Clinical review : Clinical applications of vertebral fracture assessment by dual-energy X-ray absorptiometry

• Published in: The journal of clinical endocrinology and metabolism 2006-11, Vol.91 (11), p.4215-4222
• Main Authors: LEWIECKI, E. Michael, LASTER, Andrew J
• Format: Article
• Language: English
• Subjects: Absorptiometry, Photon - economics; Absorptiometry, Photon - methods; Biological and medical sciences; Bone Density Conservation Agents - therapeutic use; Cost-Benefit Analysis; Diagnostic Imaging - methods; Endocrinopathies; Female; Fractures, Bone - diagnosis; Fractures, Bone - diagnostic imaging; Fundamental and applied biological sciences. Psychology; Humans; Medical sciences; Osteoporosis, Postmenopausal - diagnosis; Osteoporosis, Postmenopausal - diagnostic imaging; Osteoporosis, Postmenopausal - drug therapy; Quality Control; Spinal Fractures - diagnosis; Spinal Fractures - diagnostic imaging; Spinal Fractures - drug therapy; Spine - diagnostic imaging; Thoracic Vertebrae - diagnostic imaging; Thoracic Vertebrae - injuries; Vertebrates: endocrinology
• ISSN: 0021-972X; 1945-7197
• DOI: 10.1210/jc.2006-1178

Vertebral fracture (VF) is the most common type of fragility fracture, yet most VFs are not clinically apparent. VFs are associated with a significant increase in morbidity, mortality, and risk of future fracture. Many patients with VFs do not have T-scores classified as osteoporosis. Knowledge of VFs may change diagnostic classification, estimation of future fracture risk, and clinical management. VF assessment (VFA) by dual-energy x-ray absorptiometry is a method for imaging the spine to diagnose VFs. Background information and medical evidence on the technology and clinical applications of VFA was acquired by electronic searching of PubMed for appropriate terms that included vertebral fracture, imaging, diagnosis, dual-energy x-ray absorptiometry, and cost effectiveness. Matches with the highest levels of medical evidence were selected for review, recognizing that the new and evolving nature of the field required inclusion of some material that relied partly on expert opinion. The sensitivity and specificity of VFA compare favorably with spine radiographs in the ability to diagnose grade 2 and 3 VFs. VFA involves less radiation, lower cost, and often greater patient convenience than spine radiography. Cost effectiveness modeling suggests that imaging of the spine in selected patients provides essential diagnostic and therapeutic information at a nominal cost. Patients with T-scores that are classified as low bone mass (osteopenia) who are selected for pharmacological therapy based on the presence of a VF benefit by reduction in fracture risk. Guidelines for the clinical application of VFA have been developed by the International Society for Clinical Densitometry. VFA is a technology for diagnosing VFs that may alter diagnostic classification, improve fracture risk stratification, and identify patients likely to benefit from pharmacological therapy who otherwise might not be treated.