How can a smartphone app help diagnosis of spinal fractures?

Emma Clark is Professor of Clinical Musculoskeletal Epidemiology and Consultant Rheumatologist at North Bristol NHS Trust. She and researchers at the University of Bristol have developed a tool to assist healthcare professionals in spotting vertebral fractures in people with osteoporosis, which may have otherwise been missed.

What is osteoporosis?

Osteoporosis is a common condition in which the structure of bone becomes spongier and less strong. Anyone can get osteoporosis, but risk increases with age and women are about four times more likely than men to develop it.

Bone is a living tissue that’s constantly renewing itself. Old bone tissue is broken down by cells called osteoclasts and is replaced by new bone material produced by cells called osteoblasts.

The balance between the breakdown of old bone and the formation of new bone changes at different stages of our lives. For example, bone loss speeds up for several years after the menopause.

Why are vertebral fractures a problem in osteoporosis?

Osteoporotic vertebral fractures (broken bones in the back due to osteoporosis) are particularly important to identify because they increase the chances of having more fractures.

The problem is that only one in three patients are diagnosed with these fractures. One reason for this is that medical staff find it difficult to know who should have a spinal X-ray to further explore their back pain, because the criteria for referral are not well-defined.

How can this research help diagnosis?

To help diagnosis, Versus Arthritis funded a team of researchers, led by Emma Clark at the University of Bristol, to develop the Vfrac tool.

This tool consists of a checklist in a smartphone app which includes asking questions about the type of back pain the person is experiencing. It’s designed to help doctors decide who needs to be referred for an X-ray. The app has been shown to improve the diagnosis of vertebral fractures, by helping medical professionals to make referral decisions based on how people are experiencing back pain.

What have the researchers found?

In work recently published in Age and Ageing journal, researchers tested the 15-question checklist in a group of women with back pain, some who had vertebral fracture and some who didn’t.

They found that nearly all people with more than one vertebral fracture are diagnosed correctly using the Vfrac tool, and two-thirds of those with one fracture. This is a significant improvement compared to usual care.

Emma Clark, Professor of Clinical Musculoskeletal Epidemiology and lead researcher on this study said "We hope this app will help diagnose more of the 1 in 8 older people who already have existing vertebral fractures. They can then be offered help with their back pain and medications to reduce their risk of more fractures due to osteoporosis. This is likely to improve their quality of life, and reduce future healthcare costs through prevention of fractures."

What are the next steps for the research?

The researchers will test Vfrac with more people, particularly men, and will test it in a real-world situation such as a clinical appointment, to find out if it works well in practice. They are also assessing if it is likely to be cost-effective for use in the NHS.