Prevalence of Vertebral Compression Fracture Deformity by X-ray Absorptiometry of Lateral Thoracic and Lumbar Spines in a Population Referred for Bone Densitometry

Schousboe, John T.; DeBold, C. Rowan; Bowles, Carolyn A.; Glickstein, Scott L.; Rubino, Ranelle K.

doi:10.1385/jcd:5:3:239

Cited by 53 publications

(11 citation statements)

References 16 publications

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“…The geriatric population is especially at risk for such osteoporotic fractures, as bone mass decreases with age [53]. A loss of one standard deviation of bone mass doubles the risk of spine fractures [34,56,59]. It is estimated that 90% of hip and spine fractures occurring in the elderly are attributable to osteoporosis [45].…”

Section: Introductionmentioning

confidence: 99%

Vertebroplasty for osteoporotic spine fracture: prevention and treatment

2005

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IntroductionOsteoporosis is a disorder of decreased bone mass, microstructural collapse, and fragility fractures. It can affect people of all ethnic backgrounds and can result in challenging complications, ranging from compression fractures of vertebral bodies to femoral neck fractures [59]. The geriatric population is especially at risk for such osteoporotic fractures, as bone mass decreases with age [53]. A loss of one standard deviation of bone mass doubles the risk of spine fractures [34,56,59]. It is estimated that 90% of hip and spine fractures occurring in the elderly are attributable to osteoporosis [45]. The consequences of such osteoporotic vertebral fractures are diverse and include back pain, functional limitations and impairment of mood [11,37,58].A recent study in Canada examined the health-related quality of life (HRQL) in women aged 50 years and older with osteoporosis [1]. Subjects who had experienced a vertebral fracture had lower HRQL scores than participants without fracture in total score, symptoms, physical function, activities of daily living, and leisure. Acute complications of osteoporotic vertebral fractures include transient ileus, urinary retention, nausea, abdominal pain and chest pain [41,49]. Long-term effects of osteoporotic fracAbstract There is a relatively high prevalence of osteoporotic vertebral compression fractures (VCFs) in the elderly population, especially in women aged 50 or older. The result of these VCFs is increased morbidity and mortality in the short and long term. Medical treatment of these fractures includes bed rest, orthotics, analgesic medication and time. Percutaneous vertebroplasty (PVP) consists of percutaneous injection of biomaterial, such as methylmethacrylate, into the VCF to produce stability and pain relief. Biomechanical testing has shown that PVP can restore strength and stiffness of the vertebral body to the pre-fracture levels. Clinical results show immediate and maintained pain relief in 70-95% of the patients. Possible major complications include cement leakage into the spinal canal or into the venous system. Additionally, percutaneous vertebroplasty may alter the normal loading behavior of the adjacent vertebral body, and there is an increased risk of adjacent segment VCF. Kyphoplasty is a new technique, which introduces a balloon into the vertebral body transpedicularly to reduce the VCF while creating a cavity for the cement injection. This technique has the benefit of kyphosis reduction as well as less cement leakage. Research continues into the development of injectable biomaterials that are resorbable and allow for new bone formation. Vertebroplasty and kyphoplasty are safe and effective in the treatment of osteoporotic VCFs. They may allow for a faster return to function, and thus avoid the morbidity associated with medical treatment.

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Section: Introductionmentioning

confidence: 99%

Vertebroplasty for osteoporotic spine fracture: prevention and treatment

2005

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“…Vertebral body compression fractures may be detected by a plain radiograph or with Vertebral Fracture Assessment (VFA), a software addition to DXA that provides either a single-energy or a dual-energy x-ray image of the thoracic and lumbar vertebrae. Anywhere from 16% to 48% of older individuals with osteopenia on DXA have evidence of prevalent vertebral body compression fractures, most of which are low trauma [30][31][32]. The presence of such fractures changes the clinical diagnosis to osteoporosis and has a significant impact on treatment decisions.…”

Section: Resultsmentioning

confidence: 99%

Dual-Energy X-Ray Absorptiometry

Laster

2014

North Carolina Medical Journal

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Assessment of bone mineral density (BMD) by dual-energy x-ray absorptiometry (DXA) plays a vital role in the diagnosis of osteoporosis and in monitoring a patient's response to drug therapy. This commentary will discuss controversies surrounding the use of DXA for screening and monitoring of BMD in women. The National Osteoporosis Foundation (NOF) has estimated that more than 43.6 million Americans have osteoporosis or osteopenia (low bone mass) [1]. In 2005, 2 million fractures were attributed to osteoporosis, with a direct cost of $17 billion; 71% of these fractures occurred in women [2]. By 2025, costs associated with fractures are projected to increase to $25.3 billion [2].Bone mineral density (BMD) testing by dual-energy x-ray absorptiometry (DXA) is the recognized standard for the clinical assessment of skeletal health. DXA allows for the diagnosis of osteoporosis or low bone mass, strongly correlates with mechanical strength [3], is a good predictor of fracture risk [4], and affords excellent accuracy and precision [5] while minimizing patients' exposure to ionizing radiation [6]. Moreover, drug therapy has been shown to be cost effective in postmenopausal women with osteoporosis [7]. Given that approximately 40% of white women older than 50 years will have an osteoporotic fracture in their lifetime [8], having clear recommendations for screening and monitoring using DXA are essential. Because of the absence of pertinent studies in men, this commentary will only address the evaluation of BMD in women.DXA screening for low bone mass or osteoporosis is well accepted in women aged 65 years or older, regardless of risk factors, and in younger women with risk factors such as rheumatoid arthritis, glucocorticoid use, malabsorption syndromes, hyperthyroidism, hyperparathyroidism, or gastric bypass surgery. Screening of these individuals is recommended by NOF [1], the US Preventive Services Task Force (USPSTF) [9], the International Society for Clinical Densitometry (ISCD) [10], the American Association of Clinical Endocrinologists (AACE) [11], the American College of Radiology [12], and the North American Menopause Society (NAMS) [13]. Despite the fact that DXA testing has been added to the "Welcome to Medicare Exam," only 14% of eligible women had a DXA study in 2010 [14]. Over the 7-year period from 2002 through 2008, 48% of older women did not have a DXA study [14]. Is DXA Testing Overused in Younger Women?Potential misuse of DXA testing is a concern that has been raised by the Centers for Medicare & Medicaid Services (CMS) and the National Committee for Quality Assurance, which have together submitted for public comment a quality measure regarding "appropriate use of DXA scans in women under 65 years who do not meet the risk factor profile" [15]. The quality measure cites a small, retrospective study of 615 women [16], in which 41.3% of women younger than 65 years who had been sent for DXA screening were found to have been screened inappropriately, based on their lack of any of the recognized risk factors li...

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“…The sagittal view is highly accurate and correlates well with fracture risk [13,93]. However, with the presence of osteophytes and scoliosis, the precision decreases and may be artificially elevated, particularly with osteosclerotic facet joints [62].…”

Section: Radiographic Methodsmentioning

confidence: 99%

The aging spine: new technologies and therapeutics for the osteoporotic spine

et al. 2003

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IntroductionOsteoporosis is a serious problem in the United States, affecting as many as 13-18% of women and 3-6% of men [49, 55,64,68,89]. If untreated, it is estimated that more than half of all Caucasian white women will sustain an osteoporotic fracture during their lifetime [16,89]. Approximately one-half of these fractures are related to the vertebral bodies, with two-thirds being silent and one-third symptomatic. Epidemiological studies have demonstrated that multiple vertebral fractures increase morbidity [67,69], and the presence and increasing numbers of fractures significantly increase mortality rates [11, 23, 41, 48]. Despite the recognition that osteoporotic fractures increase the risk for additional vertebral fractures as well as hip fractures, the majority of individuals with these fractures remain undiagnosed and untreated [28, 31,74].Over the last ten years, great strides have been made in understanding the pathophysiology of osteoporotic vertebral fractures. Radiographic methods have been enhanced to aid in the diagnosis of osteoporosis. New therapeutics have been developed that may decrease the fragility fracture rate by up to 50% compared with controls treated only with calcium [7, 24, 40,70,79]. During the same time period, two minimally invasive procedures have been developed to rapidly address painful vertebral fractures -vertebroplasty and kyphoplasty. Details regarding these procedures are the subject of separate articles within this issue. Fracture etiology: factor of riskVertebral bodies sustain fractures under two different mechanical environments: repetitive loading that fatigues the cancellous bone and leads to the accumulation of microfractures, or single traumatic events may overload the vertebral body and lead to fracture [58]. To understand the etiology of vertebral fracture, information about the loads imposed onto the vertebral body and the load-bearing capacity of the vertebrae at the time of risk need to be quantified. This concept has been defined as the factor of risk, and represents the ratio of the load applied to the bone over the load necessary to cause a fracture [42]. The load Abstract Osteoporosis results in low-energy fractures of the spine. The load necessary to cause a vertebral fracture is determined by the characteristics related to the vertebral body structure, mineral content, and quality of bone. Radiographic techniques centered on dual X-ray absorptiometry (DXA) permit a determination of bone mass and fracture risk. Current medical therapies principally using bisphosphonate and pulsatile PTH profoundly decrease the risk of fracture (50+%). Fall prevention strategies can further decrease the possibility of fracture. A comprehensive approach to osteoporosis can favorably alter the disease.

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Prevalence of Vertebral Compression Fracture Deformity by X-ray Absorptiometry of Lateral Thoracic and Lumbar Spines in a Population Referred for Bone Densitometry

Cited by 53 publications

References 16 publications

Vertebroplasty for osteoporotic spine fracture: prevention and treatment

Vertebroplasty for osteoporotic spine fracture: prevention and treatment

Dual-Energy X-Ray Absorptiometry

The aging spine: new technologies and therapeutics for the osteoporotic spine

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