Abstract
Despite the importance of vertebral compression fractures, there is much that remains uncertain. There is no “gold standard“ for the definition which has led to epidemiologic and study differences. Height loss is a way to suspect vertebral fractures but it has its own issues. There are multiple radiographic systems for defining vertebral fractures, both prevalent and incident; risk factors for prevalent fractures have already been delineated. Recent studies have elucidated the risk factors for incident vertebral fractures including age, low weight, late menarche, lower bone mineral density, history of vertebral and nonvertebral fractures, smoking, and use of a walking aid. Fan beam densitometers have had improving ability to image the spine, a procedure now known as vertebral fracture assessment (VFA). Recently (in the United States) a CPT code and reimbursement was established. Yet, many vertebral fractures go undiagnosed, diagnosed but unreported, or reported but not utilized in patient care. Because of this, the International Osteoporosis Foundation developed a Vertebral Fracture Initiative for radiologists and the International Society for Clinical Densitometry began a VFA course. Both teaching programs use the semi-quantitative assessment of Genant to aid the radiologists and clinicians in detecting vertebral fractures.
Similar content being viewed by others
References and Recommended Reading
International Osteoporosis Foundation and European Society of Musculoskeletal Radiology: Vertebral fracture iInitiative 2003 [compact disc]. http://www.osteofound.org
International Osteoporosis Foundation and European Society of Musculoskeletal Radiology: Vertebral fracture initiative [resource document]. 2003
National Osteoporosis Foundation Working Group on Vertebral Fractures: Assessing vertebral fractures. J Bone Miner Res 1995, 10:518–523. The basic reference for defining prevalent and incident vertebral fractures.
O’Neill TW, Fesdenberg D, Varlow J, et al.: The prevalence of vertebral deformity in european men and women: the European Vertebral Osteoporosis Study. J Bone Miner Res 1996, 11:1010–1018.
Ferrar L, Jeang G, Adams J, et al.: Identification of vertebral fractures; an update. Osteoporos Int 2005, 16:717–728.
Eastell R, Cedel SC, Wahner HW, et al.: Classification of vertebral fractures. J Bone Miner Res 1991, 6:207–215.
Black DM, Cummings SR, Karpf DB, et al.: For the Fracture Intervention Trial Research Group. Randomised trial of the effect of alendronate on risk of fracture in women with existing vertebral fractures. Lancet 1996, 348:1535–1541.
Harris ST, Watts NB, Genant HK, et al.: Effects of risedronate Treatment on vertebral and non-vertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. JAMA 1999, 282:1344–1352.
Cooper C, Atkinson EJ, O’Fallon WM, et al.: Incidence of clinically diagnosed vertebral fractures: a population-based study in rochester, minnesota, 1985–1989. J Bone Miner Res 1999, 7:221–227.
Cummings SR, Kelsey JL, Nevitt MC, et al.: Epidemiology of osteoporosis and osteoporotic fractures. Epidemiol Rev 1985, 7:178–208.
Siminoski K, Jiang G, Adachi JD, et al.: Accuracy of height loss during prospective monitoring for detection of incident vertebral fractures. Osteoporos Int 2005, 16:403–410. Comprehensive article on historic height loss and monitoring of height loss in the placebo arm of the risedronate trials.
Huang C, Ross PD, Lydick E, et al.: Contributions of vertebral fractures to stature loss among elderly japanese-american women in hawaii. J Bone Miner Res 1996, 11:408–411.
Ismail AA, Cooper C, Felsenberg D, et al.: Number and type of vertebral deformities: epidemiological characteristics and relation to back pain and height loss. Osteoporos Int 1999, 9:206–213.
McCloskey EV, Spector TD, Eyres KS, et al.: The assessment of vertebral deformity: a method for use in population studies and clinical trials. Osteoporos Int 1993, 3:138–147.
International Society for Clinical Densitometry: Vertebral Fracture Assessment Lecture Syllabus, Version 5.4. 2005.
Black DM, Palermo L, Nevitt MC, et al.: Comparison of methods for defining prevalent vertebral deformities. The study of osteoporotic fractures. J Bone Miner Res 1995, 10:890–902.
Black DM, Palermo L, Nevitt MC, et al.: Defining incident vertebral deformity: a prospective comparison of several approaches. J Bone Miner Res 1999, 14:90–101.
Riggs BL, Seeman E, Hodgson SF, et al.: Effect of the fluoride/ calcium regimen on vertebral fracture occurrence in postmenopausal osteoporosis. N Engl J Med 1982, 306:446–450.
Watts NB, Harris SF, Genant HK: Intermittent cyclical etidronate treatment of post-menopausal osteoporosis. N Engl J Med 1990, 323:73–79.
Minne HW, Leidig G, Wuster C, et al.: A newly developed spine deformity index (SDI) to quantitate vertebral crush fractures in patients with osteoporosis. Bone Miner 1988, 3:335–349.
Smith-Bindman R, Steiger P, Cummings SR, et al.: The index of radiographic area (IRA): a new approach to estimating the severity of vertebral deformity. Bone Miner 1991, 15:137–150.
McCloskey EV, Spector TD, Eyres KS, et al.: The assessment of vertebral deformity: a new method for use in population studies and clinical trials. Osteoporos Int 1993, 3:138–147.
Melton LJ III, Kan SH, Frye MA, et al.: Epidemiology of vertebral fractures in women. Amer J Epidemiol 1989, 129:1000–1011.
The European Prospective Osteoporosis Study (EPOS) Group: Incidence of vertebral fracture in europe: results from the European Prospective Osteoporosis (EPOS). J Bone Miner Res 2002, 17:716–724.
van der KliftM, deLaet CEDH, McCloskey EV, et al.: Risk Factors for incident vertebral fractures in men and women: The Rotterdam Study. J Bone Miner Res 2004, 19:1172–1180.
Papaioannon A, Joseph L, Berger GIC, et al.: Risk Factors associated with incident clinical vertebral and nonvertebral fractures in postmenopausal women. The Canadian Multicentre Osteoporosis Study (CaMos), Osteoporos Int 2005, 16:568–578.
Nevitt MC, Cummings SR, Stone KL, et al.: Risk factors for a first-incident radiographic vertebral fracture in women > 65 years of age: the study of osteoporotic fractures. J Bone Miner Res 2005, 20:131–140. Delineation of the risk factors for incident fractures in the SOF populations.
Johnell O, Kanis JA, Black DM, et al.: Associations between baseline risk factors and vertebral fracture risk in the multiple outcomes of raloxifene evaluation (MORE) study. J Bone Miner Res 2004, 19:764–772.
Lindsay R, Pack S, Li Z: Longitudinal progression of fracture prevalence through a population of postmenopausal women with osteoporosis. Osteoporos Int 2005, 16:366–312.
Roy DK, O’Neill TW, Finn JD, et al.: Determinants of incident vertebral fracture in men and women: results from the European Prospective Osteoporosis Study (EPOS). Osteoporos Int 2003, 14:19–26.
Reeve J, Lunt M, Fesenberg D, et al.: Determinants of the size of the incident vertebral deformities in european men and women in the sixth to ninth decades of age: The European Prospective Osteoporosis Study (EPOS). J Bone Miner Res 2003, 18:1664–1673.
Lunt M, O’Neill TW, Felsenberg D, et al.: Characteristics of a prevalent vertebral deformity predict subsequent vertebral fracture: results from the European Prospective Osteoporosis Study(EPOS). Bone 2003, 33:505–513.
Genant HK, Wu CY, vanKujik C, et al.: Vertebral fracture assessment using a semiquantitive technique. J Bone Miner Res 1993, 8:1137–1148. The initial description of the Genant SQ assessment technique, the basis of the IOF Vertebral Fracture Initiative and the ISCD VFA course.
Crans GG, Genant HK, Krege JH: Prognostic utility of a semiquantitative spinal deformity index. Bone 2005, 37:175–179.
Fink HA, Milavetz DL, Palermo L, et al.: What proportion of incident radiographic vertebral deformities is clinically diagnosed and vice versa? J Bone Miner Res 2005, 20:1216–1222.
Gehlbach SH, Bigelow C, Heimisdottir M, et al.: Recognition of vertebral fractures in a clinical Setting. Osteoporosis Int 2000, 11:577–582.
Majumdar SR, Kim N, Colman I, et al.: Incidental vertebral fractures discovered with chest radiography in the emergency department. Arch Intern Med 2005, 165:905–909.
Delmas PD, vander Langerijt, Watts NB, et al.: Underdiagnosis of vertebral fractures is a worldwide problem: the IMPACT Study. J Bone Miner Res 2005, 20:557–563.
Binkley N, Krueger D, Gangnon R, et al.: Lateral vertebral assessment: a valuable technique to detect clinically significant vertebral fractures. Osteoporos Int 2005, In press.
Fletcher H: Anterior vertebral wedging frequency and significance. Am J Rhentgenol 1947, 57:232–238.
Hurxthal LM: Measurement of anterior vertebral compressions and biconcave vertebrae. Am J Roentgenol Radium Ther Nucl Med 1968, 103:635–6446.
Barnelt E, Norden BEC: The radiological diagnosis of osteoporosis: a new approach. Clinical Radiology 1960, 2:166–174.
Smith RW, Eyn WR, Meclnijer RC: On the incidence of senile osteoporosis. Ann Int Med 1960, 52:73–81.
Duboeuf F, Bauer DC, Chapurlat RD, et al.: Assessment of vertebral fracture using densitometric morphometry. J Clin Densitom 2005, 8:362–368.
International Society for Clinical Densitometry Official Positions. Accessed at www.iscd.org, October 3, 2005. Excellent review of vertebral fracture assessment.
Kleerekoper M, Parfit AM, Ellis BI: Measurement of vertebral fracture rates in osteoporosis. In Copenhagen International Symposium on Osteoporosis June 3–8, 1984, vol 1. Edited by Christiansen C, Arnaud CD. Copenhagen: Department of Clinical Chemistry, Glastrup Hospital; 1984:103–108.
Genant HK, Li J, Wu CY, et al.: Vertebral fractures in osteoporosis: a new method for clinical assessment. J Clin Densitom 2000, 3:281–290.
International Society for Clinical Densitometry: Vertebral Fracture Assessment Course Syllabus, Version 5.1. 2005:1–59.
Jiang G, Eastell R, Barrington NA, et al.: Comparison of methods for the visual identification of prevalent vertebral fracture in osteoporosis. Osteoporos Int 2004, 15:887–896.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Schwartz, E.N., Steinberg, D. Detection of vertebral fractures. Curr Osteoporos Rep 3, 126–135 (2005). https://doi.org/10.1007/s11914-996-0015-4
Issue Date:
DOI: https://doi.org/10.1007/s11914-996-0015-4