BACKGROUND Vertebral fracture (VF) is the most common osteoporotic fracture in postmenopausal women, although most VFs are subclinical. Prevalent VFs are a significant predictor of subsequent fracture and therefore, identification of VF improves the identification of those with high fracture risk. The aim of present study was to systematically review the literature that assessed the prevalence of VF in asymptomatic postmenopausal women, using Vertebral Fracture Assessment (VFA) by dual-energy X-ray absorptiometry. METHOD Medline, Web of Science and Cochrane databases were searched between Jan 1st, 2000 and Jan 31st, 2018, for publications in English that reported the prevalence of VFA-detected VF in asymptomatic postmenopausal women. We also searched for reports, conference papers and grey literature. Reviewers screened studies for eligibility and extracted data for included studies. Random effects meta-analyses were performed to calculate the prevalence of VF. The presence of publication bias was assessed using funnel plots by precision and Egger's Test of the Intercept. RESULTS A total of 1777 articles were identified, 94 studies were fully reviewed and 28 studies (n = 25,418) met the inclusion criteria and were analyzed. More than two thirds of the studies were cross-sectional and the sample size varied widely across the studies (from 63 to 5156). The mean age ranged from 59.5 to 86.2 years old. The prevalence of osteoporosis and osteopenia varied between 6-57.0% and 25.1-58.9%, respectively. However, among women who had prevalent VFs, up to 43% had osteopenia and as many as 32% had normal bone density. The weighted pooled prevalence of VFA-detected VF in asymptomatic women was 28% (95% CI: 23%-32%). CONCLUSION VFA is able to identify prevalent VF in asymptomatic postmenopausal women. The use of VFA identified an average of 28% of asymptomatic women with VFs, many of whom did not have a diagnosis of osteoporosis. Implementation of VFA as a routine screening tool may detect high risk women. Detection of VF might lead to pharmacological treatment in individuals who may not otherwise be treated.

中文翻译：

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使用椎体骨折评估 (VFA) 识别无症状绝经后妇女的普遍椎体骨折：系统评价和荟萃分析

背景椎骨骨折 (VF) 是绝经后妇女最常见的骨质疏松性骨折，尽管大多数 VF 是亚临床的。流行的 VF 是后续骨折的重要预测因素，因此，识别 VF 可以提高对骨折风险高的患者的识别。本研究的目的是系统地回顾通过双能 X 射线吸收测定法使用椎体骨折评估 (VFA) 评估无症状绝经后妇女 VF 患病率的文献。方法 在 2000 年 1 月 1 日至 2018 年 1 月 31 日期间，在 Medline、Web of Science 和 Cochrane 数据库中搜索了报告无症状绝经后女性 VFA 检测到 VF 患病率的英文出版物。我们还搜索了报告、会议论文和灰色文献。审查员筛选研究的资格并提取纳入研究的数据。进行随机效应荟萃分析以计算 VF 的患病率。发表偏倚的存在使用漏斗图通过精确度和 Egger's Test of the Intercept 进行评估。结果 共识别出 1777 篇文章，对 94 项研究进行了全面审查，28 项研究（n = 25,418）符合纳入标准并进行了分析。超过三分之二的研究是横断面研究，并且研究的样本量差异很大（从 63 到 5156）。平均年龄介于 59.5 至 86.2 岁之间。骨质疏松症和骨质减少的患病率分别在 6-57.0% 和 25.1-58.9% 之间。然而，在患有 VF 的女性中，高达 43% 的女性骨质减少，多达 32% 的女性骨密度正常。无症状女性 VFA 检测到的 VF 的加权汇总患病率为 28%（95% CI：23%-32%）。结论 VFA 能够识别无症状的绝经后妇女普遍存在的 VF。平均 28% 的无症状 VF 女性使用 VFA 进行识别，其中许多人没有被诊断为骨质疏松症。将 VFA 作为常规筛查工具的实施可能会发现高危女性。VF 的检测可能会导致可能无法以其他方式治疗的个体的药物治疗。