Vertebral fractures in osteoporosis often go unnoticed
On World Osteoporosis Day, healthcare organisations are calling for better detection after bone fractures.
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Vertebral fractures in people with osteoporosis are still regularly missed, even though additional testing is often possible during a bone-density measurement. The issue is receiving renewed attention on World Osteoporosis Day, which takes place on Tuesday.
Osteoporosis makes bones more fragile and increases the risk of fractures. The condition often initially causes no symptoms and is therefore regularly discovered only after someone has suffered a bone fracture, St. Antonius Hospital writes in a statement about World Osteoporosis Day.
During a bone-density measurement, the so-called DXA scan, a VFA image can also be taken. According to the Dutch guideline, this assesses the shape and height of the vertebrae. The Dutch guideline states that vertebral fractures develop without clear symptoms in about 70 per cent of cases.
The guideline describes how VFA can be carried out immediately after a DXA scan. The method is intended as screening: if there is doubt about a minor abnormality, a conventional X-ray may still be needed. In the case of more serious abnormalities, the result may, according to the guideline, be sufficient to establish a vertebral fracture.
That this additional diagnostic testing is not applied consistently everywhere is evident from earlier evaluations. In a Dutch implementation study, the proportion of patients examined rose from 4 to 97 per cent after VFA was offered systematically at fracture clinics. The study concerned patients aged 50 and over with a recent bone fracture and is not a current nationwide measurement.
The National Health Care Institute concluded in its evaluation that the conditions for better osteoporosis care had improved, but that detection in many hospitals and GP practices still lagged behind. As a result, people with osteoporosis are not always treated or do not receive timely advice about further care.
Attention to the issue does not mean that everyone with back problems needs a scan. Which diagnostic tests are appropriate depends on the medical situation and is assessed by healthcare professionals. The central point of the call is organisational: after a bone fracture, the risk of osteoporosis should be recognised and followed up more systematically.
One story, several perspectives
What is established
- Osteoporosis can make bones more fragile and is often diagnosed only after a bone fracture.
- VFA can be used in addition to a DXA scan to detect vertebral fractures.
- Earlier Dutch evaluations indicate that detection and follow-up are not carried out properly everywhere.
- No new nationwide measurement of the number of VFA examinations performed was found.
Left
Arguments Healthcare should screen more actively and consistently after a bone fracture, so that a person’s background, place of residence or the chance procedures used by a hospital have less influence on diagnosis and treatment.
Values Equal access, prevention and public responsibility.
Consequences This may require additional capacity and funding, but could also prevent new fractures and later care costs.
Centre
Arguments Improve cooperation between GPs, hospitals and fracture clinics and use existing guidelines purposefully. Not every patient needs the same diagnostic tests; professional judgement remains important.
Values Appropriate care, medical proportionality and feasibility.
Consequences A step-by-step approach can improve quality without automatically subjecting every patient to additional testing.
Right
Arguments Healthcare institutions should organise their processes better and reduce waste before new nationwide obligations or registrations are introduced.
Values Individual responsibility, efficiency and restraint in regulation.
Consequences More room for local solutions can stimulate innovation, but may also lead to differences between institutions if minimum standards are absent.
The perspectives describe how these political currents typically approach the subject; the newsroom takes no position on which perspective is right.
Fact-check Approved · Nour Haddad — AI agent
This check was carried out by AI: every claim was re-tested against the sources. Even an approved article can contain errors — stay critical.
The medical and organisational claims can be found in the Dutch guideline and publications by the National Health Care Institute. The text makes clear that the key figures come from earlier research and not from a new nationwide measurement.
- confirmed World Osteoporosis Day falls on 20 October. — Mentioned by St. Antonius Hospital. source
- confirmed Vertebral fractures develop without symptoms in about 70 per cent of cases. — Included in the Dutch guideline on additional VFA diagnostics. source
- confirmed The proportion of VFA examinations rose from 4 to 97 per cent in a Dutch implementation study. — The guideline refers to the multicentre implementation study. source
- confirmed The National Health Care Institute reported that detection was still insufficient in many hospitals and GP practices. — Stated in the evaluation of the osteoporosis improvement programme. source
- confirmed A VFA image can be taken immediately after a DXA scan. — Description in the Dutch guideline. source
Editor's note
The current event is the attention on World Osteoporosis Day on 20 October. The shortcomings in detection and the figures on VFA come from earlier evaluations and guideline information; no new nationwide series of measurements was found.Sources
- 20 oktober: aandacht voor osteoporose (botontkalking) — St. Antonius Ziekenhuis
- Passende zorg verbetertraject - Osteoporose — Zorginstituut Nederland
- Meerwaarde van aanvullende VFA bij diagnostiek met DXA — Richtlijnendatabase
More on this in Dutch media
- Het Parool — „osteoporose wervelfracturen”
- Trouw — „osteoporose wervelfracturen”
- NRC — „osteoporose wervelfracturen”