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

Jager PL, Jonkman S, Koolhaas W, Stiekema A, Wolffenbuttel BH, Slart RH - Osteoporos Int (2010)

Bottom Line: In 2,424 patients (1,573 women), results were evaluable.In women, the prevalence was 20% versus 27% found in men (p < 0.0001).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.

View Article: PubMed Central - PubMed

Affiliation: Department of Nuclear Medicine, Isala Clinics, Dr. van Heesweg 2, 8000 BM Zwolle, The Netherlands. p.l.jager@isala.nl

ABSTRACT

Unlabelled: 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.

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Related in: MedlinePlus

Frequency distribution of vertebral fractures assessed with VFA
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Fig2: Frequency distribution of vertebral fractures assessed with VFA

Mentions: The distribution of the fractures over the individual vertebral levels showed the well-known dual-peak distribution with a peak at T7 (119 fractures, 13% of total) and at T12 (169 fractures, 18% of total) (Fig. 2). The severity of the fractures was “mild” in 458 (48% of all fractures), “moderate” in 295 (31%), and “severe” in 201 (21%). Vertebral fractures were wedge shaped in 79% (n = 759), biconcave in 19% (n = 178) and “crush” in 2% (n = 17). Mild fractures were often accompanied by moderate or severe fractures, and on a per patient analysis 219 patients (9% of all patients) had mild fractures only.Fig. 2


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

Jager PL, Jonkman S, Koolhaas W, Stiekema A, Wolffenbuttel BH, Slart RH - Osteoporos Int (2010)

Frequency distribution of vertebral fractures assessed with VFA
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3046356&req=5

Fig2: Frequency distribution of vertebral fractures assessed with VFA
Mentions: The distribution of the fractures over the individual vertebral levels showed the well-known dual-peak distribution with a peak at T7 (119 fractures, 13% of total) and at T12 (169 fractures, 18% of total) (Fig. 2). The severity of the fractures was “mild” in 458 (48% of all fractures), “moderate” in 295 (31%), and “severe” in 201 (21%). Vertebral fractures were wedge shaped in 79% (n = 759), biconcave in 19% (n = 178) and “crush” in 2% (n = 17). Mild fractures were often accompanied by moderate or severe fractures, and on a per patient analysis 219 patients (9% of all patients) had mild fractures only.Fig. 2

Bottom Line: In 2,424 patients (1,573 women), results were evaluable.In women, the prevalence was 20% versus 27% found in men (p < 0.0001).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.

View Article: PubMed Central - PubMed

Affiliation: Department of Nuclear Medicine, Isala Clinics, Dr. van Heesweg 2, 8000 BM Zwolle, The Netherlands. p.l.jager@isala.nl

ABSTRACT

Unlabelled: 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.

Show MeSH
Related in: MedlinePlus