Department of Forensic Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
Nortvig & Uhrenholt Kiropraktisk Klinik, Jens Baggesens Vej 88A, 8200, Aarhus N, Denmark.
Chiropr Man Therap. 2024 Jun 24;32(1):24. doi: 10.1186/s12998-024-00545-0.
Osteoporosis is significantly associated with fractures and burdens the health of especially older people. Osteoporotic fractures cause pain, disability, and increased mortality. Early diagnosis of osteoporosis allows earlier initiation of treatment, thereby reducing the risk of osteoporotic fractures. Chiropractors encounter potential osteoporotic patients daily, and perform radiological evaluation of these and other patients, including evaluation of X-rays done for other purposes than osteoporosis. Therefore, chiropractors may identify vertebral fractures, vertebral deformity or osteopenia not otherwise suspected or recorded.
This study examines procedures available to the chiropractor to describe conventional X-rays with the focus of osteoporosis related findings. We review the indications for radiological examination in chiropractic practice, and in the realm of osteoporosis we describe radiological methods available for examination of conventional radiographs, and the necessity of inter-disciplinary communication.
National guidelines are available regarding referral for X-rays in chiropractic practice. Standardized protocols ensure image acquisition of the highest quality in the chiropractors' radiological department. Conventional X-ray examination is not indicated on clinical suspicion of osteoporosis alone, as bone mineral density testing is the diagnostic test. Radiological assessment of all available X-rays of patients above the age of 50 years should include evaluation of the bone quality, and hip and vertebral fracture assessment. The Singh index, Genant Semi-Quantitative tool (GSQ), and Algorithm-Based Qualitative method (ABQ) should be used consistently during interpretation. Referral for additional imaging and evaluation should be prompt and systematic when needed.
This article presents an overview of evidence-based radiological procedures for the purpose of promoting early diagnosis of osteoporosis. We present recommendations to the clinicians where we propose an opportunistic evaluation of X-rays, done for any reason, which include systematic evaluation of bone quality, presence of hip and vertebral fractures, and vertebral deformation of all patients above the age of 50 years. Detailed referral to healthcare professionals for further diagnostic evaluation is performed when needed. Consistent, high-quality radiological procedures in chiropractic practices could feasibly contribute to the timely diagnosis of osteoporosis, ultimately minimizing the impact of osteoporosis-related complications on patients' health.
骨质疏松症与骨折显著相关，尤其对老年人的健康造成负担。骨质疏松性骨折会引起疼痛、残疾和增加死亡率。骨质疏松症的早期诊断可以更早地开始治疗，从而降低骨质疏松性骨折的风险。整脊医师每天都会遇到潜在的骨质疏松症患者，并对这些患者和其他患者进行影像学评估，包括评估并非专门用于骨质疏松症的 X 光检查。因此，整脊医师可能会发现其他情况下未被怀疑或记录的椎体骨折、椎体畸形或骨量减少。
本研究探讨了整脊医师可用于描述与骨质疏松症相关发现的常规 X 光片的程序。我们回顾了整脊实践中放射检查的适应证，在骨质疏松症领域，我们描述了用于检查常规 X 光片的放射学方法，以及跨学科交流的必要性。
针对整脊实践中的 X 光检查，有国家指南可供参考。标准化方案可确保整脊医师放射科获取最高质量的图像。仅凭临床怀疑骨质疏松症而进行常规 X 光检查是不适当的，因为骨密度测试是诊断性测试。对 50 岁以上患者的所有可用 X 光片进行放射学评估应包括骨质量评估以及髋部和椎体骨折评估。在解释时应一致使用 Singh 指数、Genant 半定量工具（GSQ）和基于算法的定性方法（ABQ）。当需要时，应迅速且系统地转介进行额外的影像学和评估。
本文介绍了用于促进骨质疏松症早期诊断的循证放射学程序概述。我们向临床医生提出建议，即我们提出对任何原因进行的 X 光片进行机会性评估，包括对所有 50 岁以上患者的骨质量、髋部和椎体骨折以及椎体变形进行系统评估。当需要时，向医疗保健专业人员进行详细转诊以进行进一步的诊断评估。整脊实践中一致、高质量的放射学程序可以有效地帮助及时诊断骨质疏松症，最终最大限度地减少骨质疏松症相关并发症对患者健康的影响。
