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Incidental chest radiographs may help detect osteoporosis

Seventy-five percent of patients found to have a moderate-to-severe vertebral fracture in a study did not have a documented history of osteoporosis.

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Evaluating elderly patients’ chest radiographs ordered for any medical reason can help identify those with undetected osteoporosis, according to a study by Canadian researchers.

Sumit R. Majumdar, MD, MPH, and colleagues at the University of Alberta, Edmonton, reviewed a random sample of patients that underwent standard posteroanterior and lateral chest radiographs during 2001 at the emergency department of the university’s teaching hospital. The authors hypothesized that many such radiographs could help to detect moderate-to-severe vertebral fractures and help to identify patients with osteoporosis.

The study included 459 patients with a mean age of 75.2 years. These patients were admitted to the emergency department for a variety of reasons, but primarily for cardiac (23%) and pulmonary (27%) symptoms.

Overall, 67 of the 459 patients (15%) had chart-documented histories of osteoporosis, the authors said, noting women comprised 47% of the study population.

The researchers found that chest radiographs for 72 patients (16%) showed moderate-to-severe vertebral fractures. Of these, 43 (60%) had their fractures documented in the official radiology report. This yields a true fracture rate of 16% vs. an officially documented rate of 9%, according to the study.

Although women tended to have a greater prevalence compared to men, little else except age and a history of osteoporosis distinguished patients with vertebral fractures from those without, the authors said. Only 18 of the 72 patients (25%) shown to have vertebral fractures in the study also had a documented history of osteoporosis, they noted.

“The most noteworthy finding in our study is the magnitude of the underdiagnosis and undertreatment of osteoporosis . ... Fully 75% of these patients ... did not have documented histories of osteoporosis in their emergency department or inpatient medical chart,” the authors said.

“One in six elderly patients who underwent chest radiography in our emergency department had clinically important vertebral fractures. Nevertheless, only 43 (60%) of these fractures were reported, and only 25% of patients with fractures received a diagnosis of, or treatment for, osteoporosis,” they added.

For more information:

• Majumdar SR, Kim N, Colman I, et. al. Incidental vertebral fractures discovered with chest radiography in the emergency department. N Engl J Med. 2005;165:905-909.