[Vertebral fractures in osteoporosis--silent fractures of clinical importance]

Vertebral fractures are a common concern in patients with low bone mass. Even though less than half of these fractures are symptomatous, they represent a major health problem. This article gives a survey of vertebral fractures in osteoporosis as a "silent epidemic". They are of clinical importance for two main reasons. First, several studies have demonstrated an association between vertebral fractures and morbidity and even mortality. Second, an osteoporotic vertebral fracture dramatically increases a persons risk of suffering from further osteoporotic fractures, also non-axial ones. Vertebral deformities represent the clinical end point of large interventional studies on osteoporosis, and is used as a definition of osteoporosis in epidemiological studies. Spinal radiographs provide vertebrae in all shapes, from normal via slight reduction of height to severely crushed. There is no commonly accepted definition of when a reduction in height is defined as a vertebral fracture. This lack of standardisation complicates interpretation and comparison of different studies. During the last decade, several well documented treatments reducing the risk of further fractures have come into use. This points to the importance of discovering a vertebral fracture, so that the patient can be diagnosed as having osteoporosis and given appropriate treatment.