Combined vertebral fracture assessment and bone mineral density measurement: a new standard in the diagnosis of osteoporosis in academic populations

• Published in: Osteoporosis international Vol. 22; no. 4; pp. 1059 - 1068
• Main Authors: Jager, P. L., Jonkman, S., Koolhaas, W., Stiekema, A., Wolffenbuttel, B. H. R., Slart, R. H. J. A.
• Format: Journal Article
• Language: English
• Published: London Springer-Verlag 01.04.2011; Springer; Springer Nature B.V
• Subjects: Adolescent; Adult; Age Distribution; Aged; Aged, 80 and over; Biological and medical sciences; Bone density; Bone Density - physiology; Diseases of the osteoarticular system; Endocrinology; Female; Fractures; Humans; Injuries of the limb. Injuries of the spine; Investigative techniques, diagnostic techniques (general aspects); Male; Medical diagnosis; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Original; Original Article; Orthopedics; Osteoarticular system. Muscles; Osteoporosis; Osteoporosis - diagnosis; Osteoporosis - physiopathology; Osteoporosis. Osteomalacia. Paget disease; Osteoporotic Fractures - diagnosis; Osteoporotic Fractures - pathology; Osteoporotic Fractures - physiopathology; Prospective Studies; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Rheumatology; Risk factors; Sex Distribution; Spinal Fractures - diagnosis; Spinal Fractures - etiology; Spinal Fractures - pathology; Spinal Fractures - physiopathology; Spine; Traumas. Diseases due to physical agents; Young Adult; Osteoporosis; Vertebral fracture assessment; Vertebral fractures; Bone mineral density measurement; Diseases of the osteoarticular system; Rheumatology; Vertebra; Bone mineral density; Fracture; Diagnosis; Trauma
• ISSN: 0937-941X; 1433-2965
• DOI: 10.1007/s00198-010-1293-3

Summary Vertebral Fracture Analysis enables the detection of vertebral fractures in the same session as bone mineral density testing. Using this method in 2,424 patients, we found unknown vertebral fractures in approximately one out of each six patients with significant impact on management. Introduction The presence of osteoporotic vertebral fractures (VF) is an important risk factor for all future fractures independent of BMD. Yet, determination of the VF status has not become standard practice. Vertebral Fracture Assessment (VFA) is a new feature available on modern densitometers. In this study we aimed to determine the prevalence of VF using VFA in all patients referred for BMD testing in a university medical center and to evaluate its added clinical value. Methods Prospective diagnostic evaluation study in 2,500 consecutive patients referred for BMD. Patients underwent VFA in supine position after BMD testing. Questionnaires were used to assess perceived added value of VFA. Results In 2,424 patients (1,573 women), results were evaluable. In 541 patients (22%), VFA detected a prevalent VF that was unknown in 69%. In women, the prevalence was 20% versus 27% found in men ( p  < 0.0001). The prevalence of VF was 14% in patients with normal BMD (97/678), increased to 21% (229/1,100) in osteopenia and to 26% in those with osteoporosis (215/646) by WHO criteria. After excluding mild fractures VF prevalence was 13% (322/2,424). In 468 of 942 questionnaires (50% response rate), 27% of the referring physicians reported VFA results to impact on patient management. Conclusions VFA is a patient friendly new tool with a high diagnostic yield, as it detected unknown VF in one out of each six patients, with significant impact on management. We believe these findings justify considering VFA in all new patients referred for osteoporosis assessment in similar populations.