Definition and diagnosis of vertebral fracture

The majority of vertebral deformities are asymptomatic and thus definition is normally based on radiographic appearance. There are no internationally agreed criteria for vertebral fracture based on radiographic appearance. A variety of morphometric methods have been developed to ascertain changes in vertebral shape based on a reduction in vertebral height. Criteria have to be established to determine what cutoff constitutes abnormality. An alternative is to adopt a semiquantitative grading using clinical observations of a experienced radiologist. This approach enhances specificity by excluding nonosteoporotic causes of changing vertebral shape. Such methods, however, may be subject to difficulties in standardization.