title: Vertebral fractures in women aged 50 years and older with clinical risk factors for fractures in primary care.
abstract: BACKGROUND
  The identification of vertebral fractures (VFs) is important for decisions on fracture prevention. Vertebral fracture assessment (VFA) was shown to be a patient-friendly and valid method for detecting undiagnosed VFs in (Dutch) women. However, this has only been investigated in women seeking care at secondary or tertiary institutions.
  
  
  OBJECTIVE
  To investigate the prevalence of previously undiagnosed VFs in women in Dutch primary care using VFA.
  
  
  METHODS
  A total of 566 Dutch women aged 50 years and older (mean age, 69 years; SD=8.4) with clinical risk factors (CRFs) for fractures volunteered for dual-energy X-ray absorptiometry (DXA) measurement and VFA. VFs were defined semi-quantitatively using Genant's method.
  
  
  RESULTS
  One CRF was present in each of 130 women, 274 had two, and 162 women had more than two CRFs. In 120 (21%) of the women, previously unknown osteoporosis (T-score ≤ -2.5SD) was diagnosed, and in 174 (31%), a previously undiagnosed moderate or severe VF was found. No osteoporosis was found in 130 (75%) of the women with a VF. Based on the outcome of DXA, 21% of the women were eligible for treatment, while the combination of DXA and VFA resulted in a total of 250 (44%) women requiring treatment.
  
  
  CONCLUSIONS
  The percentage of previously unknown VFs diagnosed by VFA in women aged 50 years and older with one or more CRFs for fractures in primary care is high. When only using BMD measurements, only half the women eligible for treatment would actually receive this. We recommend performing VFA in all women aged 50 years and older who are referred for DXA based on Dutch case finding criteria.
authors: Tilburg University CoRPS-Center of Research on Psychology in Somatic Diseases, Tilburg, The Netherlands. m.caers@pozob.nl
authors: Martha
authors: M
authors: van den Berg
authors: Noortje A
authors: NA
authors: Verdijk
authors: Joop P W
authors: JP
authors: van den Bergh
authors: Piet P
authors: PP
authors: Geusens
authors: Esther P W A
authors: EP
authors: Talboom-Kamp
authors: Geraline L
authors: GL
authors: Leusink
authors: Victor J M
authors: VJ
authors: Pop
mesh_terms: D015502:Absorptiometry, Photon; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012307:Risk Factors; D016103:Spinal Fractures / Q000453:epidemiology*