Improved radiological diagnosis of osteoporotic vertebral fragility fractures following UK-wide interventions and re-audit-can this be maintained and translated into clinical practice?

Abstract

To determine the potential economic, morbidity and mortality impact of improvements in reporting of vertebral fragility fractures (VFFs) following a complete audit cycle. Six percent interval increase in reporting of moderate/severe VFFs results in an additional 890 hip fractures predicted in year one and a potential cost saving of £13,207,000.

Purpose: To determine the potential economic, morbidity and mortality impact of improvements in reporting of vertebral fragility fractures (VFFs) following an initial UK-wide audit initiated by the Royal College of Radiologists (RCR), collaborating with the Royal Osteoporosis Society (ROS) and Royal College of Physicians (RCP) and subsequent re-audit in 2022.

Methods: Patient-specific and organisational questionnaires in 2019 and 2022 involved retrospective analysis of between 50 and 100 consecutive, non-traumatic CT studies which included the thoracolumbar spine where the spine was not the area of clinical interest in patients > 70 years. VFFs were recorded and the severity graded using the Genant reporting system. A series of UK-wide interventions were initiated between the audits. Results of the re-audit were evaluated using a bespoke ROS calculator to identify potential patient related and economic benefits from any improvements demonstrated.

Results: Widespread improvements were evident between the two audits across all audit parameters, both patient-related and organisational. Notably, there was a 6% interval increase in reporting of moderate/severe VFFs (26 to 32%). Extrapolating from NHS England data, approximately 1.8 million non-trauma CT studies including the thoracolumbar spine for patients > 70 years were performed in the UK in 2022. The incidence of VFFs in the 2022 audit was found to be 21.7%. Using these figures and the 6% increase, the number of additional patients potentially diagnosed with a VFF equates to 23,420. Applying the ROS Benefits Calculator, in this cohort of 23,420 patients with no treatment, 890 hip fractures can be predicted in year one. With initiation of treatment, this figure falls to 328 patients (562 hip fractures prevented in year one), a potential cost saving of £13,207,000.

Conclusion: The 2022 national re-audit confirmed improvements in radiology diagnostic performance and practice in VFF reporting. Ongoing work is required to build on this improvement and to further embed best practice. To realise this potential, there will need to be significant and maintained investment in onward referral and treatment systems (fracture liaison services or equivalent). Increasing availability of artificial intelligence will significantly increase the diagnoses of these fractures.

Keywords: Computed tomography; Economic and patient impact; Genant reporting system; Osteoporosis; Vertebral fragility fractures.