Discriminating imaging findings of acute osteoporotic vertebral fracture: a prospective multicenter cohort study

Appropriate treatment of osteoporotic vertebral fractures (OVF) requires knowledge of the age of the fracture. Although diagnostic imaging has made remarkable progress in recent years, it remains difficult to differentiate acute fractures from old. Our purpose was to investigate chronological changes in radiological findings after OVF and to identify discriminators of acute versus older injuries.

We evaluated 139 vertebrae in 136 patients. All patients underwent X-ray and magnetic resonance imaging (MRI) examination within 2 weeks of injury and again after 6 months. The anterior vertebral height ratio (AVHR) was calculated on lateral X-ray, and the intensity change of the posterior wall of the fractured vertebra was evaluated on T1-weighted MRI. The cutoff AVHR value to diagnose acute fracture was determined by receiver operating characteristic (ROC) curve analysis.

Average AVHR fell from 84.6% at initial visit to 63.7% at 6 months. When acute fracture was defined as AVHR >75%, sensitivity was 85.6%, specificity was 67.6%, and positive predictive value was 72.6%. On MRI, 83.5% of fractured vertebrae showed intensity change in the posterior wall in the acute stage, which fell to 41.7% of vertebrae after 6 months. When intensity change in the posterior wall and AVHR >75% were both present, the specificity and positive predictive value for diagnosing acute fracture improved to 87.1% and 84.7%, respectively.

This study suggests that vertebral fracture rarely shows significant collapse on X-ray in the first 2 weeks after injury. The combination of intensity change in the posterior wall on MRI and AVHR >75% on X-ray indicates a high probability of acute fracture.