Breaking bad: Reporting of vertebral fragility fractures and the impact to management of bone health
Ann O’ Riordan, Shehla Farrukh, Fahd Adeeb
University Hospital Kerry
Vertebral fragility fracture (VFF) is the most common osteoporotic fracture and a strong predictor for future vertebral fracture(s) and/or hip fracture. A clear reporting of VFF by radiologists offers ample opportunity for early diagnosis and appropriate management of osteoporosis among treating physicians.
The objectives of this study were two-fold; to evaluate 1) the reporting of VFF by radiologists at one of the largest acute hospitals in southern Ireland 2) the management of osteoporosis (adherence to screening for secondary causes and commencement/switching of anti-resorptive therapy accordingly) for patients with VFF.
We conducted a retrospective cross sectional study involving all patients (n=199) who attended our specialist rheumatology outpatient clinics at University Hospital Kerry during the month of November 2018. Patients who previously had undergone plain radiography of the spine (PRS) in the previous 5 years were identified and reassessed for evidence of VFFs. Basic demographic, drug history, clarification of fragility fracture and previous related trauma, investigations for secondary causes of osteoporosis, and treatment received for osteoporosis were documented.
73 of the 199 patients had undergone previous PRS, 9 of which had evidence for VFFs. Only two patients (22.2%) were reported as having vertebral “fractures”, while 7 others had different terms used to describe the fracture(s)-2 patients with “wedging”, 1 with “compression”, 2 with “loss of height” and 2 with “collapse”. All (2 patients; 100%) with VFF reported as “fracture” had complete clarification of VFF, secondary osteoporotic work-up and treated with anti-resorptive therapy accordingly. Among the other 7 patients with VFFs but not reported as having “fracture”, 1 patient had concomitant report of “osteoporotic” bones and had complete management for osteoporosis. 4 patients had concomitant report of “osteopenia”, 3 (75%) of which received complete management for osteoporosis; while only 50% (1 patient) of the 2 remaining patients without further description of bone density received appropriate management. Further 6 patients with non-VFF were reported to have reduced bone density (1 reported as “osteoporotic” bones; 5 as “osteopenic” bones). Only one of them (16.7%) had further work-up, evaluation and management for osteoporosis.
Clear radiological report of PRS with VFFs using the word “fracture” is a strong predictor for appropriate management of bone health. It is essential that other terms used to describe VFFs such as “wedging”, “compression”, “loss of height” and “collapse” not to be used alone without the concomitant use of the word “fracture”.