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

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Abstract

Summary

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.

Purpose

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.

Methods

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.

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).

Conclusion

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.

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Acknowledgement

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).

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Correspondence to Terence Ong.

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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). https://doi.org/10.1007/s11657-017-0318-3

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  • DOI: https://doi.org/10.1007/s11657-017-0318-3

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