WHAT IS A VERTEBRAL FRACTURE

Vertebral deformities may be caused by a variety of conditions, such a s osteoporosis, severe trauma, congenital deformities, Scheuermann's d isease, osteoarthritis, and multiple myeloma. For the individual patie nt, the correct diagnosis of an osteoporotic fracture is a prerequisit e for the choice of optimal treatment and will be ensured by careful d ifferential diagnosis based on a spinal radiograph and additional diag nostic procedures. Evaluation of radiographs by experienced radiologis ts is crucial for the correct diagnosis of vertebral fractures. For cl inical trials and epidemiological studies of osteoporosis, qualitative radiological evaluation of radiographs has proven to be insufficient, since results lack reproducibility. Therefore, objective morphometric methods based on vertebral height measurements have been developed fo r fracture identification and quantification in scientific settings. S atisfactory sensitivity of these methods is usually reached at the exp ense of specificity, leading to a high number of false positives. With some differences in methodology, most of the morphometric approaches are of comparable validity. However, none of the morphometric methods allows any subclassification of vertebral deformities with respect to etiology. A combined approach based on morphometry as well as a standa rdized radiological evaluation by experts appears to be the most promi sing solution to the problem. Further efforts are needed to standardiz e radiological criteria to yield comparable results between individual readers and different studies. It has to be evaluated whether the com bined approach (clinical reading and morphometry) is necessary during follow-up evaluation, as morphometry may be sufficient for monitoring once the diagnosis has been established at baseline.