Review of radiological scoring methods of osteoporotic vertebral fractures for clinical and research settings

Background: Osteoporosis is the most common metabolic bone disease; vertebral fractures are the most common osteoporotic fractures. Methods: Several radiological scoring methods using different criteria for osteoporotic vertebral fractures exist. Quantitative morphometry (QM) uses ratios derived from direct vertebral body height measurements to define fractures. Semi-quantitative (SQ) visual grading is performed according to height and area reduction. The algorithm-based qualitative (ABQ) method introduced a scheme to systematically rule out non-fracture deformities and diagnoses osteoporotic vertebral fractures based on endplate depression. The concordance across methods is currently a matter of debate. Results: This article reviews the most commonly applied standardised radiographic scoring methods for osteoporotic vertebral fractures, attaining an impartial perspective of benefits and limitations. It provides image examples and discusses aspects that facilitate large-scale application, such as automated image analysis software and different imaging investigations. It also reviews the implications of different fracture definitions for scientific research and clinical practice. Conclusion: Accurate standardised scoring methods for assessing osteoporotic vertebral fractures are crucial, considering that differences in definition will have implications for patient care and scientific research. Evaluation of the feasibility and concordance among methods will allow establishing their benefits and limitations, and most importantly, optimise their effectiveness for widespread application. Key Points: • Several scoring methods using different criteria for assessing osteoporotic vertebral fractures exist. • Standardised osteoporotic vertebral fracture assessment should be applicable to different radiological investigations. • Accurate assessment of osteoporotic vertebral fractures is essential for proper patient management. • Optimising feasibility of scoring methods enables widespread use in scientific research. • Assessment of concordance between methods is important for application in patient care.

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