RESEARCH - Chest x-rays show many elderly have vertebral fractures, but few are treated

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Chest x-rays show many elderly have vertebral fractures, but few are treated

Rheumawire

Apr 27, 2005

Janis

Edmonton, AB - Routine chest x-rays often show osteoporotic vertebral

fractures in elderly patients, but these findings are seldom reported or

acted on, Dr Sumit R Majumdar reports in the April 25, 2005 issue of the

Archives of Internal Medicine [1].

" I was surprised by how low the rates of even diagnosis or treatment were in

elderly people who had already had a fracture, " Majumdar tells rheumawire.

" This is analogous to not treating blood pressure in someone who has had a

stroke or ignoring blood sugars in someone who has just had their foot

amputated because of diabetes. "

Many chest x-rays, few reports

Majumdar conducted a cohort study in a random sample of 500 patients older

than 60 years who had chest radiographs in the emergency department for any

indication. The primary outcome was prevalence of moderate to severe

vertebral fractures. Secondary outcomes were rates of fracture recognition

and rates of osteoporosis diagnosis and treatment. Thirty-six patients were

excluded for inadequate radiographs and 5 for other reasons. Mean age was

75.2 years, and 47% of patients were women.

The investigators found that 72 of 459 patients (16%) had moderate to severe

vertebral fractures according to independent review. Of these fractures, 29

(40%) were not recorded in the radiologists' report. The only independent

correlate of vertebral fracture was a history of osteoporosis, but of the 72

patients with fractures, only 18 (25%) had histories of osteoporosis or were

treated with osteoporosis medications.

" [A]mong those with a study-defined and clinically important vertebral

fracture, only 25% had a documented history of osteoporosis or were

receiving any effective treatments for secondary prevention of fracture, "

Majumdar writes.

The researchers also found that half of the patients with fractures were

male. " I was surprised somewhat that just as many men as women had these

clinically important fracturesmany patients and providers continue to

consider osteoporosis a disease of elderly women, " Majumdar says.

Better radiology reporting needed . . . and more treatment

" Rheumatologists, as well as other clinicians, need to advocate for all

radiologists to please report these 'incidental' findings, " Majumdar tells

rheumawire. " They are very easy to see, even for nonradiologists and

nonphysicians. "

Even when these fractures are reported, their clinical importance is being

ignored. Majumdar emphasizes that three quarters of the patients with

documented fractures were neither diagnosed with osteoporosis nor treated.

" All physicians, including rheumatologists, have benignly neglected these

findings for too long. Treatment reduces the risk of another fracture by

50%, " Majumdar says.

Source

1. Majumdar SR, Kim N, Colman I, et al. Incidental vertebral

fractures discovered with chest radiography in the emergency department.

Arch Intern Med 2005; 165:905-909.

Not an MD

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org