Skip to main content

Advertisement

SpringerLink
Log in

Vertebral fracture assessment (VFA) in patients over 50 years of age with a non-severe peripheral fracture

  • Original Article
  • Published:
Osteoporosis International Aims and scope Submit manuscript

Abstract

Summary

The prevalence of unknown vertebral fractures evaluated by systematic vertebral fracture assessment (VFA) was 21% in patients over 50 years of age who suffered from a recent low-trauma non-severe peripheral fracture. The outcome of VFA resulted in changes in the management of osteoporosis.

Introduction

The aim of this study was to evaluate the utility of VFA in detecting vertebral fractures (VFs) in patients over 50 years of age, who suffered from a recent low-trauma non-severe peripheral fracture.

Methods

This was an observational, single-center, cross-sectional study conducted in patients over 50 years of age, who presented a recent low-trauma non-severe peripheral fracture and were identified by the Fracture Liaison Service (FLS) of Amiens University Hospital between December 2017 and March 2019. VFA was interpreted by two trained rheumatologists providing a consensual reading using Genant semi-quantitative assessment.

Results

Of the 359 eligible patients, 114 patients (31.8%) were included (mean age 65.6 ± 8.4 years; 89.5% female). Twenty-four patients (21%) had one or more VF diagnosed by VFA. The total number of VF diagnosed by VFA was 30: 20 VF (66.7%) grade 1, 7 VF (23.3%) grade 2, and 3 VF (10%) grade 3. Among the 24 patients with at least one prevalent VF diagnosed by VFA, 18 patients had an osteoporosis medication adaptation after the VFA results (16 osteoporosis medication initiation and 2 treatment intensification), and 6 patients would have had an osteoporosis medication even without the VFA results (66.7% versus 33.3% respectively, p < 0.001). Of the 51 patients receiving an osteoporosis medication after DXA and VFA, 18 patients (35.3%) had a change in the management of osteoporosis after knowing the outcome of VFA. All the VFs diagnosed by VFA were unknown before. We did not evidence any threshold (age, T-score, height loss) below which no VF was detected.

Conclusions

Our study demonstrates the usefulness of systematic VFA to detect prevalent VF in patients over 50 years of age who suffer from a recent non-severe peripheral fracture.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Johnell O, Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 17:1726–1733

    Article  CAS  Google Scholar 

  2. Melton LJ, Chrischilles EA, Cooper C, Lane AW, Riggs BL (1992) Perspective. How many women have osteoporosis? J Bone Miner Res 7:1005–1010

    Article  Google Scholar 

  3. Melton LJ, Atkinson EJ, O’Connor MK, O’Fallon WM, Riggs BL (1998) Bone density and fracture risk in men. J Bone Miner Res 13:1915–1923

    Article  Google Scholar 

  4. Genant HK, Li J, Wu CY, Shepherd JA (2000) Vertebral fractures in osteoporosis: a new method for clinical assessment. J Clin Densitom 3:281–290

    Article  CAS  Google Scholar 

  5. Fuerst T, Wu C, Genant HK, von Ingersleben G, Chen Y, Johnston C et al (2009) Evaluation of vertebral fracture assessment by dual X-ray absorptiometry in a multicenter setting. Osteoporos Int 20:1199–1205

    Article  CAS  Google Scholar 

  6. Schousboe JT, DeBold CR (2006) Reliability and accuracy of vertebral fracture assessment with densitometry compared to radiography in clinical practice. Osteoporos Int 17:281–289

    Article  Google Scholar 

  7. Binkley N, Krueger D, Gangnon R, Genant HK, Drezner MK (2005) Lateral vertebral assessment: a valuable technique to detect clinically significant vertebral fractures. Osteoporos Int 16:1513–1518

    Article  Google Scholar 

  8. Dehamchia-Rehailia N, Ursu D, Henry-Desailly I, Fardellone P, Paccou J (2014) Secondary prevention of osteoporotic fractures: evaluation of the Amiens University Hospital’s fracture liaison service between January 2010 and December 2011. Osteoporos Int 25:2409–2416

    Article  CAS  Google Scholar 

  9. Genant HK, Wu CY, van Kuijk C, Nevitt MC (1993) Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 8:1137–1148

    Article  CAS  Google Scholar 

  10. Grados F, Roux C, de Vernejoul MC, Utard G, Sebert JL, Fardellone P (2001) Comparison of four morphometric definitions and a semiquantitative consensus reading for assessing prevalent vertebral fractures. Osteoporos Int 12:716–722

    Article  CAS  Google Scholar 

  11. Lewiecki EM, Gordon CM, Baim S, Binkley N, Bilezikian JP, Kendler DL, Hans DB, Silverman S, Bishop NJ, Leonard MB, Bianchi ML, Kalkwarf HJ, Langman CB, Plotkin H, Rauch F, Zemel BS (2008) Special report on the 2007 adult and pediatric position development conferences of the International Society for Clinical Densitometry. Osteoporos Int 19:1369–1378

    Article  CAS  Google Scholar 

  12. Tan TCF, Sartoris DJ, Resnick D. Differential diagnosis of osteoporotic vertebral fractures : pathology and radiology. In : Genant HK, Jergas M, Van Kuijk C editors. Vertebral fracture in osteoporosis. University of California, San Francisco : Radiology Research and Education Foundation ; 1995. p 71–94

  13. Fechtenbaum J, Kolta S, Briot K, Roux C (2011) Atlas des déformations et fractures vertébrales. Médecine Sciences publications Lavoisier

  14. Diacinti D, Fiacco RD, Pisani D, Todde F, Cattaruzza MS, Diacinti D et al (2012) Diagnostic performance of vertebral fracture assessment by the lunar iDXA scanner compared to conventional radiography. Calcif Tissue Int 91:335–342

    Article  CAS  Google Scholar 

  15. Briot K, Cortet B, Thomas T, Audran M, Blain H, Breuil V, Chapuis L, Chapurlat R, Fardellone P, Feron JM, Gauvain JB, Guggenbuhl P, Kolta S, Lespessailles E, Letombe B, Marcelli C, Orcel P, Seret P, Trémollières F, Roux C (2012) 2012 update of French guidelines for the pharmacological treatment of postmenopausal osteoporosis. Joint Bone Spine 79:304–313

    Article  Google Scholar 

  16. Cosman F, de Beur SJ, LeBoff MS, Lewiecki EM, Tanner B, Randall S, Lindsay R, National Osteoporosis Foundation (2014) Clinician’s guide to prevention and treatment of osteoporosis. Osteoporos Int 25:2359–2381

    Article  CAS  Google Scholar 

  17. Howat I, Carty D, Harrison J, Fraser M, McLellan AR (2007) Vertebral fracture assessment in patients presenting with incident nonvertebral fractures. Clin Endocrinol 67:923–930

    Article  Google Scholar 

  18. Reniu AC, Ong T, Ajmal S, Sahota O (2017) Vertebral fracture assessment in patients presenting with a non-hip non-vertebral fragility fracture: experience of a UK fracture liaison service. Arch Osteoporos 12:23

    Article  Google Scholar 

  19. Gallacher SJ, Gallagher AP, McQuillian C, Mitchell PJ, Dixon T (2007) The prevalence of vertebral fracture amongst patients presenting with non-vertebral fractures. Osteoporos Int 18:185–192

    Article  CAS  Google Scholar 

  20. El Maghraoui A, Rezqi A, Mounach A, Achemlal L, Bezza A, Ghozlani I (2013) Systematic vertebral fracture assessment in asymptomatic postmenopausal women. Bone 52:176–180

    Article  Google Scholar 

  21. Genant HK, Delmas PD, Chen P, Jiang Y, Eriksen EF, Dalsky GP, Marcus R, San Martin J (2007) Severity of vertebral fracture reflects deterioration of bone microarchitecture. Osteoporos Int 18:69–76

    Article  CAS  Google Scholar 

  22. Lentle BC, Berger C, Probyn L, Brown JP, Langsetmo L, Fine B, Lian K, Shergill AK, Trollip J, Jackson S, Leslie WD, Prior JC, Kaiser SM, Hanley DA, Adachi JD, Towheed T, Davison KS, Cheung AM, Goltzman D, CaMos Research Group (2018) Comparative analysis of the radiology of osteoporotic vertebral fractures in women and men: cross-sectional and longitudinal observations from the Canadian multicentre osteoporosis study (CaMos). J Bone Miner Res 33:569–579

    Article  CAS  Google Scholar 

  23. Greendale GA, Wilhalme H, Huang M-H, Cauley JA, Karlamangla AS (2016) Prevalent and incident vertebral deformities in midlife women: results from the study of women’s health across the nation (SWAN). PLoS One 11:e0162664

    Article  Google Scholar 

  24. Armbrecht G, Felsenberg D, Ganswindt M, Lunt M, Kaptoge SK, Abendroth K, Aroso A, Banzer D, Bhalla AK, Dequeker J, Eastell R, Hoszowski K, Lyritis G, Delmas PD, Masaryk P, Miazgowski T, Cannata J, Nuti R, Oei L, Poor G, Redlund-Johnell I, Reid DM, Reisinger W, Schatz H, Todd CJ, Woolf AD, Javaid K, Rivadeneira F, Silman AJ, Cooper C, O'Neill TW, Reeve J, European Vertebral Osteoporosis Study and European Prospective Osteoporosis Study Groups (2015) Vertebral Scheuermann’s disease in Europe: prevalence, geographic variation and radiological correlates in men and women aged 50 and over. Osteoporos Int 26:2509–2519

    Article  CAS  Google Scholar 

  25. Briot K, Roux C, Thomas T, Blain H, Buchon D, Chapurlat R, Debiais F, Feron JM, Gauvain JB, Guggenbuhl P, Legrand E, Lehr-Drylewicz AM, Lespessailles E, Tremollieres F, Weryha G, Cortet B (2018) 2018 update of French recommendations on the management of postmenopausal osteoporosis. Joint Bone Spine 85:519–530

    Article  Google Scholar 

  26. Ginther JP, Ginther AW, Brodersen LD (2017) Adding VFA to DXA identifies fracture risk in a way not duplicated by other measures. Endocr Pract 23:1375–1378

    Article  Google Scholar 

  27. Clark EM, Carter L, Gould VC, Morrison L, Tobias JH (2014) Vertebral fracture assessment (VFA) by lateral DXA scanning may be cost-effective when used as part of fracture liaison services or primary care screening. Osteoporos Int 25:953–964

    Article  CAS  Google Scholar 

  28. Roux C, Baron G, Audran M, Breuil V, Chapurlat R, Cortet B, Fardellone P, Trémollières F, Ravaud P (2011) Influence of vertebral fracture assessment by dual-energy X-ray absorptiometry on decision-making in osteoporosis: a structured vignette survey. Rheumatology (Oxford) 50:2264–2269

    Article  Google Scholar 

  29. Schousboe JT, Lix LM, Morin SN, Derkatch S, Bryanton M, Alhrbi M, Leslie WD (2019) Prevalent vertebral fracture on bone density lateral spine (VFA) images in routine clinical practice predict incident fractures. Bone 121:72–79

    Article  Google Scholar 

  30. Schousboe JT, Lix LM, Morin SN, Derkatch S, Bryanton M, Alhrbi M, Leslie WD (2019) Vertebral fracture assessment increases use of pharmacologic therapy for fracture prevention in clinical practice. J Bone Miner Res 34:2205–2212

    Article  CAS  Google Scholar 

  31. McCloskey EV, Vasireddy S, Threlkeld J, Eastaugh J, Parry A, Bonnet N, Beneton M, Kanis JA, Charlesworth D (2008) Vertebral fracture assessment (VFA) with a densitometer predicts future fractures in elderly women unselected for osteoporosis. J Bone Miner Res 23:1561–1568

    Article  Google Scholar 

  32. Kanterewicz E, Puigoriol E, Rodríguez Cros JR, Peris P (2019) Prevalent vertebral fractures and minor vertebral deformities analyzed by vertebral fracture assessment (VFA) increases the risk of incident fractures in postmenopausal women: the FRODOS study. Osteoporos Int 30:2141–2149

  33. Rosen HN, Vokes TJ, Malabanan AO, Deal CL, Alele JD, Olenginski TP, Schousboe JT (2013) The official positions of the International Society for Clinical Densitometry: vertebral fracture assessment. J Clin Densitom 16:482–488

    Article  Google Scholar 

  34. Hospers IC, van der Laan JG, Zeebregts CJ, Nieboer P, Wolffenbuttel BHR, Dierckx RA, Kreeftenberg HG, Jager PL, Slart RH (2009) Vertebral fracture assessment in supine position: comparison by using conventional semiquantitative radiography and visual radiography. Radiology 251:822–828

    Article  Google Scholar 

  35. Vokes TJ, Dixon LB, Favus MJ (2003) Clinical utility of dual-energy vertebral assessment (DVA). Osteoporos Int 14:871–878

    Article  Google Scholar 

  36. Pflimlin A, Gournay A, Delabrière I, Chantelot C, Puisieux F, Cortet B, Paccou J (2019) Secondary prevention of osteoporotic fractures: evaluation of the Lille University Hospital’s fracture liaison service between January 2016 and January 2018. Osteoporos Int 30:1779–1788

  37. Delmas PD, Genant HK, Crans GG, Stock JL, Wong M, Siris E, Adachi JD (2003) Severity of prevalent vertebral fractures and the risk of subsequent vertebral and nonvertebral fractures: results from the MORE trial. Bone 33:522–532

    Article  CAS  Google Scholar 

  38. Roux C, Fechtenbaum J, Kolta S, Briot K, Girard M (2007) Mild prevalent and incident vertebral fractures are risk factors for new fractures. Osteoporos Int 18:1617–1624

    Article  CAS  Google Scholar 

  39. Ferrar L, Jiang G, Cawthon PM, San Valentin R, Fullman R, Lambert L, Cummings SR, Black DM, Orwoll E, Barrett-Connor E, Ensrud K, Fink HA, Eastell R, Osteoporotic Fractures in Men (MrOS) Study (2007) Identification of vertebral fracture and non-osteoporotic short vertebral height in men: the MrOS study. J Bone Miner Res 22:1434–1441

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Rheumatology, Amiens University Hospital, Amiens, France

    M. Aboudiab, F. Grados, I. Henry-Desailly, P. Fardellone & V. Goëb

  2. Department of Pharmacology, Amiens University Hospital, Amiens, France

    B. Batteux

Authors
  1. M. Aboudiab
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. F. Grados
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. B. Batteux
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. I. Henry-Desailly
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. P. Fardellone
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. V. Goëb
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Aboudiab.

Ethics declarations

Conflicts of interest

Vincent Goëb has received consulting fees from Biogen, AMGEN. Patrice Fardellone has received grants from AMGEN, Lilly, UCB, X. O, Expanscience, Arrow, IPRAD. Maxime Aboudiab, Franck Grados, Benjamin Batteux and Isabelle Henry-Desailly declare that they have no conflict of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

ESM 1

(DOCX 235 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Aboudiab, M., Grados, F., Batteux, B. et al. Vertebral fracture assessment (VFA) in patients over 50 years of age with a non-severe peripheral fracture. Osteoporos Int 31, 1477–1486 (2020). https://doi.org/10.1007/s00198-020-05400-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-020-05400-5

Keywords

Search

Navigation