Bone Abstracts

Background: Vertebral fractures can indicate underlying severe osteoporosis and are often asymptomatic. Computed Tomography (CT) imaging offers an opportunity to improve their detection, though often they are underreported^1,2. Lung Health Check CT scans for lung cancer screening offer such opportunity.

Methods: Lung cancer screening programme started at Rotherham in November 2022. All patients with vertebral fractures from the programme referred to nurse-led Fracture Liaison Service (FLS) were prospectively enrolled in an excel database capturing different characteristics. We analysed data from first 14 months, up to December 2023.

Results: A total of 2816 CT scans were carried out over this period. Ninety Five (3.3%) were reported to show vertebral fractures. Of these 95 patients, only 44 were referred to Osteoporosis service. Majority of these patients were elderly; 59% were male. In majority of the patients a single fracture was detected but about 16% had 3 or more vertebral fractures. 28 out of 44 (63%) patients had no recollection of any injury or had any symptoms. Bone density was normal in 12 patients while showed osteoporosis in 15 patients. Surprisingly, FRAX was normal in 30 patients and only 9 patients in very high risk group. Common risk factors were other fractures (10), smoking (18) and alcohol use (7). All patients with osteoporosis were on treatment. Notably only a third of osteopenia patients were on treatment at the end of 1 year.

Conclusion: Less than half of patients with vertebral fractures got referred to local FLS service. Of these, only 45% were on osteoporosis treatment at the end of 1 year. This study highlights importance of improving radiology reporting, primary care awareness, simple referral pathways and treatment uptake in these high risk patients, especially those with osteopenia.

References: 1. Mitchell RM et al. Reporting of vertebral fragility fractures: can radiologists help reduce the number of hip fracturesī Arch Osteoporos 2017; 12:1-6. 2. Harvey NC et al. Mind the (treatment) gap: a global perspective on current and future strategies for prevention of fragility fractures. Osteoporos Int 2017; 28: 1507-1529.