Enhanced prediction of fracture risk combining vertebral fracture status and BMD

Siris, Ethel S.; Genant, Harry K.; Laster, Andrew J.; Chen, P.; Misurski, Derek; Krege, John H.

doi:10.1007/s00198-006-0306-8

Cited by 172 publications

(113 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…For any given BMD T-score, the risk of an incident vertebral, non-vertebral fragility, and any fracture differs by up to twelve times, two times, and seven Six patients with X-ray unsuitable for evaluation not included a Not walking for >4 weeks in the last year b Rating based upon clinical judgment Fig. 1 DXA + T-score<−2.5, DXA − T-score≥−2.5, X-ray + vertebral fracture present, X-ray − no vertebral fracture present times, respectively, when information regarding spine fractures is considered [13]. Even when corrected for BMD, prevalent vertebral fractures increase the risk of future fracture up to fivefold [14,15].…”

Section: Discussionmentioning

confidence: 99%

“…However, the most common and typical osteoporotic fractures, these of the vertebrae, are mainly asymptomatic. Yet, radiologically diagnosed vertebral deformities are associated with deterioration of certain aspects of the quality of life of the patients and numerous studies, confirmed by meta-analysis, have shown them to be strong, independent determinants of new osteoporotic fractures at several skeletal sites, including the hip [13,16,17]. Despite these and the efficacy of antiosteoporotic medications in patients with vertebral deformities, current case-finding strategies do not include spine radiographs in the selection of patients for treatment.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

et al. 2008

View full text Add to dashboard Cite

Summary 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. Introduction 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). Methods 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. Results 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. Conclusion 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.Osteoporos Int

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2008

View full text Add to dashboard Cite

show abstract

“…The presence of such fractures changes the clinical diagnosis to osteoporosis and has a significant impact on treatment decisions. Moreover, fracture risk increases as vertebral fractures increase in number and severity [33].…”

Section: Resultsmentioning

confidence: 99%

Dual-Energy X-Ray Absorptiometry

Laster

2014

North Carolina Medical Journal

View full text Add to dashboard Cite

Assessment of bone mineral density (BMD) by dual-energy x-ray absorptiometry (DXA) plays a vital role in the diagnosis of osteoporosis and in monitoring a patient's response to drug therapy. This commentary will discuss controversies surrounding the use of DXA for screening and monitoring of BMD in women. The National Osteoporosis Foundation (NOF) has estimated that more than 43.6 million Americans have osteoporosis or osteopenia (low bone mass) [1]. In 2005, 2 million fractures were attributed to osteoporosis, with a direct cost of $17 billion; 71% of these fractures occurred in women [2]. By 2025, costs associated with fractures are projected to increase to $25.3 billion [2].Bone mineral density (BMD) testing by dual-energy x-ray absorptiometry (DXA) is the recognized standard for the clinical assessment of skeletal health. DXA allows for the diagnosis of osteoporosis or low bone mass, strongly correlates with mechanical strength [3], is a good predictor of fracture risk [4], and affords excellent accuracy and precision [5] while minimizing patients' exposure to ionizing radiation [6]. Moreover, drug therapy has been shown to be cost effective in postmenopausal women with osteoporosis [7]. Given that approximately 40% of white women older than 50 years will have an osteoporotic fracture in their lifetime [8], having clear recommendations for screening and monitoring using DXA are essential. Because of the absence of pertinent studies in men, this commentary will only address the evaluation of BMD in women.DXA screening for low bone mass or osteoporosis is well accepted in women aged 65 years or older, regardless of risk factors, and in younger women with risk factors such as rheumatoid arthritis, glucocorticoid use, malabsorption syndromes, hyperthyroidism, hyperparathyroidism, or gastric bypass surgery. Screening of these individuals is recommended by NOF [1], the US Preventive Services Task Force (USPSTF) [9], the International Society for Clinical Densitometry (ISCD) [10], the American Association of Clinical Endocrinologists (AACE) [11], the American College of Radiology [12], and the North American Menopause Society (NAMS) [13]. Despite the fact that DXA testing has been added to the "Welcome to Medicare Exam," only 14% of eligible women had a DXA study in 2010 [14]. Over the 7-year period from 2002 through 2008, 48% of older women did not have a DXA study [14]. Is DXA Testing Overused in Younger Women?Potential misuse of DXA testing is a concern that has been raised by the Centers for Medicare & Medicaid Services (CMS) and the National Committee for Quality Assurance, which have together submitted for public comment a quality measure regarding "appropriate use of DXA scans in women under 65 years who do not meet the risk factor profile" [15]. The quality measure cites a small, retrospective study of 615 women [16], in which 41.3% of women younger than 65 years who had been sent for DXA screening were found to have been screened inappropriately, based on their lack of any of the recognized risk factors li...

show abstract

“…This is perhaps not surprising given that the patients investigated had a non-vertebral fracture which triggered FLS assessment. However, incorporation of VFA into FLS protocols has the potential to reveal two sub-groups of non-vertebral fracture patients that may be managed differently as a result of ascertainment of vertebral fracture status: [55]. These investigators concluded:…”

Section: Secondary Fracture Preventionmentioning

confidence: 99%

Mind the (treatment) gap: a global perspective on current and future strategies for prevention of fragility fractures

et al. 2017

View full text Add to dashboard Cite

-none for this submission. EVM -none for this submission. JAK and PJM have undertaken consultancy for governments, national osteoporosis societies, healthcare professional organisations and private sector companies relating to systematic approaches to fragility fracture care and prevention. JYR has no disclosures related to this work, and has received consultancy, lecture fees and grant support from Amgen, Analis, Asahi Kasei, Boehringer, Bristol Myers Squibb, Chiltern, Danone, Ebewee Pharma, Endocyte, Galapagos, GlaxoSmithKline, IBSAGenevrier, Lilly, Merck Sharp and Dohme, Merckle, Negma, Novartis, NovoNordisk, NPS, Nycomed-Takeda, Organon, Pfizer, PharmEvo, Radius Health, Roche, Rottapharm, Servier, Teijin, Teva, Theramex, Therabel, UCB, Will Pharma, Wyeth, Zodiac. NCWH has no disclosures related to this work, and has received consultancy, lecture fees and honoraria from Alliance for Better Bone Health, AMGEN, MSD, Eli Lilly, Servier, Shire, Consilient Healthcare and Internis Pharma. PJM serves as a consultant to the International Osteoporosis Foundation and received remuneration for his contribution to this manuscript. RR has received honoraria for participation in Advisory boards or speaker bureau fees from Danone, Labatec, Nestlé, and ObsEva. Introduction-This narrative review considers the key challenges facing healthcare professionals and policymakers responsible for providing care to populations in relation to bone health. These challenges broadly fall into 4 distinct themes: Europe PMC Funders Group

show abstract

Enhanced prediction of fracture risk combining vertebral fracture status and BMD

Cited by 172 publications

References 28 publications

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

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

Dual-Energy X-Ray Absorptiometry

Mind the (treatment) gap: a global perspective on current and future strategies for prevention of fragility fractures

Contact Info

Product

Resources

About