Skip to main content

Advertisement

SpringerLink
Log in

Diagnostic Performance of Vertebral Fracture Assessment by the Lunar iDXA Scanner Compared to Conventional Radiography

  • Original Research
  • Published:
Calcified Tissue International Aims and scope Submit manuscript

Abstract

The purpose of this study was to evaluate the diagnostic performance of vertebral fracture assessment (VFA) using the Lunar iDXA scanner. Conventional spinal radiographs and images acquired by dual-energy X-ray absorptiometry (DXA) of 350 subjects (269 females, 81 males) were evaluated by two different readers. We visualized 4,476/4,550 (98.4 %) vertebrae from T4 to L4 on VFA images compared to 4,535/4,550 (99.7 %) on radiographs. Among the visualized vertebrae, 205/4,535 (4.5 %) and 190/4,476 (4.2 %) were identified as nonfracture deformities by reading of radiographs and VFA, respectively. Vertebral fractures (VFs) were 231 in 126 patients and 228 in 125 patients by semiquantitative assessment of radiographs (SQ-Rx) and by VFA, respectively. There was excellent agreement between the two techniques and high diagnostic performance of VFA both on a per-vertebra basis (k score = 0.984, 95 % CI 0.972–0.996, sensitivity 98.68 %, specificity 99.91 %, PPV 98.25 %, NPV 99.93 %) and on a per-patient basis (k score = 0.957, 95 % CI 0.925–0.988, sensitivity 96.83 %, specificity 98.66 %, PPV 97.60 %, NPV 98.22 %). In older patients (≥65 years) affected by moderate or severe osteoarthritis, SQ-Rx and VFA identified 96 VFs and 95 versus 90 vertebral deformities, respectively. This study demonstrates that most vertebrae are evaluable using the iDXA scanner, with improved VFA diagnostic performance even in discriminating mild VFs from vertebral deformities. Therefore, VFA may be appropriate as an alternative to conventional radiography in patients at high risk of VF who are undergoing DXA bone densitometry and in the follow-up of osteoporotic patients on treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Cummings SR, Melton LJ (2002) Epidemiology and outcomes of osteoporotic fractures. Lancet 359:1761–1767

    Article  PubMed  Google Scholar 

  2. Cauley JA, Palermo L, Vogt M, Ensrud KE, Ewing S, Hochberg M, Nevitt MC, Black DM (2008) Prevalent vertebral fractures in black women and white women. J Bone Miner Res 23:1458–1467

    Article  PubMed  Google Scholar 

  3. Delmas PD, van de Langerijt L, Watts NB, Eastell R, Genant H, Grauer A, Cahall DL (2005) Underdiagnosis of vertebral fractures is a worldwide problem: the IMPACT study. J Bone Miner Res 20:557–563

    Article  PubMed  Google Scholar 

  4. Kim N, Rowe BH, Raymond G, Jen H, Colman I, Jackson SA, Siminoski KG, Chahal AM, Folk D, Majumdar SR (2004) Underreporting of vertebral fractures on routine chest radiography. Am J Roentgenol 182:297–300

    CAS  Google Scholar 

  5. Lindsay R, Pack S, Li Z (2005) Longitudinal progression of fracture prevalence through a population of postmenopausal women with osteoporosis. Osteoporos Int 16:306–312

    Article  PubMed  Google Scholar 

  6. Roux C, Fechtenbaum J, Kolta S, Briot K, Girard M (2007) Mild prevalent and incident vertebral fractures are risk factors for new fractures. Osteoporos Int 18:1617–1624

    Article  PubMed  CAS  Google Scholar 

  7. Cauley JA, Hochberg MC, Lui LY, Palermo L, Ensrud KE, Hillier TA, Nevitt MC, Cummings SR (2007) Long-term risk of incident vertebral fractures. JAMA 298:2761–2767

    Article  PubMed  CAS  Google Scholar 

  8. Johnell O, Kanis JA, Oden A, Sernbo I, Redlund-Johnell I, Petterson C, De Laet C, Jonsson B (2004) Mortality after osteoporotic fractures. Osteoporos Int 15:38–42

    Article  PubMed  CAS  Google Scholar 

  9. Romagnoli E, Carnevale V, Nofroni I, D’Erasmo E, Paglia F, De Geronimo S, Pepe J, Raejntroph N, Maranghi M, Minisola S (2004) Quality of life in ambulatory postmenopausal women: the impact of reduced bone mineral density and subclinical vertebral fractures. Osteoporos Int 15:975–980

    Article  PubMed  Google Scholar 

  10. Genant HK, Wu CY, van Kuijk C, Nevitt MC (1993) Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 8:1137–1148

    Article  PubMed  CAS  Google Scholar 

  11. Genant HK, Jergas M, Palermo L, Nevitt M, Valentin RS, Black D, Cummings SR (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 11:984–996

    Article  PubMed  CAS  Google Scholar 

  12. Gehlbach SH, Bigelow C, Heimisdottir M, May S, Walker M, Kirkwood JR (2000) Recognition of vertebral fracture in a clinical setting. Osteoporos Int 11:577–582

    Article  PubMed  CAS  Google Scholar 

  13. Blake GM, Rea JA, Fogelman I (1997) Vertebral morphometry studies using dual-energy X-ray absorptiometry. Semin Nucl Med 27:276–290

    Article  PubMed  CAS  Google Scholar 

  14. Lang T, Takada M, Gee R, Wu C, Li J, Hayashi-Clark C, Schoen S, March V, Genant HK (1997) A preliminary evaluation of the Lunar Expert-XL for bone densitometry and vertebral morphometry. J Bone Miner Res 12:136–143

    Article  PubMed  CAS  Google Scholar 

  15. Crabtree N, Wright J, Walgrove A, Rea J, Hanratty L, Lunt M, Fogelman I, Palmer R, Vickers M, Compston JE, Reev J (2000) Vertebral morphometry: repeat scan precision using the Lunar Expert-XL and the Hologic 4500A. A study for the “WISDOM” RCT of hormone replacement therapy. Osteoporos Int 11:537–543

    Article  PubMed  CAS  Google Scholar 

  16. Damilakis J, Adams JE, Guglielmi G, Link TM (2010) Radiation exposure in X-ray-based imaging techniques used in osteoporosis. Eur Radiol 20:2707–2714

    Article  PubMed  Google Scholar 

  17. Olenginski TP, Newman ED, Hummel JL, Hummer M (2006) Development and evaluation of a vertebral fracture assessment program using IVA and its integration with mobile DXA. J Clin Densitom 9:72–77

    Article  PubMed  Google Scholar 

  18. Schousboe JT, Vokes T, Broy SB, Ferrar L, McKiernan F, Roux C, Binkley N (2008) Vertebral fracture assessment: the 2007 ISCD official positions. J Clin Densitom 11:92–108

    Article  PubMed  Google Scholar 

  19. Thorpe JA, Steel SA (1999) Image resolution of the Lunar Expert-XL. Osteoporos Int 10:95–101

    Article  PubMed  CAS  Google Scholar 

  20. Duboeuf F, Bauer DC, Chapurlat RD, Dinten JM, Delmas P (2005) Assessment of vertebral fracture using densitometric morphometry. J Clin Densitom 8:362–368

    Article  PubMed  CAS  Google Scholar 

  21. Rea JA, Chen MB, Li J, Blake GM, Steiger P, Genant HK, Fogelman I (2000) Morphometric X-ray absorptiometry and morphometric radiography of the spine: a comparison of prevalent vertebral deformity identification. J Bone Miner Res 15:564–574

    Article  PubMed  CAS  Google Scholar 

  22. Ferrar L, Jiang G, Eastell R, Peel NF (2003) Visual identification of vertebral fractures in osteoporosis using morphometric X-ray absorptiometry. J Bone Miner Res 18:933–938

    Article  PubMed  CAS  Google Scholar 

  23. Schousboe JT, Debold CR (2006) Reliability and accuracy of vertebral fracture assessment with densitometry compared to radiography in clinical practice. Osteoporos Int 17:281–289

    Article  PubMed  Google Scholar 

  24. Pavlov L, Gamble GD, Reid IR (2005) Comparison of dual-energy X-ray absorptiometry and conventional radiography for the detection of vertebral fractures. J Clin Densitom 8:379–385

    Article  PubMed  Google Scholar 

  25. Vokes TJ, Dixon LB, Favus MJ (2003) Clinical utility of dual-energy vertebral assessment (DVA). Osteoporos Int 14:871–878

    Article  PubMed  Google Scholar 

  26. Binkley N, Krueger D, Gangnon R, Genant HK, Drezner MK (2005) Lateral vertebral assessment: a valuable technique to detect clinically significant vertebral fractures. Osteoporos Int 16:1513–1518

    Article  PubMed  Google Scholar 

  27. Fuerst T, Wu C, Genant HK, von Ingersleben G, Chen Y, Johnston C, Econs MJ, Binkley N, Vokes TJ, Crans G, Mitlak BH (2009) Evaluation of vertebral fracture assessment by dual X-ray absorptiometry in a multicenter setting. Osteoporos Int 20:1199–1205

    Article  PubMed  CAS  Google Scholar 

  28. Krueger D, Vallarta-Ast N, Checovich M, Gemar D, Binkley N (2012) BMD measurement and precision: a comparison of GE Lunar Prodigy and iDXA densitometers. J Clin Densitom 15:21–25

    Article  PubMed  Google Scholar 

  29. Hurxthal LM (1968) Measurement of anterior vertebral compressions and biconcave vertebrae. Am J Roentgenol Radium Ther Nucl Med 103:635–644

    PubMed  CAS  Google Scholar 

  30. Jiang G, Eastell R, Barrington NA, Ferrar L (2004) Comparison of methods for the visual identification of prevalent vertebral fracture in osteoporosis. Osteoporos Int 15:887–896

    Article  PubMed  CAS  Google Scholar 

  31. Lane NE, Nevitt MC, Genant HK, Hochberg MC (1993) Reliability of new indices of radiographic osteoarthritis of the hand and hip and lumbar disc degeneration. J Rheumatol 20:1911–1918

    PubMed  CAS  Google Scholar 

  32. Ismail AA, Cooper C, Felsenberg D, Varlow J, Kanis JA, Silman AJ, O’Neill TW (1999) Number and type of vertebral deformities: epidemiological characteristics and relation to back pain and height loss. European Vertebral Osteoporosis Study Group. Osteoporos Int 9:206–213

    Article  PubMed  CAS  Google Scholar 

  33. Buehring B, Krueger D, Checovich M, Gemar D, Vallarta-Ast N, Genant HK, Binkley N (2010) Vertebral fracture assessment: impact of instrument and reader. Osteoporos Int 21:487–494

    Article  PubMed  CAS  Google Scholar 

  34. Hospers IC, van der Laan JG, Zeebregts CJ, Nieboer P, Wolffenbuttel BH, Dierckx RA, Kreeftenberg HG, Jager PL, Slart RH (2009) Vertebral fracture assessment in supine position: comparison by using conventional semiquantitative radiography and visual radiography. Radiology 251:822–828

    Article  PubMed  Google Scholar 

  35. Jager PL, Jonkman S, Koolhaas W, Stiekema A, Wolffenbuttel BH, Slart RH (2011) Combined vertebral fracture assessment and bone mineral density measurement: a new standard in the diagnosis of osteoporosis in academic populations. Osteoporos Int 22:1059–1068

    Article  PubMed  CAS  Google Scholar 

  36. Guglielmi G, Diacinti D, van Kuijk C, Aparisi F, Krestan C, Adams JE, Link TM (2008) Vertebral morphometry: current methods and recent advances. Eur Radiol 18:1484–1496

    Article  PubMed  CAS  Google Scholar 

  37. Vosse D, Heijckmann C, Landewe R, van der Heijde D, van der Linden S, Geusens P (2007) Comparing morphometric X-ray absorptiometry and radiography in defining vertebral wedge fractures in patients with ankylosing spondylitis. Rheumatology (Oxford) 46:1667–1671

    Article  CAS  Google Scholar 

  38. Chapurlat RD, Duboeuf F, Marion-Audibert HO, Kalpakcioglu B, Mitlak BH, Delmas PD (2006) Effectiveness of instant vertebral assessment to detect prevalent vertebral fracture. Osteoporos Int 17:1189–1195

    Article  PubMed  CAS  Google Scholar 

  39. Kleerekoper M, Nelson DA (1992) Vertebral fracture or vertebral deformity. Calcif Tissue Int 50:5–6

    Article  PubMed  CAS  Google Scholar 

  40. Ziegler R, Scheidt-Nave C, Leidig-Bruckner G (1996) What is a vertebral fracture? Bone 18:169S–177S

    Article  PubMed  CAS  Google Scholar 

  41. Ferrar L, Jiang G, Armbrecht G, Reid DM, Roux C, Gluer CC, Felsenberg D, Eastell R (2007) Is short vertebral height always an osteoporotic fracture? The Osteoporosis and Ultrasound Study (OPUS). Bone 41:5–12

    Article  PubMed  CAS  Google Scholar 

  42. Ferrar L, Jiang G, Clowes JA, Peel NF, Eastell R (2008) Comparison of densitometric and radiographic vertebral fracture assessment using the algorithm-based qualitative (ABQ) method in postmenopausal women at low and high risk of fracture. J Bone Miner Res 23:103–111

    Article  PubMed  Google Scholar 

  43. Diacinti D, Pisani D, Del Fiacco R, Francucci CM, Fiore CE, Frediani B, Barone A, Bartalena T, Cattaruzza MS, Guglielmi G, Romagnoli E, Minisola S (2011) Vertebral morphometry by X-ray absorptiometry: which reference data for vertebral heights? Bone 49:526–536

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors have stated that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Radiology, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, RM, Italy

    Daniele Diacinti & Davide Diacinti

  2. Department of Clinical Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, RM, Italy

    Romano Del Fiacco, Serena Arima, Elisabetta Romagnoli, Jessica Pepe, Cristiana Cipriani & Salvatore Minisola

  3. Department of Clinical and Molecular Medicine, Sant’ Andrea Hospital, Sapienza University of Rome, Via Grottarossa 1035-1039, 00189, Rome, RM, Italy

    Daniela Pisani & Federico Todde

  4. Department of Public Health and Infectious Diseases, Sapienza University of Rome, P.le Aldo Moro5, 00185, Rome, RM, Italy

    Maria Sofia Cattaruzza

Authors
  1. Daniele Diacinti
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Romano Del Fiacco
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Daniela Pisani
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Federico Todde
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Maria Sofia Cattaruzza
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Davide Diacinti
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Serena Arima
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Elisabetta Romagnoli
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Jessica Pepe
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Cristiana Cipriani
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Salvatore Minisola
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Daniela Pisani.

Additional information

The authors have stated that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Diacinti, D., Del Fiacco, R., Pisani, D. et al. Diagnostic Performance of Vertebral Fracture Assessment by the Lunar iDXA Scanner Compared to Conventional Radiography. Calcif Tissue Int 91, 335–342 (2012). https://doi.org/10.1007/s00223-012-9643-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00223-012-9643-0

Keywords

Search

Navigation