New report identifies huge opportunity for radiologists to refer patients with spinal fractures

Two-thirds of spinal fractures go undiagnosed – meaning 2.2 million people are slipping through the net and are at risk of further fractures. Yet a new report from the Royal Osteoporosis Society (ROS) presents a surprising opportunity for radiologists to safeguard the health and independence of millions of people.

Osteoporosis can lead to life-changing spinal fractures. More than one in 10 women over the age of 50 have one or more spinal fractures, rising to one in five in the over 70s.

Spinal fractures can be asymptomatic or present with the generic symptom of back pain and loss of height. As a result, they are often wrongly dismissed as an inevitable part of ageing.

However, a spinal fracture can become debilitating and extremely painful, and is a powerful predictor of the devastating hip fracture, which does more than any other to create long-term disability and loss of independence. A quarter of those who go on to suffer a hip fracture die within a year of the injury.

An opportunity to identify spinal fractures arises when a patient is referred to radiology for imaging (for example, a CT-scan) for any reason. Though the spine may not be the focus of the investigation, the viewing of the vertebrae on the image creates an opportunity to spot undiagnosed fractures.

The radiologist should then be able to signpost a patient with a spinal fracture for investigation for osteoporosis, ideally by direct referral to the hospital’s Fracture Liaison Service (FLS) - the tried and tested model for systematically identifying osteoporosis patients and then moving them onto a treatment plan to strengthen their bones.

However, today’s report includes findings from the National Audit of Radiology Services by the Royal College of Radiologists, supported by the ROS and the Royal College of Physicians, which found that where a spinal fracture had been identified, only 5.5% of reports made recommendations for further investigation.

The data shows that the main reason for these missed opportunities is the lack of a referral pathway for osteoporosis. Only 19% of radiology departments had a defined pathway for referring patients with a spinal fracture to an FLS or osteoporosis service, due to a lack of multidisciplinary collaboration between departments.

Radiology departments use alert systems to notify health professionals who have referred patients for imaging, of significant, unexpected, or urgent findings. This provides a ready-made opportunity for radiology departments to include spinal fractures in their policy for alerts – an urgent change called for by the ROS today.

The Royal College of Radiologists has published guidance on reporting vertebral fractures in the wake of findings from the National Audit of Radiology Services.

The ROS’s new policy manifesto, also published today, makes four calls on Government and the NHS to break the silence on the condition and end the missed opportunities around osteoporosis in the NHS. They are to:

1. End the postcode lottery for accessing quality-assured secondary fracture prevention
2. Incentivise GP surgeries to routinely use digital tools, which can assess risk and prevent the first fracture
3. Make osteoporosis core business across health and social care, joining the dots with a coherent pathway of care and prevention
4. Level up investment in research into musculoskeletal conditions, which is disproportionately low