Unrecognized vertebral body fractures (VBFs) in chest radiographic reports in Taiwan: a hospital-based study

Osteoporosis and its associated fragility fractures greatly impact the health-care system. VBF can be inadvertently overlooked on radiological examinations, which may delay diagnosis and treatment of osteoporosis. This hospital-based study evaluated chest radiographs to determine the prevalence rate of unrecognized VBF. Digitalized chest radiographs stored in the Taipei Veterans General Hospital Radiology Information System (TVGHRIS) were retrieved for study. One month of image data from 2009 was randomly obtained. All patients were over 55 years of age. Posterior-anterior (PA) and lateral chest radiographs were available for all patients. All selected chest radiographs were reviewed by two radiologists who were blinded to the official reports. Comparisons between official reports and the reference reports determined the prevalence of unrecognized VBF. Chest radiographs from 1655 patients (mean age 71.9 ± 10.4 years, 63.9% male) were reviewed. The prevalence of recognized VBF was significantly higher in consensus reports compared to the official reports (23.0% vs. 4.8%, p<0.001). Overall, 79% of VBFs were undiagnosed. The prevalence of unrecognized VBFs was 18.2% (19.6% in men, 15.7% in women). VBFs in men were more likely to be unrecognized than women (19.6% vs. 15.7%, p=0.04). Adjusted for age, gender was not an independent risk factor for unrecognized VBF in logistic regression. In conclusion, the high rate of unrecognized VBF in a tertiary medical center in Taiwan highlights the need to improve radiographic recognition of VBF, which could aid early treatment of osteoporosis in older adults.