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Visual identification of vertebral fractures from spinal radiographs makes use of operator expertise in ruling out non-fracture deformities or normal variants. Morphometric X-ray absorptiometry (MXA) has recently been developed to assess vertebral deformity status quantitatively by dual energy X-ray absorptiometry (DXA). The reliability of MXA measurements depends on the precision of the technique, and this is influenced by system error, variability associated with morphometric analysis, and variability within study populations. This technique has proved to be useful in the identification and evaluation of osteoporotic vertebral deformities in both epidemiologic surveys and clinical trials. The major limitation of DXA vertebral assessment is the poor quality of images of thoracic vertebrae. We conclude that, used as a screening tool, this approach may help to identify vertebral fractures with a reduced radiation dose to the patient, and that technological improvements are necessary to improve image quality.

Raloxifene (RLX), a selective estrogen receptor modulator (SERM), is currently indicated for the prevention and treatment of post-menopausal osteoporosis. At present, RLX is evaluated in other areas of study that include the reduction of the risk of breast cancer and cardiovascular (CV) disease in post-menopausal women. This SERM acts as an estrogen agonist in the skeleton, on serum lipid metabolism and on a number of coagulation factors, while it is an estrogen antagonist in the breast and uterus. Although our current data are incomplete, RLX has a favourable risk-benefit safety profile and is one of the most promising medical agents not only for the prevention of osteoporosis, but also for a large number of other disorders in post-menopausal women.