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1 Department of Radiology and Diagnostic Imaging, University of Alberta,
Edmonton, AB, Canada.
2 Department of Emergency Medicine, University of Alberta, Edmonton, AB,
Canada.
3 Department of Medicine, Division of General Internal Medicine, 2E3.07 Walter
Mackenzie Health Sciences Centre, University of Alberta, and University of
Alberta Hospital, 8440 112th St., Edmonton, AB T6G 2B7, Canada.
OBJECTIVE. Osteoporosis is underdiagnosed and therefore undertreated. We determined the potential usefulness of chest radiography for detecting clinically important vertebral fractures by performing semiquantitative reviews and quantitative digital morphometry on 100 routine chest radiographs taken in the emergency department and comparing the yield of these independent reviews with official radiology reports.
MATERIALS AND METHODS. One hundred randomly selected chest
radiographs of patients 60 years or older who presented to the emergency
department of a tertiary care hospital were evaluated. Radiographs were
selected without knowledge of the presenting complaint and were independently
reviewed by two board-certified radiologists and a radiology resident. A
validated semiquantitative method was used to assess lateral chest radiographs
for vertebral fracture. In addition, quantitative digital morphometry was
undertaken. A clinically important vertebral fracture was defined as one that
was at least moderate to severe (loss of height 
25%).
RESULTS. Mean age of the population was 75 years, 47% were women,
and 46% were admitted to the hospital. According to the reference radiologist,
prevalence of moderate to severe vertebral fractures was 22%. Simple agreement
was 87–88% among reviewers; kappa values were moderate
(0.56–0.58). The greatest agreement was between the reference standard
radiologist and quantitative digital morphometry (89% agreement; 
=
0.67). Only 55% (12/22) of vertebral fractures we identified were mentioned in
the official radiology reports.
CONCLUSION. Chest radiography has potential as a screening tool for revealing previously undiagnosed vertebral fractures, although in this study only half of moderate to severe fractures that we identified were mentioned in official reports.
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