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Integration of VFA, bone density data more sensitive for fracture risk in men.

PHILADELPHIA -- The addition of vertebral fracture assessment to bone mineral density measurement identified almost 20% of men at increased risk for future vertebral and peripheral fractures who might otherwise have been missed by dual-energy x-ray absorptiometry alone in a study of more than 1,100 older veterans, Dr. Neff Binkley reported in a poster at the annual meeting of the American Society for Bone and Mineral Research.

The researchers performed both bone mineral assessment using dual-energy x-ray absorptiometry (DXA) and vertebral fracture assessment (VFA) on 1,168 male veterans (mean age 69 years), who were referred for clinically indicated bone mass measurement during a 2-year period.

Information was collected about current medication use, fracture history, tallest height achieved, and current use of alcohol and tobacco. Height was measured with a stadiometer while the men were in stocking feet. The group was primarily white (97%).

DXA findings showed that 48% of the men in this population were osteopenic; 29% were osteoporotic, based on World Health Organization criteria, wrote Dr. Binkley, associate director of the Institute on Aging at the University of Wisconsin, Madison. One clinician interpreted DXA and VFA scans. The Genant visual semiquantitative approach was used to identify and categorizes fractures (J. Bone Miner. Res. 1993;8:1137-48).

Using VFA, the researchers were able to adequately visualize 78% of vertebral bodies from T4-L5 and 93% from T8-L5. VFA identified vertebral fractures in 32% of the men--604 fractures in 374 men. The fracture distribution was bimodal with peak fracture prevalence in the midthoracic spine and at the thoracolumbar junction.

Most fractures (77%) were moderate, followed by severe fractures (19%), and mild fractures (4%). Most men with VFA-identified fracture (61%) had only one; 39% had two or more. Fracture prevalence was higher in men with lower bone mineral density and increased with increasing age.

Vertebral fractures were identified in 18% of men, who would not otherwise have been identified as being at greater risk for fracture. These men were osteopenic, had no history of fracture, and were not currently using glucocorticoids. The researchers suggested that these findings lend weight to using osteopenia as an indication for vertebral fracture assessment.

Greater historical height loss was associated with higher vertebral fracture prevalence. Importantly, vertebral fracture prevalence did not increase until a height loss of 2.5 inches or greater was reported. "It seems reasonable that a larger amount of height loss could be considered as an indication for VFA performance," Dr. Binkley and his colleagues wrote.

Knowledge of vertebral fractures may change diagnostic classification, estimation of future fracture risk, and clinical management.


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Title Annotation:vertebral fracture assessment
Author:Wachter, Kerri
Publication:Family Practice News
Geographic Code:1USA
Date:Nov 1, 2006
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