Where’s the break? Critique of radiographic vertebral fracture diagnostic methods

This is the authors' abstract. We don't add key points for this paper.

Vertebrall fractures are the most common osteoporotic fractures and are associated with the highest risk of subsequent incident fractures [1]. The majority of vertebral fractures do not come to medical attention and thus remain undiagnosed [2]. In most osteoporosis guidelines [3, 4], vertebral fracture, unrelated to trauma and on its own, represents an intervention threshold for pharmacological treatment and may need no further risk assessment, including bone mineral density (BMD) measurement. Furthermore, the Endocrine Society has recently published a clinical practice guideline related to therapy of osteoporosis in menopausal women who are a year or more past their final menstruation, [5] in which they recommended treatment with bone-forming agents in these women with osteoporosis at very high risk of fracture, such as those with severe (Grade 3) or multiple vertebral fractures. Anabolic therapy has recently proven to be superior to antiresorptives for incident vertebral fracture prevention in randomized, controlled clinical trial data of teriparatide versus risedronate [6]. Although vertebral fractures are common and important in osteoporosis diagnosis and management, the definition of osteoporotic vertebral fracture remains controversial [7–10]. Our purpose is to clear confusion for clinicians. In 2000, 21.5% of men and 23.5% of women in a population-based national cohort of 6433 persons aged ≥ 50 years showed a Grade 1 or higher vertebral fracture (VF) or deformity that were systematically assessed by lateral vertebral radiography [11]. This prevalence was based on technologist triage followed by determination of 20–25% anterior wedging or three standard deviations (3 SD) greater height deviation than unaffected vertebrae at the same anatomical level in the same cohort [12]. On spine radiographs, the method identified the anterior, posterior, and middle vertebral heights of the superior and inferior endplates and compared the morphometry with the same, unaffected vertebral body in the population, as had Eastell in Rochester data [13]. Further refinements of the morphometric approach to vertebral fractures were developed by the late Professor Harry Genant at the University of California, San Francisco