Simplified Criteria for Selecting Patients for Vertebral Fracture Assessment

Abstract

The 2013 Position Development Conference of the International Society for Clinical Densitometry (ISCD) has adopted simplified indications for vertebral fracture assessment (VFA) based on an analysis of the Study of Osteoporotic Fractures (SOF). This showed that a simpler regression model, which included only age, bone mineral density (BMD), and height loss, was able to differentiate women with vertebral fractures from those without vertebral fractures almost as well as more complex models. We aimed to verify these findings in 1228 women referred for BMD testing and determine if the 2013 ISCD indications for VFA would perform as well the 2007 indications. The simple and complex SOF-based models were similar in terms of sensitivity (88.4% vs 89.4%), specificity (44.4% vs 45.5%), positive (25.9% vs 26.5%) and negative (94.5% vs 95.1%) predictive values, and area under the receiver operating characteristics curve (AUROC) (0.664 vs 0.674). The 2013 and 2007 ISCD VFA indications did not differ significantly in terms of sensitivity (88.2% vs 91.3%), specificity (41.3% vs 37.5%), positive (25.3% vs 22.9%) and negative (93.9% vs 95.5%) predictive values, and AUROC (0.648 vs 0.644). Our study provides support for the use of the simplified 2013 ISCD VFA indications as a practical approach to VFA testing.

Vertebral Fracture Assessment Increases Use of Pharmacologic Therapy for Fracture Prevention in Clinical Practice

“…In Canada, Manitoba is the only province that currently systematically employs VFA as part of their provincial bone densitometry and fracture assessment protocols. VFA at the time of bone densitometry is inexpensive, convenient, point‐of‐care testing with minimal patient radiation exposure and minimal added bone technologist time commitment to perform . Our study and others have shown that bone density technologists can successfully implement a decision rule to identify those referred for bone densitometry as also appropriate candidates for VFA.…”

“…VFA at the time of bone densitometry is inexpensive, convenient, point-of-care testing with minimal patient radiation exposure and minimal added bone technologist time commitment to perform. (13,(41)(42)(43)(44) Our study and others (19,42) have shown that bone density technologists can successfully implement a decision rule to identify those referred for bone densitometry as also appropriate candidates for VFA. Prior studies that have shown that clinicians can be easily trained to identify vertebral fractures on lateral spine images.…”

Classical and Nonclassical Manifestations of Primary Hyperparathyroidism

“…(95) Several cross-sectional studies, with retrospective (n = 7) and prospective (n = 4) data collection, evaluated the prevalence of morphometric VFx in patients with PHPT (Table 2). (62,72,(96)(97)(98)(99)(100)(101)(102)(103)(104)(105) The cohorts enrolled between 98 and 588 patients, mostly postmenopausal women, age 59-73 years. Disease severity was either heterogeneously defined or not reported.…”

“… d Recruited among patients screened for VFA according to the 2013 NOF screening criteria by Chou and colleagues. ( 105 ) …”

Vertebral Fracture Identification

“…81,82 However, VFA is gaining a lot of popularity and consensus, with cost-effective value, expanding indications, and its incorporation into a one-stop diagnostic pathway, as several authoritative authors and societies have testified (e.g., International Society for Clinical Densitometry official positions, 2013 and 2015). [83][84][85][86][87] Many differential diagnoses have to be considered in individuals with vertebral deformities. Several pitfalls can interfere with vertebral height measurement or evaluation.…”