title: Combined vertebral fracture assessment and bone mineral density measurement: a patient-friendly new tool with an important impact on the Canadian Risk Fracture Classification.
abstract: OBJECTIVE
  Vertebral fractures often go unnoticed, while they constitute a significant risk factor for new fractures, independent of the bone density. Vertebral Fracture Assessment (VFA) is a new feature on DXA bone densitometry equipment. Our purpose was to determine the added value of VFA and its impact on the Canadian fracture risk classification using data from a Dutch academic cohort.
  
  
  METHODS
  All 958 consecutive patients (64% female, mean age 53 [20-94], mean weight 75 kg [32-150]) who underwent BMD measurement at the University Medical Center Groningen, The Netherlands also underwent VFA in the same session.
  
  
  RESULTS
  The prevalence of vertebral fractures was 26%. In 68% of these patients this fracture was unknown. The severity was "mild" (20%-25% height loss) in 43%, "moderate" (25%-35%) in 44% and "severe" (>35% height loss) in 13%. Even after excluding mild fractures, the prevalence of vertebral fractures was 17%. In the 28% with normal BMD the vertebral fracture prevalence was still 18%, in the 43% with osteopenia 23%, and in the 29% with osteoporosis 36%. The Canadian risk classification was "low fracture risk" in 68%, "moderate" in 19%, and "high" in 13%. Adding VFA altered the classification in 20% of the patients, to become 54%, 27%, and 19%, respectively.
  
  
  CONCLUSIONS
  VFA added to BMD is a patient friendly diagnostic tool with a high diagnostic yield, as it detected unknown vertebral fractures and altered diagnostic classification in approximately 1 out of every 5 patients. These results suggest that BMD plus VFA may become the new standard in osteoporosis testing.
authors.affiliation: Department of Nuclear Medicine, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada. jager@hhsc.ca
authors.forename: Pieter L
authors.initials: PL
authors.lastname: Jager
authors.forename: Riemer H J A
authors.initials: RH
authors.lastname: Slart
authors.forename: Colin L
authors.initials: CL
authors.lastname: Webber
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Adachi
authors.forename: Alexandra L
authors.initials: AL
authors.lastname: Papaioannou
authors.forename: Karen Y
authors.initials: KY
authors.lastname: Gulenchyn
mesh_terms: D015502:Absorptiometry, Photon / Q000379:methods*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density; D001851:Bone Diseases, Metabolic / Q000175:diagnosis* / Q000453:epidemiology*; D002170:Canada; D015984:Causality; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010024:Osteoporosis / Q000175:diagnosis / Q000453:epidemiology; D015995:Prevalence; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods*; D012720:Severity of Illness Index; D016103:Spinal Fractures / Q000175:diagnosis* / Q000453:epidemiology*; D055815:Young Adult