Identifying osteoporotic vertebral fracture

Abstract

Osteoporosis per se is not a harmful disease. It is the sequela of osteoporosis and most particularly the occurrence of osteoporotic fracture that makes osteoporosis a serious medical condition. All of the preventative measures, investigations, treatment and research into osteoporosis have one primary goal and that is to prevent the occurrence of osteoporotic fracture. Vertebral fracture is by far and away the most prevalent osteoporotic fracture. The significance and diagnosis of vertebral fracture are discussed in this article.

Keywords: Vertebral fracture; computed tomography (CT); magnetic resonance imaging (MRI); metastases; osteoporosis; radiography.

Figure 1

Lateral radiograph showing vertebral fracture cascade with fractures of many contiguous or near contiguous vertebrae.

Figure 2

Lateral radiographs showing (A) normal thoracic and (B) normal lumbar vertebrae.

Figure 3

Difficult call. Distinguishing between physiological wedging of the T12, L1 and L2 vertebral bodies (arrows) and a mild fracture is difficult in this case. Anterior vertebral body height is not quite reduced to >20% of what you would normally expect it to be (given expected physiological wedging at this level). There is also short vertebral height of the L4 vertebral body (open arrow) in that the height is not reduced to more than 20% of what you would normally expect it to be at this level.

Figure 4

There is short vertebral height of all the lumbar vertebrae particularly L4 and L5 (arrows). There is also physiological wedging of L1 (open arrow).

Figure 5

Schematic diagram showing endplate impressions caused by (A) Scheuermann’s disease; (B) Schmorl’s node and (C) Cupid’s bow deformity.

Figure 6

There is a severe osteoporotic fracture of the T12 vertebral body (open arrow) with a mild osteoporotic fracture of the L1 vertebral body (arrow). There is a lumbar scoliosis with obliquity of the lower three lumbar vertebrae (*).

Figure 7

Schematic diagram of Genant semi-quantitative analysis of vertebral fracture severity.

Figure 8

Lateral thoracic spine radiograph. There is a severe fracture of the T11 vertebral body (arrow) with a moderate fracture of the T4 vertebral body (thick arrow).

Figure 9

Schematic diagram showing examples of reference point placement for quantitative morphometry.

Figure 10

Vertebral fracture assessment by DXA showing mild fracture of L1 vertebral body. DXA, dual energy X-ray absorptiometry.

Figure 11

T2-weighted sagittal MRI showing typical osteoporotic-type fracture of T12 vertebral body with preservation of some marrow fat and fluid filled cavity within vertebral body (closed arrow). There is a chronic fracture of the L3 vertebral body with fat filling the marrow cavity (open arrow). MRI, magnetic resonance imaging.