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Clinical utility of dual-energy vertebral assessment (DVA)

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The current study was undertaken to evaluate the clinical utility of DVA, a system for imaging the lateral spine on the Lunar Prodigy densitometer. DVA images were obtained and bone density of the lumbar spine and proximal femur measured in 297 subjects (272 women), aged 64±13 years. The images were classified as: normal (N) if no fractures were detected and all vertebrae between T6 and L4 were visualized, fracture (F) if any vertebra had a fracture (defined as 25% or more reduction in the vertebral height) even if some of the other vertebrae could not be visualized, and un-interpretable (U) if at least one of the vertebra between T6 and L4 could not be classified and no fractures were detected in the visualized vertebrae. A subset of 66 patients also had standard radiographs of the thoracic and lumbar spine. Compared to radiographs, DVA had a 95% sensitivity to detect fractures and 82% specificity (to exclude them). Among all 297 subjects studied, DVAs were interpretable in 87%. They were classified as N in 204 (68%), F in 55 (19%) and U in 38 (13%). The reasons for un-interpretability were: scoliosis, scapular or rib shadow, severe arthritic changes and multiple vertebral compression fracture with severe spinal deformities. Only 11% of F subjects gave a history of a vertebral fracture, and only 56% of F subjects met the BMD criteria for osteoporosis (T score <−2.5). These results indicate that adding DVA, a low radiation and relatively low cost "point of service" procedure, to BMD measurement provides the clinician with a more comprehensive fracture risk assessment than that afforded by clinical evaluation and BMD measurement alone.

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This study was supported by the grant AR42739/4A2 S1 from the National Institutes of Health and an unrestricted educational grant from the Fred and Susan Novy Family Foundation. The authors wish to thank Gina Keys and William Wilson for performing the DVA scans and Anca Guiu and Deepti Singh for help with data processing.

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Correspondence to Tamara J. Vokes.

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This study was presented in part at the ISCD Annual Meeting and Scientific Session, 13–16 February 2002, in Atlanta and at the Fifth International Symposium on Clinical Advances in Osteoporosis, 6–9 March 2002, in Honolulu.

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Vokes, T.J., Dixon, L.B. & Favus, M.J. Clinical utility of dual-energy vertebral assessment (DVA). Osteoporos Int 14, 871–878 (2003).

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