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Gender and the recognition of vertebral fractures.

Osteoporosis is a generalized skeletal disorder characterized by decreases in bone quantity and quality, or both, leading to an increased risk of fragility (that is low trauma or low energy) fractures. With the delineation of this disease, and the recognition that it may affect both sexes, and following the demonstration by Fuller Albright that treatment with estrogens could reverse the negative calcium balance that developed in women after menopause or oophorectomy, effective treatments for osteoporosis began to emerge in the late 20 century (1). From a radiological (“imaging”) perspective, apropos of osteoporosis, peripheral fracture recognition in general is rarely a challenge. More recently, techniques have been developed to measure bone density or mass. Not least, small aperture high resolution computed tomography and magnetic resonance imaging methods are yielding insights into bone micro-architecture and “bone quality” (2). All the more perplexing, therefore, is the fact that, despite these observations, there had been only limited evidence available for use in effectively diagnosing osteoporotic vertebral fractures (OVFs) from plain radiographs—especially as these are the most widely used tool in this context. Inevitably, as a consequence there had remained great uncertainty about their evolution and confusing data about their location and incidence as a function of gender. The tangled web we weave