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Vertebral fracture assessment by DXA is inferior to X-ray in clinical severe osteoporosis

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Abstract

Summary

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.

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References

  1. Bazzocchi A, Spinnato P, Fuzzi F, Diano D, Morselli-Labate AM, Sassi C, Salizzoni E, Battista G, Guglielmi G (2012) Vertebral fracture assessment by new dual-energy X-ray absorptiometry. Bone 50(4):836–841. doi:10.1016/j.bone.2012.01.018

    Article  PubMed  Google Scholar 

  2. Kanis JA, Pitt FA (1992) Epidemiology of osteoporosis. Bone 13:7–15

    Article  Google Scholar 

  3. Silverman SL (1992) The clinical consequences of vertebral compression fracture. Bone 13:27–31

    Article  Google Scholar 

  4. Ferrar L, Jiang G, Adams J, Eastell R (2005) Identification of vertebral fractures: an update. Osteoporos Int 16(7):717–728. doi:10.1007/s00198-005-1880-x

    Article  CAS  PubMed  Google Scholar 

  5. Melton LJ, Atkinson EJ, Cooper C, O’Fallon WM, Riggs BL (1999) Vertebral fractures predict subsequent fractures. Osteoporos Int 10:214–221

    Article  PubMed  Google Scholar 

  6. Black DM, Arden NK, Palermo L, Pearson J, Cummings SR (1999) Prevalent vertebral deformities predict hip fractures and new vertebral 5. Deformities but not wrist fractures. American Society for Bone and Mineral Research 14

  7. Ross PD, Genant HK, Davis JW, Miller PD, Wasnich RD (1993) Predicting vertebral fracture incidence from prevalent fractures and bone density among non-black. Osteoporotic Women 3:120–126

    CAS  Google Scholar 

  8. Van Brussel MS, Lems WF (2009) Clinical relevance of diagnosing vertebral fractures by vertebral fracture assessment. Curr Osteoporos Rep 7:103–106

    Article  PubMed  Google Scholar 

  9. Schousboe JT, DeBold CR, Bowles C, Glickstein S, Rubino RK (2002) Prevalence of vertebral compression fracture deformity by X-ray absorptiometry of lateral thoracic and lumbar spines in a population referred for bone densitometry. J Clin Densitom 5(3):239–246. doi:10.1385/jcd:5:3:239

    Article  PubMed  Google Scholar 

  10. Fuerst T, Wu C, Genant HK, von Ingersleben G, Chen Y, Johnston C, Econs MJ, Binkley N, Vokes TJ, Crans G, Mitlak BH (2009) Evaluation of vertebral fracture assessment by dual X-ray absorptiometry in a multicenter setting. Osteoporos Int 20(7):1199–1205. doi:10.1007/s00198-008-0806-9

    Article  CAS  PubMed  Google Scholar 

  11. Schousboe JT, Debold CR (2006) Reliability and accuracy of vertebral fracture assessment with densitometry compared to radiography in clinical practice. Osteoporos Int 17(2):281–289. doi:10.1007/s00198-005-2010-5

    Article  PubMed  Google Scholar 

  12. 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(12):1513–1518. doi:10.1007/s00198-005-1891-7

    Article  PubMed  Google Scholar 

  13. Hospers IC, Van der Laan JG, Zeebregts CJ, Nieboer P, Wolffenbuttel BHR, Dierckx RA, Kreeftenberg HG, Jager PL, Slart RHJA (2009) Vertebral fracture assessment in supine position- comparison by using conventional semiquantitative radiography and visual radiography. musculoskeletal imaging

  14. Chapurlat RD, Duboeuf F, Marion-Audibert HO, Kalpakcioglu B, Mitlak BH, Delmas PD (2006) Effectiveness of instant vertebral assessment to detect prevalent vertebral fracture. Osteoporos Int 17(8):1189–1195. doi:10.1007/s00198-006-0121-2

    Article  CAS  PubMed  Google Scholar 

  15. Diacinti D, Guglielmi G, Pisani D, Diacinti D, Argiro R, Serafini C, Romagnoli E, Minisola S, Catalano C, David V (2012) Vertebral morphometry by dual-energy X-ray absorptiometry (DXA) for osteoporotic vertebral fractures assessment (VFA). Radiol Med 117(8):1374–1385. doi:10.1007/s11547-012-0835-5

    Article  CAS  PubMed  Google Scholar 

  16. Diacinti D, Del Fiacco R, Pisani D, Todde F, Cattaruzza MS, Diacinti D, Arima S, Romagnoli E, Pepe J, Cipriani C, Minisola S (2012) Diagnostic performance of vertebral fracture assessment by the lunar iDXA scanner compared to conventional radiography. Calcif Tissue Int 91(5):335–342. doi:10.1007/s00223-012-9643-0

    Article  CAS  PubMed  Google Scholar 

  17. Damiano J, Kolta S, Porcher R, Tournoux C, Dougados M, Roux C (2006) Diagnosis of vertebral fractures by vertebral fracture assessment. J Clin Densitom 9(1):66–71. doi:10.1016/j.jocd.2005.11.002

    Article  PubMed  Google Scholar 

  18. Rea JA, Li J, Blake GM, Steiger P, Genant HK, Fogelman I (2000) Visual assessment of vertebral deformity by X-ray absorptiometry—a highly predictive method to exclude vertebral deformity. Osteoporos Int 11:660–668

    Article  CAS  PubMed  Google Scholar 

  19. Vokes TJ, Dixon LB, Favus MJ (2003) Clinical utility of dual-energy vertebral assessment (DVA). Osteoporos Int 14(11):871–878. doi:10.1007/s00198-003-1461-9

    Article  PubMed  Google Scholar 

  20. Genant HK, Wu CY, Van Kuijk C, Nevitt MC (1993) Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res. doi:10.1002/jbmr.5650080915

    Google Scholar 

  21. Eastell R, Cedel SL, Wahner HW, Riggs BL, Melton LJ (1991) Classification of vertebral fractures. J Bone Miner Res 6:215–207

    Google Scholar 

  22. Schousboe JT, Vokes T, Broy SB, Ferrar L, McKiernan F, Roux C, Binkley N (2008) Vertebral fracture assessment: the 2007 ISCD official positions. J Clin Densitom 11(1):92–108. doi:10.1016/j.jocd.2007.12.008

    Article  PubMed  Google Scholar 

  23. Genant HK, Jergas M (2003) Assessment of prevalent and incident vertebral fractures in osteoporosis research. Osteoporos Int 14(Suppl 3):S43–55. doi:10.1007/s00198-002-1348-1

    Article  PubMed  Google Scholar 

  24. Kanis JA, Group WS (1993) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis—synopsis of a WHO report. International Osteoporosis

  25. Nuti R, Brandi ML, Isaia G, Tarantino U, Silvestri S, Adami S (2009) New perspectives on the definition and the management of severe osteoporosis: the patient with two or more fragility fractures. J Endocrinol Invest 32(9):783–788. doi:10.3275/6436, 10.1007/BF03346537

  26. Landis RJ, Koch GG (1977) An application of hierarchical kappa-type statistics in the assessment of majority agreement among multiple observers. Biometrics 33:363–374

    Article  CAS  PubMed  Google Scholar 

  27. Rud B, V A, Hyldstrup L (2015) Accuracy of densitometric vertebral fracture assessment when performed by DXA technicians—a cross-sectional, multiobserver study. Osteoporos Int. doi:10.1007/s00198-015-3395-4

    PubMed  Google Scholar 

  28. Buehring B, Krueger D, Checovich M, Gemar D, Vallarta-Ast N, Genant HK, Binkley N (2010) Vertebral fracture assessment: impact of instrument and reader. Osteoporos Int 21(3):487–494. doi:10.1007/s00198-009-0972-4

    Article  CAS  PubMed  Google Scholar 

  29. Ettinger B, Black DM, Mitlak BH, Knickerbocker RK, Nickelsen T, Genant HK, Christiansen C, Delmas PD, Zanchetta JR, Stakkestad J, Gluer CC, Krueger K, Cohen FJ, Eckert S, Ensrud KE, Avioli LV, Lips P, Cummings SR (1999) Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: result from a 3-year randomized clinical trial. Multiple Outcomes of Raloxifene Evaluation (MORE) investigators. JAMA 282:637–645

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

This study was financially supported by Eli Lilly, Denmark, and The Lundbeck Foundation (R7-A608-B486).

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Authors and Affiliations

  1. Research Centre of Ageing and Osteoporosis, Department of Endocrinology PE, Rigshospitalet, Copenhagen, Denmark

    L. Deleskog, B. R. Nielsen & P. Schwarz

  2. Department of Radiology, Frederiksberg University Hospital, Copenhagen, Denmark

    N. Ø. Laursen

  3. Faculty of Health Sciences, Copenhagen University, Copenhagen, Denmark

    P. Schwarz

Authors
  1. L. Deleskog
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  2. N. Ø. Laursen
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  4. P. Schwarz
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Correspondence to P. Schwarz.

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Deleskog, L., Laursen, N.Ø., Nielsen, B.R. et al. Vertebral fracture assessment by DXA is inferior to X-ray in clinical severe osteoporosis. Osteoporos Int 27, 2317–2326 (2016). https://doi.org/10.1007/s00198-016-3532-8

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