# Genant — Genant visual semiquantitative vertebral fracture grading

> Per-vertebra visual fracture assessment from T4 through L4 using morphology plus anterior, middle or posterior height loss and projected-area loss; morphometry confirms severity but cannot diagnose fracture alone.

**Situação:** vigente · **Órgão:** Coluna · **Órgão emissor:** Genant et al. / International Society for Clinical Densitometry · **Versão:** 1993 original; 2023 ISCD VFA technique of choice · **Ano:** 1993

> ⚠️ Uma versão mais nova pode existir (em revisão).

## Procedência e vigência
- Família: léxico
- Tipo de lógica: flat
- Modalidade: XR, DXA, CT
- Fonte primária: Genant HK, Wu CY, van Kuijk C, Nevitt MC. Vertebral fracture assessment using a semiquantitative technique (1993) — https://doi.org/10.1002/jbmr.5650080915
- Última verificação: 2026-07-24
- Última checagem: 2026-08-12

## Lógica de decisão
Diagnose fracture visually before grading severity. Preserve level, morphology, measurements, borderline or subthreshold states, differential diagnosis and modality; never infer osteoporosis treatment or acuity from the grade alone.

## Categorias

| Código | Rótulo | Critérios | Conduta | Risco | Localizador | Verificado |
| --- | --- | --- | --- | --- | --- | --- |
| 0 | Grade 0, normal | Grade 0: the identified vertebra has expected regional shape and no visual endplate, cortical or configuration change consistent with fracture. Height loss below 20% supports Grade 0 only when morphology is normal; a definite subthreshold endplate fracture or a questionable deformity must not be hidden in this category. | List the vertebral level and technical evaluability. Grade 0 at one level requires no fracture-specific action from this scale, but it does not exclude fracture at another level, low bone density or another cause of symptoms and cannot determine osteoporosis care. | Grade 0 means no visual fracture at the assessed level, not zero future fracture risk. Risk still depends on age, bone density, prior fractures, medications and clinical factors, which the Genant code does not quantify. | Grigoryan et al. 2003, PMC3591834, Genant visual semiquantitative assessment and Figs. 1-3: normal Grade 0 requires visual assessment against adjacent and expected regional morphology; the text warns that normal wedging, biconcavity and degenerative remodeling can mimic mild fracture. | ✓ |
| 0.5 | Grade 0.5, borderline or questionable deformity | Optional Grade 0.5: a borderline vertebra shows some deformation but cannot be clearly assigned a definite Grade 1 fracture. Preserve the observed endplate, cortex, shape and height findings; Grade 0.5 is an uncertainty category, not a definitive mild osteoporotic fracture. | Compare prior imaging and clinical context and consider diagnostic radiography or other imaging when confirmation would change care, especially with malignancy, a lytic or sclerotic feature, an unidentifiable level or another non-benign concern. Do not initiate grade-specific treatment from 0.5 alone. | Borderline and mild deformities have the greatest reader subjectivity and may reflect normal variation or non-osteoporotic disease. The 0.5 label carries no calibrated probability that the vertebra is fractured or that another fracture will occur. | Grigoryan et al. 2003, PMC3591834, visual semiquantitative description states that Grade 0.5 is sometimes used for deformation not clearly assignable to Grade 1 and discusses subjectivity of borderline and mild deformities. ISCD 2023 lists equivocal fracture as an indication for follow-up imaging based on the clinical picture. | ✓ |
| 1 | Grade 1, mild fracture | Grade 1 mild fracture: a visually credible vertebral fracture with approximately 20-25% reduction in anterior, middle or posterior height and approximately 10-20% reduction in projected vertebral-body area. Report wedge, biconcave or crush shape separately and exclude a normal or degenerative mimic. | Clearly report the mild fracture and integrate age, symptoms, BMD, prior fractures, glucocorticoids and secondary causes under local osteoporosis guidance. The grade alone does not choose medication, vertebral augmentation, surgery or follow-up timing; equivocal Grade 1 morphology may require confirmation. | A prevalent vertebral fracture is clinically relevant and associated with later fracture and morbidity, but Grade 1 does not supply an individual risk percentage. Mild grades are the most vulnerable to projection, regional shape and reader variation. | Grigoryan et al. 2003, PMC3591834, visual SQ section: Grade 1 is 20-25% height and 10-20% projected-area reduction; the article explains morphology, nonfracture differentials, mild-grade subjectivity and future-fracture association. ISCD 2023 requires visual fracture diagnosis rather than morphometry alone. | ✓ |
| 2 | Grade 2, moderate fracture | Grade 2 moderate fracture: a visually credible fracture with approximately 26-40% reduction in anterior, middle or posterior height and approximately 21-40% reduction in projected vertebral-body area. Preserve exact level, measurements and morphology and distinguish osteoporosis from trauma, neoplasm or another deforming process. | Communicate the moderate vertebral fracture and any acuity or pathologic features and support appropriate osteoporosis or secondary-cause evaluation. Genant Grade 2 alone cannot select a drug, brace, procedure or surgical pathway; neurologic or malignant features require their own urgent assessment. | Moderate vertebral fracture indicates greater structural deformity and contributes to clinical fracture-risk assessment, but it is not a stand-alone probability model. Patient risk remains dependent on the full fracture history, BMD and clinical context. | Grigoryan et al. 2003, PMC3591834, visual SQ section defines Grade 2 as 26-40% height and 21-40% area reduction and details visual morphology and differential diagnosis. ISCD 2023 retains the method for VFA and specifies follow-up imaging for malignant, equivocal, lytic or sclerotic concerns. | ✓ |
| 3 | Grade 3, severe fracture | Grade 3 severe fracture: a visually credible vertebral fracture with greater than 40% reduction in vertebral height and projected area. The configuration may be wedge, biconcave or crush; severe collapse still requires assessment for traumatic, neoplastic, infectious and other non-osteoporotic causes. | Report severe collapse, level, canal or neurologic implications, acuity features and any suspicious bone destruction separately and prompt appropriate specialist evaluation. The grade does not autonomously determine osteoporosis therapy, augmentation, stabilization or oncologic care. | Grade 3 is the maximum Genant severity category and represents substantial structural loss, but the classification gives no patient-specific mortality, neurologic or future-fracture probability. Etiology, acuity, multiplicity and clinical risk factors remain decisive. | Grigoryan et al. 2003, PMC3591834, visual SQ section defines Grade 3 as greater than 40% height and projected-area reduction and separates severity from wedge, biconcave or crush shape; differential-diagnosis sections require visual exclusion of non-osteoporotic deformity. | ✓ |

### Citações por categoria
- **0**: Grigoryan M, Guermazi A, Roemer FW, Delmas PD, Genant HK. Recognizing and reporting osteoporotic vertebral fractures (2003) — https://pmc.ncbi.nlm.nih.gov/articles/PMC3591834/ · Grigoryan et al. 2003, PMC3591834, Genant visual semiquantitative assessment and Figs. 1-3: normal Grade 0 requires visual assessment against adjacent and expected regional morphology; the text warns that normal wedging, biconcavity and degenerative remodeling can mimic mild fracture.
- **0.5**: Grigoryan M, Guermazi A, Roemer FW, Delmas PD, Genant HK. Recognizing and reporting osteoporotic vertebral fractures (2003) — https://pmc.ncbi.nlm.nih.gov/articles/PMC3591834/ · Grigoryan et al. 2003, PMC3591834, visual semiquantitative description states that Grade 0.5 is sometimes used for deformation not clearly assignable to Grade 1 and discusses subjectivity of borderline and mild deformities. ISCD 2023 lists equivocal fracture as an indication for follow-up imaging based on the clinical picture.
- **1**: Grigoryan M, Guermazi A, Roemer FW, Delmas PD, Genant HK. Recognizing and reporting osteoporotic vertebral fractures (2003) — https://pmc.ncbi.nlm.nih.gov/articles/PMC3591834/ · Grigoryan et al. 2003, PMC3591834, visual SQ section: Grade 1 is 20-25% height and 10-20% projected-area reduction; the article explains morphology, nonfracture differentials, mild-grade subjectivity and future-fracture association. ISCD 2023 requires visual fracture diagnosis rather than morphometry alone.
- **2**: Grigoryan M, Guermazi A, Roemer FW, Delmas PD, Genant HK. Recognizing and reporting osteoporotic vertebral fractures (2003) — https://pmc.ncbi.nlm.nih.gov/articles/PMC3591834/ · Grigoryan et al. 2003, PMC3591834, visual SQ section defines Grade 2 as 26-40% height and 21-40% area reduction and details visual morphology and differential diagnosis. ISCD 2023 retains the method for VFA and specifies follow-up imaging for malignant, equivocal, lytic or sclerotic concerns.
- **3**: Grigoryan M, Guermazi A, Roemer FW, Delmas PD, Genant HK. Recognizing and reporting osteoporotic vertebral fractures (2003) — https://pmc.ncbi.nlm.nih.gov/articles/PMC3591834/ · Grigoryan et al. 2003, PMC3591834, visual SQ section defines Grade 3 as greater than 40% height and projected-area reduction and separates severity from wedge, biconcave or crush shape; differential-diagnosis sections require visual exclusion of non-osteoporotic deformity.

## Histórico de versões

| Data | Evento | Detalhe | Situação |
| --- | --- | --- | --- |
| 2026-08-12 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-08-11 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-08-10 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-08-09 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-08-08 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-08-07 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-08-06 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-08-05 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-08-04 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-08-03 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-08-02 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-08-01 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-07-31 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-07-30 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-07-29 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-07-28 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-07-27 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-07-26 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-07-25 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 1993-09-01 | published | Genant semiquantitative vertebral fracture grading published. | confirmed |


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> Conteúdo de referência reescrito. Confira a publicação primária vigente. Não é dispositivo médico nem substitui o julgamento clínico. O radiologista responsável pelo laudo permanece o autor e o responsável.

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