scholarly journals Opportunistic diagnosis of osteoporotic vertebral fractures on standard imaging performed for alternative indications

BJR|Open ◽  
2021 ◽  
Author(s):  
Shane W. Davy ◽  
Diane Bergin
Keyword(s):  
Vertebral Fractures ◽  
Imaging Modality ◽  
Osteoporotic Fractures ◽  
Clinical Suspicion ◽  
Clinical Indication ◽  
X Rays ◽  
X Ray ◽  
Osteoporotic Vertebral Fractures ◽  
Increased Risk ◽  
Bone Scans

Osteoporotic vertebral fractures (VF) are the most common type of osteoporotic fracture. Patients with VF are at increased risk of hip fractures or additional VFs, both of which contribute to patient morbidity and mortality. Early diagnosis of VFs is essential so patients can be prescribed appropriate medical therapy. Most patients with clinical suspicion for VF have an X-ray of the spine. Many VFs are invisible on X-ray and require further imaging. CT can provide excellent bony detail but uses high doses of ionising radiation. MRI provides excellent soft tissue detail and can distinguish old from new fractures in addition to differentiating osteoporotic VFs from other causes of back pain. Bone scans have a limited role due to poor specificity. The literature suggests that radiologists frequently miss or do not report VFs when imaging is requested for an alternative clinical indication and when there is no clinical suspicion of VF. Common examples include failure to identify VFs on lateral chest x-rays, sagittal reformats of CT thorax and abdomen, lateral localizers on MRI and scout views on CT. Failure to diagnose a VF is a missed opportunity to improve management of osteoporosis and reduce risk of further fractures. This article discusses the role of radiographs, CT, MRI and Bone Scintigraphy in the assessment and recognition of osteoporotic fractures. This article focuses on opportunistic diagnosis of vertebral fractures on imaging studies that are performed for other clinical indications. It does not discuss use of DXA which is a specific imaging modality for osteoporosis.

scholarly journals POS0016 THE EVALUATION OF FUNCTIONAL ABILITIES OF PATIENTS WITH OSTEOPOROTIC VERTEBRAL FRACTURES AS A BASIS FOR REHABILITATION PROGRAMS DEVELOPING

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 209.2-210
Author(s):  
L. Marchenkova ◽  
V. Vasileva ◽  
M. Eryomushkin
Keyword(s):  
Muscle Strength ◽  
Vertebral Fractures ◽  
Trunk Muscles ◽  
Control Group ◽  
Study Group ◽  
Primary Osteoporosis ◽  
X Rays ◽  
Functional Abilities ◽  
Rehabilitation Programs ◽  
Osteoporotic Vertebral Fractures

Background:Due to the demand for special rehabilitation programs for patients with osteoporotic vertebral fractures (VFs), it is of interest to study the functional abilities of those patients. The scientific hypothesis suggests that osteoporotic VFs would cause muscle weakness, muscle dysfunction and conditional disturbances.Objectives:to estimate muscle strength, motor function and coordination disorders in patients with VFs in the setting of systemic osteoporosis as a basis for rehabilitation programs developing.Methods:120 patients aged 43−80 with primary osteoporosis were enrolled. Study group comprised of 60 subjects (56 women, 4 men) with at least 1 VF confirmed by X-rays. Control group included 60 subjects (56 women, 4 men) with osteoporosis but without any osteoporotic fracture. The examination program included back muscles tenzodynamometry, balance tests and stabilometry.Results:Muscle strength deficiency was estimated in study group in trunk flexors (TF) — 40.9% and in trunk extensors (TE) — 18.1% with an adequate function of the left lateral flexors (LLF) and in right lateral flexors (RLF). Patients with VFs had the lower muscle strength vs controls of TE (15.64±9.8 vs 27.73±9.9 kg, p=0.00002), TF (14.61±8.98 vs 21.28±8.38 kg, p=0.0006), LLF (13.10±7.2 vs 24.06±8.9 kg, p=0.005) and RLF 13.44±7.43 vs 24.26±7.65 kg, p=0.0003). Patients with VFs lose their balance faster during one-leg-standing test with open eyes (5.0 [1.0; 10.0] vs 7.5 [5.0; 10.5] sec in control group, p=0.03) and with closed eyes (2.0 [0; 3.0] vs 3.5 [3.0; 5.0] sec, p=0.04). Fukuda-Unterberger test showed greater side dislocation in study group — 40° [25; 45] vs controls 30° [10; 45], (p=0.02). According to stabilometry study group was characterized vs control group by lower balance coefficient with open eyes (77.2±7.6 vs 85.7±9.4%, p=0.002) and with closed eyes (67.1±9.8 vs 73.4±9.9%, p=0.03), greater sagittal displacement (6.8 [2.1; 37.7] vs 4.8 [1.8; 10.7] mm, p=0.025) and deviation in the saggital plane (1.2 [-1.07; 1.5] vs -1.2 [-1.5; 1.2] mm, p=0.01), and also less pressure center velocity (9.51±4.4 vs 7.1±2.7 mm/sec, р=0.009).Conclusion:Osteoporotic VFs are associated with reduction of trunk muscles strength and negatively affect static and dynamic balance function that should be taken into account when developing rehabilitation programs for these patients.Disclosure of Interests:None declared.

scholarly journals Differentiation of Traumatic Osteoporotic and Non-Osteoporotic Vertebral AO A3 Fractures by Analyzing the Posterior Edge Morphology—A Retrospective Feasibility Study

2020 ◽  
Vol 9 (12) ◽  
pp. 3910
Author(s):  
Thomas Vordemvenne ◽  
Dirk Wähnert ◽  
Sebastian Klingebiel ◽  
Jens Lohmaier ◽  
René Hartensuer ◽  
...  
Keyword(s):  
Vertebral Body ◽  
Vertebral Fractures ◽  
Osteoporotic Fractures ◽  
Hounsfield Units ◽  
Posterior Edge ◽  
Simple Method ◽  
Dorsal Edge ◽  
Osteoporotic Vertebral Fractures ◽  
Edge Fragment ◽  
Edge Morphology

Background: Differentiation between traumatic osteoporotic and non-osteoporotic vertebral fractures is crucial for optimal therapy planning. We postulated that the morphology of the posterior edge of the cranial fragment of A3 vertebral fractures is different in these entities. Therefore, the purpose of this study is to develop and validate a simple method to differentiate between osteoporotic and non-osteoporotic A3 vertebral fractures by morphological analysis. Methods: A total of 86 computer tomography scans of AO Type A3 (cranial burst) vertebral body fractures (52 non-osteoporotic, 34 osteoporotic) were included in this retrospective study. Posterior edge morphology was analyzed using the sagittal paramedian slice with the most prominent shaped bulging. Later, the degree of bulging of the posterior edge fragment was quantified using a geometric approach. Additionally, the Hounsfield units of the broken vertebral body, the vertebra above, and the vertebra below the fracture were measured. Results: We found significant differences in the extent of bulging comparing osteoporotic and non-osteoporotic fractures in our cohort. Using the presented method, sensitivity was 100%, specificity was 96%. The positive predictive value (PPV) was 94%. In contrast, by evaluating the Hounsfield units, sensitivity was 94%, specificity 94% and the PPV was 91%. Conclusions: Our method of analysis of the bulging of the dorsal edge fragment in traumatic cranial burst fractures cases allows, in our cases, a simple and valid differentiation between osteoporotic and non-osteoporotic fractures. Further validation in a larger sample, including dual-energy X-ray absorptiometry (DXA) measurements, is necessary.

Increased risk of osteoporotic fractures in patients with systemic sclerosis: a nationwide population-based study

2014 ◽  
Vol 74 (7) ◽  
pp. 1347-1352 ◽  
Author(s):  
Chien-Chih Lai ◽  
Shu-Hung Wang ◽  
Wei-Sheng Chen ◽  
Chia-Jen Liu ◽  
Tzeng-Ji Chen ◽  
...  
Keyword(s):  
Systemic Sclerosis ◽  
Incidence Rate ◽  
Hip Fractures ◽  
Vertebral Fractures ◽  
Cox Regression ◽  
Osteoporotic Fractures ◽  
Population Based ◽  
High Dose ◽  
Increased Risk ◽  
Rate Ratios

ObjectivesTo identify the incidence rate (IR) and risk factors of osteoporotic fractures (OFs) among systemic sclerosis (SSc) patients.MethodsA cohort study was conducted using the Taiwan National Health Insurance database. Patients with SSc and respective age- and gender-matched controls without SSc were enrolled. The primary endpoint was the first occurrence of OF. The Cox proportional hazard model was used to investigate the risk factor of OFs in the SSc cohort.ResultsAmong 1712 SSc patients (77.8% female, mean age 50.3 years) with a median follow-up of 5.2 years, 54 patients developed vertebral fractures, 17 patients developed hip fractures, and 7 patients developed radius fractures (IR: 6.99, 2.18 and 0.90 per 1000 person-years, respectively). Compared with the controls, the incidence rate ratios (IRRs) (95% CIs) among SSc patients were 1.78 (1.30 to 2.39, p<0.001) for vertebral fractures and 1.89 (1.05 to 3.22, p=0.026) for hip fractures. The IRRs for overall OFs were 1.74 (1.32 to 2.27, p<0.001) for women and 1.06 (0.33 to 2.66, p=0.856) for men. The SSc patients experienced hip fractures at a younger age (67.2 vs 75.2 years, p=0.005), and had a higher 1-year mortality rate (13% vs 3%, p=0.006) of vertebral fractures than did the controls. Multivariable Cox regression analyses indicated that older age, being female, using daily prednisolone equivalent to >7.5 mg, and bowel dysmotility treated with intravenous metoclopramide are associated with OF.ConclusionsSSc patients had a high IR of vertebral and hip fractures, especially those who were female, older, used a high dose of corticosteroid or experienced bowel dysmotility.

Vertebral morphometry by dual-energy X-ray absorptiometry (DXA) for osteoporotic vertebral fractures assessment (VFA)

2012 ◽  
Vol 117 (8) ◽  
pp. 1374-1385 ◽  
Author(s):  
D. Diacinti ◽  
G. Guglielmi ◽  
D. Pisani ◽  
D. Diacinti ◽  
R. Argirò ◽  
...  
Keyword(s):  
Vertebral Fractures ◽  
Dual Energy ◽  
Vertebral Morphometry ◽  
X Ray ◽  
Osteoporotic Vertebral Fractures

scholarly journals Automatic projection image registration for nanoscale X-ray tomographic reconstruction

2018 ◽  
Vol 25 (6) ◽  
pp. 1819-1826 ◽  
Author(s):  
Haiyan Yu ◽  
Sihao Xia ◽  
Chenxi Wei ◽  
Yuwei Mao ◽  
Daniel Larsson ◽  
...  
Keyword(s):  
Spatial Resolution ◽  
Imaging Modality ◽  
Energy State ◽  
Tomographic Reconstruction ◽  
Three Dimensional ◽  
Visual Assessment ◽  
Superior Performance ◽  
X Rays ◽  
X Ray ◽  
Projection Images

Novel developments in X-ray sources, optics and detectors have significantly advanced the capability of X-ray microscopy at the nanoscale. Depending on the imaging modality and the photon energy, state-of-the-art X-ray microscopes are routinely operated at a spatial resolution of tens of nanometres for hard X-rays or ∼10 nm for soft X-rays. The improvement in spatial resolution, however, has led to challenges in the tomographic reconstruction due to the fact that the imperfections of the mechanical system become clearly detectable in the projection images. Without proper registration of the projection images, a severe point spread function will be introduced into the tomographic reconstructions, causing the reduction of the three-dimensional (3D) spatial resolution as well as the enhancement of image artifacts. Here the development of a method that iteratively performs registration of the experimentally measured projection images to those that are numerically calculated by reprojecting the 3D matrix in the corresponding viewing angles is shown. Multiple algorithms are implemented to conduct the registration, which corrects the translational and/or the rotational errors. A sequence that offers a superior performance is presented and discussed. Going beyond the visual assessment of the reconstruction results, the morphological quantification of a battery electrode particle that has gone through substantial cycling is investigated. The results show that the presented method has led to a better quality tomographic reconstruction, which, subsequently, promotes the fidelity in the quantification of the sample morphology.

Low incidence of vertebral fractures in early spondyloarthritis: 5-year prospective data of the DESIR cohort

2018 ◽  
Vol 78 (1) ◽  
pp. 60-65 ◽  
Author(s):  
Julie Sahuguet ◽  
Jacques Fechtenbaum ◽  
Anna Molto ◽  
Adrien Etcheto ◽  
Clementina López-Medina ◽  
...  
Keyword(s):  
Thoracic Spine ◽  
Vertebral Fractures ◽  
Inflammatory Back Pain ◽  
X Rays ◽  
Prospective Data ◽  
Increased Risk ◽  
Low Incidence ◽  
Low Prevalence ◽  
Central Facility ◽  
Actual Prevalence

ObjectivesAn increased risk of vertebral fractures (VFs) has been reported in spondyloarthritis (SpA). Our hypothesis is that the prevalence of VFs is lower than reported in previous studies, especially in early SpA. This study aimed at assessing the incidence of radiographical VFs over 5 years in early axial SpA.MethodsThe DESIR (DEvenir des Spondylarthropathies Indifférenciées Récentes) cohort, which included patients with inflammatory back pain highly suggestive of axial SpA, is the basis of this study. All radiographs of the DESIR cohort had been assessed at a central facility, by one investigator specialised in the field of the diagnosis of VFs according to Genant’s method. We assessed the prevalence and incidence of VFs and vertebral deformities at baseline and over 5 years.ResultsFive-year X-rays were available for 432 patients (mean age 34.3±8.7 years, 53% women). Diagnosis of VF was doubtful and needed adjudication for 19 patients (4.4%). 13 patients had prevalent VFs (3.0%) which were located at the thoracic spine (12 were grade 1). At 5 years, five patients had an incident VF (1.15%); seven vertebrae were fractured, mostly located at the thoracic spine (n=6/7), and of grade 1 (n=6/7).ConclusionIn the DESIR cohort, a population of early SpA, we found a low prevalence and incidence of VFs (3.0% and 1.15 %), respectively. This confirms our hypothesis that the actual prevalence and incidence of VFvertebral fracture in SpA is lower than that reported in the previous studies.

Percutaneous Transpedicular Vertebroplasty versus Conservative Management in Osteoporotic Vertebral Fractures

2016 ◽  
Vol 695 ◽  
pp. 205-211
Author(s):  
Iulian Popa ◽  
Petre Matusz ◽  
Diana Andrei ◽  
Mihai Mardare ◽  
Dan V. Poenaru
Keyword(s):  
Conservative Management ◽  
Vertebral Fractures ◽  
Percutaneous Vertebroplasty ◽  
Osteoporotic Fractures ◽  
Control Group ◽  
First Year ◽  
Lung Capacity ◽  
Osteoporotic Vertebral Fractures ◽  
Group 2 ◽  
Group 1

Osteoporotic vertebral fractures can lead to late collapse which often cause kyphotic spinal deformity, persistent back pain, decreased lung capacity, increased fracture risk and increased mortality. The purpose of our study is to compare the efficacy and safety of vertebroplasty against conservative management of osteoporotic vertebral fractures without neurologic symptoms. A total of 66 patients with recent OVF on MRI examination were included in the study. All patients were admitted from September 2009 to September 2012. The cohort was divided in two groups: first study group consisted of 33 prospectively followed consecutive patients who suffered 40 vertebral osteoporotic fractures treated by percutaneous vertebroplasty (Group 1), and the control group consisted of 33 patients who suffered 41 vertebral osteoporotic fractures treated conservatory because they reffused vertebroplasty (Group 2). Vertebroplasty with PMMA was performed in 30 patients on 39 VBs, including four thoracic vertebras, 27 vertebras of the thoracolumbar jonction and 8 lumbar vertebras. In the Group 2 were included 30 patients with 39 OVFs (four thoracic vertebras, 23 vertebras of the thoracolumbar junction and 11 lumbar vertebras). In our study on OVF, vertebroplasty delivered superior clinical and radiological outcomes over the first year from intervention when compared to consevative treatment of patients with osteoporotic compression fractures without neurological deficit.

scholarly journals Osteoporotic fractures in rheumatoid arthritis patients in Argentina: a matched retrospective cohort study

2021 ◽  
Vol 61 (1) ◽  
Author(s):  
Florencia S. Pierini ◽  
Martin Brom ◽  
Marina Scolnik ◽  
Valeria Scaglioni ◽  
Javier E. Rosa ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Regression Analysis ◽  
Vertebral Fractures ◽  
Index Date ◽  
Cox Regression ◽  
Osteoporotic Fractures ◽  
Fracture Incidence ◽  
University Hospital ◽  
Cox Regression Analysis ◽  
Increased Risk

Abstract Background To compare the incidence of osteoporotic fractures in patients with rheumatoid arthritis (RA) with matched controls from a university hospital. Methods Consecutive RA patients (n = 100) were matched (age and sex) with controls (1:2). The follow-up period began at the index date, defined as the date of diagnosis for RA patients and the date of the first medical claim at the Health Management Organization (HMO) for non-RA patients. Fracture incidence rates per 1000 persons-years (PY) for distinct types of fractures were calculated. Multivariate cox regression analysis was performed to identify factors associated with fractures. Results One hundred RA patients were followed for a total of 975.1 patients-years and 200 controls for 1485.7 patients-years. No difference was found in the overall fracture incidence rate per 1000 PY between RA and controls (19.5, 95% CI 12.7–28.6 vs 12.1, 95% CI 7.7–18.7, p = 0.07). In the Cox regression analysis, only age (HR 1.06, 95% CI 1.02–1.11, p = 0.006) and history of a prior fracture (HR 9.85, 95% CI 2.97–32.64, p <  0.001) were associated with fractures after the index date. The stratified analysis of the fractures by location showed that only the vertebral fractures were more frequent in RA patients compared with controls (12.9 per 1000 PY, 95% CI 8.9–25.8, vs. 3.4, 95% CI 1.4–8.1, respectively, p = 0.01). Conclusion Patients with RA didn’t show an overall increased risk of osteoporotic fractures compared with matched controls, but vertebral fractures were more frequently observed in patients with RA.

New Ultrasound-Based Methods for Early Osteoporosis Diagnosis and Fracture Risk Estimation

2014 ◽  
Vol 4 (2) ◽  
pp. 24-38
Author(s):  
Sergio Casciaro ◽  
Maria Daniela Renna ◽  
Paola Pisani ◽  
Antonio Greco ◽  
Francesco Conversano ◽  
...  
Keyword(s):  
Risk Estimation ◽  
Osteoporotic Fractures ◽  
Economic Costs ◽  
Gold Standard Method ◽  
Treatment Of Osteoporosis ◽  
X Ray ◽  
Non Invasive ◽  
Osteoporosis Diagnosis ◽  
Increased Risk ◽  
The Impact

Osteoporosis is the most common disorder of bone metabolism. The main consequence of this disease is the increased risk of fracture. Osteoporotic fractures represent a serious problem in terms of social and economic costs. Then, there is a strong need for the assessment of the best practices in prevention and treatment of osteoporosis. Dual X-ray absorptiometry (DXA) represents the current “gold standard” method for osteoporosis diagnosis. However, DXA cannot be employed for population mass screenings, because of required exposition to ionizing radiation and high management costs. The aim of this paper was to review the currently available techniques for osteoporosis diagnosis and also to illustrate the feasibility of an innovative quick, cheap and non-invasive ultrasound-based methodology. The results recently published by the authors' research group suggest that the proposed approach has the potential for routine application in early diagnosis, which is the key to resize the impact of osteoporosis on healthcare systems.

scholarly journals A common polymorphism in the 5'-untranslated region of the aromatase gene influences bone mass and fracture risk

2004 ◽  
pp. 699-704 ◽  
Author(s):  
MT Zarrabeitia ◽  
JL Hernandez ◽  
C Valero ◽  
AL Zarrabeitia ◽  
M Garcia-Unzueta ◽  
...  
Keyword(s):  
Bone Mass ◽  
Postmenopausal Women ◽  
Vertebral Fractures ◽  
Untranslated Region ◽  
Mineral Density ◽  
Peripheral Tissues ◽  
Taq Polymerase ◽  
Aromatase Gene ◽  
Osteoporotic Vertebral Fractures ◽  
Increased Risk

OBJECTIVE: The aromatization of androgenic precursors in peripheral tissues, including bone, is the main source of estrogens after the menopause. CYP19, the gene encoding aromatase, has a long 5'-untranslated region with several variants of exon I and specific promoters. The aim of this study was to investigate the possible relationship between a common biallelic (C/G) polymorphism located on exon I.2 and bone mineral density (BMD). DESIGN: This was designed to be an association study between CYP19 polymorphism and BMD and the risk of vertebral fractures in women. METHODS: DNA was extracted from the peripheral blood of 299 women (116 premenopausal and 183 postmenopausal). CYP19 alleles were identified by a method based on the exonuclease activity of Taq-polymerase. BMD was determined by dual-energy absorptiometry. RESULTS: In premenopausal women there were no genotype-related differences in BMD. However, postmenopausal women with the CC genotype had lower spine and hip BMD than those with the GG genotype. The association between CYP19 genotypes and BMD was independent of other variables, such as age, height, body weight, calcium intake or years since menopause. The CC genotype was also associated with an increased risk of osteoporotic vertebral fractures (odds ratio 2.0; P=0.03). Serum levels of estrone and estradiol were similar in women with CC and GG alleles. CONCLUSIONS: A common biallelic polymorphism in the 5'-untranslated region of the CYP19-aromatase gene was associated with significant differences in bone mass and the risk of vertebral fractures in postmenopausal women. Given the frequency of allelic variants, genotype-related differences appear to be important from the perspective of the individual as well as the general population. Further studies are needed to elucidate underlying mechanisms that may be dependent on differences in estrogen bioactivity at the bone tissue level.

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