Common chest X-ray in the elderly can reveal osteoporosis

Apr 27 2005

According to Canadian researchers undetected osteoporosis in the elderly might be discovered if chest X-rays that are done for other reasons were examined for fractures of the vertebrae.

After checking hundreds of chest X-rays for fractures of the vertebrae, the most common bone break associated with osteoporosis but one that doctors notice in only about a third of cases, they found that a large number of cases were underdiagnosed and undertreated.

Previous studies have estimated 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 but 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.

Osteoporosis is a weakening of the bones caused when the bone-building process becomes unbalanced and bone is reabsorbed by the body more quickly than it is replaced, it goes hand in hand with aging and occurs four times more frequently in women because of their loss of estrogen after menopause. Calcium, Vitamin D, exercise and some medications can combat the disease.

Researchers at the University of Alberta Hospital, Edmonton, Canada, led by Sumit R. Majumdar, M.D., M.P.H., 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. They had had a chest X-ray done for some reason and the team reviewed in detail the medical charts and radiographs to determine whether the patient had a moderate-to-severe vertebral fracture.

Seventy-two of the 459 patients had a moderate-to-severe vertebral fracture on the basis of their radiograph. Forty-three of the fractures were documented in the original radiographic reports. Of the 72 patients with fractures, only 18 had histories of osteoporosis.

The team say that even among the 198 patients admitted to the hospital 32 also had a vertebral fracture but there was no documented addition of osteoporosis medications during hospitalization or at discharge.

The study found that one in six elderly patients who underwent chest radiography in emergency the departments had clinically important vertebral fractures but only 43 of these fractures were reported, and only 25 percent of patients with fractures received a diagnosis of or treatment for osteoporosis.

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.