Journal List > J Korean Soc Spine Surg > v.22(3) > 1076053

J Korean Soc Spine Surg. 2015 Sep;22(3):104-108. Korean.
Published online September 30, 2015.
© Copyright 2015 Korean Society of Spine Surgery
Diagnosis of Osteoporotic Spinal Fractures
Young-Hoon Kim, M.D., Ph.D., Sang-Il Kim, M.D. and Sang-Yup Han, M.D.
Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Corresponding author: Young-Hoon Kim, M.D., Ph.D. Department of Orthopedic Surgery, Seoul St. Mary's Hospital, School of Medicine, The Catholic University of Korea, Seoul, Korea 222 Banpodae-ro, Seocho-Gu, Seoul, 137-701, Korea TEL: +82-2-2258-6118, FAX: +82-2-535-9834, Email:
Received August 18, 2015; Revised August 18, 2015; Accepted September 02, 2015.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


Study Design

Literature review.


To present updated information on the diagnosis of osteoporotic spinal fractures (OSFs).

Summary of Literature Review

Conventional modalities including simple radiographs, bone mineral density (BMD) tests, and bone scans are sufficient for diagnosis of OSFs. However, other clinical and radiographic clues should be considered for prediction of the prognosis and differential diagnosis.

Materials and Methods

Review of the relevant literature.


Clinical clues including morphometric changes in the vertebral body are sufficient for diagnosis of OSFs. BMD testing is helpful for diagnosis of osteoporosis. However, simple radiographs and BMD tests do not present sufficient information on the prognosis of OSFs. The location of the involved segments, morphological characteristics, and other co-morbidities should be taken into consideration in the initial management of OSFs. Moreover, pathologic conditions leading to spinal fractures should be taken into account in some clinical situations.


With increasing reports of complicated OSFs or other pathologic fractures, other diagnostic modalities and clinical factors should be considered in predicting the prognosis of OSFs and differentiating OSFs from other pathologic conditions.

Keywords: Osteoporosis; Spinal fractures; Diagnosis; Complication


Fig. 1
Radiographic characteristics for differential diagnosis of osteoporotic spinal fractures with pathologic fractures. A 52-year-old man presenting multiple compression fractures. T2 weighted (A), T1 weighted (B) and T2 fat suppression (C) images show multiple spinal fractures with posterior bulging of the vertebral body, involvement of the posterior column, and decreased signal intensity of the marrow compared to the intervertebral disc (*) in the T1 weighted image.
Click for larger image

Fig. 2
A 76 year old woman presented acute osteoporotic spinal fracture with dynamic instability. Standing (A) and supine (B) radiographs show the intravertebral cleft at the index vertebra (*) with dynamic instability.
Click for larger image

1. Green AD, Colon-Emeric CS, Bastian L, et al. Does this woman have osteoporosis. JAMA 2004;292:2890–2900.
2. Genant HK, Jergas M, Palermo L, et al. Comparison of semiquantitative visual and quantitative morphometric assessment of prevalent and incident vertebral fractures in osteoporosis The Study of Osteoporotic Fractures Research Group. J Bone Miner Res 1996;11:984–996.
3. Kuet KP, Charlesworth D, Peel NF. Vertebral fracture assessment scans enhance targeting of investigations and treatment within a fracture risk assessment pathway. Osteoporos Int 2013;24:1007–1014.
4. Vokes T, Bachman D, Baim S, et al. Vertebral fracture assessment: the 2005 ISCD Official Positions. J Clin Densitom 2006;9:37–46.
5. Lewiecki EM, Laster AJ. Clinical review: Clinical applications of vertebral fracture assessment by dual-energy x-ray absorptiometry. J Clin Endocrinol Metab 2006;91:4215–4222.
6. Sugita M, Watanabe N, Mikami Y, et al. Classification of vertebral compression fractures in the osteoporotic spine. J Spinal Disord Tech 2005;18:376–381.
7. Ha KY, Kim YH. Risk factors affecting progressive collapse of acute osteoporotic spinal fractures. Osteoporos Int 2013;24:1207–1213.
8. Tsujio T, Nakamura H, Terai H, et al. Characteristic radiographic or magnetic resonance images of fresh osteoporotic vertebral fractures predicting potential risk for nonunion: a prospective multicenter study. Spine (Phila Pa 1976) 2011;36:1229–1235.
9. Kanis JA, McCloskey EV, Johansson H, et al. European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 2013;24:23–57.
10. Kanis JA, McCloskey EV, Johansson H, et al. Case finding for the management of osteoporosis with FRAX--assessment and intervention thresholds for the UK. Osteoporos Int 2008;19:1395–1408.
11. Marshall D, Johnell O, Wedel H. Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ 1996;312:1254–1259.
12. Watts NB. Fundamentals and pitfalls of bone densitometry using dual-energy X-ray absorptiometry (DXA). Osteoporos Int 2004;15:847–854.
13. Muijs SP, Akkermans PA, van Erkel AR, et al. The value of routinely performing a bone biopsy during percutaneous vertebroplasty in treatment of osteoporotic vertebral compression fractures. Spine (Phila Pa 1976) 2009;34:2395–2399.
14. Schoenfeld AJ, Dinicola NJ, Ehrler DM, et al. Retrospective review of biopsy results following percutaneous fixation of vertebral compression fractures. Injury 2008;39:327–333.
15. Sung JK, Jee WH, Jung JY, et al. Differentiation of acute osteoporotic and malignant compression fractures of the spine: use of additive qualitative and quantitative axial diffusion-weighted MR imaging to conventional MR imaging at at 3.0 T. Radiology 2014;271:488–498.
16. Geith T, Schmidt G, Biffar A, et al. Quantitative evaluation of benign and malignant vertebral fractures with diffusion-weighted MRI: what is the optimum combination of b values for ADC-based lesion differentiation with the single-shot turbo spin-echo sequence? AJR Am J Roentgenol 2014;203:582–588.
17. Murakami H, Kawahara N, Gabata T, et al. Vertebral body osteonecrosis without vertebral collapse. Spine (Phila Pa 1976) 2003;28:E323–E328.
18. Kumpan W, Salomonowitz E, Seidl G, et al. The intravertebral vacuum phenomenon. Skeletal radiology 1986;15:444–447.
19. Kim YC, Kim YH, Ha KY. Pathomechanism of intravertebral clefts in osteoporotic compression fractures of the spine. Spine J 2014;14:659–666.
20. Ryan PJ, Fogelman I. Osteoporotic vertebral fractures: diagnosis with radiography and bone scintigraphy. Radiology 1994;190:669–672.
21. Handel SF, Lee YY. Computed tomography of spinal fractures. Radiol Clin North Am 1981;19:69–89.