ISR Autumn Meeting 2017
Clinical Presentations - 1st Prize
The impact of radiology reporting of vertebral fractures on treatment of fracture risk
Leah Rooney Donncha O'Gradaigh
University Hospital Waterford
Vertebral fractures, the most common sites of fracture secondary to osteoporosis, are often incidentally identified on radiographs or CT scans. This represents an opportunity to investigate and treat individuals for osteoporosis, reducing the incidence of future fractures.
Radiologists use a variety of terms to describe vertebral fractures, and do not always use the term ‘fracture’. Terminology such as wedge deformity, vertebral loss of height, collapse, compression, concavity, and vertebra plana are commonly used. Our study investigates the variation in terminology used to report a vertebral fracture and its impact on clinicians’ decision to investigate and treat for osteoporosis.
To review the variation in reporting of vertebral fractures in thoracic spine radiographs and study the impact of such variation on the decision to commence treatment for osteoporosis and/or on referral to the Fracture Liaison Service (FLS).
We reviewed the reports of all thoracic spine X-rays performed in a tertiary hospital over a 1-year period. We identified those with fractures and the noted the wording used, such as: fracture, wedge, loss of height, collapse or concavity. We determined if each fracture case over age 50 had been referred to the FLS and, via electronic records, if treatment for osteoporosis had been started / continued or not. Of those with vertebral fractures not referred to the FLS, hospital records were reviewed and GPs contracted to determine if treatment for osteoporosis had been commenced.
Over 1-year, 586 thoracic spine radiographs were performed of which 234 had positive findings consistent with vertebral fractures. Of the 234, 74% used the term ‘fracture’ in the report and the other 26% described the vertebral fracture using different terminology, excluding the word fracture (19% wedge deformities; 2% vertebral loss of height and 5% other, such as: compression, collapse, concavity and vertebra plana).
There were 138 fracture cases over the age of 50, of whom only 35 (25%) were referred to the FLS.
Within the over-50 cohort, patients whose thoracic spine X-ray reports used the word ‘fracture’ are more likely to be treated for osteoporosis than patients whose reports used other terminology, 64% vs 42%.
In addition to the impact of report terminology, treatment rates among the individuals reviewed in the FLS were higher than among those treated as inpatients or by GPs, 90% vs 48%.
In this study, two important observations were made. A significant proportion of radiology reports, while recognising vertebral fractures, do not refer to them as such. Secondly, fewer cases are referred for further assessment by a FLS when the term fracture is not used. In both instances, fewer patients are recommended treatment demonstrating that the terminology used to describe vertebral fractures impacts the clinician’s decision to treat for osteoporosis.