Undetected osteoporosis in the elderly might be discovered if chest radiographs (x-ray images) that are done for other reasons were examined for fractures of the vertebrae, according to an article in the April 25 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

Previous studies estimate that 12 to 25 percent of people aged 50 to 60 years have one or more osteoporosis-related vertebral fracture, the most common fracture associated with osteoporosis, according to background information in the article. While only 30 percent of these fractures come to medical attention the other 70 percent are associated with illness, death, decreased quality of life and increased risk of future fractures. The authors suggest that the many chest radiographs elderly patients undergo for other health reasons might be examined to determine the presence of vertebral fractures.

Sumit R. Majumdar, M.D., M.P.H., of the University of Alberta Hospital, Edmonton, Canada, and colleagues selected a random sample of about 10 percent of patients older than 60 who had been evaluated in the emergency department of a large teaching hospital and had a chest radiograph done for any reason. The medical charts and radiographs were then reviewed in detail to determine whether the patient had a moderate-to-severe vertebral fracture.

Seventy-two (16 percent) of the 459 patients had a moderate-to-severe vertebral fracture on the basis of their radiograph. Forty-three (60 percent) of the fractures were documented in the original radiographic reports. Of the 72 patients with fractures, only 18 (25 percent) had histories of osteoporosis. "Even among the patients admitted to the hospital (198) who also had a vertebral fracture (32), there was no documented addition of osteoporosis medications during hospitalization or at discharge," the authors report.

"The most noteworthy finding in our study is the magnitude of the underdiagnosis and undertreatment of osteoporosis in elderly patients with a vertebral fracture," the authors write. "One in six elderly patients who underwent chest radiography in our emergency department had clinically important vertebral fractures. Nevertheless, only 43 (60 percent) of these fractures were reported, and only 25 percent of patients with fractures received a diagnosis of or treatment for osteoporosis."

(Arch Intern Med. 2005; 165:905-909. Available post-embargo at archinternmed.)

Editor's Note: This study was supported by grants from Alberta Heritage Foundation for Medical Research, Edmonton. Dr. Majumdar is a Population Health Investigator of the Alberta Heritage Foundation for Medical Research and a New Investigator of the Canadian Institutes of Health Research, Ottawa, Canada. One of the co-authors, Dr. Rowe holds a Canadian Research Chair in Emergency Airway Diseases from the Canadian Institutes of Health Research.

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