Clinical Applications of Vertebral Fracture Assessment by Dual-Energy X-Ray Absorptiometry
E. Michael Lewiecki and
Andrew J. Laster
New Mexico Clinical Research and Osteoporosis Center (E.M.L.), Albuquerque, New Mexico 87106; and Arthritis and Osteoporosis Consultants of the Carolinas (A.J.L.), Charlotte, North Carolina 28207
Address all correspondence and requests for reprints to: E. Michael Lewiecki, M.D., F.A.C.P., New Mexico Clinical Research, Osteoporosis Center, 300 Oak Street NE, Albuquerque, New Mexico 87106. E-mail: lewiecki{at}aol.com.
Context: Vertebral fracture (VF) is the most common type offragility 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 VFsdo not have T-scores classified as osteoporosis. Knowledge ofVFs may change diagnostic classification, estimation of futurefracture risk, and clinical management. VF assessment (VFA)by dual-energy x-ray absorptiometry is a method for imagingthe spine to diagnose VFs.
Evidence Acquisition: Background information and medical evidenceon the technology and clinical applications of VFA was acquiredby electronic searching of PubMed for appropriate terms thatincluded vertebral fracture, imaging, diagnosis, dual-energyx-ray absorptiometry, and cost effectiveness. Matches with thehighest levels of medical evidence were selected for review,recognizing that the new and evolving nature of the field requiredinclusion of some material that relied partly on expert opinion.
Evidence Synthesis: The sensitivity and specificity of VFA comparefavorably with spine radiographs in the ability to diagnosegrade 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 spinein selected patients provides essential diagnostic and therapeuticinformation at a nominal cost. Patients with T-scores that areclassified as low bone mass (osteopenia) who are selected forpharmacological therapy based on the presence of a VF benefitby reduction in fracture risk. Guidelines for the clinical applicationof VFA have been developed by the International Society forClinical Densitometry.
Conclusions: VFA is a technology for diagnosing VFs that mayalter diagnostic classification, improve fracture risk stratification,and identify patients likely to benefit from pharmacologicaltherapy who otherwise might not be treated.
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