Vertebral Fracture Assessment vs Conventional Spine Radiography

The use of vertebral fracture assessment (VFA) has shown adequate performance for the detection of vertebral fractures, reports a retrospective study and meta-analysis published in Osteoporosis International.

Historically, vertebral fractures have been diagnosed with conventional radiographs of the spine, but recently, the use of VFA has been promoted as an alternative tool for the diagnosis of such fractures.

The current study sought to assess the performance of VFA vs conventional spinal radiography in the investigators’ fracture liaison service (FLS) for the diagnosis of vertebral fractures in patients being evaluated for osteoporosis following a recent fracture. Another aim of this study was to systematically review all published literature on the performance of VFA vs conventional radiographs in patients being evaluated for osteoporosis and to conduct a meta-analysis on the data. A risk for bias assessment was also performed.

A total of 542 patients with fractures (75% women; mean age, 67.5±10.1 years; median time between fracture and FLS visit, 2.3 months) were included in the study. Overall, 188 patients (35%) had sustained a fracture of the distal radius, 61 patients (11%) of the ankle, 58 patients (11%) of the proximal humerus, 50 patients (9%) of the hip, and 25 patients (5%) of the vertebrae. Of all study participants, 319 (59%) had osteopenia, 163 (30%) had osteoporosis, and 60 (11%) had normal bone mineral density.

The sensitivity of low-radiation VFA for the detection of grade 2 or more vertebral fracture was 0.77 (95% CI, 0.70-0.84); the specificity was 0.80 (95% CI, 0.76-0.84). Of the 542 patients, 297 (55%) had ≥1 vertebrae and 135 (25%) had ≥3 vertebrae that could not be evaluated by VFA. The pooled sensitivity of VFA for detection of a grade 2 or more vertebral fracture was 0.84 (95% CI, 0.72-0.92); the pooled specificity was 0.90 (95% CI, 0.84-0.94).

The systematic review identified 16 studies with a total of 3238 individuals (81% women), with a mean age between 45 and 74 years. Overall, 7 studies had a low risk for bias and 9 had an intermediate risk.

Findings from the meta-analysis demonstrated an adequate performance of VFA for detection of vertebral fractures. Caution should be exercised about relying exclusively on VFA for the assessment of vertebral fractures.

Reference

Malgo F, Hamdy NAT, Ticheler CHJM, et al. Value and potential limitations of vertebral fracture assessment (VFA) compared to conventional spine radiography: experience from a fracture liaison service (FLS) and a meta-analysis [published online August 25, 2017]. Osteoporos Int. doi: 10.1007/s00198-017-4137-6