Recognition of vertebral fracture in a clinical setting

Osteoporosis-related vertebral fractures have important health consequences for older individuals, including disability and increased mortality. Becau se these fractures can be prevented with appropriate medications, recogniti on and treatment of high-risk patients is warranted. A cross-sectional surv ey was carried out in a large, regional hospital in New England to examine the frequency with which vertebral fractures are identified and treated by clinicians in a population of hospitalized older women who have radiographi c evidence of fractures. The study population consisted of 934 women aged 6 0 years and older who were hospitalized between October 1, 1995 and March 3 1, 1997, and who had a chest radiograph obtained. Vertebral fractures in th e thoracic region were identified by two radiologists. Discharge diagnoses, medical record notes and radiology reports were compared with the results of the radiologists' readings to determine the frequency with which fractur es were identified and appropriate, osteoporosis-preventing medications pre scribed. Moderate or severe vertebral fractures were identified for 132 (1 4.1%) study subjects, but only 17 (1.8%) of the 934 participants had a disc harge diagnosis of vertebral fracture. Of these 132, only 17% had fracture noted in the medical record or discharge summary; 50% of contemporaneous ra diology reports identified a fracture as present; and 23% of the time it wa s found in the radiologist's summary impression. Only 18% of medical record s indicated that fracture patients had been prescribed calcium, vitamin D, estrogen replacement or an antiresorptive agent. Relatively few hospitalize d older women with radiographically demonstrated vertebral fractures were t hus identified or treated by clinicians, suggesting a need for improved rec ognition.