Intended for healthcare professionals

Letters Vertebral fracture treatment

Clinicians need to treat underlying osteoporosis

BMJ 2011; 343 doi: (Published 10 August 2011) Cite this as: BMJ 2011;343:d5040
  1. Denys A Wahl, science manager1,
  2. Cyrus Cooper, professor of rheumatology and director2,
  3. Steven Boonen, professor of clinical gerontology and geriatric medicine3
  1. 1International Osteoporosis Foundation, Nyon, Switzerland
  2. 2MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
  3. 3Division of Gerontology and Geriatrics and Centre for Musculoskeletal Research, Leuven University Department of Experimental Medicine, Belgium
  1. dwahl{at}

Wilson asks how clinicians should treat vertebral fractures in the light of current evidence.1

A vertebral compression fracture signals a patient at high risk of subsequent fractures who should be managed appropriately.2 Vertebral fractures have debilitating consequences and even increase the risk of death. Coordinated, multidisciplinary, and systematic systems of care are being implemented worldwide, which capture fracture patients and accompany them through diagnosis, treatment, and follow-up. These systems are cost effective and can help prevent recurrent fractures.3 A key objective of this approach is the treatment of the underlying cause of vertebral fracture, which is usually osteoporosis.

Treatments do not prevent all fractures, but large scale clinical trials have shown that treatment for osteoporosis can reduce vertebral fracture rates by 30-70%.4 However, patients are still being missed and left undiagnosed and untreated. In elderly patients in hospital who had a lateral chest radiograph, fewer than 50% of vertebral fractures identified later by radiography were reported in the radiological reports and even fewer in the medical records.5 Less than a fifth of patients identified as having vertebral fractures received appropriate treatment for osteoporosis within a year of the fracture.6

We thus urge all doctors to narrow this gap in care.


Cite this as: BMJ 2011;342:d5040


  • Competing interests: None declared.


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