Radiographic evaluation of vertebral fractures in osteoporotic patients.

Vertebral fractures, are a serious clinical problem for elderly osteoporotic patients, have been increasingly recognized and are now common. On the assumption that it is difficult to diagnose osteoporotic vertebral fractures on plain radiographs, we studied 78 consecutive patients aged over 50 years with severe back pain with or without minor trauma. All patients had been admitted to our department and had undergone radiographic examinations including plain radiography, magnetic resonance imaging (MRI) and bone scintigraphy. Surprisingly, 74 of the patients (94.9%) with severe back pain had vertebral fractures. Low intensity on T1-weighted MRI indicated that the severe back pain was a symptom of vertebral fracture. The patients were divided into two groups: those with total, and those with partial T1-weighted hypointensity of the vertebral body on MRI. Thirty-five of the vertebral fractures (47.3%) were not detectable on plain radiographs, and patients without trauma showed vertebral deformity more frequently than those with trauma. The patients were treated conservatively with bed rest until the severe back pain had subsided, after which they were evaluated clinically. The average period of bed rest was 22.3 days, which did not differ significantly in relation to the occurrence of trauma, the extent of the signal change in the vertebral body on MRI or the presence of vertebral deformity. Even without vertebral deformity or trauma, vertebral fractures required long periods of bed rest for pain relief and entailed serious clinical problems.