From the Guidelines
Osteoporotic and traumatic fractures are diagnosed through a combination of clinical assessment, imaging studies, and sometimes laboratory tests, with dual-energy X-ray absorptiometry (DEXA) scans being the primary imaging modality used to screen for osteoporosis in high-risk individuals, as recommended by the American College of Radiology in 2022 1. The diagnosis of osteoporotic and traumatic fractures involves a multi-step approach. When a patient presents with symptoms such as pain, swelling, deformity, or limited mobility following trauma or in high-risk individuals, healthcare providers first perform a physical examination to assess the affected area.
- X-rays are typically the initial imaging test ordered, as they can visualize most fractures and provide information about bone density.
- However, some fractures, particularly stress fractures or subtle osteoporotic fractures, may not be visible on plain radiographs.
- In these cases, more advanced imaging such as CT scans, MRI, or bone scans may be necessary.
- CT scans provide detailed cross-sectional images of bone structure, while MRI can detect bone marrow edema associated with fractures and evaluate surrounding soft tissue damage.
- For suspected osteoporotic fractures, DEXA scans are used to measure bone mineral density and assess fracture risk, as they are the current gold standard test for diagnosing osteoporosis in people without a known osteoporotic fracture 1.
- Laboratory tests may also be ordered to evaluate for underlying conditions that contribute to bone fragility, including calcium, vitamin D levels, and markers of bone turnover. The diagnosis ultimately depends on correlating the clinical presentation with imaging findings and, when appropriate, laboratory results, with the goal of reducing osteoporosis-associated morbidity and mortality, and improving quality of life for patients with osteoporotic and traumatic fractures 1.
From the Research
Diagnosis of Osteoporotic and Traumatic Fractures
- Osteoporotic fractures are diagnosed using a combination of clinical evaluation, imaging, and laboratory tests 2
- Imaging techniques used to diagnose osteoporotic fractures include:
- Conventional radiology to evaluate spinal fractures
- Dual energy x-ray densitometry to measure bone mineral density (BMD)
- Quantitative computerized tomography (QCT) to provide a 3-D volumetric assessment of BMD
- Magnetic resonance imaging (MRI) to assess bone microarchitecture and other bone tissue properties
- Bone scintigraphy and ultrasound in certain cases
- Dual x-ray absorptiometry (DXA) is the current reference standard for assessing bone health and estimating fracture risk 3
- DXA-based Trabecular Bone Score (TBS) can provide complementary information about bone microarchitecture 3
- Finite element analysis (FEA) of computed tomography (CT) images can provide estimates of bone strength, which can add value to fracture risk assessment beyond BMD 3, 4
- Biomechanical CT (BCT) analysis of previously acquired routine abdominal or pelvic CT scans can be used to identify patients at high risk of hip fracture 4
- Radiographic diagnosis of osteoporotic vertebral fractures is important for therapeutic and prognostic implications, and several classification systems are used to diagnose these fractures based on conventional radiography 5