Canadian researchers have found that one in six older adults who under-went chest radiography in the ED were found to have moderate-to-severe vertebral fractures. Especially notable was the determination that only a quarter of the patients with fractures had a history of osteoporosis.

The study involved 459 patients older than 60 years who were seen in an Alberta hospital ED during 2001 and had chest X-rays taken for any reason. Their mean age was 75 years; slightly more than half were men, 80% were white, and 15% had a known history of osteoporosis. For each case, research staff independently reviewed the radiologist's report as well as the patient's ED and inpatient medical charts.

The researchers determined that 72 patients (16%) had moderate-to-severe vertebral fractures, 29 (40%) of which were not documented in the radiologists' reports. Only 18 (25%) of the patients with fractures had a history of osteoporosis.

When various patient characteristics were considered, "only a history of osteoporosis was associated with correct identification and reporting of a vertebral fracture."

Comparing their finding of a 16% prevalence rate to the 9% prevalence reported by the radiologists, the researchers concluded that vertebral fractures are significantly underreported. They theorized that the problem likely stemmed not from the radiology staff's inability to identify fracture, but from the fact that findings of vertebral fractures "were considered incidental in nature by busy radiologists" who evaluated the X-rays of patients likely to be in the ED for other, more acute illnesses. The researchers concluded that underreporting of vertebral fractures in older adults is associated with the underdiagnosis and undertreatment of osteoporosis in this population. -Sylvia Foley, senior editor

Majumdar SR, et al. Arch Intern Med 2005;165(8):905-9.