A vertebral height loss of 20% or more is a fracture (Genant grade 1–3) and must be named in the report — including incidentally on a chest or abdominal CT; MRI separates acute from old and benign from malignant collapse.
Orient first
- Genant semiquantitative grades: mild 20–25%, moderate 25–40%, severe > 40% height loss.
- Vertebral fractures are under-reported on CT sagittal reformats — the single most useful osteoporosis finding.
- Malignant collapse: convex posterior border, pedicle involvement, soft tissue mass, other lesions.
Acquire the study
- Lateral thoracic and lumbar spine radiographs centred on T7 and L3.
The manoeuvre
- Lateral view: anterior, middle and posterior vertebral heights in mm — reduction relative to adjacent vertebrae.
- Shape on the lateral view: wedge, biconcave (codfish) or crush; Genant grade.
- Count all fractures from T4 to L4 on both lateral radiographs.
What confirms it
- Height loss of 20% or more with an osteoporotic morphology; MRI features favouring benign collapse.
What licenses you to exclude it
- Normal vertebral heights exclude a fracture; they do not exclude osteoporosis.
The classic misread
- Leaving a moderate fracture on a chest CT out of the report.
- Calling a malignant collapse osteoporotic without checking the pedicles and posterior border.