Osteoporosis International

, Volume 19, Issue 8, pp 1167–1173 | Cite as

Routine versus targeted vertebral fracture assessment for the detection of vertebral fractures

Original Article



Fracture risk is underestimated in women with unknown vertebral fractures. Using VFA, we compared two screening methods: targeted (6,388 women) and routine (2,176 women). Routine screening detected fractures in 20%. Targeted screening only required 5% attending for DXA to undergo VFA but only detected 9.6% of women with fractures.


BMD alone underestimates fracture risk in women with unknown vertebral fractures. We report the results of routine vertebral fracture assessment (VFA) screening and compare with targeted screening.


Our centre initially targeted VFA at women with reasons to suspect a vertebral fracture. Later we changed to routine VFA screening for all women over 65. We retrospectively compare each screening method’s ability to detect vertebral fractures.


Six thousand three hundred and eighty-eight women over 65 underwent DXA during the period of targeted VFA and 2,176 during routine VFA. Routine VFA detected 420 (20.0%) women with fracture. Most vertebral fractures (56.2%) occurred in women with osteopenia. Routine VFA would be expected to alter the management of 1 in 6 osteopenic women. Targeted VFA was performed in 332 (5.2%) women detecting 122 (1.9%) women with fractures. It was estimated that targeted VFA only detected 9.6% of women with a vertebral fracture. Targeted VFA failed to detect fractures in 18.1% of the population attending for DXA and in 29% of those with osteoporosis.


Routine VFA detects vertebral fractures in 20% of women over 65. Targeted VFA greatly reduces the number of VFAs performed but only detects a minority of the women with vertebral fractures.


Bone mineral density Screening Vertebral fractures Vertebral fracture assessment 


Conflicts of interest



  1. 1.
    Riggs BL, Melton LJ (1995) The worldwide problem of osteoporosis: insights afforded by epidemiology. Bone 17(5):505S–511SPubMedCrossRefGoogle Scholar
  2. 2.
    Nevitt MC, Cummings SR, Stone KL et al (2005) Risk factors for a first-incident radiographic vertebral fracture in women > or = 65 years of age: the study of osteoporotic fractures. J Bone Miner Res 20(1):131–140PubMedCrossRefGoogle Scholar
  3. 3.
    Lunt M, Felsenberg D, Reeve J et al (1997) Bone density variation and its effects on risk of vertebral deformity in men and women studied in thirteen European centers: the EVOS Study. J Bone Miner Res 12(11):1883–1894PubMedCrossRefGoogle Scholar
  4. 4.
    Melton LJ 3rd, Lane AW, Cooper C et al (1993) Prevalence and incidence of vertebral deformities. Osteoporos Int 3(3):113–119PubMedCrossRefGoogle Scholar
  5. 5.
    Hall SE, Criddle RA, Comito TL et al (1999) A case-control study of quality of life and functional impairment in women with long-standing vertebral osteoporotic fracture. Osteoporos Int 9(6):508–515PubMedCrossRefGoogle Scholar
  6. 6.
    Nevitt MC, Thompson DE, Black DM et al (2000) Effect of alendronate on limited-activity days and bed-disability days caused by back pain in postmenopausal women with existing vertebral fractures. Fracture Intervention Trial Research Group. Arch Intern Med 160(1):77–85, 10PubMedCrossRefGoogle Scholar
  7. 7.
    Cauley JA, Thompson DE, Ensrud KC et al (2000) Risk of mortality following clinical fractures. Osteoporos Int 11(7):556–561PubMedCrossRefGoogle Scholar
  8. 8.
    Lindsay R, Silverman SL, Cooper C et al (2001) Risk of new vertebral fracture in the year following a fracture. JAMA 285(3):320–323, 17PubMedCrossRefGoogle Scholar
  9. 9.
    Black DM, Arden NK, Palermo L et al (1999) Prevalent vertebral deformities predict hip fractures and new vertebral deformities but not wrist fractures. Study of Osteoporotic Fractures Research Group. J Bone Miner Res 14(5):821–828PubMedCrossRefGoogle Scholar
  10. 10.
    Ismail AA, Cockerill W, Cooper C et al (2001) Prevalent vertebral deformity predicts incident hip though not distal forearm fracture: results from the European Prospective Osteoporosis Study. Osteoporos Int 12(2):85–90PubMedCrossRefGoogle Scholar
  11. 11.
    Rea JA, Chen MB, Li J et al (2000) Morphometric X-ray absorptiometry and morphometric radiography of the spine: a comparison of prevalent vertebral deformity identification. J Bone Miner Res 15(3):564–574PubMedCrossRefGoogle Scholar
  12. 12.
    Rea JA, Chen MB, Li J et al (2000) Visual assessment of vertebral deformity by X-ray absorptiometry: a highly predictive method to exclude vertebral deformity. Osteoporos Int 11(8):660–668PubMedCrossRefGoogle Scholar
  13. 13.
    Binkley N, Krueger D, Gangnon R et al (2005) Lateral vertebral assessment: a valuable technique to detect clinically significant vertebral fractures. Osteoporos Int 16(12):1513–1518PubMedCrossRefGoogle Scholar
  14. 14.
    Chapurlat RD, Duboeuf F, Marion-Audibert HO et al (2006) Effectiveness of instant vertebral assessment to detect prevalent vertebral fracture. Osteoporos Int 17(8):1189–1195PubMedCrossRefGoogle Scholar
  15. 15.
    Steel SA, Thorpe JA, Walker R et al (1999) Development and evaluation of a phantom for morphometric X-ray absorptiometry. Osteoporos Int 9(1):38–44PubMedCrossRefGoogle Scholar
  16. 16.
    Genant HK, Wu CY, van Kuijk C et al (1993) Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 8(9):1137–1148PubMedGoogle Scholar
  17. 17.
    Kanis JA, Gluer CC (2000) An update on the diagnosis and assessment of osteoporosis with densitometry. Committee of Scientific Advisors, International Osteoporosis Foundation. Osteoporos Int 11(3):192–202PubMedCrossRefGoogle Scholar
  18. 18.
    Genant HK, Jergas M, Palermo L et al (1996) Comparison of semiquantitative visual and quantitative morphometric assessment of prevalent and incident vertebral fractures in osteoporosis The Study of Osteoporotic Fractures Research Group. J Bone Miner Res 11(7):984–996PubMedCrossRefGoogle Scholar
  19. 19.
    Rea JA, Chen MB, Li J et al (1999) Morphometric X-ray absorptiometry and morphometric radiography of the spine: a comparison of analysis precision in normal and osteoporotic subjects. Osteoporos Int 9(6):536–544PubMedGoogle Scholar
  20. 20.
    Ross PD, Davis JW, Epstein RS et al (1991) Pre-existing fractures and bone mass predict vertebral fracture incidence in women. Ann Intern Med 1;114(11):919–923Google Scholar
  21. 21.
    Schousboe JT, DeBold CR, Bowles C et al (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, FallPubMedCrossRefGoogle Scholar
  22. 22.
    Greenspan SL, von Stetten E, Emond SK et al (2001) Instant vertebral assessment: a noninvasive dual X-ray absorptiometry technique to avoid misclassification and clinical mismanagement of osteoporosis. J Clin Densitom 4(4):373–380PubMedCrossRefGoogle Scholar
  23. 23.
    Kanis JA, Barton IP, Johnell O (2005) Risedronate decreases fracture risk in patients selected solely on the basis of prior vertebral fracture. Osteoporos Int 16(5):475–482PubMedCrossRefGoogle Scholar
  24. 24.
    Quandt SA, Thompson DE, Schneider DL et al (2005) Effect of alendronate on vertebral fracture risk in women with bone mineral density T scores of−1.6 to −2.5 at the femoral neck: the Fracture Intervention Trial. Mayo Clin Proc 80(3):343–349PubMedCrossRefGoogle Scholar
  25. 25.
    Schousboe JT, Ensrud KE, Nyman JA et al (2006) Cost-effectiveness of vertebral fracture assessment to detect prevalent vertebral deformity and select postmenopausal women with a femoral neck T-score>-2.5 for alendronate therapy: a modeling study. J Clin Densitom 9(2):133–143PubMedCrossRefGoogle Scholar
  26. 26.
    Schousboe JT, Debold CR (2006) Reliability and accuracy of vertebral fracture assessment with densitometry compared to radiography in clinical practice. Osteoporos Int 17(2):281–289PubMedCrossRefGoogle Scholar
  27. 27.
    Vokes TJ, Dixon LB, Favus MJ (2003) Clinical utility of dual-energy vertebral assessment (DVA). Osteoporos Int 14(11):871–878PubMedCrossRefGoogle Scholar
  28. 28.
    Laster AJ, Lewiecki EM, for the ISCD Board of Directors (2007) Vertebral Fracture Assessment by Dual-Energy X-ray Absorptiometry: Insurance Coverage Issues in the United States A White Paper of the International Society for Clinical Densitometry. J Clin Densitom 10(3):227–238PubMedCrossRefGoogle Scholar
  29. 29.
    Gallagher JC, Genant HK, Crans GG et al (2005) Teriparatide reduces the fracture risk associated with increasing number and severity of osteoporotic fractures. J Clin Endocrinol Metab 90(3):1583–1587PubMedCrossRefGoogle Scholar
  30. 30.
    Crans GG, Silverman SL, Genant HK et al (2004) Association of severe vertebral fractures with reduced quality of life: reduction in the incidence of severe vertebral fractures by teriparatide. Arthritis Rheum 50(12):4028–4034PubMedCrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2007

Authors and Affiliations

  1. 1.Centre for Metabolic Bone DiseaseHull Royal InfirmaryHullUK

Personalised recommendations