Vertebral Fracture Identification

Osteoporosis is still considered to be one of the major public health problems dealing with vertebral fractures and hip fractures; in addition, it is largely known that mortality have also increased after vertebral fractures. Currently, the diagnosis of osteoporosis, measured by dual-energy X-ray absorptiometry (DXA), is based on areal bone mineral density (aBMD), but osteoporotic fractures can occur also when aBMD is still above the pathologic range. Several imaging modalities, such as computed tomography (CT) scans and magnetic resonance imaging (MRI), have been used to improve bone assessments and its relation to fracture risk prediction. Among these the most applied is quantitative CT (QCT) scans, which can measure volumetric BMD (vBMD) and trabecular bone score (TBS), attempting not only to measure the “bone quantity” but also the “bone quality,” by means of the study of microarchitecture, structure, bone turnover, and bone strength. MRI is also being studied as a tool to assess vertebral bone density based on bone marrow fat content; in fact, vertebral osteoporosis is characterized by thinning trabecular and cortical bone and an increase in fat. A comprehensive assessment of fracture risk requires data on bone density, fracture history, and bone quality, which can be provided by several imaging modalities, each with its own advantages and disadvantages. Clinically, DXA remains to be the most widely available and used technique to assess BMD as it is the only validated method to diagnosis osteoporosis by WHO T-score criteria. The function of densitometers has expanded to include vertebral fracture assessment (VFA) and TBS, though accessibility to these add-on tools is still limited.