Active identification of vertebral fracture in the FLS model of care.

The identification of vertebral fracture is a key point in an FLS. We have analyzed the characteristics of 570 patients according to the route of identification (referral by other doctors, emergency registry or through VFA), concluding that promoting referral by other doctors with a training campaign is effective. PURPOSE: Vertebral fractures (VF) are associated with increased risk of further VFs. Our objective was to analyze the characteristics of patients with VF seen in a Fracture Liaison Service (FLS). METHODS: An observational study was carried out on patients with VF referred to the outpatient metabolic clinic (OMC) after a training campaign, identified in the emergency registry, and captured by VF assessment with bone densitometry (DXA-VFA) in patients with non-VFs. Patients with traumatic VF or VF > 1 year, infiltrative or neoplastic disease were excluded. The number and severity of VFs (Genant) were analyzed. Treatment initiation in the first 6 months after baseline visit was reviewed. RESULTS: Overall, 570 patients were included, mean age 73. The most common route for identifying VF was through referral to OMC (303 cases), followed by the emergency registry (198) and DXA-VFA (69). Osteoporosis by DXA was found in 312 (58%) patients and 259 (45%) had ≥ 2 VFs. The rate of grade 3 VFs was highest among patients on the emergency registry. Those identified through OMC had a higher number of VFs, a higher rate of osteoporosis, more risk factors and greater treatment initiation. Patients with VFs detected by DXA-VFA were mostly women with a single VF and had a lower rate of osteoporosis by DXA. CONCLUSIONS: We present the distribution of VFs by the route of identification in an FLS. Promoting referral by other doctors with a training campaign may help in the quality improvement of the FLS-based model of care.

Vertebral sarcoidosis: clinical and imaging findings.

OBJECTIVE: To report our experience with 3 cases of vertebral sarcoidosis (VS) and review the available literature. METHODS: We retrospectively analyzed 3 patients with VS, with special emphasis on radiologic imaging. The literature was reviewed using the MEDLINE database. RESULTS: In 2 cases, VS was the first manifestation of sarcoidosis. Severe pain was present in all patients. Chest radiographs showed normal results. Therapy with corticosteroids and calcitonin relieved the pain. In 2 patients, the pathologic vertebral magnetic resonance imaging abnormalities normalized with treatment. CONCLUSIONS: Although bone lesions in sarcoidosis may occur throughout the entire skeleton, axial involvement is rare. VS may be the initial presentation of the disease, and pain frequently is present. This condition is usually responsive to glucocorticoids. Magnetic resonance imaging may be helpful in monitoring the response to treatment.