Osteoporotic Vertebral Fractures are Common in Hip Fracture Patients and are Under-recognized |
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| Authors: | Michael A. Kelly Eva McCabe Diane Bergin Stephen R. Kearns John P. McCabe Catherine Armstrong Fiona Heaney John J. Carey |
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| Affiliation: | 1. Department of Trauma and Orthopedic Surgery, Galway University Hospitals, Ireland;2. Department of Rheumatology, Galway University Hospitals, Ireland;3. School of Medicine, National University of Ireland, Galway, Ireland;4. Department of Radiology, Galway University Hospitals, Ireland;1. Exercise and Physical Activity Resource Center (EPARC), Department of Family Medicine and Public Health, University of California, San Diego (UCSD), La Jolla, CA, USA;2. UCSD Bone Densitometry School, La Jolla, CA, USA;3. Department of Psychiatry, UCSD, La Jolla, CA, USA;4. Sam and Rose Stein Institute for Research on Aging, UCSD, La Jolla, CA, USA;1. IRCCS Istituto Ortopedico Galeazzi, Milano, Italy;2. Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy;3. Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Milano, Italy;4. TECHNOLOGIC Srl, Torino, Italy;5. Sezione di Scienze Radiologiche, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli Studi di Palermo, Palermo, Italy;6. Former: Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, UO Medicina Nucleare, Milano, Italy;1. Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia;2. Department of Biomedical Engineering, University of Melbourne, Melbourne, Australia;3. Diabetes Service, Royal Women''s Hospital, Melbourne, Australia;4. Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Melbourne, Australia;5. Centre for Women''s Infectious Diseases Research, Royal Women''s Hospital, Melbourne, Australia;6. Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia;7. Infection & Immunity, Murdoch Children''s Research Institute, Melbourne, Australia;8. Bone and Mineral Medicine, Royal Melbourne Hospital, Melbourne, Australia;1. Clinical Epidemiology Unit, Hospital Infantil de México Federico Gómez-Facultad de Medicina UNAM, Mexico City, Mexico;2. Research Department, Med-Imaps, Pessac, France;3. Hospital Ángeles Puebla, Puebla, México;4. Centro de Investigación en Artritis y Osteoporosis, Mexicali, México;5. Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico;1. Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia;2. Department of Endocrinology, Monash Health, Melbourne, Victoria, Australia;3. Hudson Institute of Medical Research, Melbourne, Victoria, Australia;4. Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia |
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| Abstract: | Introduction: The vertebrae are the most common site for osteoporotic fracture. While they can result in disability and increased mortality, only one-third present clinically. People with multiple fractures are at greater risk of future fractures. Most hip fracture patients are neither diagnosed nor treated for their underlying osteoporosis. Computed tomography (CT) studies are often performed on hospitalised patients, can be used to diagnose osteoporosis and are gaining popularity for opportunistic osteoporosis screening by measuring BMD and other bone strength indices. The aim of this study was to assess the prevalence of vertebral fractures on CT pulmonary angiograms (CTPA) in a cohort of hip fracture patients and whether this increased their diagnosis and treatment rates. Methods: We retrospectively identified all hip fractures admitted to our institution between 2010 and 2017 to identify those who underwent CTPA scans. An independent, blinded consultant musculoskeletal radiologist reviewed the images for vertebral fractures and quantified severity using Genant criteria. Results were compared to the original radiology report, discharge diagnoses and treatment rates for osteoporosis. Results:Eleven percent (225/2122) of patients had CTPA images available. Seventy percent (158) were female with a mean age of 78 years (SD: 11). The median length of stay for all patients was 16 days (1–301). Forty percent (90) of patients had at least one vertebral fracture present and 20% (46) had more than one fracture. Only one in 5 radiology reports noted the fractures. 24% of subjects had osteoporosis treatment recorded at hospital discharge and there was no difference between those with vertebral fractures to those without. Conclusion: Many hip fracture patients have undiagnosed spine fractures. A screening strategy which evaluates CT scans for fractures has potential to increase diagnosis and treatment rates of osteoporosis. However, more work is needed to increase awareness. |
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