title: Underreported vertebral fractures in an Italian population: comparison of plain radiographs vs quantitative measurements.
abstract: OBJECTIVE
  Vertebral fractures (VFs) are the hallmark of osteoporosis and are responsible for almost 70,000 hospital admissions yearly, implying social costs and impaired quality of life for patients. In recent years, several techniques, both qualitative and quantitative, have been proposed for VF diagnosis, but a gold standard is not yet available and the visual semiquantitative (VSQ) assessment proposed by Genant remains the most validated. However, given the lack of a standardised method, in clinical practice, the diagnosis of VF is often missed, and patients are not correctly assessed. The aim of our study was to estimate the percentage of VFs not detected in clinical practice in italian population using the VSQ method and a new morphometric technique.
  
  
  METHODS
  In 283 postmenopausal women referred to our clinic for osteoporosis screening, we performed a clinical examination, plain spinal radiographs (for VSQ assessment) and digital computerised morphometry (DCM) to assess VFs. Bone density was measured using dual-energy X-ray absorptiometry (DXA).
  
  
  RESULTS
  Forty-seven percent of patients had a T score <-2.5 standard deviations (SD), and 35.2% were osteopenic, but no significant correlations between T score and grade or number of fractures were found. DCM identified VFs in 38.5% of patients versus 32.5% using the VSQ method. Overall, 280 VFs were detected by DCM and 236 by VSQ, whereas only 105 were recognised by the reports.
  
  
  CONCLUSIONS
  VFs went undetected in 55.5% according to the VSQ method on standard spinal radiographs. Therefore, the morphometric technique may be helpful when performed with the semiquantitative approach to improve recognition of VFs. However, other studies are needed to further validate the utility of this new morphometric technique in clinical practice.
authors.affiliation: Department of Internal Medicine - Metabolic Bone Disease Unit, University of Palermo, Via Del Vespro 147, 90143 Palermo, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Difede
authors.forename: G
authors.initials: G
authors.lastname: Scalzo
authors.forename: S
authors.initials: S
authors.lastname: Bucchieri
authors.forename: G
authors.initials: G
authors.lastname: Moretti
authors.forename: G
authors.initials: G
authors.lastname: Campisi
authors.forename: N
authors.initials: N
authors.lastname: Napoli
authors.forename: G
authors.initials: G
authors.lastname: Battista Rini
authors.forename: G
authors.initials: G
authors.lastname: Guglielmi
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008875:Middle Aged; D058866:Osteoporotic Fractures / Q000175:diagnosis / Q000000981:diagnostic imaging*; D011859:Radiography; D012680:Sensitivity and Specificity; D016103:Spinal Fractures / Q000175:diagnosis / Q000000981:diagnostic imaging*; D013131:Spine / Q000000981:diagnostic imaging