Introduction
Epidemiology of vertebral fractures
Prevalence and incidence by age and sex
Geographic variation
Vertebral fractures and mortality
Clinical significance of vertebral fractures
Vertebral fracture and risk of further fractures
Vertebral fractures and quality of life
Methods for detection and interpretation of vertebral fractures
DXA VFA method
Other technologies for targeted and opportunistic identification of vertebral fractures: CT, MRI, and SPECT
CT
MRI
SPECT
Classification of vertebral fracture: QM, SQ, Genant, and ABQ methods
Limitations and thresholds in diagnosis of fracture
Significance of grade 1 fractures
Current indications for vertebral fracture assessment by DXA
International Society for Clinical Densitometry (ISCD) (ref 105) | International Osteoporosis Foundation- The European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (IOF-ESCEO) (ref 56) | National Osteoporosis Foundation (NOF) (ref 107) |
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Lateral Spine imaging with Standard Radiography or Densitometric VFA is indicated when T-score is < -1.0 and of one or more of the following is present: • Women age ≥ 70 years or men ≥ age 80 years • Historical height loss > 4 cm (> 1.5 inches) • Self-reported but undocumented prior vertebral fracture • Glucocorticoid therapy equivalent to ≥5 mg of prednisone or equivalent per day for ≥ 3 months Recommendations from the ISCD adult Official Position Statement 2019 | VFA should therefore be considered in high-risk individuals, using either spine radiographs or lateral spine DXA imaging in postmenopausal women: • History of ≥ 4 cm height loss • Kyphosis • Recent or current long-term oral glucocorticoid therapy, • BMD T-score ≤ − 2.5. • It should also be considered in individuals with a history of non-vertebral fracture Recommendations from the IOF-ESCEO: European guidance for the diagnosis and management of osteoporosis in postmenopausal women | Vertebral imaging should be performed: In all women age 70 and older and all men age 80 and older if BMD T-score is ≤ − 1.0 at the spine, total hip, or femoral neck. In women age 65 to 69 and men age 70 to 79 if BMD T-score is ≤ − 1.5 at the spine, total hip, or femoral neck. In postmenopausal women and men age 50 and older with specific risk factors: • Low-trauma fracture during adulthood (age 50 and older) • Historical height loss (difference between the current height and peak height at age 20) of 1.5 in. or more (4 cm) • Prospective height loss (difference between the current height and a previously documented height measurement) of 0.8 in. or more (2 cm) • Recent or ongoing long-term glucocorticoid treatment If bone density testing is not available, vertebral imaging may be considered based on age alone. |
Clinical approach to routine VFA in FLS secondary fracture prevention
Value of VFA in secondary prevention
VFA in FLS: previous work
Clinical approach to VFA in FLS
Conclusion and future directions
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To detect subclinical vertebral fractures, which may modify risk category and thus commencement or type and duration of therapy, depending on age and local criteria for intervention;
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To provide baseline assessment, based on which later incident vertebral fractures can be discriminated from prevalent fractures, critical to optimal treatment monitoring.