title: Underdiagnosis of vertebral fractures is a worldwide problem: the IMPACT study.
abstract: Accurate radiographic diagnosis of vertebral fractures is important. This multicenter, multinational study assessed radiographic diagnoses of vertebral fracture in 2451 postmenopausal women with osteoporosis. Comparison between local and central readings yielded a false-negative rate of 34%. Underdiagnosis of vertebral fracture is a worldwide problem.
  
  
  BACKGROUND
  Vertebral fractures are the most common complication of osteoporosis. Although they are associated with significant morbidity, they frequently do not come to clinical attention. Accurate radiographic diagnosis is important.
  
  
  METHODS
  In a multicenter, multinational prospective study (the IMPACT trial), the accuracy of radiographic diagnosis of vertebral fracture was evaluated in postmenopausal women 65-80 years of age newly diagnosed with osteoporosis (based on BMD measurement). Lateral radiographs of the thoracolumbar spine were evaluated for identification of vertebral fractures, first locally and subsequently at a central reading center, using a validated semiquantitative method. False-positive and false-negative rates were calculated based on adjudicated discrepancies between the initial interpretation at the local site and the subsequent central reading, considered the "reference standard."
  
  
  RESULTS
  Of 2451 women with an evaluable radiograph both centrally and locally, 789 (32%) had at least one vertebral fracture. Adjudicated discrepancies (n = 350 patients) between local and central readings because of undetected vertebral fracture (68%) or equivocal terminology in the local radiology report (32%) yielded a false-negative rate of 34%.
  
  
  CONCLUSIONS
  Underdiagnosis of vertebral fractures was observed in all geographic regions (false-negative rates: North America, 45.2%; Latin America, 46.5%; Europe/South Africa/Australia, 29.5%). The false-positive rate was 5% globally. Underdiagnosis of vertebral fracture is a worldwide problem attributable in part to a lack of radiographic detection, use of ambiguous terminology in the radiology report, or both. Efforts to improve accuracy and reduce variability in terminology and interpretation may increase the effectiveness of spinal radiography for detecting vertebral fractures in patients with osteoporosis.
authors.affiliation: INSERM Unit 403 and University Claude Bernard, Lyon, France. delmas@lyon.inserm.fr
authors.forename: Pierre D
authors.initials: PD
authors.lastname: Delmas
authors.forename: Lex
authors.initials: L
authors.lastname: van de Langerijt
authors.forename: Nelson B
authors.initials: NB
authors.lastname: Watts
authors.forename: Richard
authors.initials: R
authors.lastname: Eastell
authors.forename: Harry
authors.initials: H
authors.lastname: Genant
authors.forename: Andreas
authors.initials: A
authors.lastname: Grauer
authors.forename: David L
authors.initials: DL
authors.lastname: Cahall
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D015519:Bone Density; D005060:Europe; D005260:Female; D014943:Global Health; D006801:Humans; D007843:Latin America; D008159:Lumbar Vertebrae / Q000293:injuries; D009656:North America; D015663:Osteoporosis, Postmenopausal / Q000150:complications*; D011446:Prospective Studies; D011859:Radiography; D013019:South Africa; D016103:Spinal Fractures / Q000000981:diagnostic imaging* / Q000209:etiology; D013904:Thoracic Vertebrae / Q000293:injuries