Incidence of new fractures in women with osteoporosis-induced vertebral fractures detected on routine lateral chest radiographs.
OBJECTIVE
Vertebral fractures represent one of the major complications of osteopororis. Diagnosis is followed by a pharmacological, interventional or surgical treatment. Up to day there are non practice guidelines for a screening evaluation of bone fractures in elderly and most of the fractures remain undiagnosed. We prospectively evaluated the prevalence of vertebral fractures on chest X-rays to determine the diagnostic and prognostic roles of chest X-ray in predicting new bone fractures 2 years after the initial radiogram.


METHODS
Between March 2004 and October 2005, 4,045 women underwent chest X-ray in our radiology department for any indication. We identified 166 women with the presence of at least one vertebral fracture. A questionnaire was administered to these women to collect information about diagnosis of osteoporosis, history of malignancy, systemic diseases, osteoporosis-inducing drugs and pharmacological, radiological or surgical treatment received.


RESULTS
Out of the 166 women (age 73+/-10.5 years) with vertebral fractures, we interviewed 101 women; 13 had died and 52 were not found. Most of the patients were on menopause (97.1%, 98/101) with an average age of menopause of 48,2 years (+/-6 years). Among the patients on menopause, 15,8% (16/101) had undergone hysterectomy. All patients received a diagnosis of osteoporosis, which was reached with a chest X-ray report in 23.7% (24/101) of cases. A new skeletal fracture occurred in 20.5% (5/27) of patients receiving treatment against a frequency of 20.8% (16/74) in patients without treatment. No statistical difference was found between the groups (p = 0.374).


CONCLUSIONS
Inadequate treatment may explain the lack of a substantial difference in new fracture risk between treated and untreated patients. For these reason we discuss about the evaluation of an adeguate therapeutic approaches in prevention of osteoporosis-induced fractures.
Occhicone
F
F
Department of Radiology, Interdisciplinary Center for Biomedical Research, University Campus Bio-Medico of Rome, Via Alvaro del Portillo 21, 00128 Rome, Italy. f.occhicone@unicampus.it
Quattrocchi
C C
CC
Napoli
N
N
Dell'Aia
P
P
D'Agostino
F
F
Pozzilli
P
P
Beomonte Zobel
B
B
D000368:Aged; D016009:Chi-Square Distribution; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data; D015994:Incidence; D010024:Osteoporosis / Q000150:complications* / Q000000981:diagnostic imaging* / Q000453:epidemiology; D011379:Prognosis; D013902:Radiography, Thoracic; D016103:Spinal Fractures / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology*; D011795:Surveys and Questionnaires