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Targeted vertebral fracture assessment for optimizing fracture prevention in Canada

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Abstract

Summary

Vertebral fracture assessment (VFA) provides incremental information in identifying women and men aged 70 years and older qualifying for anti-osteoporosis treatment compared with FRAX® major osteoporotic fracture (MOF) probability computed with bone mineral density (BMD).

Purpose

This analysis was performed to inform appropriate use of VFA testing as part of Osteoporosis Canada’s Guidelines Update, assuming vertebral fracture is an indication for pharmacotherapy in women and men.

Methods

Women and men aged 70 years and older without previous high-risk fracture (i.e., hip, spine, or multiple fractures) were identified in a BMD registry for the province of Manitoba, Canada. MOF probability with BMD was computed using the Canadian FRAX® tool. VFA was performed in those with a minimum BMD T-score of −1.5 or lower.

Results

The study population consisted of 7289 women (mean age 76.7 ± 5.6 years) and 1323 men (77.9 ± 5.8 years). More women than men qualified for VFA testing (48.7% vs 25.4%, respectively, p < 0.001). Among those undergoing VFA, a vertebral fracture was more commonly detected among men than women (22.9% vs 13.3%, p < 0.001), and vertebral fracture prevalence increased with lower BMD T-score (both p trend <0.001). The number needed to screen with VFA to detect a vertebral fracture was 8 for women and 4 for men. MOF probability was substantially lower in men than in women, and fewer men than women (3.3% vs 20.2%, p < 0.001) met a treatment threshold of MOF 20% or greater. In those with MOF probability <20%, VFA identified an incremental 5.4% of men and 3.4% of women for treatment based upon vertebral fracture.

Conclusions

The number needed to screen to identify a previously unappreciated vertebral fracture is low and further improves with lower BMD T-score. VFA identified more men as qualifying for treatment than MOF probability. In women, treatment qualification was predominantly from MOF probability.

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References

  1. Brown JP, Josse RG, Scientific Advisory Council of the Osteoporosis Society of Canada (2002) 2002 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. CMAJ. 167(10 Suppl):S1–S34

    PubMed  PubMed Central  Google Scholar 

  2. Papaioannou A, Morin S, Cheung AM, Atkinson S, Brown JP, Feldman S, Hanley DA, Hodsman A, Jamal SA, Kaiser SM, Kvern B, Siminoski K, Leslie WD, for the Scientific Advisory Council of Osteoporosis Canada (2010) 2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary. CMAJ. 182(17):1864–1873

    Article  Google Scholar 

  3. Kanis JA, Oden A, Johnell O, Johansson H, De Laet C, Brown J et al (2007) The use of clinical risk factors enhances the performance of BMD in the prediction of hip and osteoporotic fractures in men and women. Osteoporos Int 18(8):1033–1046

    Article  CAS  Google Scholar 

  4. Leslie WD, Morin SN, Lix LM, Binkley N (2018) Comparison of treatment strategies and thresholds for optimizing fracture prevention in Canada: a simulation analysis. Arch Osteoporos [in press October 9 2019]

  5. Leslie WD, Morin SN, Lix LM, Binkley N (2020) Targeted bone density testing for optimizing fracture prevention in Canada. Osteoporos Int

  6. Leslie WD, Metge C (2003) Establishing a regional bone density program: lessons from the Manitoba experience. J Clin Densitom 6(3):275–282

    Article  Google Scholar 

  7. Leslie WD, Caetano PA, Macwilliam LR, Finlayson GS (2005) Construction and validation of a population-based bone densitometry database. J Clin Densitom 8(1):25–30

    Article  Google Scholar 

  8. Looker AC, Wahner HW, Dunn WL, Calvo MS, Harris TB, Heyse SP, Johnston Jr CC, Lindsay R (1998) Updated data on proximal femur bone mineral levels of US adults. Osteoporos Int 8(5):468–489

    Article  CAS  Google Scholar 

  9. Schousboe JT, Lix LM, Morin SN, Derkatch S, Bryanton M, Alhrbi M, Leslie WD (2019) Prevalent vertebral fracture on bone density lateral spine (VFA) images in routine clinical practice predict incident fractures. Bone. 121:72–79

    Article  Google Scholar 

  10. Leslie WD, Lix LM, Johansson H, Oden A, McCloskey E, Kanis JA, Manitoba Bone Density Program (2010) Independent clinical validation of a Canadian FRAX tool: fracture prediction and model calibration. J Bone Miner Res 25(11):2350–2358

    Article  Google Scholar 

  11. Fraser LA, Langsetmo L, Berger C, Ioannidis G, Goltzman D, Adachi JD et al (2011) Fracture prediction and calibration of a Canadian FRAX(R) tool: a population-based report from CaMos. Osteoporos Int 22(3):829–837

    Article  Google Scholar 

  12. Leslie WD, Lix LM, Langsetmo L, Berger C, Goltzman D, Hanley DA, Adachi JD, Johansson H, Oden A, McCloskey E, Kanis JA (2011) Construction of a FRAX® model for the assessment of fracture probability in Canada and implications for treatment. Osteoporos Int 22(3):817–827

    Article  CAS  Google Scholar 

  13. 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(11):887–896

    Article  CAS  Google Scholar 

  14. Lentle B, Trollip J, Lian K (2016) The radiology of osteoporotic vertebral fractures redux. J Clin Densitom 19(1):40–47

    Article  Google Scholar 

  15. Lentle BC, Berger C, Probyn L, Brown JP, Langsetmo L, Fine B, Lian K, Shergill AK, Trollip J, Jackson S, Leslie WD, Prior JC, Kaiser SM, Hanley DA, Adachi JD, Towheed T, Davison KS, Cheung AM, Goltzman D, for the CaMos Research Group (2018) Comparative analysis of the radiology of osteoporotic vertebral fractures in women and men: cross-sectional and longitudinal observations from the Canadian Multicentre Osteoporosis Study (CaMos). J Bone Miner Res 33(4):569–579

    Article  CAS  Google Scholar 

  16. Welch VA, Akl EA, Guyatt G, Pottie K, Eslava-Schmalbach J, Ansari MT, de Beer H, Briel M, Dans T, Dans I, Hultcrantz M, Jull J, Katikireddi SV, Meerpohl J, Morton R, Mosdol A, Petkovic J, Schünemann HJ, Sharaf RN, Singh JA, Stanev R, Tonia T, Tristan M, Vitols S, Watine J, Tugwell P (2017) GRADE equity guidelines 1: considering health equity in GRADE guideline development: introduction and rationale. J Clin Epidemiol 90:59–67

    Article  Google Scholar 

  17. Welch VA, Akl EA, Pottie K, Ansari MT, Briel M, Christensen R, Dans A, Dans L, Eslava-Schmalbach J, Guyatt G, Hultcrantz M, Jull J, Katikireddi SV, Lang E, Matovinovic E, Meerpohl JJ, Morton RL, Mosdol A, Murad MH, Petkovic J, Schünemann H, Sharaf R, Shea B, Singh JA, Solà I, Stanev R, Stein A, Thabaneii L, Tonia T, Tristan M, Vitols S, Watine J, Tugwell P (2017) GRADE equity guidelines 3: considering health equity in GRADE guideline development: rating the certainty of synthesized evidence. J Clin Epidemiol 90:76–83

    Article  Google Scholar 

  18. Akl EA, Welch V, Pottie K, Eslava-Schmalbach J, Darzi A, Sola I, Katikireddi SV, Singh J, Murad MH, Meerpohl J, Stanev R, Lang E, Matovinovic E, Shea B, Agoritsas T, Alexander PE, Snellman A, Brignardello-Petersen R, Gloss D, Thabane L, Shi C, Stein AT, Sharaf R, Briel M, Guyatt G, Schünemann H, Tugwell P (2017) GRADE equity guidelines 2: considering health equity in GRADE guideline development: equity extension of the guideline development checklist. J Clin Epidemiol 90:68–75

    Article  Google Scholar 

  19. Pottie K, Welch V, Morton R, Akl EA, Eslava-Schmalbach JH, Katikireddi V, Singh J, Moja L, Lang E, Magrini N, Thabane L, Stanev R, Matovinovic E, Snellman A, Briel M, Shea B, Tugwell P, Schunemann H, Guyatt G, Alonso-Coello P (2017) GRADE equity guidelines 4: considering health equity in GRADE guideline development: evidence to decision process. J Clin Epidemiol 90:84–91

    Article  Google Scholar 

  20. Cosman F, de Beur SJ, LeBoff MS, Lewiecki EM, Tanner B, Randall S, Lindsay R, National Osteoporosis Foundation (2014) Clinician’s guide to prevention and treatment of osteoporosis. Osteoporos Int 25(10):2359–2381

    Article  CAS  Google Scholar 

  21. Borges JLC, Sousa da Silva M, Ward RJ, Diemer KM, Yeap SS, Lewiecki EM Repeating vertebral fracture assessment: the 2019 ISCD official position. J Clin Densitom 2019

  22. Vokes T, Bachman D, Baim S, Binkley N, Broy S, Ferrar L, Lewiecki EM, Richmond B, Schousboe J, International Society for Clinical Densitometry (2006) Vertebral fracture assessment: the 2005 ISCD official positions. J Clin Densitom 9(1):37–46

    Article  Google Scholar 

  23. 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(1):92–108

    Article  Google Scholar 

  24. Camacho PM, Petak SM, Binkley N, Clarke BL, Harris ST, Hurley DL, Kleerekoper M, Lewiecki EM, Miller PD, Narula HS, Pessah-Pollack R, Tangpricha V, Wimalawansa SJ, Watts NB (2016) American Association of Clinical Endocrinologists and American College of Endocrinology clinical practice guidelines for the diagnosis and treatment of postmenopausal osteoporosis—2016. Endocr Pract 22(Suppl 4):1–42

    Article  Google Scholar 

  25. Compston J, Cooper A, Cooper C, Gittoes N, Gregson C, Harvey N et al (2017) UK clinical guideline for the prevention and treatment of osteoporosis. Arch Osteoporos 12(1):43

    Article  CAS  Google Scholar 

  26. van der Velde RY, Bours SPG, Wyers CE, Lems WF, Geusens P, van den Bergh JPW (2017) Effect of implementation of guidelines on assessment and diagnosis of vertebral fractures in patients older than 50 years with a recent non-vertebral fracture. Osteoporos Int

  27. Schousboe JT, Ensrud KE, Nyman JA, Kane RL, Melton LJ 3rd. (2006) Cost-effectiveness of vertebral fracture assessment to detect prevalent vertebral deformity and select postmenopausal women with a femoral neck T-score > −2.5 for alendronate therapy: a modeling study. J Clin Densitom 9(2):133–143

    Article  Google Scholar 

  28. Lentle B, Koromani F, Brown JP, Oei L, Ward L, Goltzman D, Rivadeneira F, Leslie WD, Probyn L, Prior J, Hammond I, Cheung AM, Oei EH, on behalf of the Vertebral Fracture Research Groups of the CaMos, STOPP, and Rotterdam Studies (2019) The radiology of osteoporotic vertebral fractures revisited. J Bone Miner Res 34(3):409–418

    Article  Google Scholar 

  29. Ferrar L, Jiang G, Cawthon PM, San Valentin R, Fullman R, Lambert L, Cummings SR, Black DM, Orwoll E, Barrett-Connor E, Ensrud K, Fink HA, Eastell R, Osteoporotic Fractures in Men (MrOS) Study (2007) Identification of vertebral fracture and non-osteoporotic short vertebral height in men: the MrOS study. J Bone Miner Res 22(9):1434–1441

    Article  Google Scholar 

  30. Oei L, Koromani F, Breda SJ, Schousboe JT, Clark EM, van Meurs JB et al (2018) Osteoporotic vertebral fracture prevalence varies widely between qualitative and quantitative radiological assessment methods: the Rotterdam Study. J Bone Miner Res 33(4):560–568

    Article  Google Scholar 

Download references

Acknowledgments

The authors thank the Osteoporosis Canada Guidelines Update Fracture Risk Assessment Working Group for their guidance as this work evolved. The authors acknowledge the Manitoba Centre for Health Policy for use of data contained in the Population Health Research Data Repository (HIPC 2016/2017-29).  Lisa Lix is supported by a Tier I Canada Research Chair.

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Authors and Affiliations

  1. University of Manitoba, Winnipeg, MB, Canada

    William D. Leslie & Lisa M. Lix

  2. Department of Medicine, St. Boniface Hospital, Room C5121, 409 Tache Avenue, Winnipeg, MB, R2H 2A6, Canada

    William D. Leslie

  3. University of Wisconsin, Madison, WI, USA

    Neil Binkley

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  1. William D. Leslie
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Contributions

Authors’ roles: conception, design, analysis, drafting the article (WDL), interpretation of data (all authors); critically revising the article for important intellectual content (all authors); final approval of the version to be published (all authors); and agreement to be accountable for all aspects of the work (all authors). WDL had full access to all the data in the study and takes the responsibility for the integrity of the data and the accuracy of the data analysis.

Corresponding author

Correspondence to William D. Leslie.

Ethics declarations

The results and conclusions are those of the authors, and no official endorsement by the Manitoba Centre for Health Policy, Manitoba Health, Seniors and Active Living, or other data providers is intended or should be inferred. This article has been reviewed and approved by the members of the Manitoba Bone Density Program Committee.

Conflicts of interest

William Leslie and Lisa Lix have no conflicts of interest. Neil Binkley has nothing to declare for the context of this paper but has received research support (paid to institution) from Radius and GE Healthcare and consultant/advisory board fees from Amgen.

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Leslie, W.D., Lix, L.M. & Binkley, N. Targeted vertebral fracture assessment for optimizing fracture prevention in Canada. Arch Osteoporos 15, 65 (2020). https://doi.org/10.1007/s11657-020-00735-2

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