Adding value in radiology—improved radiological diagnosis of osteoporotic vertebral fragility fractures following National UK Audit and Interventions

Vertebral fragility fractures (VFFs) are the most common osteoporotic fracture, with significant associated morbidity, mortality, and risk of future fractures. Unfortunately, VFFs are frequently underdiagnosed and underreported. With this background, The Royal College of Radiologists (RCR), in collaboration with the Royal College of Physicians (RCP) and Royal Osteoporosis Society (ROS), undertook a UK-wide retrospective audit in 2019 to assess radiology reporting of incidental VFFs present on CT studies. The audit standards were not achieved; however, following a series of interventions, a re-audit in 2022 demonstrated generalized improvement in compliance with the audit parameters, in particular a 6-percentage point increase in moderate/severe VFFs reported. This article examines the potential benefits in terms of reductions in patient morbidity, mortality, and costs that could be expected if the improvements identified were translated to a national level, acknowledging and discussing other improvements that need to occur, with particular reference to onward referral pathways.