Differentiation Between Osteoporotic and Neoplastic Vertebral Fractures: State of The Art and Future Perspectives

Vertebral fractures are a common condition occurring in the context of osteoporosis and malignancy. These entities affect a group of patients in the same age range; clinical features may be indistinct and symptoms non-existing, and thus present challenges to diagnosis. In this article, we review the use and accuracy of different imaging modalities available to characterize vertebral fracture etiology, from well-established classical techniques to the role of new and advanced imaging techniques and the prospective use of artificial intelligence. We also address the role of imaging in treatment. In the context of osteoporosis, the importance of opportunistic diagnosis is highlighted. In the near future, the use of automated computer-aided diagnostic algorithms applied to different imaging techniques may be really useful to aid in diagnosis.