Patient Has No Complaints, But Family Is Concerned

An 80-year-old woman presents to the emergency department for evaluation. Her family reports that she has baseline dementia and resides in an assisted living facility. Staff there report that recently the patient has fallen multiple times. The patient herself does not voice any specific complaints, but her family has noticed she is not as active or walking as much as usual. Medical history is significant for mild hypertension. On physical exam, you note that the patient is awake and alert but oriented only to person. Her vital signs are stable. Primary and secondary survey do not demonstrate any obvious injury or trauma. You order some basic blood work, as well as some imaging studies—including thoracic and lumbar radiographs. The lateral thoracic radiograph is shown. What is your impression?