Recognizing osteoporotic vertebral deformity on frontal view radiograph: a cohort analysis and a pictorial review



Opportunities exist to detect osteoporotic vertebral deformities (VDs) on frontal radiograph (FR) indicated for lung or abdominal diseases, while literature have been mostly based on lateral radiograph (LR). This study analyzed the detectability of moderate and severe grades VD on FR.


There were 105 female cases (mean 72 years, range 55~93 year), who were referred for digital spine FR and LR with back and/or leg pain. The LR and FR were read, osteoporotic VDs with < 20%, 20–25%, 25–40%, and > 40% vertebral body height loss were recorded as minimal, mild, moderate, and severe grades, respectively. After a 10-month interval, only FRs were read again, and each vertebra was classified as (1) no notable VD, (2) with notable VD, and (3) ambiguous. The first reading was the reference, while the second reading was allowed to miss minimal/mild VCD and endplate/cortex fracture.


Counting by subjects, for 98 cases, the two reading sessions had agreement, including 43 “true negative” cases and 55 true positive cases. There were two false positive cases, and five ambiguous cases. In total, 1286 vertebra were assessed, FR reading had 1126 vertebrae “true negative,” 130 vertebrae true positive, one vertebra false negative, 3 vertebrae false positive, and 26 ambiguous vertebrae (65.4% being true negative and 34.6% being true positive). Most of the disagreements were associated with kyphosis or poor X-ray projection. Nineteen illustrative cases are presented graphically.


Moderate and severe grades of VD are identifiable on FR as long as the involved vertebrae are clearly filmed.

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This study is partially supported by ITF project of Hong Kong SAR (code: ITS/334/18).

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Correspondence to Yì Xiáng J. Wáng or Zhi-Han Yan.

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Wáng, Y.X.J., Du, MM., Che-Nordin, N. et al. Recognizing osteoporotic vertebral deformity on frontal view radiograph: a cohort analysis and a pictorial review. Arch Osteoporos 15, 41 (2020).

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  • Osteoporosis
  • Radiograph
  • Spine
  • Vertebral fracture
  • Frontal view