Computer-based screening of chest X-rays for vertebral compression fractures as an osteoporosis index in men

We evaluated the recognition of osteoporosis in the veteran male population through a computer-based review of chest X-ray (CXR) reports in the Veterans Affairs Northern California Health Care System database, looking for unrecognized vertebral fractures. All CXR reports between January 1, 2000 and December 31, 2001, were scanned for the terms “compression” or “wedg (where the “ ” indicates a wild card search encompassing such terms as “wedge” or “wedging”)”. During this time, 26,994 CXR examinations were performed on 18,069 patients. 22,494 (83.3% of the total) CXR examinations were done in 14,561 men ≥ 50 years of age. 780 CXR reports (3.5%) encompassing 664 men (4.5%) contained at least one key phrase suggesting osteoporosis. Three years later, 495 of these 664 men were still living. 99 of these (20%) had been diagnosed with osteoporosis, 72 (15%) had a dual-energy X-ray absorptiometry (DXA) scan, and 89 (18%) had ever been prescribed a bisphosphonate. Overall, only 126 (25%) men had chart documentation indicating some recognition by the provider of the abnormality reported on CXR. We conclude that a significant fraction of men > 50 years old may have unrecognized osteoporosis severe enough to result in vertebral fracture. We conclude that computerized screening of CXR reports may represent an effective strategy to aid clinicians in identifying men at risk for further debilitating fractures.