Vertebral fracture assessment by dual-energy X-ray absorptiometry along with bone mineral density in the evaluation of postmenopausal osteoporosis.

This is a cross-sectional study to look at the utility of DXA-VFA in addition to bone mineral density (BMD) in the evaluation of postmenopausal osteoporosis. Vertebral fracture (VF) was detected in more than two-thirds of postmenopausal women referred for DXA-BMD. Addition of DXA-VFA detected additional 27% with VF whose BMD were in the non-osteoporotic range. INTRODUCTION: VFs are the hallmark of osteoporotic fractures. Prevalent vertebral fractures are an independent risk factor for future fragility fractures. This study was conducted to look at the prevalence of VF by DXA-vertebral fracture assessment (VFA) and to study the utility of DXA-VFA in addition to bone mineral density (BMD) in the evaluation of osteoporosis. METHODS: A cross-sectional study of the postmenopausal women above the age of 50 years who were referred for BMD assessment by DXA. All subjects underwent VFA and BMD assessment by Hologic DXA. RESULTS: Four hundred postmenopausal women with a mean age of 62.7 +/- 6.2 years underwent BMD and VFA assessment by DXA. Prevalent VF was seen in 261 (65.2%) subjects, of which 114 (28.5%) subjects, 135 (33.7%) subjects, and 12 (3%) subjects had mild, moderate, and severe VF, respectively. Among subjects with VF, 136 (52.1%) and 90 (34.5%) had BMD-defined osteoporosis at the spine and femur neck, respectively. Overall, 59% with VF had osteoporosis at either the spine or femur neck. Forty-one-percent subjects with VF had BMD in non-osteoporotic range at both sites, of which 20% had moderate-to-severe VF. Addition of DXA-VFA to BMD assessment detected additional 27% with VF whose BMD was in the non-osteoporotic range. CONCLUSION: VF was seen in more than two-thirds of the postmenopausal women referred for osteoporosis evaluation. VFA identified additional patients with VF whose BMD was not in the osteoporotic range. Incorporation of VFA to BMD will assist in documenting prevalent vertebral fracture which is an independent risk factor for incident fragility fracture irrespective of the BMD.