Detection of incidental vertebral fractures on routine lateral chest radiographs.
OBJECTIVE
This study sought to assess the usefulness of routine lateral chest radiographs for detecting unrecognised vertebral compression fractures.


METHODS
We prospectively selected outpatients without symptoms or risk factors for osteoporosis who underwent chest radiography for different clinical indications. Two independent reviewers with different levels of experience assessed the radiographs for vertebral deformities and graded them as mild, moderate and severe according to the semiquantitative Genant Index. The kappa statistic was used to evaluate interobserver agreement and verify the reproducibility of this method. The prevalence of vertebral fractures observed was compared with that recorded in the official radiology reports.


RESULTS
Our study involved 145 patients (73 men, 72 women; age range 50-86 years, mean age 67.5). Clinically relevant vertebral fractures were seen in 18/145 patients (12.4%). These were moderate in 13 patients and severe in five, and single in 12 patients and multiple in six. Interobserver agreement was very high (kappa=0.9). Only 11% of these fractures were recorded in the official reports.


CONCLUSIONS
Lateral chest radiographs could be effective for assessing previously unknown vertebral compression fractures in individuals without clinical evidence or risk factors for osteoporosis.
Cataldi
V
V
Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Parma, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 11, 43100 Parma, Italy. viviana.cataldi@gmail.com
Laporta
T
T
Sverzellati
N
N
De Filippo
M
M
Zompatori
M
M
D000368:Aged; D000369:Aged, 80 and over; D003627:Data Interpretation, Statistical; D005260:Female; D050815:Fractures, Compression / Q000000981:diagnostic imaging* / Q000453:epidemiology; D006801:Humans; D033162:Incidental Findings; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010024:Osteoporosis / Q000000981:diagnostic imaging*; D015995:Prevalence; D011446:Prospective Studies; D013902:Radiography, Thoracic; D016103:Spinal Fractures / Q000000981:diagnostic imaging* / Q000453:epidemiology; D011795:Surveys and Questionnaires; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging* / Q000293:injuries
Osteoporos Int. 2000;11(7):577-82
11069191
Calcif Tissue Int. 2003 Dec;73(6):550-4
14517719
J Bone Miner Res. 2000 Apr;15(4):721-39
10780864
Osteoporos Int. 2001;12(9):716-22
11605736
Ann Intern Med. 1991 Jun 1;114(11):919-23
2024857
J Bone Miner Res. 1993 Sep;8(9):1137-48
8237484
Arch Intern Med. 2004 May 24;164(10):1108-12
15159268
AJR Am J Roentgenol. 2004 Feb;182(2):297-300
14736649
Osteoporos Int. 1993 May;3(3):120-6
8481587
Lancet. 2002 May 18;359(9319):1761-7
12049882
Eur Radiol. 2007 Jun;17(6):1591-602
17131124
Clin Imaging. 2007 Jul-Aug;31(4):225-7
17599614
BMJ. 2006 Dec 16;333(7581):1251-6
17170416
Am J Geriatr Pharmacother. 2004 Jun;2(2):112-8
15555487
Lancet. 2002 Jun 1;359(9321):1929-36
12057569
J Gen Intern Med. 2006 Apr;21(4):352-6
16686811
Arch Intern Med. 2005 Apr 25;165(8):905-9
15851642
Osteoporos Int. 2005 Dec;16(12):1815-22
15981020