Indefinition in the radiological diagnosis of vertebral fractures and its impact in the prediction of their risk of occurrence

Abstract

The difficulties inherent to the radiological diagnosis of fracture of vertebral bodies derive from the proportions between their trabecular to cortical bone contents (75:25). In long bones, where the proportion is reversed, the fracture is easily defined by the discontinuity of tissue. The fractures of vertebral bodies are the most frequent among those associated with osteoporosis. For 50-years old women, the risk of vertebral fracture is twice that of hip or forearm fractures. Though the literature contains a total of 27 definitions for the radiological assessment of vertebral fractures, no consensus has yet been attained. The absence of a gold standard affects the analysis of prevalence, the estimation of risk of fracture and the therapeutic decision. This revision reports the story of knowledge acquisition since the early description of osteoporosis by Albright (1941), the analysis of prevalence of vertebral fractures with conventional radiology to the calculation of 10-years risk of fracture using DXA. It may be noteworthy that the latter studies have not employed the same definition of vertebral fracture.