Incidental vertebral fractures on computed tomography.

Vertebral fractures are the most common osteoporotic fracture and predict subsequent fracture and mortality. We undertook an audit (Auckland City Hospital, Auckland, New Zealand) to determine whether targeted assessment for incidental vertebral fractures on computed tomography (CT) examinations of the chest or abdomen in older people would detect previously unidentified vertebral fractures. In 175 consecutive patients aged >65 years, sagittal images of the spine were obtained by reformatting data from CT examinations of the chest or abdomen. Vertebral fractures were assessed using a semi-quantitative technique. The prevalence of vertebral fractures was 13%, with 41 vertebral fractures identified in 22 patients; 12/22 (55%) had vertebral fracture mentioned in the formal CT report, and 2/12 patients with contemporaneous plain films had vertebral fracture mentioned in the X-ray report. The vertebral fracture was newly identified in 17 (77%) patients, but vertebral fracture and osteoporosis were each listed in the relevant discharge summary or clinic letter for only 14% of patients, and only 31% of patients with fracture subsequently received osteoporosis treatment. In summary, assessing sagittal spine images reformatted from CT examinations of the chest or abdomen detects previously unidentified vertebral fractures, offering an undervalued opportunity to assess fracture risk and intervene with treatments that prevent fractures and reduce mortality.