Prevalence of Vertebral Fractures in CTPA’s in Adults Aged 75 and Older and Their Association with Subsequent Fractures and Mortality

Llewelyn Jones,Inder Singh,Nimit Goyal,Chris Edwards,Sukhdev Singh

doi:10.3390/geriatrics5030056

Abstract

Identifying vertebral fractures is prudent in the management of osteoporosis and the current literature suggests that less than one-third of incidental vertebral fractures are reported. The aim of this study is to determine the prevalence of reported and unreported vertebral fractures in computerized tomography pulmonary angiograms (CTPA) and their relevance to clinical outcomes. All acutely unwell patients aged 75 or older who underwent CTPAs were reviewed retrospectively. 179 CTPAs were reviewed to identify any unreported vertebral fractures. A total of 161 were included for further analysis. Of which, 14.3% (23/161) were reported to have a vertebral fracture, however, only 8.7% (14/161) of reports used the correct terminology of ‘fracture’. On subsequent review, an additional 19.3% (31/161) were noted to have vertebral fractures. Therefore, the overall prevalence of vertebral fractures was 33.5% (54/161). A total of 22.2% (12/54) of patients with a vertebral fracture on CTPA sustained a new fragility fracture during the follow-up period (4.5 years). In comparison, a significantly lower 10.3% (11/107) of patients without a vertebral fracture developed a subsequent fragility fracture during the same period (p = 0.04). Overall mortality during the follow-up period was significantly higher for patients with vertebral fractures (68.5%, 37/54) as compared to those without (45.8%, 49/107, p = 0.006). Vertebral fractures within the elderly population are underreported on CTPAs. The significance of detecting incidental vertebral fractures is clear given the increased rates of subsequent fractures and mortality. Radiologists and physicians alike must be made aware of the importance of identifying and treating incidental, vertebral fragility fractures.

Highlights

Osteoporosis is a skeletal disease of decreased bone mass and microarchitectural deterioration resulting in bone fragility and a susceptibility to fracture [1]
Our analysis shows the prevalence of vertebral fractures on computerized tomography pulmonary angiograms (CTPA) in patients aged 75 and over to be 33.5%
We demonstrated a statistically significant relationship between the presence of a vertebral fracture on CTPA and an increased rate of subsequent fractures, which held true when looking at hip fractures

Summary

Introduction

Osteoporosis is a skeletal disease of decreased bone mass and microarchitectural deterioration resulting in bone fragility and a susceptibility to fracture [1]. The clinical consequence of osteoporosis, are associated with significant morbidity and mortality with an estimated cost to the National Health Service (NHS) of £4.4 billion annually [2]. Identifying those at risk of fractures is the first step in initiating appropriate medical treatment, which is known to significantly reduce the risk of further fragility fractures [3]. In addition to the FRAX score, including previous fractures as an input variable in their analysis, the treatment for osteoporosis can be commenced immediately following identification of a vertebral fracture if further investigation is not clinically appropriate.

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