Multi-site opportunistic diagnosis of vertebral fragility fractures in computed tomography scans

​Author(s): Staal J.; Peters A.; Kariki E.; Hyatt R.; Javaid K.; Russell E.; O'Neill T.; Poole K.; Chappell D.; Rajak R.
Source: Osteoporosis International; Dec 2018; vol. 29
Publication Date: Dec 2018
Publication Type(s): Conference Abstract
Abstract:Objectives: Vertebral Fragility Fractures (VFFs) are an early manifestation of osteoporosis. VFFs may triple the risk of future hip fracture1 yet VFF patients are often underrepresented in Fracture Liaison Services (FLSs). We assessed the rate of opportunistic VFFs in Computed Tomography (CT) scans of the Thorax, Abdomen and Pelvis and reviewed whether they had been previously reported.We also investigated whether the identified VFF patients had been referred to an FLS. Materials andMethods:We retrospectively audited pseudonymised CT scans of patients 50 years and older, containing the spine. The scans were performed over a 12-month period at 5 NHS hospitals in the UK (Cambridge, Croydon, East Lancashire, Oxford and Salford). We used the Optasia Medical ASPIRETM service, a commercial VFF case-finding service combining machine learning with radiologist over-read (EK). VFFs were classified using the Genant-SQ method2 and only moderate and severe VFFs were included. We compared our findings with the original radiology reports. Result(s): We collected meta-data from 47,889 scans (50.1% female) and used a sample of 1,638 scans for analysis. Of these, 237 patients (53.4% female) had VFFs (14.5% +/- 1.7%, 95% CI). VFF prevalence between sites was not significantly different. Four sites (Cambridge, Croydon, East Lancashire, Oxford) checked the original radiology reports and FLS referral. The median reporting rate was 67.7% (IQR 55.7%, 74.5%) and the median FLS referral was 13.3% (IQR 10.8%, 22.0%). Conclusion(s): On average, 1 in 7 patients had at least one moderate VFF with a median of only 13.3% being seen by the FLS. Whilst men are underrepresented in FLSs3, nearly as many men as women in this cohort were found to have VFFs. Opportunistic diagnosis of VFF can greatly increase the number of patients referred to FLSs, potentially protecting the patients' quality of life and decreasing the economic burden of osteoporosis4.
Database: EMBASE