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Targeted vertebral fracture assessment for optimizing fracture prevention in Canada

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Abstract

Summary

Vertebral fracture assessment (VFA) provides incremental information in identifying women and men aged 70 years and older qualifying for anti-osteoporosis treatment compared with FRAX® major osteoporotic fracture (MOF) probability computed with bone mineral density (BMD).

Purpose

This analysis was performed to inform appropriate use of VFA testing as part of Osteoporosis Canada’s Guidelines Update, assuming vertebral fracture is an indication for pharmacotherapy in women and men.

Methods

Women and men aged 70 years and older without previous high-risk fracture (i.e., hip, spine, or multiple fractures) were identified in a BMD registry for the province of Manitoba, Canada. MOF probability with BMD was computed using the Canadian FRAX® tool. VFA was performed in those with a minimum BMD T-score of −1.5 or lower.

Results

The study population consisted of 7289 women (mean age 76.7 ± 5.6 years) and 1323 men (77.9 ± 5.8 years). More women than men qualified for VFA testing (48.7% vs 25.4%, respectively, p < 0.001). Among those undergoing VFA, a vertebral fracture was more commonly detected among men than women (22.9% vs 13.3%, p < 0.001), and vertebral fracture prevalence increased with lower BMD T-score (both p trend <0.001). The number needed to screen with VFA to detect a vertebral fracture was 8 for women and 4 for men. MOF probability was substantially lower in men than in women, and fewer men than women (3.3% vs 20.2%, p < 0.001) met a treatment threshold of MOF 20% or greater. In those with MOF probability <20%, VFA identified an incremental 5.4% of men and 3.4% of women for treatment based upon vertebral fracture.

Conclusions

The number needed to screen to identify a previously unappreciated vertebral fracture is low and further improves with lower BMD T-score. VFA identified more men as qualifying for treatment than MOF probability. In women, treatment qualification was predominantly from MOF probability.

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Acknowledgments

The authors thank the Osteoporosis Canada Guidelines Update Fracture Risk Assessment Working Group for their guidance as this work evolved. The authors acknowledge the Manitoba Centre for Health Policy for use of data contained in the Population Health Research Data Repository (HIPC 2016/2017-29).  Lisa Lix is supported by a Tier I Canada Research Chair.

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Authors and Affiliations

  1. University of Manitoba, Winnipeg, MB, Canada

    William D. Leslie & Lisa M. Lix

  2. Department of Medicine, St. Boniface Hospital, Room C5121, 409 Tache Avenue, Winnipeg, MB, R2H 2A6, Canada

    William D. Leslie

  3. University of Wisconsin, Madison, WI, USA

    Neil Binkley

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  1. William D. Leslie
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  2. Lisa M. Lix
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  3. Neil Binkley
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Contributions

Authors’ roles: conception, design, analysis, drafting the article (WDL), interpretation of data (all authors); critically revising the article for important intellectual content (all authors); final approval of the version to be published (all authors); and agreement to be accountable for all aspects of the work (all authors). WDL had full access to all the data in the study and takes the responsibility for the integrity of the data and the accuracy of the data analysis.

Corresponding author

Correspondence to William D. Leslie.

Ethics declarations

The results and conclusions are those of the authors, and no official endorsement by the Manitoba Centre for Health Policy, Manitoba Health, Seniors and Active Living, or other data providers is intended or should be inferred. This article has been reviewed and approved by the members of the Manitoba Bone Density Program Committee.

Conflicts of interest

William Leslie and Lisa Lix have no conflicts of interest. Neil Binkley has nothing to declare for the context of this paper but has received research support (paid to institution) from Radius and GE Healthcare and consultant/advisory board fees from Amgen.

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Leslie, W.D., Lix, L.M. & Binkley, N. Targeted vertebral fracture assessment for optimizing fracture prevention in Canada. Arch Osteoporos 15, 65 (2020). https://doi.org/10.1007/s11657-020-00735-2

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