Purpose or Case Report: Genant’s semi-quantitative classification is widely used to assess osteoporotic vertebral fractures in adults. However, its pediatric application remains limited. The lack of standardized pediatric criteria may lead to under-recognition of fractures and suboptimal management. This is especially relevant in children with metabolic disease, chronic corticosteroid exposure, or oncologic treatments, where early detection and standardized reporting are critical to prevent fracture progression. The objectives of this study were 1) determine the prevalence of vertebral fractures in children with metabolic disease or secondary osteoporosis, and 2) evaluate the explicit use of Genant’s classification in radiology reports.
Methods & Materials: A retrospective review was conducted on pediatric patients who underwent lateral spine radiographs (T4–L4) between January 2024 and January 2025. Inclusion criteria were: any age, initial or follow-up radiologic examination and availability of a lateral spine view between T4 and L4. Exclusion criteria included traumatic fractures and sickle cell disease. Clinical, anthropometric, and bone densitometry data were collected. Radiology reports were analyzed for clinical details from the referring physician, and adherence to Genant’s classification, namely explicit mention of vertebral height loss, its percentage, fracture type and level. Descriptive and prevalence analyses were performed using Excel 2025.
Results: Of 437 patients reviewed, 339 met inclusion criteria (mean age 10.8 years; 59% male). The prevalence of vertebral fractures was 38%. Main underlying diagnoses were leukemia (23%), bone dysplasia (19%) and neuromuscular disorders (16%). None of the radiology requisitions mentioned Genant’s classification or requested vertebral fracture grading. Only 3% of radiology reports applied Genant’s classification, and 0.3% documented the percentage of vertebral height loss. In contrast, 16% mentioned unchanged fractures without staging or description, while 60% reported no fracture.
Conclusions: Vertebral fragility fractures are common among at-risk children but are rarely reported using standardized Genant criteria. This underuse contrasts with international recommendations and may reflect limited awareness of its pediatric applicability. Standardizing vertebral fracture assessment through detailed clinical information and systematic application of Genant’s classification could enhance radiologist-clinician communication and improve follow-up and preventive care in children.