Instant Vertebral Assessment

Greenspan, Susan L.; Stetten, Eric von; Emond, Sarah; Jones, Lisa P.; Parker, Robert A.

doi:10.1385/jcd:4:4:373

Cited by 120 publications

(21 citation statements)

References 43 publications

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“…However, we found that 16% of patients with normal BMD at the lumbar spine had a prevalent vertebral deformity (26% of which were multiple). This is comparable to that seen in an earlier study conducted in women aged over 65 years without a non-vertebral fracture and with normal BMD at the spine, which revealed a prevalence of vertebral fracture of 18.7% [15]. …”

Section: Discussionsupporting

confidence: 88%

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The prevalence of vertebral fracture amongst patients presenting with non-vertebral fractures

et al. 2006

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Introduction Despite vertebral fracture being a significant risk factor for further fracture, vertebral fractures are often unrecognised. A study was therefore conducted to determine the proportion of patients presenting with a nonvertebral fracture who also have an unrecognised vertebral fracture. Methods Prospective study of patients presenting with a non-vertebral fracture in South Glasgow who underwent DXA evaluation with vertebral morphometry (MXA) from DV5/6 to LV4/5. Vertebral deformities (consistent with fracture) were identified by direct visualisation using the Genant semi-quantitative grading scale. Results Data were available for 337 patients presenting with low trauma non-vertebral fracture; 261 were female. Of all patients, 10.4% were aged 50-64 years, 53.2% were aged 65-74 years and 36.2% were aged 75 years or over. According to WHO definitions, 35.0% of patients had normal lumbar spine BMD (T-score j1 or above), 37.4% were osteopenic (T-score j1.1 to j2.4) and 27.6% osteoporotic (Tscore j2.5 or lower). Humerus (n=103, 31%), radius-ulna (n=90, 27%) and hand/foot (n=53, 16%) were the most common fractures. For 72% of patients (n=241) the presenting fracture was the first low trauma fracture to come to clinical attention. The overall prevalence of vertebral deformity established by MXA was 25% (n=83); 45% (n=37) of patients with vertebral deformity had deformities of more than one vertebra. Of the patients with vertebral deformity and readable scans for grading, 72.5% (58/80) had deformities of grade 2 or 3. Patients presenting with hip fracture, or spine T-score ej2.5, or low BMI, or with more than one prior non-vertebral fracture were all significantly more likely to have evidence of a prevalent vertebral deformity (p<0.05). However, 19.8% of patients with an osteopenic T-score had a vertebral deformity (48% of which were multiple), and 16.1% of patients with a normal T-score had a vertebral deformity (26.3% of which were multiple). Following non-vertebral fracture, some guidelines suggest that anti-resorptive therapy should be reserved for patients with DXA-proven osteoporosis. However, patients who have one or more prior vertebral fractures (prevalent at the time of their non-vertebral fracture) would also become candidates for anti-resorptive therapy-which would have not been the case had their vertebral fracture status not been known. Overall in this study, 8.9% of patients are likely to have had a change in management by virtue of their underlying vertebral deformity status. In other words, 11 patients who present with a non-vertebral fracture would need to undergo vertebral morphometry in order to identify one patient who ought to be managed differently. Conclusions Our results support the recommendation to perform vertebral morphometry in patients who are

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Section: Discussionsupporting

confidence: 88%

“…In another study of 482 women aged over 65 years without a non-vertebral fracture, the prevalence of vertebral fracture was 18.3% [15]. In a smaller study of 58 women with Colles’ fracture, vertebral fractures were identified by MXA in 19% of patients [16].…”

Section: Discussionmentioning

confidence: 99%

The prevalence of vertebral fracture amongst patients presenting with non-vertebral fractures

et al. 2006

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“…8,9 Although adult aBMD has been shown to be predictive of future fracture risk in longitudinal epidemiologic studies, 10,11 there is no evidence in children indicating this is so, and even among adults the sensitivity of DXA for assessing vertebral fracture risk is relatively low (65% using World Health Organization criteria). 12 The aBMD results are often presented as T and Z scores. The World Health Organization criteria for diagnosing osteoporosis in adults are based on BMD T scores (defined as the standard deviation [SD] score of the observed aBMD compared with that of a normal young adult).…”

Section: Methods For Assessing Bone Health and Associated Pitfalls Dxamentioning

confidence: 99%

Quantitative Bone Analysis in Children: Current Methods and Recommendations

Specker

Schöenau

2005

The Journal of Pediatrics

123

102

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“…This can be done by lateral radiography of the thoracic and lumbar spine. Alternatively, vertebral fracture assessment, a technique that can assess vertebral fractures with DXA technology, can often be done at the same time as DXA (199 [EL 2], 200 [EL 3], 201 [EL 2]). Both historical height loss and prospective height loss have been associated with a new vertebral fracture (98 [EL 2], 99 [EL 2]).…”

Section: Evidence-based Discussion Of Recommendationsmentioning

confidence: 99%