Vertebral fracture assessment by DXA is inferior to X-ray in clinical severe osteoporosis

Deleskog, L.; Laursen, N.; Nielsen, Barbara Rubek; Schwarz, Peter

doi:10.1007/s00198-016-3532-8

Cited by 19 publications

(9 citation statements)

References 30 publications

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“…Some studies pointed out that sensitivity and specificity are not uniformly distributed over the spine. In general, sensitivity is lower in the upper thoracic area [39, 42, 45] due to lower image quality especially in the upper thoracic levels, which may also partly explain the lower sensitivity in our study.…”

Section: Discussionmentioning

confidence: 64%

Diagnosis of vertebral deformities on chest CT and DXA compared to routine lateral thoracic spine X-ray

et al. 2018

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SummaryX-ray, CT and DXA enable diagnosis of vertebral deformities. For this study, level of agreement of vertebral deformity diagnosis was analysed. We showed that especially on subject level, these imaging techniques could be used for opportunistic screening of vertebral deformities in COPD patients.IntroductionX-ray and CT are frequently used for pulmonary evaluation in patients with chronic obstructive pulmonary disease (COPD) and also enable to diagnose vertebral deformities together with dual-energy X-ray absorptiometry (DXA) imaging. The aim of this research was to study the level of agreement of these imaging modalities for diagnosis of vertebral deformities from T4 to L1.MethodsEighty-seven subjects (mean age of 65; 50 males; 57 COPD patients) who had X-ray, chest CT (CCT) and DXA were included. Evaluable vertebrae were scored twice using SpineAnalyzer™ software. ICCs and kappas were calculated to examine intra-observer variability. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under the receiver operating characteristic curve (AUROC) were calculated to compare vertebral deformities diagnosed on the different imaging modalities.ResultsICCs for height measurements were excellent (> 0.94). Kappas were good to excellent (0.64–0.77). At vertebral level, the AUROC was 0.85 for CCT vs. X-ray, 0.74 for DXA vs. X-ray and 0.77 for DXA vs. CCT. Sensitivity (51%–73%) and PPV (57%–70%) were fair to good; specificity and NPV were excellent (≥ 96%). At subject level, the AUROC values were comparable.ConclusionsReproducibility of height measurements of vertebrae is excellent with all three imaging modalities. On subject level, diagnostic performance of CT (PPV 79–82%; NPV 90–93%), and to a slightly lesser extend of DXA (PPV 73–77%; NPV 80–89%), indicates that these imaging techniques could be used for opportunistic screening of vertebral deformities in COPD patients.Electronic supplementary materialThe online version of this article (10.1007/s00198-018-4412-1) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 64%

Diagnosis of vertebral deformities on chest CT and DXA compared to routine lateral thoracic spine X-ray

et al. 2018

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“…Physical evaluation was conducted measuring height and weight, according to standard procedures, and vitamin D status was assessed by HPLC, measuring 25 (OH)D serum concentrations; BMD was measured at the lumbar spine (mean of L1-L4) in anteroposterior projection, and at femoral neck by dual-energy X-ray absorptiometry (DXA) (Hologic Discovery) [58]. A dorso-lumbar X-ray scan was applied in lateral projection, according to Genant's classification, to exclude previous subclinical vertebral fractures [59].…”

Section: Plos Onementioning

confidence: 99%

Quality of life and psychological functioning in postmenopausal women undergoing aromatase inhibitor treatment for early breast cancer

et al. 2020

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Introduction Aromatase inhibitors (AIs) dramatically increased breast cancer (BC) survival, leading to enhanced attention to their long-term consequences on psychological functioning. Conflicting data has been examined regarding the association between AIs administration and the clinical psychological features in BC survivors (BCSs). Purpose As psychological symptoms often occur in such chronic diseases, our study aimed at exploring anxious and depressive symptoms and the perceived quality of life (QoL) in BCSs assessed for osteoporosis. Methods The total sample consisted of a clinical sample of 51 outpatient postmenopausal women, diagnosed with BC, and a control group composed of 51 healthy postmenopausal women. All recruited participants were evaluated through the clinical gold standard interview and completed the following self-rating scales: the Hamilton Anxiety Rating Scale, Beck Depression Inventory II edition, and 36-Item Short Form Health Survey, which were administered at baseline and after 6 months in BCSs in AIs treatment, compared with controls. Moreover, all participants were assessed for vitamin D status, bone mineral density (BMD) and subclinical vertebral fractures. Data regarding age, age at menopause, body mass index (BMI), smoking habits and alcohol consumption was collected.

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“…A total number of 3238 subjects were included in the analysis, the vast majority of whom were women ( n = 2626). The number of subjects per study ranged from 35 [ 18 ] to 930 [ 19 ] subjects. Mean age of the studied populations ranged from 45 to 74 years.…”

Section: Resultsmentioning

confidence: 99%

“…The youngest included patient was 23 years old [ 20 ] and the oldest 96 years old [ 21 ]. There were seven studies that included both female and male subjects [ 18 , 20 , 22 – 26 ]. One study included both male and female subjects but did not specify the exact gender distribution of subjects who had conventional spinal radiography in addition to VFA [ 25 ] (Table 3 ).…”

Section: Resultsmentioning

confidence: 99%

Value and potential limitations of vertebral fracture assessment (VFA) compared to conventional spine radiography: experience from a fracture liaison service (FLS) and a meta-analysis

et al. 2017

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SummaryWe evaluated the value of VFA in the identification of vertebral fractures using a retrospective study and a meta-analysis. Performance of VFA was adequate in the meta-analysis although this was not demonstrated in our centre. We recommend checking the performance of VFA tools before exclusively relying on this tool.IntroductionVertebral fractures are traditionally diagnosed using conventional radiographs of the spine. Vertebral fracture assessment (VFA) has been advocated as an alternative tool in the diagnosis of these fractures.MethodsWe conducted a retrospective study as well as a systematic review and a meta-analysis to evaluate the performance of VFA compared to conventional spinal radiography in patients who had sustained a fracture and thus at risk for osteoporosis. A risk of bias analysis was also performed.ResultsThe diagnostic study included 542 patients (25% male) with fractures. The sensitivity of low-radiation VFA to detect a patient with a vertebral fracture ≥ Genant grade 2 was 0.77 and its specificity 0.80. Two hundred ninety-seven (55%) patients had ≥1 and 135(25%) ≥3 unevaluable vertebrae. The systematic review identified 16 studies including a total of 3238 subjects (19% male) with a mean age range of 45 to 74 years. Seven studies had a low risk of bias and 9 had an intermediate risk, mainly due to not consecutively including patients. The pooled sensitivity of VFA to detect a patient with a vertebral fracture ≥Genant grade 2 was 0.84 (95% CI, 0.72–0.92) and specificity 0.90 (95% CI, 0.84–0.94).ConclusionsOur findings from the meta-analysis suggest an adequate performance of VFA for the detection of vertebral fractures. However, we could not demonstrate these findings in our center, especially the specificity. Our data advocate caution with exclusively relying on VFA in the assessment of vertebral fractures without identifying performance and potential limitations of the technique.Electronic supplementary materialThe online version of this article (doi:10.1007/s00198-017-4137-6) contains supplementary material, which is available to authorized users.

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Vertebral fracture assessment by DXA is inferior to X-ray in clinical severe osteoporosis

Cited by 19 publications

References 30 publications

Diagnosis of vertebral deformities on chest CT and DXA compared to routine lateral thoracic spine X-ray

Diagnosis of vertebral deformities on chest CT and DXA compared to routine lateral thoracic spine X-ray

Quality of life and psychological functioning in postmenopausal women undergoing aromatase inhibitor treatment for early breast cancer

Value and potential limitations of vertebral fracture assessment (VFA) compared to conventional spine radiography: experience from a fracture liaison service (FLS) and a meta-analysis

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