Abstract
Introduction
Vertebral fragility fractures (VFFs) are the most prevalent form of osteoporotic fracture, with an incidence of >20% in women >70 years old. While often clinically silent in isolation, VFFs are associated with future osteoporotic fractures, decreased quality of life and an 8-fold increase in age-adjusted mortality.
Radiologists may facilitate early diagnosis of VFFs, allowing for more cost-effective intervention with greater patient outcomes. However, a national audit in 2019 demonstrated widespread failings in the radiological recognition and reporting of VFFs, according to criteria outlined by the Royal Osteoporosis Society. Crucially, only 2% of reports in patients with moderate-severe VFFs recommended referral to Fracture Liaison Services (FLS), compared to the national target of 100%.
Here, we evaluate local VFF recognition and reporting performance, relative to the Royal College of Radiologists (RCR) targets.
Methods:
Single-centre retrospective analysis of all CT thorax, abdomen and pelvis scans in >50-year-olds. Two cycles were completed, with implementation of educational posters and a quick-code reporting alert between cycles. The proportion of reports meeting best practice criteria were measured.
The criteria included: assessment of bony integrity (target 100%), correct identification of moderate-severe VFFs (target 90%), use of correct terminology in reports (target 100%), referral of moderate-severe VFFs to the FLS (target 100%).
Results:
Bony integrity was assessed in 100% in both cycles. Identification of moderate-severe VFFs improved from 37% to 64% between cycles. Correct terminology was used in 63% and 56% of reports in the first and second cycles respectively. 0% of patients were recommended for FLS referral in both cycles.
Conclusion:
This audit demonstrates local shortcomings in VFF recognition and reporting. While there was an improvement in identification of VFFs between cycles, RCR targets were still not met post-intervention. This reflects a nation-wide issue in the under-diagnosis.