title: Vertebral fracture assessment by dual X-ray absorptiometry: a valid tool to detect vertebral fractures in community-dwelling older adults in a population-based survey.
abstract: OBJECTIVE
  Vertebral fractures are associated with higher morbidity and mortality. Since 70% of vertebral fractures are clinically silent, a radiologic image of the spine has to be acquired for the diagnosis. The aim of this study was to compare the performance of Vertebral Fracture Assessment (VFA) by dual x-ray absorptiometry (DXA) with radiographs to identify vertebral fractures in community-dwelling older adults.
  
  
  METHODS
  A total of 429 older adults (ages ≥65 years) were enrolled in this cohort. VFA by DXA measurements were evaluated by 2 expert rheumatologists by consensus, and spine radiographs were analyzed according to the semiquantitative method by an expert radiologist. The correlation between VFA and spine radiographs to identify vertebral fractures was analyzed by kappa scores.
  
  
  RESULTS
  The prevalence of vertebral fractures in VFA and radiographs was 29.1% and 29.4%, respectively (P = 0.99). The frequency of unavailable vertebrae was significantly lower in spinal radiographs than in VFA (0.9% and 5.6%, respectively; P < 0.001), particularly in T4-T6. According to VFA, 5,013 vertebrae (96%) were identified as normal and 144 (2.7%) had grade 1, 58 (1.1%) had grade 2, and 12 (0.2%) had grade 3 fractures. The sensitivity of VFA was 72.9% and the specificity was 99.1% to identify vertebral fractures. The sensitivity increased to 92% and the specificity increased to 99.9% when excluding grade 1 deformities. A good correlation between VFA and radiographs (κ = 0.74) was observed, and the exclusion of grade 1 resulted in even better agreement (κ = 0.84).
  
  
  CONCLUSIONS
  In community-dwelling older adults, VFA and radiographs had comparable performances in identifying vertebral fractures, particularly if mild deformities are excluded. Therefore, this methodology is a feasible and promising alternative to improve the management of patients with a high risk of osteoporotic fractures.
authors.affiliation: Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Diogo S
authors.initials: DS
authors.lastname: Domiciano
authors.forename: Camille P
authors.initials: CP
authors.lastname: Figueiredo
authors.forename: Jaqueline B
authors.initials: JB
authors.lastname: Lopes
authors.forename: Marcia E
authors.initials: ME
authors.lastname: Kuroishi
authors.forename: Liliam
authors.initials: L
authors.lastname: Takayama
authors.forename: Valéria F
authors.initials: VF
authors.lastname: Caparbo
authors.forename: Priscila
authors.initials: P
authors.lastname: Fuller
authors.forename: Paulo F
authors.initials: PF
authors.lastname: Menezes
authors.forename: Márcia
authors.initials: M
authors.lastname: Scazufca
authors.forename: Eloisa
authors.initials: E
authors.lastname: Bonfa
authors.forename: Rosa M R
authors.initials: RM
authors.lastname: Pereira
mesh_terms: D015502:Absorptiometry, Photon / Q000379:methods*; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging* / Q000293:injuries; D008297:Male; D011159:Population Surveillance / Q000379:methods*; D012111:Residence Characteristics; D016103:Spinal Fractures / Q000000981:diagnostic imaging* / Q000453:epidemiology; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging* / Q000293:injuries