Utility of Vertebral Fracture Recognition in Osteoporosis

Vertebral fractures are important because they predict future fractures are associated with increased morbidity and mortality, and because effective therapies exist to prevent them. However, only about 1/3 of vertebral fractures found on imaging are clinically recognized. Therefore, imaging is required for their detection. Yet spine imaging is usually not obtained in the course of management of patients with osteoporosis. Furthermore, even when radiographic images obtained for various clinical indications do include the spine views, vertebral fractures are often not recognized or not reported. In response to this unmet need, Vertebral fracture assessment (VFA, spine image obtained on densitometers) was developed but is still underutilized, at least in part due to problems with reimbursement. Greater awareness of vertebral fractures and their importance among radiologists and clinicians should lead to higher rate of vertebral fracture detection on multiple imaging modalities including spine radiographs and VFA, and also on radiographs, CT and MRI scan of the chest and abdomen obtained for other indications. With appropriate educational efforts and changes in reimbursement policies, it may be possible to improve the rate of detection of vertebral fractures and thus make a diagnosis of osteoporosis (which presence of vertebral fractures signifies) in many patients whose disease is otherwise unrecognized and untreated. © 2016, Springer Science+Business Media New York.