Osteoporosis International

, Volume 20, Issue 8, pp 1347–1352 | Cite as

Spine radiographs to improve the identification of women at high risk for fractures

  • J. C. Netelenbos
  • W. F. Lems
  • P. P. Geusens
  • H. J. Verhaar
  • A. J. M. Boermans
  • M. M. Boomsma
  • P. G. H. Mulder
  • S. E. Papapoulos
Original Article



In women older than 60 years with clinical risk factors for osteoporosis but without osteoporosis based on bone mineral density (T-score ≥ −2.5), a systematic survey with X-rays of the spine identified previously unknown vertebral deformities in 21% of women.


This study determines the prevalence of vertebral deformities in elderly women with clinical risk factors for osteoporosis but with BMD values above the threshold for osteoporosis (T-score ≥ −2.5).


Bisphosphonate naïve women older than 60 years attending 35 general practices in the Netherlands with ≥2 clinical risk factors for osteoporosis were invited for BMD measurement (DXA). In women with T-score ≥ −2.5 at both spine and the hips, lateral radiographs of the thoracic and lumbar spine were performed.


Of 631 women with a DXA measurement, 187 (30%) had osteoporosis (T-score < −2.5 at the spine or the hip). Of the remaining 444 women with T-score ≥ −2.5 at both spine and hip, 387 had additional spine radiographs, of whom 80 (21%) had at least one vertebral deformity.


In elderly women with clinical risk factors for osteoporosis but BMD T-score ≥ −2.5, addition of spine radiographs identified vertebral deformities in 21% (95% CI: 17–25). Since these women are at risk of future fractures, antiosteoporotic treatment should be considered.


Bone mineral density Case finding Dual-energy X-ray absorptiometry Spine radiographs 


  1. 1.
    Anon (2002) America’s bone health: the state of osteoporosis and low bone mass in our nation. National Osteoporosis Foundation, Washington (DC)Google Scholar
  2. 2.
    Anon (2004) Bone health and osteoporosis: a report of the surgeon general. Rockville (MD): US Department of Health and Human Services, Office of the Surgeon General. Available at http://www.surgeongeneral.gov/library/bonehealth/ [last accessed 7 June 2007]
  3. 3.
    RIVM osteoporosis fact sheath, available at http://www.rivm.nl/vtv/object_document/o1793n18373.html [last accessed at 7 June 2007]
  4. 4.
    Hofman A, Boerlage PA, Bots ML et al (1995) Prevalence of chronic diseases in the elderly; the ERGO study (Erasmus Rotterdam Health and the Elderly). Ned Tijdschr Geneeskd 139(39):1975–1978PubMedGoogle Scholar
  5. 5.
    Geusens PP, Lems WF, Verhaar HJ et al (2006) Review and evaluation of the Dutch guidelines for osteoporosis. J Eval Clin Pract 12(5):539–548PubMedCrossRefGoogle Scholar
  6. 6.
    Kaptoge S, Armbrecht G, Felsenberg D et al (2006) Whom to treat? The contribution of veretebral X-rays to risk-based algorithms for fracture prediction: results from the European Prospective Osteoporosis Study. Osteoporos Int 17(9):1369–1381PubMedCrossRefGoogle Scholar
  7. 7.
    CBO Guideline Osteoporosis; second revised guideline. Available at http://www.cbo.nl/product/richtlijnen/folder20021023121843/osteoporose.pdf/view
  8. 8.
    Genant HK, Li J, Wu CY, Shepherd JA (2000) Vertebral fractures in osteoporosis: a new method for clinical assessment. J Clin Densitometry 3(3):281–290CrossRefGoogle Scholar
  9. 9.
    Siris ES, Miller PD, Barrett-Connor E et al (2001) Identification and fracture outcomes of undiagnosed low bone mineral density in postmenopausal women. Results from the National Osteoporosis Risk Assessment. JAMA 286(22):2815–2822PubMedCrossRefGoogle Scholar
  10. 10.
    Miller PD, Siris ES, Barrett-Connor E et al (2002) Prediction of fracture risk in postmenopausal white women with peripheral bone densitometry: evidence from the National Osteoporosis Risk Assessment. J Bone Miner Res 17(12):2222–2230PubMedCrossRefGoogle Scholar
  11. 11.
    Schuit SC, van der Klift M, Weel AE et al (2004) Fracture incidence and association with bone mineral density in elderly men and women. The Rotterdam Study. Bone 34(1):195–202CrossRefGoogle Scholar
  12. 12.
    Sornay-Rendu E, Munoz F, Garnero P Duboeuf F, Delmas PD (2005) Identification of Osteopenic Women at High Risk of Fracture: The OFELY Study. J Bone Miner Res 20(10):1813–1819PubMedCrossRefGoogle Scholar
  13. 13.
    Siris ES, Genant HK, Laster AJ et al (2007) Enhanced prediction of fracture risk combining vertebral fracture status and BMD. Osteoporos Int 18(6):761–777PubMedCrossRefGoogle Scholar
  14. 14.
    Black DM, Arden NK, Palermo L, Pearson J, Cummings SR (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
  15. 15.
    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
  16. 16.
    Klotzbuecher CM, Ross PD, Landsman PB, Abbott TA 3rd, Berger M (2000) Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res 15(4):721–39PubMedCrossRefGoogle Scholar
  17. 17.
    Kanis JA, Johnell O, De Laet C et al (2004) A meta-analysis of previous fracture and subsequent fracture risk. Bone 35(2):375–382PubMedCrossRefGoogle Scholar
  18. 18.
    Lems WF (2007) Clinical relevance of vertebral fractures. Ann Rheum Dis 66(1):2–4PubMedCrossRefGoogle Scholar
  19. 19.
    Kanis JA, Johnell O, Oden A et al (2008) FRAX and the assessment of fracture probability in men and women from the UK. Osteoporos Int 19(4):385–397PubMedCrossRefGoogle Scholar
  20. 20.
    Khosla S, Melton LJ III (2007) Clinical practice. Osteopenia. N Engl J Med 356(22):2293–2300PubMedCrossRefGoogle Scholar
  21. 21.
    Chapurlat RD, Duboeuf F, Marion-Audibert HO et al (2006) Effectiveness of instant vertebral assessment to detect prevalent vertebral fracture. Osteoporosis Int 17(8):1189–1195CrossRefGoogle Scholar
  22. 22.
    Vosse D, Heijckmann C, Landewé R et al (2007) Comparing morphometric X-ray absorptiometry and radiography in defining vertebral wedge fractures in patients with ankylosing spondylitis. Rheumatology (Oxford) 46(11):1667–1671CrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2008

Authors and Affiliations

  • J. C. Netelenbos
    • 1
  • W. F. Lems
    • 2
  • P. P. Geusens
    • 3
    • 4
  • H. J. Verhaar
    • 5
  • A. J. M. Boermans
    • 6
  • M. M. Boomsma
    • 7
  • P. G. H. Mulder
    • 8
  • S. E. Papapoulos
    • 9
  1. 1.Department of EndocrinologyVU University Medical CenterAmsterdamThe Netherlands
  2. 2.Department of RheumatologyVU University Medical CenterAmsterdamThe Netherlands
  3. 3.Department of Internal Medicine/RheumatologyUniversity HospitalMaastrichtThe Netherlands
  4. 4.University HasseltHasseltBelgium
  5. 5.Mobility Laboratory, Department of Geriatric MedicineUniversity Medical CenterUtrechtThe Netherlands
  6. 6.LosserThe Netherlands
  7. 7.Medical departmentGlaxoSmithKlineZeistThe Netherlands
  8. 8.Erasmus University Medical CenterRotterdamThe Netherlands
  9. 9.Department of Endocrinology and Metabolic DiseasesUniversity Medical CenterLeidenThe Netherlands

Personalised recommendations