What is the initial imaging modality to evaluate suspected osteoporotic vertebral fractures?

• A. MRI
• B. Plain radiographs (X-ray)
• C. DEXA
• D. Ultrasound

Answer: (B)

Plain radiographs are the first step because they are quick, widely available, and able to show vertebral compression with height loss or wedging, giving an immediate view of fracture presence and spinal alignment. They provide a practical baseline to gauge the extent of vertebral deformity and help decide whether more detailed imaging is needed. Although MRI is more sensitive for acute fractures and can detect bone marrow edema and occult injuries, it is typically reserved for cases where X-rays are inconclusive, there are neurologic symptoms, or there’s a need to differentiate fracture from other conditions. DEXA measures bone density rather than fracture and isn’t used to evaluate an acute vertebral fracture. Ultrasound isn’t used for assessing vertebral fractures either. If the clinical suspicion remains high despite a normal plain film, MRI or CT can be pursued to confirm the diagnosis.