Purpose
Introduction
1 in 3 women and 1 in 5 men over the age of 50 will experience an osteoporotic fragility fracture[1].
Osteoporotic hip fractures cause severe disability and decrease life expectancy,
costing the NHS £2 billion a year[2].
Patients with vertebral fragility fractures (VFFs) are at increased risk of hip fracture[3].
Up to 70% of VFFs are not clinically diagnosed[4],
but are common incidental findings on scans
VFFs seen on imaging are significantly under-diagnosed by radiologists[5],
meaning a large proportion of patients are not receiving...
Methods and Materials
Retrospective cohort study
Setting: John Radcliffe Hospital,
Oxford
Cohort: patients ≥50 years old with previous imaging (CT,
MRI or X-ray) of the spine
Data source: The hospital’s PACS archive
Identification of fractures: VFFs were identified using the Genant semi-quantitative classification (Figures 1 and 2) and reviewed by a consultant radiologist
Exclusion criteria: pubic rami fractures,
peri-prosthetic fractures,
history of high-velocity trauma,
bone malignancy,
multiple myeloma,
disorders of bone e.g.
osteogenesis imperfecta
Results
1.
Reporting of vertebral fragility fractures (VFFs)
732 patients over the age of 50 who had a hip fracture in 2013 were identified.
157 of these patients had previous imaging of the spine (over a fifth).
41% of these patients had detectable VFFs (Table 1,
Figure 3).
Only 46% of the VFFs first detectable on imaging were reported as ‘fractured’ by the interpreting radiologist at the time of imaging (Table 2,
Figure 3).
Of those fractures that were not reported,
91% were reported by non-musculoskeletal...
Conclusion
Conclusions
A significant proportion of fragility hip fracture patients have had previous spinal imaging in which VFFs are detectable.
Less than half of these VFFs are reported at the time of imaging by the interpreting radiologist,
representing consistent underdiagnosis of these fractures.
Only 25% of patients with a VFF were documented to be taking treatment for osteoporosis.
Increasing reporting and communication with primary health care providers could increase the number of patients receiving treatment for osteoporosis,
and reduce the risk of subsequent hip fracture.
Future...
References
[1] International Osteoporosis Foundation: http://www.iofbonehealth.org/
[2] NICE.
Osteoporosis: assessing the risk of fragility fracture (2012)
[3] Melton,
LJ.
et al.
Vertebral fractures predict subsequent fractures.
Osteoporosis International.
10:214-21 (1999)
[4] Cooper,
C.
and Melton,
LJ.
Vertebral Fracture: how large is the silent epidemic? BMJ 304:793-794 (1992)
[5] .
Gehlbach,
S.
H.,
Bigelow,
C.,
Heimisdottir,
M.,
May,
S.,
Walker,
M.,
Kirkwood,
J.
R.,
Recognition of vertebral fractures in a clinical setting.
Osteoporos Int,
11,
577–82 (2000)
[6]Genant,
HK.
et al.
Vertebral fracture assessment using a semiquantitative...
Personal Information
Ruth Mitchell and Paul Jewell: Oxford University Medical School
Kassim Javaid: Nuffield Department of Orthopaedics,
Rheumatology and Musculoskeletal Sciences,
University of Oxford
Simon Ostlere: Nuffiield Orthopeadic Centre,
Oxford University Hospitals