Improving the detection and management of vertebral fractures (VF) in an acute trust: Audit of clinical features of patients with undiagnosed osteoporotic VF on CT scan
Author(s): Joseph F.; Wolfendale H.; Hyatt R.; Holmes A.
Source: Osteoporosis International; Dec 2018; vol. 29
Publication Date: Dec 2018
Publication Type(s): Conference Abstract
Abstract:Background: Vertebral fractures (VF) are themost common osteoporotic fracture; however around 70% are undiagnosed. VF are powerful predictors for further fracture (relative risk 2.8 for hip; 5.4 for further VF) (1). Method(s): CT scans containing the spine of patients aged >50 years from December 2015-October 2016 were analysed for VF using the Optasia Aspire?service; a commercial case-finding service combining machine learning with radiologist over-read. Diagnosed fractures were graded (2) and only moderate or severe VF included. The data were also interrogated for clinical variables.A combination of case notes, clinical portal and FLS database were used. Result(s): 47/325 (14.5%) scans showed moderate-severe VF. 18/47 patients had died by commencement of this audit; in 5, data were insufficient. Data was collected from March-April 2018. 13 (54%) of patients were female; 7 (29%) were aged 50-69; 12 (50%) 70-89; 5 (21%) were 90-100. Patients had 1-12 comorbidities (average 6.4). 54%(13) had prior fracture(s); of these, 46% had VF. 6 (25%) were on bone sparing treatment; but only 2 (8%) known to FLS. 6 (25%) of reports used the terms: Bosteoporotic fracture/loss of vertebral height/wedge fracture; 18 (75%) made no mention of VF. 8 (33%) had prior spinal X rays, of which 6 (75%)were reported as VF. 3 (12%) were admitted with fragility fractures after the CT scan. Discussion(s): The majority of CT reports made no mention of VF. VF was more frequently reported on plain X-ray. Most patientswere over 70; with multiple comorbidities. The majority had prior fractures; many VF. Only a minority were on bone sparing treatment and few known to FLS. Significant numbers were admitted with fragility fracture after their CT. Conclusion(s): This sample confirms that VF is common; and important to detect. A significant number of patients were admitted shortly after the CT with a further fragility fracture, potentially preventable. Although we have FLS locally; it has recruited few patients with VF. This study will prompt it to expand its scope to cover vertebral fractures. The trust is also looking at implementing a VF assessment and treatment pathway.
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