Bone Abstracts

Vertebral fractures are the most common osteoporotic fractures and a key predictor of future fracture risk, morbidity, and mortality. Many are asymptomatic and identified incidentally on imaging performed for other indications, creating a diagnostic challenge: distinguishing true vertebral fractures from non-fracture deformities resulting from physiological variation, degenerative change, or developmental morphology. Accurate classification is essential, as misdiagnosis may lead to inappropriate treatment, inaccurate fracture risk assessment, and unreliable research data. This presentation provides a practical overview of imaging modalities used in vertebral fracture assessment, including radiography, DXA-based vertebral fracture assessment (VFA), CT, and MRI, highlighting their strengths and limitations in differentiating true fractures from vertebral shape variations. Emphasis will be placed on key imaging features of structural failure, particularly endplate and cortical disruption, and on common mimics such as degenerative change, Scheuermann disease, physiological wedging, and other anatomical variants. Using illustrative imaging cases, the presentation demonstrates a practical approach to interpreting vertebral deformities and recognising osteoporotic vertebral fractures. Improved recognition of fracture features and diagnostic pitfalls can support more accurate interpretation, better patient management, and identification of individuals at increased fracture risk.