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Study highlights missed opportunity to prevent hip fractures

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New research published in Archives of Osteoporosis shows how radiologists can help identify patients at an increased risk of hip fracture.

People with osteoporotic vertebral (spine) fragility fractures (VFFs) have a higher risk of future fractures, including potentially devastating and life-threatening hip fractures.

A new retrospective study by researchers at the University of Oxford found that, within a cohort of hip fracture patients, many had previous imaging studies showing incidental vertebral fractures. Yet less than half (46%) of these vertebral fractures were reported at the time of imaging.

According to the International Osteoporosis Foundation, the study puts a spotlight on the under-reporting of osteoporotic vertebral fractures, particularly by radiologists who are not specialised in musculoskeletal imaging. This under-reporting is a missed opportunity for diagnosing and treating osteoporosis — and thereby reducing the risk of subsequent hip fractures, the organisation said.

The researchers used data from the local Fracture Liaison Service to case-find all hip fracture patients from 2013 presenting to hospital. Among these, they identified the patients who had also previously undergone radiological imaging that included the spine in the previous six years. All identified radiological images were re-examined and VFFs were identified in 41% of the cases (65/157).

Only 30 out of the 65 cases (46%) were reported by a radiologist when the fracture was first visible.

The findings showed that non-musculoskeletal radiologists were less likely to identify vertebral fractures: 91% of unreported VFFs were from imaging reported by non-musculoskeletal radiologists.

Only 25% of the patients identified with a VFF were reported as being on osteoporosis therapy at the time of hip fracture.

Commenting on the study, Dr Ruth M. Mitchell from Merton College at the University of Oxford, said: “It is essential that radiologists are vigilant for the presence of VFFs on routine imaging, particularly in older patients. Equally important is having an effective referral system in place to ensure these patients, once identified, are directed to fracture prevention services. We believe that together this will increase the number of patients receiving effective osteoporosis therapy, protecting against future hip fractures and the associated mortality, morbidity and cost.”