2812 Local radiological reporting of vertebral fragility fractures: a missed opportunity for early osteoporosis intervention?

Abstract

Introduction Vertebral fragility fractures (VFFs) are the most prevalent form of osteoporotic fracture, with an incidence of >20% in women >70 years old1. 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 mortality2. Radiologists may facilitate early diagnosis of VFFs, allowing for more cost-effective intervention with greater patient outcomes 3. However, a national audit in 2019 demonstrated widespread failings in the radiological recognition and reporting of VFFs1, according to criteria outlined by the Royal Osteoporosis Society4. 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) targets5. 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. References available on request.