Archives of Orthopaedic and Trauma Surgery

, Volume 139, Issue 11, pp 1497–1503 | Cite as

Incidental identification of vertebral compression fractures in patients over 60 years old using computed tomography scans showing the entire thoraco-lumbar spine

  • Julio UrrutiaEmail author
  • Pablo Besa
  • Cristobal Piza
Orthopaedic Surgery



Vertebral compression fractures (VCF) are frequently asymptomatic; incidental diagnosis is a valuable opportunity to identify low bone mass and to start treatment. We aimed to determine the proportion of patients over 60 years old evaluated with chest plus abdominal and pelvic computed tomography (CT) scans, allowing visualization of the entire thoraco-lumbar spine, who incidentally present VCF.

Materials and methods

We evaluated 300 patients over 60 years old who under went chest plus abdominal and pelvic CT scans. Using sagittal reformats we looked for VCF using the method described by Genant. Accordingly, VCF were classified into mild, moderate or severe. We also determined the percentage of VCF described in the radiological reports.


In our cohort [median age 72.5 years (61–94)], 45.67% were males and 54.33% were females. In total, 43 patients (14.33%) had at least one VCF; 32 (10.67%) had one VCF, whereas 11 (3.67%) exhibited multiple VCF, with a total of 84 fractures. 42 were mild fractures, 29 moderate and 13 severe. The proportion of males (13.87%) and females (14.72%) with VCF was not different (p = 0.83). Patients with VCF were older than those without VCF (p < 0.01). Only age but not sex was independently associated with the presence of VCF. Only 32.56% of patients we identified as having a VCF had a description in their report (14 patients).


An important proportion of patients over 60 years old evaluated with chest plus abdominal and pelvic CT scans present VCF. The reporting of these VCF is insufficient; radiologists and clinicians should include their detection in their search pattern.


Vertebral compression fractures Opportunistic screening Osteoporosis Computed tomography scans Sagittal reformations Spinal fractures 



There is no funding source.

Compliance with ethical standards

Conflict of interest

Author Julio Urrutia, co-author Pablo Besa, and co-author Cristobal Piza declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.


  1. 1.
    Christiansen BA, Bouxsein ML (2010) Biomechanics of vertebral fractures and the vertebral fracture cascade. Curr Osteoporos Rep 8:198–204. CrossRefPubMedGoogle Scholar
  2. 2.
    Delmas PD, Genant HK, Crans GG, Stock JL, Wong M, Siris E, Adachi JD (2003) Severity of prevalent vertebral fractures and the risk of subsequent vertebral and nonvertebral fractures: results from the MORE trial. Bone 33:522–532CrossRefGoogle Scholar
  3. 3.
    Klotzbuecher CM, Ross PD, Landsman PB, Abbott TA IIIrd, Berger M (2000) Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res 15:721–739. CrossRefPubMedGoogle Scholar
  4. 4.
    Lindsay R, Silverman SL, Cooper C, Hanley DA, Barton I, Broy SB, Licata A, Benhamou L, Geusens P, Flowers K, Stracke H, Seeman E (2001) Risk of new vertebral fracture in the year following a fracture. JAMA 285:320–323CrossRefGoogle Scholar
  5. 5.
    Longo UG, Loppini M, Denaro L, Maffulli N, Denaro V (2012) Osteoporotic vertebral fractures: current concepts of conservative care. Br Med Bull 102:171–189. CrossRefPubMedGoogle Scholar
  6. 6.
    Ross PD (1997) Clinical consequences of vertebral fractures. Am J Med 103:30S–42S; (discussion 42S–43S)CrossRefGoogle Scholar
  7. 7.
    Cataldi V, Laporta T, Sverzellati N, De Filippo M, Zompatori M (2008) Detection of incidental vertebral fractures on routine lateral chest radiographs. Radiol Med 113:968–977. CrossRefPubMedGoogle Scholar
  8. 8.
    Kim N, Rowe BH, Raymond G, Jen H, Colman I, Jackson SA, Siminoski KG, Chahal AM, Folk D, Majumdar SR (2004) Underreporting of vertebral fractures on routine chest radiography. AJR Am J Roentgenol 182:297–300. CrossRefPubMedGoogle Scholar
  9. 9.
    Majumdar SR, Kim N, Colman I, Chahal AM, Raymond G, Jen H, Siminoski KG, Hanley DA, Rowe BH (2005) Incidental vertebral fractures discovered with chest radiography in the emergency department: prevalence, recognition, and osteoporosis management in a cohort of elderly patients. Arch Intern Med 165:905–909. CrossRefPubMedGoogle Scholar
  10. 10.
    Mui LW, Haramati LB, Alterman DD, Haramati N, Zelefsky MN, Hamerman D (2003) Evaluation of vertebral fractures on lateral chest radiographs of inner-city postmenopausal women. Calcif Tissue Int 73:550–554. CrossRefPubMedGoogle Scholar
  11. 11.
    Gehlbach SH, Bigelow C, Heimisdottir M, May S, Walker M, Kirkwood JR (2000) Recognition of vertebral fracture in a clinical setting. Osteoporos Int 11:577–582. CrossRefPubMedGoogle Scholar
  12. 12.
    Crandall CJ, Newberry SJ, Diamant A, Lim YW, Gellad WF, Booth MJ, Motala A, Shekelle PG (2014) Comparative effectiveness of pharmacologic treatments to prevent fractures: an updated systematic review. Ann Intern Med 161:711–723. CrossRefPubMedGoogle Scholar
  13. 13.
    Chassang M, Grimaud A, Cucchi JM, Novellas S, Amoretti N, Chevallier P, Bruneton JN (2007) Can low-dose computed tomographic scan of the spine replace conventional radiography? An evaluation based on imaging myelomas, bone metastases, and fractures from osteoporosis. Clin Imaging 31:225–227. CrossRefPubMedGoogle Scholar
  14. 14.
    Bauer JS, Muller D, Ambekar A, Dobritz M, Matsuura M, Eckstein F, Rummeny EJ, Link TM (2006) Detection of osteoporotic vertebral fractures using multidetector CT. Osteoporos Int 17:608–615. CrossRefPubMedGoogle Scholar
  15. 15.
    Woo EK, Mansoubi H, Alyas F (2008) Incidental vertebral fractures on multidetector CT images of the chest: prevalence and recognition. Clin Radiol 63:160–164. CrossRefPubMedGoogle Scholar
  16. 16.
    Williams AL, Al-Busaidi A, Sparrow PJ, Adams JE, Whitehouse RW (2009) Under-reporting of osteoporotic vertebral fractures on computed tomography. Eur J Radiol 69:179–183. CrossRefPubMedGoogle Scholar
  17. 17.
    Muller D, Bauer JS, Zeile M, Rummeny EJ, Link TM (2008) Significance of sagittal reformations in routine thoracic and abdominal multislice CT studies for detecting osteoporotic fractures and other spine abnormalities. Eur Radiol 18:1696–1702. CrossRefPubMedGoogle Scholar
  18. 18.
    Carberry GA, Pooler BD, Binkley N, Lauder TB, Bruce RJ, Pickhardt PJ (2013) Unreported vertebral body compression fractures at abdominal multidetector CT. Radiology 268:120–126. CrossRefPubMedGoogle Scholar
  19. 19.
    Bartalena T, Giannelli G, Rinaldi MF, Rimondi E, Rinaldi G, Sverzellati N, Gavelli G (2009) Prevalence of thoracolumbar vertebral fractures on multidetector CT: underreporting by radiologists. Eur J Radiol 69:555–559. CrossRefPubMedGoogle Scholar
  20. 20.
    Adams JE (2016) Opportunistic Identification of vertebral fractures. J Clin Densitom 19:54–62. CrossRefPubMedGoogle Scholar
  21. 21.
    Kubota T, Yamada K, Ito H, Kizu O, Nishimura T (2005) High-resolution imaging of the spine using multidetector-row computed tomography: differentiation between benign and malignant vertebral compression fractures. J Comput Assist Tomogr 29:712–719CrossRefGoogle Scholar
  22. 22.
    Genant HK, Wu CY, van Kuijk C, Nevitt MC (1993) Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 8:1137–1148. CrossRefPubMedGoogle Scholar
  23. 23.
    Grados F, Roux C, de Vernejoul MC, Utard G, Sebert JL, Fardellone P (2001) Comparison of four morphometric definitions and a semiquantitative consensus reading for assessing prevalent vertebral fractures. Osteoporos Int 12:716–722. CrossRefPubMedGoogle Scholar
  24. 24.
    Oudkerk SF, de Jong PA, Attrach M, Luijkx T, Buckens CF, Mali WP, Oner FC, Resnick DL, Vliegenthart R, Verlaan JJ (2017) Diagnosis of diffuse idiopathic skeletal hyperostosis with chest computed tomography: inter-observer agreement. Eur Radiol 27:188–194. CrossRefPubMedGoogle Scholar
  25. 25.
    Melton LJ IIIrd, Kan SH, Frye MA, Wahner HW, O’Fallon WM, Riggs BL (1989) Epidemiology of vertebral fractures in women. Am J Epidemiol 129:1000–1011CrossRefGoogle Scholar
  26. 26.
    Grazio S, Korsic M, Jajic I (2005) Prevalence of vertebral fractures in an urban population in Croatia aged fifty and older. Wien Klin Wochenschr 117:42–47CrossRefGoogle Scholar
  27. 27.
    Davies KM, Stegman MR, Heaney RP, Recker RR (1996) Prevalence and severity of vertebral fracture: the Saunders county bone quality study. Osteoporos Int 6:160–165CrossRefGoogle Scholar
  28. 28.
    Jones G, White C, Nguyen T, Sambrook PN, Kelly PJ, Eisman JA (1996) Prevalent vertebral deformities: relationship to bone mineral density and spinal osteophytosis in elderly men and women. Osteoporos Int 6:233–239CrossRefGoogle Scholar
  29. 29.
    Olmez N, Kaya T, Gunaydin R, Vidinli BD, Erdogan N, Memis A (2005) Intra- and interobserver variability of Kleerekoper’s method in vertebral fracture assessment. Clin Rheumatol 24:215–218. CrossRefPubMedGoogle Scholar
  30. 30.
    Oliver M, Inaba K, Tang A, Branco BC, Barmparas G, Schnuriger B, Lustenberger T, Demetriades D (2012) The changing epidemiology of spinal trauma: a 13-year review from a level I trauma centre. Injury 43:1296–1300. CrossRefPubMedGoogle Scholar
  31. 31.
    Graffy PM, Lee SJ, Ziemlewicz TJ, Pickhardt PJ (2017) Prevalence of vertebral compression fractures on routine CT scans according to L1 trabecular attenuation: determining relevant thresholds for opportunistic osteoporosis screening. AJR Am J Roentgenol 209:491–496. CrossRefPubMedGoogle Scholar
  32. 32.
    Mazieres B (2013) Diffuse idiopathic skeletal hyperostosis (Forestier–Rotes–Querol disease): What’s new? Joint Bone Spine 80:466–470. CrossRefPubMedGoogle Scholar
  33. 33.
    Delmas PD, van de Langerijt L, Watts NB, Eastell R, Genant H, Grauer A, Cahall DL, Group IS (2005) Underdiagnosis of vertebral fractures is a worldwide problem: the IMPACT study. J Bone Miner Res 20:557–563. CrossRefPubMedGoogle Scholar
  34. 34.
    Fink HA, Milavetz DL, Palermo L, Nevitt MC, Cauley JA, Genant HK, Black DM, Ensrud KE, Fracture Intervention Trial Research G (2005) What proportion of incident radiographic vertebral deformities is clinically diagnosed and vice versa? J Bone Miner Res 20:1216–1222. CrossRefPubMedGoogle Scholar
  35. 35.
    Grigoryan M, Guermazi A, Roemer FW, Delmas PD, Genant HK (2003) Recognizing and reporting osteoporotic vertebral fractures. Eur Spine J 12 Suppl 2:S104–S112. CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Akesson K, Marsh D, Mitchell PJ, McLellan AR, Stenmark J, Pierroz DD, Kyer C, Cooper C, Group IOFFW (2013) Capture the fracture: a best practice framework and global campaign to break the fragility fracture cycle. Osteoporos Int 24:2135–2152. CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Schröder G, Knauerhase A, Willenberg HS, Kundt G, Wendig D, Schober HS (2017) Biomechanics of the osteoporotic spine, pain, and principles of training. Arch Orthop Trauma Surg 137(5):617–624. CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Orthopaedic Surgery, School of MedicinePontificia Universidad Catolica de ChileSantiagoChile

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