Vertebral Fracture Assessment: The 2007 ISCD Official Positions

Observer agreement in pediatric semiquantitative vertebral fracture diagnosis

“…The one anatomical area where there is a low rate of vertebrae exceeding this ratio is the mid-thoracic spine, where some anterior wedging is normally present that produces the natural thoracic kyphosis, leading to some false positives in this region of the spine using the GSQ method [31,35,36]. The rate of false positives is sufficiently low that the GSQ threshold of 20% is applied throughout the spine, including the mid-thoracic region, in clinical practice recommendations [13][14][15]. Solid data on normal height ratios in children is limited to the lower thoracic spine and lumbar area, where values are similar to those of adults and do not exceed 20% [37].…”

“…The predominant approach used in the field of adult osteoporosis is the modified Genant semi-quantitative method (GSQ method) [1][2][3][4][5][6][7][8][9]. This system has been used in many of the major drug trials and in clinical studies and has been recommended for use in routine clinical practice [13][14][15]. The procedure involves visually assessing anterior, middle, and posterior height ratios of each vertebral body from T4 to L4 on lateral spine images, with height reductions graded on a four-point scale [1,3].…”

The Diagnosis and Workup of Patients for Osteoporosis or Osteopenia (Low Bone Mass)

“…It is a densitometric spine imaging than can detect vertebral fractures. (Schousboe, 2008) Most vertebral fractures are asymptomatic and if present can increase an individual's future risk of fracture. A Vertebral Fracture Assessment (VFA) is a diagnostic method in which low intensity or dual x-ray absorptiometry is used to examine the lateral spine (T 4 -L 4 ), thereby identifying vertebral fractures.…”

“…(Leipzig, 1999) There is much less radiation with a VFA in comparison to a lateral spine x-ray (3µSV for VFA versus 600µSV for a radiograph). According to the International Society of Clinical Densitometry a vertebral fracture assessment should be performed in the following circumstances: (Schousboe, 2008) The VFA is interpreted using a semi-quantitative visual inspection with assignment of fracture grade by the radiologist or the clinician. Using Genant's method, the clinician determines if a vertebra is fractured or normal.…”

Osteoporosis in Men: Insights for the Clinician

“…While standard X-rays of the lumbar and thoracic spine have been the usual method for diagnosis of compression fracture, there is a definite radiation dose associated with such X-rays. Vertebral fracture assessment (VFA) is an image performed by many DXA machines [Schousboe et al 2008]. In addition to the convenience of performing VFA at the time of DXA, the technique is associated with a much lower radiation dose than standard X-rays.…”