Vertebral fragility fractures are common, affecting approximately 50% of all postmenopausal women and 33% of men over the age of 50, and are the most common type of fracture seen in osteoporosis. The management of vertebral fragility fractures in the acute care setting is lacking in standardization, in the use of evidence-based practice, and in addressing the underlying cause of osteoporosis. The purpose of this project was to develop an evidence-based protocol to standardize the care of the vertebral fragility fracture in the acute care setting. This protocol included patient education, fall risk assessment, screening for osteoporosis, and follow up with an osteoporosis clinic for comprehensive management once discharged. This project used the Donabedian model to provide a conceptual framework for evaluating the structure, process, and outcomes related to the practice problem. This quantitative study involved 10 participants that were selected using purposive sampling and used process control charting to show compliance with elements of the guideline, and descriptive data to depict process change. Guideline compliance was measured over an 8-week period and indicated successful implementation of fall risk assessment with a 100% compliance rate and osteoporosis screening with an 80% compliance rate. Compliance with fracture education and securement of follow up were difficult to ascertain in the 8-week period and non-compliance evident. In conclusion, two elements of the guideline showed to be an unstable process and further work is necessary to improve. Positive social change may result from empowering nurses by education and giving them autonomy to use evidence-based practice to decrease the risk for secondary vertebral fragility fractures.

No description available.

Sweden and Norway have the worldwide highest incidence of osteoporotic fractures. As these fractures constitute a tremendous and growing problem, primary prevention is of great importance. The principal causes of an osteoporotic fracture are a fall and a fragile skeleton. The aim of the studies reported in these papers was therefore to determine the genetic and environmental influences on fractures and the genetic influence on the two main reasons to the emergence of osteoporotic fractures; bone mineral density and propensity to fall. In the present thesis, we display that the heritability of fractures is dependent on fracture site and age. With increasing age, lifestyle becomes the dominant explanatory factor. These results indicate that focus should be on lifestyle interventions for the prevention of fractures in the elderly. Although the genetic liability to impaired balance is modest, twins with self-reported impaired balance have a substantially increased risk of osteoporotic fractures compared to their co-twin without impaired balance. Asking a patient about his or her balance might be a simple tool for future risk assessment. The genetic influence on bone phenotypes is under strong genetic influence in Swedish adult twins. These findings are in agreement with the results from previous studies in other countries, with a lower incidence of osteoporotic fractures compared to Sweden. The high heritability of bone phenotypes together with the low heritability of fractures at old age, indicates that bone mineral density has a modest influence on fracture risk at old age. In summary, based on the results in this thesis, more emphasis should be targeted to the prevention of falls, by strength and balance training in order to prevent the occurrence of  low energy fractures in the elderly.

Orientador: Yvens Barbosa Fernandes / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-19T18:49:05Z (GMT). No. of bitstreams: 1 Cavalcante_RodrigoAlvesdeCarvalho_M.pdf: 47962870 bytes, checksum: 30187744bcc8d761f23631f51a4d472c (MD5) Previous issue date: 2012 / Resumo: Fraturas da coluna tóraco-lombar tem alta prevalência em todo mundo e, portanto, exige dos cirurgiões de coluna uma constante tomada de condutas no sentido de propor a melhor forma de tratamento para os doentes acometidos com essas fraturas. A melhor forma de tratar as mesmas seria então tentar agrupá-las, classificá-las e a definir a presença ou não de instabilidade, definindo uma conduta de tratamento clínico ou cirúrgico. Dentre os vários sistemas de classificações existentes para classificar essas fraturas, os mais utilizados na atualidade são o Thoracolumbar Injury Classification System (TLICS) escore e sistema de Classificação da ArbeitgemeinschaftOsteosynthesefragen (AO). Nesse estudo foi utilizado o escore TLICS recentemente publicado para avaliar retrospectivamente 49 doentes tratados cirurgicamente entre 2003 a 2009 no Hospital das Clínicas da Unicamp e no Hospital Dr. Mário Gatti em Campinas-SP, por fraturas em coluna tóraco-lombar. O TLICS recomendou tratamento em 47 de 49 pacientes operados (96%), sendo identificada correlação estatística significante do mesmo, com o sistema de classificação AO (p= 0.0088), com status neurológico( p=0.001) e a correlação da classificação AO com status neurológico( p=0.041), utilizando o teste de Fischer. Os resultados do presente estudo permitem concluir que esse escore é acurado para predizer a conduta cirúrgica no tratamento dessas lesões / Abstract: Fractures of the thoracic and lumbar spine have a high prevalence worldwide, therefore, requires the spine surgeons conduct a continuous decision to propose the best treatment for patients affected with these fractures. The best way to treat the same would then try to group and classify them and after that define its stability or instability, a defining conduct of clinical or surgical treatment. Among the various classification systems exist to classify these fracture, the most frequently used are TLICS score and Arbeitgemeinschaft fur Osteosynthesefragen (AO) classification system. We used the recently published TLICS score to evaluate retrospectively 49 patients treated surgically between 2003 to 2009 at the Hospital of UNICAMP and Dr. Mário Gatti Hospital in Campinas-SP, for fractures at the thoracolumbar spine. The TLICS score recommended treatment in 47 of 49 operated patients (96%), being identified a significance statistical analysis correlation between the same with the AO classification system (p=0.0088), the TLICS score and neurological status (p=0.001) and the AO classification system and neurological status (p=0.041); therefore, the results presented in this article show be accurate to predict the surgical treatment of these lesions / Mestrado / Neurologia / Mestre em Ciências Médicas

Vertebral fractures affect at least 12-20% of men and women over the age of 50, and the risk of fracture increases exponentially with age. Despite their high prevalence, the failure mechanisms leading to these fractures are not well understood. For example, clinical observations of fractured vertebra often note that one or both vertebral endplates have collapsed, but the precise involvement of the endplates in the initiation and progression of failure has not yet been defined. The mechanisms of failure may also relate to spatial variations in the density and microstructure of the porous trabecular bone within the vertebra as well as to the health of the adjacent intervertebral discs (IVDs) which transfer loads directly to the vertebral endplates. Delineating the contributions of these factors would shed light on the etiology of vertebral fractures and would aid in development of clinically feasible, patient-specific finite element (FE) models of the vertebra. These models are built from a patient's quantitative computed tomography (QCT) scan and have shown tremendous promise for accurate, patient-specific estimates of bone strength and fracture risk. Further validation studies are required to assess the impact of the choices of material properties and boundary conditions, as a prerequisite for broad implementation of these FE models in clinical care. The overall goal of this work was to define the failure processes involved in vertebral fractures and to evaluate the accuracy of patient-specific FE models in simulating these processes. Mechanical testing of human spine segments, in conjunction with micro-computed tomography, enabled the assessment of deformation at the vertebral endplate and deformation throughout the entire bone, as the vertebra was loaded to failure under both axial compression and anterior flexion. These data were compared against predictions of vertebral deformation obtained from QCT-based FE models. The impact of the choice of boundary conditions was specifically examined by comparing the accuracy of the FE predictions between models that simulated applied loads based on measured distributions of pressure within IVDs and models that used highly idealized boundary conditions. The results of these studies demonstrated that sudden and non-recoverable endplate deflection is a defining feature of biomechanical failure of the vertebra, for both compression and flexion loading. The locations of endplate collapse as vertebral failure progressed were associated with the porosity of the endplate and the microstructure of the underlying trabecular bone. FE analyses incorporating the experimentally observed endplate deflections as boundary conditions provided more accurate predictions of displacements throughout the rest of the vertebra when compared to FE models with highly idealized boundary conditions. Under anterior flexion, the use of boundary conditions informed by measurements of IVD pressure mitigated, but did not eliminate, the inaccuracy of the idealized boundary conditions. No further improvement in accuracy was found when using boundary conditions based on pressure measurements corresponding only to IVDs whose level of degeneration matched that observed in the IVDs adjacent to the vertebra being modeled. Overall, the accuracy of the FE predictions of vertebral deformation was only moderate, particularly near the locations of endplate collapse. The outcomes of this work indicate that the vertebral endplate is principally involved in vertebral fractures and that current methods for QCT-based FE models do not adequately capture this failure mechanism. These outcomes provide a biomechanical rationale for clinical diagnoses of vertebral fracture based on endplate collapse. These outcomes also emphasize that future studies of patient-specific FE models should incorporate physiologically relevant loading conditions and also material properties that more accurately represent the vertebral endplate in order to obtain higher fidelity predictions of vertebral failure.

No description available.

Fraturas e luxações vertebrais decorrente de trauma consistem afecção neurológica frequente na prática clínica veterinária, sendo a coluna tóraco-lombar a mais comumente afetada em cães, e em muitos casos o tratamento cirúrgico é de eleição. Existem diversas técnicas propostas a realizar estabilização vertebral, entretanto, estudos em coluna tóraco-lombar não foram realizados para avaliar as propriedades biomecânicas de cada técnica. Baseado nisso, nossa pesquisa teve como objetivo fazer uma avaliação biomecânica comparando a força e rigidez promovidas por cinco diferentes técnicas de estabilização em coluna toracolombar (Pinos com Cimento Ósseo, Técnica Segmentar Modificada, Placa Bloqueada e Clamp Rod Internal Fixation utilizando parafusos monocorticais e bicorticais) frente às forças de compressão e flexão. Foram utilizadas 34 colunas tóraco-lombares de cães, divididas em cinco grupos. Para realização dos testes biomecânicos, foi utilizada a máquina de ensaios Kratos (modelo KE3000MP) e célula de carga de 100 kg. Para cada corpo de prova, três testes biomecânicos foram realizados, o controle, no segmento íntegro, após desarticulação de T13/L1 e após realização de uma das técnicas de estabilização propostas. Os dados foram exportados para análise estatística para o programa Statistical Package for the Social Sciences (SPSS) versão 18.0. Os resultados permitiram concluir que, apesar de não haver diferença estatística significativa, a Placa Bloqueada foi a técnica que promoveu maior rigidez e estabilidade nas vértebras lesionadas, seguida do CRIF bicortical, técnica Segmentar Modificada e Pinos e Cimento Ósseo. Estatisticamente, a Placa Bloqueada e o CRIF com parafusos bicorticais apresentaram maior rigidez e estabilidade em T13/L1 quando comparados com a técnica CRIF monocortical, que por sua vez, não alcançou rigidez necessária para adequada estabilização das vértebras. / Spinal fractures and luxations resulting from trauma consist frequent disorder in clinical veterinary practice, being thoracolumbar spine the region that is the most commonly affected in canines, thus in many cases surgical treatment is necessary. There are several proposed techniques of implants to perform spinal stabilization; however, few studies of the thoracolumbar spine were carried out to evaluate the biomechanical properties of each technic. Therefore, the objective of the present study is to analyze biomechanical effects comparing the strength and the stiffness promoted by five different technics of stabilization in the thoracolumbar spine (pin with bone cement, modified segmental stabilization, locking plate and clamp rod internal fixation) under compression and bending forces. In the study, thirty four thoracolumbar dog spines were used, dividing the specimens in five groups. In order to perform the biomechanical tests, it was used a Kratos testing machine (model KE3000MP) and loading cell of 100 Kg. Each body of proof was submitted to three biomechanical tests, the control, in the segment intact, after disarticulation of the T13/L1 and after the realization of one of the proposed technics. Data were exported to statistical analyses to the Statistical Package for the Social Sciences (SPSS) version 18.0. The results led to the conclusion that despite there was no statistically significant difference between the techniques, the Locking Plate was the technique that promoted greater rigidity and stability in the injured vertebrae, followed by the Clamp Rod Internal Fixation bicortical, Modified Segmental Instrumentation and Pins with Bone Cement. Statistically, the locking plate and the Clamp Rod Internal Fixation with bicortical pins showed more stiffness and stability in T13/L1 when compared to the Clamp Rod Internal Fixation monocortical, which did not achieved the adequate rigidity for the stabilization of the vertebrae.

Fraturas e luxações vertebrais decorrente de trauma consistem afecção neurológica frequente na prática clínica veterinária, sendo a coluna tóraco-lombar a mais comumente afetada em cães, e em muitos casos o tratamento cirúrgico é de eleição. Existem diversas técnicas propostas a realizar estabilização vertebral, entretanto, estudos em coluna tóraco-lombar não foram realizados para avaliar as propriedades biomecânicas de cada técnica. Baseado nisso, nossa pesquisa teve como objetivo fazer uma avaliação biomecânica comparando a força e rigidez promovidas por cinco diferentes técnicas de estabilização em coluna toracolombar (Pinos com Cimento Ósseo, Técnica Segmentar Modificada, Placa Bloqueada e Clamp Rod Internal Fixation utilizando parafusos monocorticais e bicorticais) frente às forças de compressão e flexão. Foram utilizadas 34 colunas tóraco-lombares de cães, divididas em cinco grupos. Para realização dos testes biomecânicos, foi utilizada a máquina de ensaios Kratos (modelo KE3000MP) e célula de carga de 100 kg. Para cada corpo de prova, três testes biomecânicos foram realizados, o controle, no segmento íntegro, após desarticulação de T13/L1 e após realização de uma das técnicas de estabilização propostas. Os dados foram exportados para análise estatística para o programa Statistical Package for the Social Sciences (SPSS) versão 18.0. Os resultados permitiram concluir que, apesar de não haver diferença estatística significativa, a Placa Bloqueada foi a técnica que promoveu maior rigidez e estabilidade nas vértebras lesionadas, seguida do CRIF bicortical, técnica Segmentar Modificada e Pinos e Cimento Ósseo. Estatisticamente, a Placa Bloqueada e o CRIF com parafusos bicorticais apresentaram maior rigidez e estabilidade em T13/L1 quando comparados com a técnica CRIF monocortical, que por sua vez, não alcançou rigidez necessária para adequada estabilização das vértebras. / Spinal fractures and luxations resulting from trauma consist frequent disorder in clinical veterinary practice, being thoracolumbar spine the region that is the most commonly affected in canines, thus in many cases surgical treatment is necessary. There are several proposed techniques of implants to perform spinal stabilization; however, few studies of the thoracolumbar spine were carried out to evaluate the biomechanical properties of each technic. Therefore, the objective of the present study is to analyze biomechanical effects comparing the strength and the stiffness promoted by five different technics of stabilization in the thoracolumbar spine (pin with bone cement, modified segmental stabilization, locking plate and clamp rod internal fixation) under compression and bending forces. In the study, thirty four thoracolumbar dog spines were used, dividing the specimens in five groups. In order to perform the biomechanical tests, it was used a Kratos testing machine (model KE3000MP) and loading cell of 100 Kg. Each body of proof was submitted to three biomechanical tests, the control, in the segment intact, after disarticulation of the T13/L1 and after the realization of one of the proposed technics. Data were exported to statistical analyses to the Statistical Package for the Social Sciences (SPSS) version 18.0. The results led to the conclusion that despite there was no statistically significant difference between the techniques, the Locking Plate was the technique that promoted greater rigidity and stability in the injured vertebrae, followed by the Clamp Rod Internal Fixation bicortical, Modified Segmental Instrumentation and Pins with Bone Cement. Statistically, the locking plate and the Clamp Rod Internal Fixation with bicortical pins showed more stiffness and stability in T13/L1 when compared to the Clamp Rod Internal Fixation monocortical, which did not achieved the adequate rigidity for the stabilization of the vertebrae.

As fraturas benignas osteoporóticas e malignas da coluna vertebral representam um desafio diagnóstico para os médicos especialistas. As fraturas benignas osteoporóticas ocorrem em virtude da fragilidade óssea da osteoporose e as fraturas malignas são secundárias a infiltração neoplásica. Estes dois grupos tem em comum o fato de acometerem predominantemente a população idosa. Alguns sinais radiológicos favorecem o diagnóstico de fraturas benignas osteoporóticas enquanto outros sinais de imagem favorecem o diagnóstico de fraturas malignas, no entanto nenhum sinal identificado nas imagens é específico. O propósito de realizar esse estudo foi identificar se o nível de formação médica dos radiologistas e ortopedistas (cirurgiões da coluna vertebral) exerce influência para o diagnóstico etiológico dessas fraturas nos exames de RM da coluna lombar, assim como avaliar o grau de concordância intra e interobservador para o diagnóstico de fraturas benignas por osteoporose e fraturas malignas. Foram incluídos no estudo de forma retrospectiva os exames de 63 pacientes consecutivos da rotina clínica do HCRP, realizados previamente por indicação clínica e com diagnóstico de fratura não traumática de corpo vertebral. Para avaliar a influência do nível de formação médica, quatro radiologistas e dois cirurgiões da coluna vertebral com diferentes níveis de formação realizaram avaliações de forma independente e as cegas em relação as demais leituras e em relação às informações do prontuário clínico. As imagens de RM anonimizadas e no formato DICOM foram avaliadas em workstation OsiriX. Os médicos observadores fizeram as leituras classificando cada vértebra da região lombar da seguinte forma: sem fratura, com fratura de características benignas ou com fratura de características malignas. Cada observador realizou duas leituras, com intervalo de 15 dias entre as leituras. O padrão de referência foi obtido a partir da avaliação pormenorizada do prontuário eletrônico de cada paciente realizada por médico radiologista sênior, a partir do Sistema de Informações do Hospital (HIS) e do Sistema Informatizado da radiologia (RIS), incluindo a biópsia com confirmação histopatológica nos casos de neoplasia e o seguimento clinico e laboratorial por pelo menos dois anos nos casos em que não houve indicação clínica de biópsia. Utilizando este padrão de referência foram calculadas para cada leitura, a sensibilidade, a especificidade, acurácia, valor preditivo positivo e negativo com intervalo de confiança (IC) 95%. Os resultados demonstram uma excelente concordância intraobservador e uma boa concordância interobservador, porém sem relevância estatística. Além disso, de uma forma geral a sensibilidade dos observadores para a detecção de fraturas malignas foi boa. A especificidade, acurácia e valor preditivo negativo foram elevados para todos os observadores. O valor preditivo positivo variou de moderado a substancial. Portanto, não houve influência do nível de formação médica para o desempenho diagnóstico na detecção de fraturas benignas osteoporóticas e fraturas malignas nas imagens de ressonância magnética. / Benign osteoporotic and malignant spinal fractures represent a diagnostic challenge for medical specialists. Osteoporotic benign fractures occur because of the bone fragility of osteoporosis and malignant fractures are secondary to neoplastic infiltration. These two groups have in common the fact that they affect predominantly the elderly population. Some radiological signs favor the diagnosis of benign osteoporotic fractures while other imaging signs favor the diagnosis of malignant fractures, however no signs identified in the images are specific. The purpose of this study was to identify whether the level of medical training of radiologists and orthopedists (spine surgeons) influences the etiological diagnosis of these fractures in lumbar spinal MRI (magnetic resonance imaging), as well as to evaluate the degree of intra and interobserver agreement for the diagnosis of benign fractures due to osteoporosis and malignant fractures. We retrospectively included the exams of 63 consecutive patients from the clinical routine of the HCRP, performed previously by clinical indication and with diagnosis of non-traumatic vertebral body fracture. To evaluate the influence of the level of medical training, four radiologists and two spine surgeons with different levels of training performed evaluations independently, without knowing the other readings and without the information in the medical record. The anonymized MRI in the DICOM format were evaluated in OsiriX workstation. Observer doctors did the readings by classifying each vertebra in the lumbar region as follows: no fracture, with fracture of benign features or with fracture of malignant characteristics. Each observer performed two readings, with a 15-day interval between readings. The reference standard was obtained from the detailed evaluation of each patient\'s electronic medical record by a senior radiologist, with the Hospital Information System (HIS) and the Computerized Radiology System, including biopsy with histopathological confirmation in cases of neoplasia and clinical and laboratory follow-up for at least two years in cases in which there was no clinical indication of biopsy. Using this reference standard, sensitivity, specificity, accuracy, positive and negative predictive value with 95% confidence interval (CI) were calculated for each reading. The results demonstrate excellent intraobserver agreement and good interobserver agreement, but without statistical relevance. In addition, the sensitivity of the observers for the detection of malignant fractures was generally good. The specificity, accuracy and negative predictive value were high for all observers. The positive predictive value ranged from moderate to substantial. Therefore, there was no influence of the level of medical training for diagnostic performance in the detection of benign osteoporotic fractures and malignant fractures in magnetic resonance imaging.

As fraturas benignas osteoporóticas e malignas da coluna vertebral representam um desafio diagnóstico para os médicos especialistas. As fraturas benignas osteoporóticas ocorrem em virtude da fragilidade óssea da osteoporose e as fraturas malignas são secundárias a infiltração neoplásica. Estes dois grupos tem em comum o fato de acometerem predominantemente a população idosa. Alguns sinais radiológicos favorecem o diagnóstico de fraturas benignas osteoporóticas enquanto outros sinais de imagem favorecem o diagnóstico de fraturas malignas, no entanto nenhum sinal identificado nas imagens é específico. O propósito de realizar esse estudo foi identificar se o nível de formação médica dos radiologistas e ortopedistas (cirurgiões da coluna vertebral) exerce influência para o diagnóstico etiológico dessas fraturas nos exames de RM da coluna lombar, assim como avaliar o grau de concordância intra e interobservador para o diagnóstico de fraturas benignas por osteoporose e fraturas malignas. Foram incluídos no estudo de forma retrospectiva os exames de 63 pacientes consecutivos da rotina clínica do HCRP, realizados previamente por indicação clínica e com diagnóstico de fratura não traumática de corpo vertebral. Para avaliar a influência do nível de formação médica, quatro radiologistas e dois cirurgiões da coluna vertebral com diferentes níveis de formação realizaram avaliações de forma independente e as cegas em relação as demais leituras e em relação às informações do prontuário clínico. As imagens de RM anonimizadas e no formato DICOM foram avaliadas em workstation OsiriX. Os médicos observadores fizeram as leituras classificando cada vértebra da região lombar da seguinte forma: sem fratura, com fratura de características benignas ou com fratura de características malignas. Cada observador realizou duas leituras, com intervalo de 15 dias entre as leituras. O padrão de referência foi obtido a partir da avaliação pormenorizada do prontuário eletrônico de cada paciente realizada por médico radiologista sênior, a partir do Sistema de Informações do Hospital (HIS) e do Sistema Informatizado da radiologia (RIS), incluindo a biópsia com confirmação histopatológica nos casos de neoplasia e o seguimento clinico e laboratorial por pelo menos dois anos nos casos em que não houve indicação clínica de biópsia. Utilizando este padrão de referência foram calculadas para cada leitura, a sensibilidade, a especificidade, acurácia, valor preditivo positivo e negativo com intervalo de confiança (IC) 95%. Os resultados demonstram uma excelente concordância intraobservador e uma boa concordância interobservador, porém sem relevância estatística. Além disso, de uma forma geral a sensibilidade dos observadores para a detecção de fraturas malignas foi boa. A especificidade, acurácia e valor preditivo negativo foram elevados para todos os observadores. O valor preditivo positivo variou de moderado a substancial. Portanto, não houve influência do nível de formação médica para o desempenho diagnóstico na detecção de fraturas benignas osteoporóticas e fraturas malignas nas imagens de ressonância magnética. / Benign osteoporotic and malignant spinal fractures represent a diagnostic challenge for medical specialists. Osteoporotic benign fractures occur because of the bone fragility of osteoporosis and malignant fractures are secondary to neoplastic infiltration. These two groups have in common the fact that they affect predominantly the elderly population. Some radiological signs favor the diagnosis of benign osteoporotic fractures while other imaging signs favor the diagnosis of malignant fractures, however no signs identified in the images are specific. The purpose of this study was to identify whether the level of medical training of radiologists and orthopedists (spine surgeons) influences the etiological diagnosis of these fractures in lumbar spinal MRI (magnetic resonance imaging), as well as to evaluate the degree of intra and interobserver agreement for the diagnosis of benign fractures due to osteoporosis and malignant fractures. We retrospectively included the exams of 63 consecutive patients from the clinical routine of the HCRP, performed previously by clinical indication and with diagnosis of non-traumatic vertebral body fracture. To evaluate the influence of the level of medical training, four radiologists and two spine surgeons with different levels of training performed evaluations independently, without knowing the other readings and without the information in the medical record. The anonymized MRI in the DICOM format were evaluated in OsiriX workstation. Observer doctors did the readings by classifying each vertebra in the lumbar region as follows: no fracture, with fracture of benign features or with fracture of malignant characteristics. Each observer performed two readings, with a 15-day interval between readings. The reference standard was obtained from the detailed evaluation of each patient\'s electronic medical record by a senior radiologist, with the Hospital Information System (HIS) and the Computerized Radiology System, including biopsy with histopathological confirmation in cases of neoplasia and clinical and laboratory follow-up for at least two years in cases in which there was no clinical indication of biopsy. Using this reference standard, sensitivity, specificity, accuracy, positive and negative predictive value with 95% confidence interval (CI) were calculated for each reading. The results demonstrate excellent intraobserver agreement and good interobserver agreement, but without statistical relevance. In addition, the sensitivity of the observers for the detection of malignant fractures was generally good. The specificity, accuracy and negative predictive value were high for all observers. The positive predictive value ranged from moderate to substantial. Therefore, there was no influence of the level of medical training for diagnostic performance in the detection of benign osteoporotic fractures and malignant fractures in magnetic resonance imaging.