'One in six elderly patients who underwent chest radiography in our emergency department had clinically important vertebral fractures. Nevertheless, only 43 (60 percent) of these fractures were reported, and only 25 percent of patients with fractures received a diagnosis of, or treatment for, osteoporosis.'

The X-rays could reveal fractures of the vertebrae that are commonly associated with osteoporosis, the researchers say.

Previous studies estimate that 12 to 25 percent of people aged 50 to 60 years have one or more osteoporosis-related vertebral fractures, according to background information in the article. While only 30 percent of these fractures come to medical attention, the other 70 percent are associated with illness, death, decreased quality of life, as well as increased risk of future fractures.

The authors suggest that the many chest X-rays elderly patients undergo for other health reasons might be examined to determine the presence of vertebral fractures.

Vertebral Fractures Seen, Not Treated

Sumit R. Majumdar, M.D., M.P.H., and colleagues 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 and had a chest X-ray done for any reason.

The medical charts and X-rays then were reviewed in detail to determine whether the patient had a moderate-to-severe vertebral fracture.

Seventy-two (16 percent) of the 459 patients had a moderate-to-severe vertebral fracture on the basis of their X-ray. Forty-three (60 percent) of the fractures were documented in the original X-ray reports.

Of the 72 patients with fractures, only 18 (25 percent) had histories of osteoporosis. "Even among the patients admitted to the hospital (198) who also had a vertebral fracture (32), there was no documented addition of osteoporosis medications during hospitalization or at discharge," the authors report.

Magnitude of Underdiagnosis

"The most noteworthy finding in our study is the magnitude of the underdiagnosis and undertreatment of osteoporosis in elderly patients with a vertebral fracture," the authors write.

"One in six elderly patients who underwent chest radiography in our emergency department had clinically important vertebral fractures. Nevertheless, only 43 (60 percent) of these fractures were reported, and only 25 percent of patients with fractures received a diagnosis of, or treatment for, osteoporosis."