Skip to main content


Log in

Vertebral fracture assessment in patients presenting with a non-hip non-vertebral fragility fracture: experience of a UK Fracture Liaison Service

  • Original Article
  • Published:
Archives of Osteoporosis Aims and scope Submit manuscript



Twenty-five percent of patients with a non-hip non-vertebral fragility fracture have an undiagnosed vertebral fracture detected by vertebral fracture assessment during bone densitometric assessment. The prevalence of an undiagnosed vertebral fracture is higher in older people, and they are more likely to have multiple vertebral fractures.


Most vertebral fragility fractures (VFF) have no history of trauma. Vertebral fracture assessment (VFA) during dual energy x-ray absorptiometry (DXA) can be used to detect these VFFs. This study aims to identify the prevalence of undiagnosed VFF in patients presenting with a non-hip non-vertebral fragility fracture.


Patients identified by the fracture liaison service (FLS) of a large UK university hospital presenting with a non-hip non-vertebral fragility fracture were evaluated from 1 January 2012 to 30 September 2015. Local protocol identified those that would proceed for VFA. Data was collected on patient characteristics, fracture details, bone mineral density (BMD) measurements and VFA results.


Five hundred sixty-seven patients (mean (SD) age, 72 (9.4) years) of mostly women (88.3%) had a VFA performed as part of their DXA assessment. One hundred forty-three patients (25.2%) were identified to have a vertebral fracture, of whom 57.3% of them had one fracture. 49.5% of those with vertebral fractures had BMD measurements diagnostic of osteoporosis. Mean (SD) age was higher in those with vertebral fractures compared to those without; 74.9 (8.3) years vs 70.4 (9.5) years, p < 0.00. Those aged 75 years and over were more likely to have multiple fractures than those younger than 75 years (16.3 vs 4%, p = 0.01).


A quarter of patients presenting with a non-hip non-vertebral fragility fracture have an undiagnosed vertebral fracture. Older people are more likely to have vertebral fractures and more likely to have multiple fractures. VFA during bone densitometric assessment can further aid stratifying future fracture risk.

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

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

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

Instant access to the full article PDF.

Similar content being viewed by others


  1. Cooper C, Atkinson EJ, O’Fallon M, Melton LJ III (1992) Incidence of clinically diagnosed vertebral fractures: a population based study in Rochester, Minnesota. J Bone Miner Res 7(2):221–227

    Article  CAS  PubMed  Google Scholar 

  2. Cummings SR, Melton LJ (2002) Epidemiology and outcomes of osteoporotic fractures. Lancet 18;359(9319):1761–1767

    Article  Google Scholar 

  3. Rao RD, Singrakhia MD (2003) Painful osteoporotic vertebral fracture. Pathogenesis, evaluation and roles of vertebroplasty and kyphoplasty in its management. J Bone Joint Surg Am 85-A(10):2010–2022

    Article  PubMed  Google Scholar 

  4. Ismail AA, O'Neill TW, Cooper C et al (1998) Mortality associated with vertebral deformity in men and women: results from the European Prospective Osteoporosis Study (EPOS). Osteoporos Int 8(3):291–297

    Article  CAS  PubMed  Google Scholar 

  5. Kado DM, Browner WS, Palermo L et al (1999) Vertebral fractures and mortality in older women: a prospective study. Study of Osteoporotic Fractures Research Group. Arch Intern Med 14;159(11):1215–1220

    Article  Google Scholar 

  6. Ensrud KE, Thompson DE, Cauley JA et al (2000) Prevalent vertebral deformities predict mortality and hospitalization in older women with low bone mass. J Am Geriatr Soc 48(3):241–249

    Article  CAS  PubMed  Google Scholar 

  7. 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 10;160(1):77–85

    Article  Google Scholar 

  8. Melton LJ III, Atkinson EJ, Cooper C et al (1999) Vertebral fractures predict subsequent fractures. Osteoporos Int 10(3):214–221

    Article  PubMed  Google Scholar 

  9. Clark EM, Carter L, Gould VC et al (2014) Vertebral fracture assessment (VFA) by lateral DXA scanning may be cost-effective when used as part of fracture liaison services or primary care screening. Osteoporos Int 25(3):953–964

    Article  CAS  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(9):1137–1148

    Article  CAS  PubMed  Google Scholar 

  11. Pearson D, Horton B, Green DJ et al (2006) Vertebral morphometry by DXA: a comparison of supine lateral and decubitus lateral densitometers. J Clin Densitom 9(3):295–301

    Article  PubMed  Google Scholar 

  12. Gallacher SJ, Gallacher AP, McQuillian C et al (2007) The prevalence of vertebral fracture amongst patients presenting with non-vertebral fracture. Osteoporos Int 18:185–192

    Article  CAS  PubMed  Google Scholar 

  13. National Institute for Health and Clinical Excellence (2011) Alendronate, etidronate, risedronate, raloxifene, strontium ranelate and teriparatide for the secondary prevention of osteoporotic fragility fractures in postmenopausal women. NICE guideline (TA161), London

  14. Cosman F, de Beur SJ, LeBoff MS et al (2014) Osteoporosis Foundation (NOF) Clinician’s guide to prevention and treatment osteporosis. Osteoporos Int 25(10):2359–2381

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Schousboe JT, Vokes T, Broy SB et al (2008) Vertebral fracture assessment: the 2007 ISCD official positions. J Clin Densitom 11(1):92–108

    Article  PubMed  Google Scholar 

Download references


We would like to thank Lindsey Marshall for assisting with interpreting data from the fracture liaison service database.

AC was awarded a travel grant by the “Fundación Española de Medicina Interna” (FEMI) to visit the Nottingham University Hospital NHS trust.

TO is a current recipient of a research training fellowship by the Dunhill Medical Trust (RTF49/0114).

Author information

Authors and Affiliations


Corresponding author

Correspondence to Terence Ong.

Ethics declarations

Conflict of interest


Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Reniu, A.C., Ong, T., Ajmal, S. et al. Vertebral fracture assessment in patients presenting with a non-hip non-vertebral fragility fracture: experience of a UK Fracture Liaison Service. Arch Osteoporos 12, 23 (2017).

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: