Incidental vertebral fractures on computed tomography.

Area of Science:

• Geriatric Medicine
• Radiology
• Orthopedics

Background:

• Osteoporotic vertebral fractures are the most common type and are linked to increased subsequent fracture risk and mortality.
• Current diagnostic pathways may miss incidental vertebral fractures detected on non-spinal computed tomography (CT) scans.

Purpose of the Study:

• To audit the detection rate of incidental vertebral fractures in patients over 65 undergoing chest or abdominal CT scans.
• To evaluate the subsequent management and reporting of identified vertebral fractures.

Main Methods:

• A retrospective audit of 175 patients aged over 65 years at Auckland City Hospital.
• Sagittal spine images were reformatted from existing chest or abdominal CT data.
• Vertebral fractures were assessed using a semi-quantitative method, and reporting was reviewed.

Main Results:

• A prevalence of 13% for vertebral fractures was found, with 41 fractures in 22 patients.
• 77% of identified vertebral fractures were newly discovered.
• Only 14% of patients had vertebral fractures or osteoporosis mentioned in discharge summaries, and 31% received osteoporosis treatment.

Conclusions:

• Reformatting CT data to assess spinal images is an effective method for detecting previously unidentified vertebral fractures in older adults.
• This approach represents an underutilized opportunity to identify patients at high risk for osteoporosis and subsequent fractures.
• Early identification and intervention can significantly reduce fracture risk and mortality.