L Deleskog1, N Ø Laursen2, B R Nielsen1, P Schwarz3,4. 1. Research Centre of Ageing and Osteoporosis, Department of Endocrinology PE, Rigshospitalet, Copenhagen, Denmark. 2. Department of Radiology, Frederiksberg University Hospital, Copenhagen, Denmark. 3. Research Centre of Ageing and Osteoporosis, Department of Endocrinology PE, Rigshospitalet, Copenhagen, Denmark. Peter.schwarz@regionh.dk. 4. Faculty of Health Sciences, Copenhagen University, Copenhagen, Denmark. Peter.schwarz@regionh.dk.
Abstract
UNLABELLED: Spine fractures are diagnosed by X-ray or vertebral fracture assessment (VFA) by dual-energy X-ray absorptiometry (DXA) scanning. The use of VFA evaluation by DXA is still debated. We demonstrate that VFA is inferior relative to X-ray in visualizing vertebrae properly in the upper spine and therefore with a reduced diagnostic performance in detecting fractures. INTRODUCTION: Vertebral fracture assessment (VFA) by DXA has been evaluated for many years, and its use in clinical practice is still debated. In a cross-sectional setting, we aimed to compare VFA with traditional radiography in vertebral fracture (VF) diagnosis in severe osteoporotic patient. METHODS: A total of 207 patients referred to the outpatient clinic for teriparatide treatment were screened, out of whom 35 (16.9 %) severe osteoporotic patients were identified (mean age 67.5 ± 11.3 years and median T-score -3.2 interquartile range (IQR) (-1.9 to -3.7). VF diagnosis was performed independently using VFA and X-ray in accordance with the semiquantitative (SQ) approach. The same technician performed the primary interpretation on both sets of images, after which a radiologist and an endocrinologist reviewed the evaluation for a conclusive judgement. RESULTS: In total, 180 radiographic fractures were detected, corresponding to 5.1 fractures per individual. Using VFA, 18.5 % of vertebrae were considered unreadable, compared to 2.0 % on X-ray. The accuracy of VFA in VF detection using X-ray as a reference resulted in sensitivity and specificity of 75.5 and 86.7 %, respectively. Sensitivity decreased from the lumbar to thoracic level. Nevertheless, VFA only identified fractures consistently between Th11 and L3. CONCLUSION: Our data, based on a severe osteoporotic population, demonstrate that VFA is inferior relative to X-ray in visualizing vertebrae properly in the upper spine, resulting in vertebrae not being assessable for analysis and a reduced diagnostic performance in detecting fractures. Improvements in DXA techniques are needed for it to be comparable with X-ray in VF diagnosis.
UNLABELLED: Spine fractures are diagnosed by X-ray or vertebral fracture assessment (VFA) by dual-energy X-ray absorptiometry (DXA) scanning. The use of VFA evaluation by DXA is still debated. We demonstrate that VFA is inferior relative to X-ray in visualizing vertebrae properly in the upper spine and therefore with a reduced diagnostic performance in detecting fractures. INTRODUCTION:Vertebral fracture assessment (VFA) by DXA has been evaluated for many years, and its use in clinical practice is still debated. In a cross-sectional setting, we aimed to compare VFA with traditional radiography in vertebral fracture (VF) diagnosis in severe osteoporoticpatient. METHODS: A total of 207 patients referred to the outpatient clinic for teriparatide treatment were screened, out of whom 35 (16.9 %) severe osteoporoticpatients were identified (mean age 67.5 ± 11.3 years and median T-score -3.2 interquartile range (IQR) (-1.9 to -3.7). VF diagnosis was performed independently using VFA and X-ray in accordance with the semiquantitative (SQ) approach. The same technician performed the primary interpretation on both sets of images, after which a radiologist and an endocrinologist reviewed the evaluation for a conclusive judgement. RESULTS: In total, 180 radiographic fractures were detected, corresponding to 5.1 fractures per individual. Using VFA, 18.5 % of vertebrae were considered unreadable, compared to 2.0 % on X-ray. The accuracy of VFA in VF detection using X-ray as a reference resulted in sensitivity and specificity of 75.5 and 86.7 %, respectively. Sensitivity decreased from the lumbar to thoracic level. Nevertheless, VFA only identified fractures consistently between Th11 and L3. CONCLUSION: Our data, based on a severe osteoporotic population, demonstrate that VFA is inferior relative to X-ray in visualizing vertebrae properly in the upper spine, resulting in vertebrae not being assessable for analysis and a reduced diagnostic performance in detecting fractures. Improvements in DXA techniques are needed for it to be comparable with X-ray in VF diagnosis.
Authors: R D Chapurlat; F Duboeuf; H O Marion-Audibert; B Kalpakçioglu; B H Mitlak; P D Delmas Journal: Osteoporos Int Date: 2006-06-07 Impact factor: 4.507
Authors: Alberto Bazzocchi; Paolo Spinnato; Federica Fuzzi; Danila Diano; Antonio M Morselli-Labate; Claudia Sassi; Eugenio Salizzoni; Giuseppe Battista; Giuseppe Guglielmi Journal: Bone Date: 2012-01-31 Impact factor: 4.398
Authors: B Ettinger; D M Black; B H Mitlak; R K Knickerbocker; T Nickelsen; H K Genant; C Christiansen; P D Delmas; J R Zanchetta; J Stakkestad; C C Glüer; K Krueger; F J Cohen; S Eckert; K E Ensrud; L V Avioli; P Lips; S R Cummings Journal: JAMA Date: 1999-08-18 Impact factor: 56.272
Authors: M Abdalbary; M Sobh; S Elnagar; M A Elhadedy; N Elshabrawy; M Abdelsalam; K Asadipooya; A Sabry; A Halawa; A El-Husseini Journal: Osteoporos Int Date: 2022-06-24 Impact factor: 5.071
Authors: F Malgo; N A T Hamdy; C H J M Ticheler; F Smit; H M Kroon; T J Rabelink; O M Dekkers; N M Appelman-Dijkstra Journal: Osteoporos Int Date: 2017-08-25 Impact factor: 4.507
Authors: M J van Dort; E A P M Romme; F W J M Smeenk; P P P M Geusens; E F M Wouters; J P van den Bergh Journal: Osteoporos Int Date: 2018-02-12 Impact factor: 4.507