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Radiographic methods for evaluating osteoporotic vertebral fractures. Jt Bone Spine

INSERM, ERI12, Faculté de Médecine et de Pharmacie, 1 rue des Louvels 80037 Amiens, France
Joint, bone, spine: revue du rhumatisme (Impact Factor: 3.22). 03/2009; 76(3):241-7. DOI: 10.1016/j.jbspin.2008.07.017
Source: PubMed

ABSTRACT Reproducible methods for the radiological assessment of osteoporotic vertebral fractures, defined based on accurate criteria, are needed in everyday practice and in therapeutic trials and epidemiological studies.
To describe and to evaluate methods for osteoporotic vertebral fracture assessment based on standard radiographs or dual-energy X-ray absorptiometry (DXA) and to determine the role for each method in clinical practice, therapeutic trials, and epidemiological studies.
A review written by a rheumatologist based on his clinical experience and on a literature review was submitted to four experts. Studies in English or French published between 1975 and February 2008 were retrieved from Medline using the keywords vertebral fracture, osteoporosis, vertebral deformity, and vertebral fracture assessment.
One hundred forty-nine articles were selected and read in their full-text version. There was no consensus regarding the definition of osteoporotic vertebral fractures. The following methods were evaluated: visual assessment, Genant's semi-quantitative assessment, Jiang's algorithm-based qualitative method, morphometric radiography, and DXA of the spine. In everyday practice, Genant's semi-quantitative assessment on standard radiographs may provide useful information on the severity and prognosis of osteoporosis. DXA done for bone mineral density measurement may detect vertebral fractures in asymptomatic patients. Assessment of standard radiographs remains the reference standard for diagnosing vertebral fractures in patients with suggestive symptoms (e.g., pain in the thoracic or lumbar spine, height loss, or thoracic kyphosis). For therapeutic trials and epidemiological studies, Genant's semi-quantitative assessment used by a trained and experienced observer is the preferred method, based on its good reproducibility and ability to differentiate fractures from other deformities. However, thousands of radiographs may be needed, making routine interpretation by an expert impractical. A visual semi-quantitative method may be used to separate normal radiographs from radiographs showing possible or obvious fractures, which can then be read by an expert. Alternatively, radiomorphometric indices can be determined on digitized radiographs in combination with a semi-quantitative assessment, with discordant cases being reviewed by an expert. We do not recommend Jiang's method at present, as it is still undergoing validation.

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    • "A. Herrera et al. / Maturitas xxx (2015) xxx–xxx 7 reproducibility, this method has shown high reliability for the diagnosis (97.60%) when compared to morphometric studies [25], and it has been considered the most useful for studies like the present one [26]. Dual-energy X-ray absorptiometry (DXA) was ruled out for difficulties in the access to a DXA study in certain areas of our country; on the other hand, the images of the upper thoracic vertebrae were obtained with this method are hardly measurable. "
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    Maturitas 03/2015; [Epub ahead of prin](3). DOI:10.1016/j.maturitas.2014.12.004 · 2.86 Impact Factor
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    • "The visual semiquantitative (VSQ) assessment on conventional spine radiograph proposed in 1993 by Genant and colleagues remains the most validated and used method in clinical practice [13]. However, some authors support a combined approach of VSQ and quantitative morphometric methods to overcome limits of single methods side by side [16] [17]. Great importance has been given to the incidental diagnosis of VFs, during imaging examinations for other clinical purposes. "
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