Osteoporosis: A Renascent Impact of Vertebral Fractures in the Diagnosis and Management

Dear Colleagues,

Osteoporosis is a progressive skeletal disease characterized by bone loss and microarchitectural deterioration, resulting in increased fragility and a growing number of low-trauma fractures. Vertebral fracture (VF) is the most common osteoporotic fracture, with prevalence ranging between 10 and 65% in the aging population worldwide. The majority of vertebral fractures develop gradually, without a well-identified traumatic event, and only one in every three to four is associated with sudden clinical symptoms (back pain or visible spine deformation). However, the asymptomatic VF as well as the symptomatic ones are accompanied by posture changes, loss of height, functional impairment, disability, diminished quality of life, and a 6-9% increased mortality. Moreover, recent data suggest that VF frequently serves as a sentinel fracture followed by a 5- to 10-fold higher risk of further fractures (spine or other skeletal sites, including the hip) in the subsequent 1-2 years. These imminent fractures could be partly prevented by the early initiation of treatment for osteoporosis; however, the silent VFs are mostly underdiagnosed, leading to the failure of treatment. By its silent nature, vertebral fractures significantly contribute to the growing pandemic of osteoporotic fracture prevalence.

Therefore, there is an unmet need to reveal as many vertebral deformities as possible, even in spite of their silent nature. Modern CT and MR techniques are undoubtedly the best methods for this requirement; however, we are far from the solution due to limits in capacity and some radiation aspects of these methods. In the future, artificial intelligence can hopefully widen the ability of MR and CT to make the diagnostic efforts more effective. On the other hand, bone densitometry is currently the most frequent test used for evaluation of osteoporosis, working with extremely low radiation doses. VFA (vertebral fracture assessment) is a densitometric method to detect vertebral deformities, promising an easy break-out from the current problem. VFA only needs a few minutes and a slightly larger radiation dose over traditional densitometry, without extra costs or extra time.

In this Special Issue the vertebral fractures will be studied from that perspective as to how they promote the installment of the global fracture pandemia. A detailed overview of the currently used medical procedures will be followed by introducing the VFA method and evaluating its precision. An additional paper explores the real-life potential of VFA to detect more vertebral fractures in our osteoporosis center. Finally, VFA will be checked in a special form of secondary osteoporosis in women with breast cancer treated by antiestrogens. 

The primary aim of this Special Issue is nothing less than reaching a renaissance in regard to vertebral fractures in the medical horizon of osteoporosis specialists. A secondary aim is to help more common use of VFA in every densitometric event, promoting more precise fracture risk assessment for therapeutic decisions.

Prof. Dr. Csaba Horvath
Guest Editor

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