Koromani Fjorda, Li Jiawei, Hagino Hiroshi, Eastell Richard, Vlug Annegreet, Wang Ling, Yue Hua, Ha Yong-Chan, Cummings Steven, Minisola Salvatore, Glüer Claus-C, Oei Ling
Department of Internal Medicine, Erasmus MC, Rotterdam, the Netherlands.
Faculty of Medicine, School of Health Science, Tottori University, Japan.
Bone Rep. 2025 May 15;25:101851. doi: 10.1016/j.bonr.2025.101851. eCollection 2025 Jun.
Osteoporotic vertebral fractures (VFs) are among the most common and clinically significant manifestations of skeletal fragility, contributing substantially to morbidity, disability, and future fracture risk worldwide. Yet, their recognition and management remain inconsistent across regions. To explore differences and similarities in the prevalence, diagnosis, management, and prevention of vertebral fractures, the East Meets West (EmW) Action Group of the European Calcified Tissue Society convened a multi-country exchange among clinical and research experts from Europe, the USA, and East Asia. This report summarizes the discussions and synthesizes current knowledge on the topic. Evidence from China, South Korea, Japan, and Germany shows a wide range in reported VF prevalence and incidence, largely influenced by differences in population aging, imaging access, and diagnostic adjudication methods. While lateral spine radiographs remain the standard for detection in both research and clinical care, variable use of quantitative morphometry (QM), semi-quantitative (SQ), and algorithm-based qualitative (ABQ) methods limits comparability. MRI remains the gold standard for assessing fracture acuity, but is not feasible for widespread screening. VFA via DXA is gaining popularity, although underutilized in several settings. Despite the availability of effective pharmacologic treatments, including bisphosphonates, denosumab, and anabolic agents, treatment rates following VF remain suboptimal across all countries studied. None of the countries currently has a nationwide vertebral fracture screening program, although fracture liaison services (FLS) and AI-assisted imaging offer promising pathways forward. The lack of a universally accepted definition and gold standard for VF adjudication continues to hamper clinical decision-making and data harmonization. This report highlights the need for greater international consensus on diagnostic criteria, improved integration of vertebral fracture screening into clinical workflows, and the development of targeted strategies to close treatment gaps and reduce the global burden of vertebral fractures.
骨质疏松性椎体骨折（VFs）是骨骼脆弱最常见且具有临床重要意义的表现之一，在全球范围内对发病率、残疾率及未来骨折风险有重大影响。然而，不同地区对其的识别和管理仍不一致。为探讨椎体骨折在患病率、诊断、管理及预防方面的异同，欧洲钙化组织协会的东西方（EmW）行动小组组织了一次欧洲、美国和东亚临床及研究专家的多国交流活动。本报告总结了讨论内容并综合了该主题的现有知识。来自中国、韩国、日本和德国的证据表明，报告的椎体骨折患病率和发病率差异很大，这在很大程度上受人口老龄化、影像检查可及性及诊断判定方法差异的影响。虽然脊柱侧位X线片在研究和临床护理中仍是检测的标准方法，但定量形态测量法（QM）、半定量法（SQ）和基于算法的定性法（ABQ）的使用差异限制了可比性。MRI仍是评估骨折严重程度的金标准，但不适用于广泛筛查。通过双能X线吸收法（DXA）进行椎体骨折评估（VFA）越来越受欢迎，尽管在一些情况下未得到充分利用。尽管有有效的药物治疗方法，包括双膦酸盐、地诺单抗和促合成药物，但在所研究的所有国家中，椎体骨折后的治疗率仍不理想。目前没有一个国家有全国性的椎体骨折筛查项目，不过骨折联络服务（FLS）和人工智能辅助影像检查提供了有前景的发展途径。缺乏普遍接受的椎体骨折判定定义和金标准继续阻碍临床决策和数据协调。本报告强调需要在诊断标准上达成更大的国际共识，改善将椎体骨折筛查纳入临床工作流程的情况，并制定有针对性的策略以缩小治疗差距并减轻全球椎体骨折负担。
