Practical Use of Bone Scan in Patients with an Osteoporotic Vertebral Compression Fracture

Rib fractures are one of main causes of chest or flank pain when related to an osteoporotic vertebral compression fracture (OVCF). The authors investigated the incidence and risk factors of rib fracture in 284 patients with OVCF using bone scans and evaluated the feasibility as to whether bone scans could be utilized as a useful screening tool. Hot uptake lesions on ribs were found in 122 cases (43.0%). The factors analyzed were age, sex, number and locations of fractured vertebrae, BMD, and compression rates as determined using initial radiography. However, no statistical significances were found. In 16 cases (5.6%), there were concurrent multiple fractures of both the thoracic and lumbar spines not detected by single site MRI. Sixty cases (21.1%) of OVCF with the a compression rate of less than 15% could not be identified definitely by initial plain radiography, but were confirmed by bone scans. It is concluded that a bone scan has outstanding ability for the screening of rib fractures associated with OVCF. Non-adjacent multiple fractures in both thoracic and lumbar spines and fractures not identified definitely by plain radiography were detected on bone scans, which provided a means for determining management strategies and predicting prognosis. Graphical Abstract Keywords: Osteoporosis, Spine, Compression Fracture, Rib Fracture, Osteoporotic Fracture INTRODUCTION Osteoporosis is a systemic musculoskeletal disease that gradually reduces bone mineral density (BMD) and changes bone microarchitectures (1). Vertebral compression fractures are one of the most common osteoporotic fractures with an incidence of 700,000 cases per year in the United States (2), and in South Korea the incidence of osteoporotic fractures is on the rise (3). Regarding the treatment of an osteoporotic vertebral compression fracture (OVCF), conservative treatments like bed rest, medication, and braces used to be the norm. However, for persistent-painful OVCF resistant to conservative treatments, percutaneous vertebroplasty and kyphoplasty are now considered the treatments of choice, because both have been demonstrated to achieve satisfactory pain relief in the majority of OVCF patients (4). However, a significant proportion of OVCF patients complain of consistent chest or flank pain (5), and experience no meaningful pain relief even after percutaneous vertebroplasty or kyphoplasty, whereas others experience some relief of back pain, but still suffer from continuous chest or flank pain. In a previous study, the authors found that rib fractures are one of main causes of persistent chest or flank pain (6). In fact, rib fractures are one of the most common osteoporotic non-vertebral fractures in the elderly (7). And it has been reported that the presence of a rib fracture is associated with an elevated risk of new osteoporotic fractures (8). Therefore, the authors sought to document the frequency of rib fractures in OVCF patients and to identify factors that affect their occurrence by conducting bone scans. In addition, the authors tried to confirm the efficacy of bone scan as a screening tool for OVCF. Therefore, we analyzed cases of non-adjacent multiple fractures unconfirmed by single-site MRI scans due to the co-occurrence of OVCF in the thoracic and lumbar spines. In addition, the authors investigated cases of fractures that might have been overlooked due to the indication of minute reductions in anterior height at initial plain radiography, noting the report that fracture diagnosis is delayed or neglected in about 25 to 50% of OVCF patients (9).