Detection of vertebral fracture in an acute hospital setting: an intervention to reduce future fracture risk through fracture liaison service intervention?

Michael Toal,Sarah English,Nicole Pierce,John R Lindsay,Julie Moss,Connor Mcloughlin

doi:10.1007/s11657-020-00832-2

Abstract

SummaryWe introduced a standardised reporting system in the radiology department to highlight vertebral fractures and to signpost fracture prevention services. Our quality improvement project achieved improved fracture reporting, access to the FLS service, bone density assessment and anti-fracture treatment.PurposeIdentification of vertebral fragility fractures (VF) provides an opportunity to identify individuals at high risk who might benefit from secondary fracture prevention. We sought to standardise VF reporting and to signpost fracture prevention services. Our aim was to improve rates of VF detection and access to our fracture liaison service (FLS).MethodsWe introduced a standardised reporting tool within the radiology department to flag VFs with signposting for referral for bone densitometry (DXA) and osteoporosis assessment in line with Royal Osteoporosis Society guidelines. We monitored uptake of VF reporting during a quality improvement phase and case identification within the FLS service.ResultsRecruitment of individuals with VF to the FLS service increased from a baseline of 63 cases in 2017 (6%) to 95 (8%) in 2018 and 157 (8%) in 2019 and to 102 (12%) in the first 6 months of 2020 (p = 0.001). One hundred fifty-three patients with VFs were identified during the QI period (56 males; 97 females). Use of the terminology ‘fracture’ increased to 100% (mean age 70 years; SD 13) in computed tomography (n = 110), plain X-ray (n = 37) or magnetic resonance imaging (n = 6) reports within the cohort. Signposting to DXA and osteoporosis assessment was included in all reports (100%). DXA was arranged for 103/153; 12 failed to attend. Diagnostic categories were osteoporosis (31%), osteopenia (36%) or normal bone density (33%). A new prescription for bone protection therapy was issued in 63/153. Twelve of the series died during follow-up.ConclusionsStandardisation of radiology reporting systems facilitates reporting of prevalent vertebral fractures and supports secondary fracture prevention strategies.

Highlights

Vertebral fractures are the most common osteoporosis fracture and are associated with significant morbidity [1]
A voice prompt reporting system was introduced within our picture archiving and communication system (PACS), to flag the presence of vertebral fracture and to signpost referring clinicians to fracture prevention services according to Royal Osteoporosis Society guidelines [1]
We initially examined the prevalence of vertebral fractures in a baseline retrospective study of 154 non-traumatic computed tomography (CT) imaging scans and radiology reports from Sectra Radiology Imaging Services (RIS), in those aged 50 years or older

Summary

Introduction

Vertebral fractures are the most common osteoporosis fracture and are associated with significant morbidity [1]. A voice prompt reporting system was introduced within our picture archiving and communication system (PACS), to flag the presence of vertebral fracture and to signpost referring clinicians to fracture prevention services according to Royal Osteoporosis Society guidelines [1]. Vertebral fractures are most likely to be under-reported on imaging obtained for non-musculoskeletal indications. This includes images acquired using all modalities that involve any part of the thoracolumbar spine, with the greatest opportunity presented by the increasing number of CT scans undertaken in older adults.*. When a vertebral fracture has been identified the reporting radiologist should indicate within the report that the referring clinician should refer the patient for a DXA scan and osteoporotic assessment.*. Page 9 of 10 160 is that radiologists to use the voice prompt function within Sectra RIS.

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