Short summary

Fractures of the spine (vertebral fractures) are the most common osteoporotic fracture, and are generally held to be associated with significant and clinically relevant increases in mortality and risk of future fractures. However, many VF are asymptomatic and left undiagnosed, even in cases where opportunistic identification is feasible. The knowledge about long-term outcomes of such unrecognized vertebral fractures is currently limited. The aim of this project is to evaluate the health and socioeconomic outcomes of opportunistically identified vertebral fractures. 

Rationale

Fractures of the spine (vertebral fractures) are the most common osteoporotic fracture. They can be traumatic or spontaneous, and may manifest with back pain, functional impairment and reduced height, yet may also be asymptomatic or present with uncharacteristic pain mistakenly interpreted as non-fracture related back pain. The prevalence of vertebral fractures has been estimated to 12-26% in population-based studies of men and women aged 50 years or older, increasing with age.

Symptomatic and screen-detected vertebral fractures are generally held to be associated with significant and clinically relevant increases in mortality and risk of future fractures, as well as reductions in health-related quality of life. Contrary to the considerable literature on symptomatic and screen-detected vertebral fractures, there is a paucity of data on outcomes of patients with opportunistically identified vertebral fractures. Those studies that do exist, have indicated an increased risk of future fractures in patients with a prevalent vertebral fracture.

Despite the poor outcomes of patients with symptomatic or screen-detected vertebral fractures, evidence is accumulating that vertebral fractures visible on radiology exams performed as part of daily clinical practice are significantly underreported and undertreated. Several studies have investigated the correlation between vertebral fractures present on spine x-rays or CT scans and the reporting of such fractures. These studies have demonstrated that only between 13 and 60% of such prevalent vertebral fractures are documented in the radiology report. The reasons for this are not entirely clear, but it seems plausible that an underlying need for further evidence regarding long-term outcomes of opportunistically identified vertebral fractures plays an important role. 

The aim of this project is to assess key health and socioeconomic outcomes of untreated vertebral fractures identified through CT scans used in routine clinical imaging on a wide range of indications, and to evaluate factors modifying these outcomes.

Description of the cohort

This is an observational cohort study of 2,000 unique, consecutive patients undergoing a CT scan at the department of radiology at Holbæk Hospital from 1st January 2010 and onwards. We will re-evaluate these CT scans to identify patients with prevalent vertebral fracture(s) at baseline, who will constitute the exposed study cohort. An age- and gender-matched comparator cohort without vertebral fractures at baseline will be sampled from the CT scan population. 

Data and biological material

The study population will be linked to national registries for capturing key health and socioeconomic outcomes over the subsequent 7 years from inclusion in the study.

Collaborating researchers and departments

Department of medicine, Holbæk Hospital & Institute of Clinical Medicine, University of Southern Denmark

• Michael Kriegbaum Skjødt, MD GDBA
• Professor Bo Abrahamsen, MD PhD FASBMR

DaCHE, Danish Centre for Health Economics, University of Southern Denmark

• Professor Kim Rose Olsen, MScEcon PhD

MRC Lifecourse Epidemiology Unit, University of Southampton

• Professor Cyrus Cooper, OBE DL FMedSci