures represent one of the major complications of osteopororis. Diagnosis is followed by a pharmacological, interventional or surgical treatment. Up to day there are non practice guidelines for a screening evaluation of bone fractures in elderly and most of the fractures remain undiagnosed. We prospectively evaluated the prevalence of vertebral fractures on chest X-rays to determine the diagnostic and prognostic roles of chest X-ray in predicting new bone fractures 2 years after the initial radiogram.

Materials and methods

Between March 2004 and October 2005, 4,045 women underwent chest X-ray in our radiology department for any indication. We identified 166 women with the presence of at least one vertebral fracture. A questionnaire was administered to these women to collect information about diagnosis of osteoporosis, history of malignancy, systemic diseases, osteoporosis-inducing drugs and pharmacological, radiological or surgical treatment received.

Results

Out of the 166 women (age 73±10.5 years) with vertebral fractures, we interviewed 101 women; 13 had died and 52 were not found. Most of the patients were on menopause (97.1%, 98/101) with an average age of menopause of 48,2 years (±6 years). Among the patients on menopause, 15,8% (16/101) had undergone hysterectomy. All patients received a diagnosis of osteoporosis, which was reached with a chest X-ray report in 23.7% (24/101) of cases. A new skeletal fracture occurred in 20.5% (5/27) of patients receiving treatment against a frequency of 20.8% (16/74) in patients without treatment. No statistical difference was found between the groups (p = 0.374).

Conclusions

Inadequate treatment may explain the lack of a substantial difference in new fracture risk between treated and untreated patients. For these reason we discuss about the evaluation of an adeguate therapeutic approaches in prevention of osteoporosis-induced fractures.

Keywords

Osteoporosis Chest X rays Vertebral fracture Bisphosphonates 

Incidenza di nuove fratture in donne con fratture vertebrali indotte dall’osteoporosi, visualizzate nelle proiezioni laterali della radiografia del torace

Riassunto

Obiettvo

Le fratture vertebrali rappresentano una delle maggiori complicanze dell’osteoporosi, la cui diagnosi è seguita dall’instaurazione di un trattamento medico-chirurgico. Attualmente non esistono linee guida che raccomandino uno screening nella popolazione di età avanzata e molte fratture rimangono non diagnosticate. L’obiettivo del nostro studio è quello di valutare prospetticamente la prevalenza delle fratture vertebrali visualizzate alla radiografia del torace e determinarne il ruolo diagnostico e prognostico calcolando il rischio di nuove fratture due anni dopo la prima diagnosi radiologica.

Materiali e metodi

Da marzo 2004 ad ottobre 2005, presso il nostro dipartimento di Diagnostica per Immagini, sono state eseguite 4045 radiografie del torace su donne che si sottoponevano a tale esame per svariate indicazioni. Dallo studio di tali referti sono state individuate 166 donne con fratture vertebrali secondarie ad osteoporosi. In base ai referti ottenuti, ci si è proposti di intervistare tali pazienti attraverso un questionario allo scopo di comprendere quante di loro fossero a conoscenza della malattia, di verificare l’esistenza di patologie concomitanti e di ricercare eventuali fattori che possano aver predisposto allo sviluppo delle lesioni vertebrali e l’eventuale terapia in atto.

Risultati

Delle 166 pazienti individuate (età media 73 anni±10,5), con diagnosi di deformazioni o fratture vertebrali secondarie ad osteoporosi, sono state intervistate 101 donne; 13 sono decedute e 52 non sono state intervistate per difficoltà nel reperirle. La maggior parte di queste è risultata in menopausa (97,1%, 98/101) e l’età media della menopausa è stata di 48,2 anni (±6 anni). Inoltre, tra tutte le pazienti in menopausa, il 15,8% (16/101) ha subito intervento di isterectomia. Delle 101 pazienti al corrente della malattia, il 23,7% (24/101) ne è venuto a conoscenza solo in occasione della radiografia del torace da noi eseguita. Un nuovo evento fratturativo si è verificato nel 20,5% (5/27) delle pazienti in terapia contro una frequenza del 20,8% (16/74) delle pazienti che non avevano mai intrapreso alcun trattamento per l’osteoporosi. Pertanto non è stata riscontrata una differenza statisticamente significativa tra i due gruppi (p=0,374).

Conclusioni

Un trattamento inadeguato spiega l’assenza di differenza nel rischio di nuove fratture tra pazienti sottoposte o meno a terapia. Per tale ragione risulta necessario valutare le cause dell’assenza di un adeguato approccio terapeutico nella prevenzione delle fratture indotte dall’osteoporosi.

Parole chiave

Osteoporosi Radiografia del torace Frtture vertebrali Bifosfonati 

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References/Bibliografia

  1. 1.
    Kanis JA, Melton LJ III, Christiansen C et al (1994) The diagnosis of osteoporosis. J Bone Miner Res 9:1137–1141CrossRefPubMedGoogle Scholar
  2. 2.
    Melton LJ (1995) How many women have osteoporosis now? J Bone Miner Res 10:175–177CrossRefPubMedGoogle Scholar
  3. 3.
    Kado DM, Browner WS, Palermo L et al (1999) Vertebral fractures and mortality in older women A prospective study. Arch Intern Med 159:1215–1220CrossRefPubMedGoogle Scholar
  4. 4.
    Arlot ME, Sornay-Rendu E, Garnero P et al (1997) Apparent pre- and postmenopausal bone loss evaluated by DXA at different skeletal sites in women: the OFELY cohort. J Bone Miner Res 12:683–690CrossRefPubMedGoogle Scholar
  5. 5.
    Ahlborg HG, Johnell O, Turner CH et al (2003) Bone loss and bone size after menopause. N Eng J Med 349:327–334CrossRefGoogle Scholar
  6. 6.
    Link TM, Guglielmi G, van Kuijk C, Adams JE (2005) Radiologic assessment of osteoporotic vertebral fractures: diagnostic and progbnostic implications. Eur Radiol 15:1521–1532CrossRefPubMedGoogle Scholar
  7. 7.
    Black DM, Palermo L, Nevitt MC et al (1995) Comparison of methods for defining prevalent vertebral deformities: the study of osteoporotic fractures. J Bone Miner Res 10:890–902CrossRefPubMedGoogle Scholar
  8. 8.
    Jiang G, Eastell R, Barrington NA, Ferrar L (2004) Comparison of methods for the visual identification of prevalent vertebral fracture in osteoporosis. Osteoporos Int 15:887–896CrossRefPubMedGoogle Scholar
  9. 9.
    Kleerekoper M, Nelson DA (1992) Vertebral fracture or vertebral deformity? Calcific Tissue Int 50:5–6CrossRefGoogle Scholar
  10. 11.
    Genant HK, Wu CY, van Kuijk C, Nevitt MC (1993) Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 8:1137–1148CrossRefPubMedGoogle Scholar
  11. 10.
    Guglielmi G, Diacinti D, van Kuijk C et al (2008) Vertebral morphometry: current methods and recent advances. Eur Radiol 18:1484–1496CrossRefPubMedGoogle Scholar
  12. 12.
    Hurxthal LM (1968) Measurement of anterior vertebral compressions and biconcave vertebrae. Am J Roentgenol 103:635–644Google Scholar
  13. 13.
    Lunt M, Ismail AA, Felsenberg D et al (2002) Defining incident vertebral deformities in population studies: a comparison of morphometric criteria. Osteoporos Int 13:809–815CrossRefPubMedGoogle Scholar
  14. 14.
    Cataldi V, Laporta T, Sverzellati N et al (2008) Detection of incidental vertebral fractures on routine lateral chest radiographs. Radiol Med 113:968–977CrossRefPubMedGoogle Scholar
  15. 15.
    Tayyab NA, Samartzis D, Altiok H et al (2007) The reliability and diagnostic value of radiographic criteria in sagittal spine deformities: comparison of the vertebral wedge ratio to the segmental cobb angle. Spine 32:E451–E459CrossRefPubMedGoogle Scholar
  16. 16.
    Brower WS, Pressman AR, Nevitt MC, Cummings SR (1996) Mortality following fractures in older woman: The study of osteoporotic fractures. Arch Intern Med 156:1521–1525CrossRefGoogle Scholar
  17. 17.
    Wolinsky FD, Fitzgerald JF, Stump TE (1997) The effect of hip fracture on mortality, hospitalization and functional status: a prospective status. Am J Public Health 87:398–403CrossRefPubMedGoogle Scholar
  18. 18.
    Cauley JA, Thompson DE, Ensrud KC et al (2000) Risk of mortality following clinical fractures. Osteoporos Int 11:556–561CrossRefPubMedGoogle Scholar
  19. 19.
    Kim N, Rowe BH, Raymond G et al (2004) Underreporting of vertebral fractures on routine chest radiography. AJR Am J Roentgenol 182:297–300PubMedGoogle Scholar
  20. 20.
    Ross PD (1997) Clinical consequences of vertebral fractures. Am J Med 103:S30–S43CrossRefGoogle Scholar
  21. 21.
    Majumdar SR, Kim N, Colman I et al (2005) Incidental vertebral fractures dicovered with chest radiography in the emergency department. Arch Intern Med 165:905–909CrossRefPubMedGoogle Scholar
  22. 22.
    International Committee for Osteoporosis Clinical Guidelines of 1999 and North American Menopause Society (2006) Management of osteoporosis in postmenopausal women: 2006 position statement of The North American Menopause Society. Menopause 13:340–367CrossRefGoogle Scholar
  23. 23.
    Syversen U, Halse JI (2008) Treatment of osteoporosis with parathyroid hormone. Tidsskr Nor Laegeforen 128:39–41PubMedGoogle Scholar
  24. 24.
    Stroup J, Kane MP, Abu-Baker AM (2008) Teriparatide in the treatment of osteoporosis. Am J Health Syst Pharm 65:532–539CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Italia 2010

Authors and Affiliations

  • F. Occhicone
    • 1
  • C.C. Quattrocchi
    • 1
    • 3
  • N. Napoli
    • 2
  • P. Dell’Aia
    • 1
  • F. D’Agostino
    • 1
  • P. Pozzilli
    • 1
  • B. Beomonte Zobel
    • 1
  1. 1.Department of Radiology, Interdisciplinary Center for Biomedical ResearchUniversity Campus Bio-Medico of RomeRomeItaly
  2. 2.Endocrinology and Diabetology UnitUniversity Campus Bio-Medico of RomeRomeItaly
  3. 3.IRCCS, Fondazione Santa LuciaRomeItaly

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