Bone Abstracts

Objective: To emphasize the clinical importance, and quantify the degree of underreporting of vertebral fractures (VF) with and without edema on spinal magnetic resonance (MR) imaging.

Methods: All spinal MR images obtained for patients ≥45 years, hospitalized from 1/6/2014 to 31/12/2015 at a single tertiary-care institution, were retrospectively reviewed to identify prevalent VFs. VF and fracture severity were classified using Genant’s method. Data regarding VF diagnosis, dual energy X-ray absorptiometry (DXA) imaging, and initiation of osteoporosis treatment were extracted from each patient’s MR report and medical record.

Results: Images were reviewed from 1040 patients (567 women, 55%). Mean age was 61.3 years (range: 45–93 years). 265 patients (25%) were shown to have VFs, 161 of which were single fractures (61%). VF was officially reported for only 89 patients (34%). Twenty-eight patients with reported VF also had MR evidence of bone marrow edema, however edema was documented for only half of the patients (14/28). Among 176 patients with unreported VFs, a total of 247 fractures were identified (224 mild fractures (91%), 20 moderate fractures (8%), three severe fractures (1%)). Of the 89 patients with VF, only 20 (23%) were subsequently referred for DXA, and only 49 (55%) had VF mentioned among their discharge diagnoses. Only 28 cases (31%) were prescribed pharmacologic treatment for osteoporosis (e.g. antiresorptive agents) when discharged. Of the 28 patients whose VFs were accompanied by bone marrow edema, only 6 had a subsequent DXA, and 14 were discharged on osteoporosis therapy.

Conclusion: We found that VFs are underreported on routine spinal MR imaging, especially mild fractures and fractures with edema. For reported fractures, significant gaps still exist in subsequent osteoporosis evaluation and treatment. Timely reporting of such fractures, as well as recognition of appropriate next steps in treatment should be emphasized to ensure the comprehensive care of patients.