Vertebral fracture identification

Vertebral insufficiency fractures are important as they (1) may provide a source for patient symptoms, (2) provide indisputable evidence of weak bone, and (3) are usually the first osteoporotic fracture to occur. Vertebral fractures are usually diagnosed radiographically, and guidelines from the National Osteoporosis Foundation, International Osteoporosis Foundation, and International Society of Clinical Densitometry have suggested targeted screening for patients at risk of these subclinical fractures. The radiographic signs of vertebral body fracture are significant height loss±end plate fracture/cortical buckling. Vertebral fracture assessment by dual X-ray absorptiometry is increasingly used as is low-dose computed tomography (CT) examination. Magnetic resonance imaging (MRI) is the preferred method of evaluating acute vertebral fracture as many recent fractures may be incorrectly labeled radiographically. MRI is also excellent at distinguishing osteoporotic from metastatic fracture. Vertebral fracture severity is best graded using the Genant semiquantitative grading system. Morphometric analysis is helpful for serial longitudinal studies. Many osteoporotic fractures can be identified opportunistically during spine analysis on thoracoabdominal CT examinations performed for unrelated regions.