title: Diagnosis of vertebral fractures using a low-dose biplanar imaging system.
abstract: Vertebral fractures (VFs) are independent risk factors for new fractures. However, spine radiographs cannot be used as a screening method. EOS® has a good diagnostic value for the diagnosis of VF with a better legibility of upper thoracic spine and a higher concordance between readers compared to vertebral fracture assessment (VFA).
  
  
  BACKGROUND
  Vertebral fractures (VFs) are risk factors for new fractures. However, spine radiographs cannot be used as a screening method for both cost and radiation concerns. EOS® X-ray imaging system which allows the acquisition of biplane images in an upright weight-bearing position with low radiation dose was used. The objective of this study was to compare EOS® to VFA for the diagnosis of VF.
  
  
  METHODS
  We conducted a cross-sectional study in subjects aged above 50 years with indication for spine imaging. EOS® and VFA of the spine were performed the same day. Sensitivity (Se), specificity (Sp), negative predictive value (NPV), and the interobserver precision of EOS® were compared to VFA for the diagnosis of VF.
  
  
  RESULTS
  Two hundred patients (mean age 66.2 years) were included. At the vertebral level, 2.4 and 3.6 % of vertebrae were not legible using EOS® and VFA, respectively (p = 0.0007). The legibility of spine was significantly affected by scoliosis (odds ratio (OR) = 2.8, p < 0.0001, for EOS®, and OR = 1.8, p = 0.0041, for VFA). Sixty-six patients (33.0 %) and 69 (34.5 %) had at least one VF using VFA and EOS®, respectively. At patient level, Se, Sp, and NPV for the diagnosis of VF of EOS® were 79.7, 91.6, and 99 %, respectively. Concordance between both observers was very good for EOS® (kappa-score = 0.89), higher than for VFA (κ = 0.67).
  
  
  CONCLUSIONS
  This study shows that EOS® has a good diagnostic value for the diagnosis of VF with a better legibility of upper thoracic spine and a higher concordance between readers compared to VFA.
authors.affiliation: Cochin Hospital, Rheumatology Department, INSERM U1153, Paris Descartes University, Paris, France. karine.briot@cch.aphp.fr.
authors.forename: K
authors.initials: K
authors.lastname: Briot
authors.affiliation: Cochin Hospital, Rheumatology Department, INSERM U1153, Paris Descartes University, Paris, France.
authors.forename: J
authors.initials: J
authors.lastname: Fechtenbaum
authors.affiliation: Cochin Hospital, Rheumatology Department, INSERM U1153, Paris Descartes University, Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Etcheto
authors.affiliation: Cochin Hospital, Rheumatology Department, INSERM U1153, Paris Descartes University, Paris, France.
authors.forename: S
authors.initials: S
authors.lastname: Kolta
authors.affiliation: Cochin Hospital, Radiology Department, INSERM U1153, Paris Descartes University, Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Feydy
authors.affiliation: Cochin Hospital, Rheumatology Department, INSERM U1153, Paris Descartes University, Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Roux
mesh_terms: D015502:Absorptiometry, Photon / Q000379:methods; D000368:Aged; D015519:Bone Density / Q000502:physiology; D003430:Cross-Sectional Studies; D005260:Female; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D058866:Osteoporotic Fractures / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011829:Radiation Dosage; D012307:Risk Factors; D016103:Spinal Fractures / Q000000981:diagnostic imaging* / Q000503:physiopathology; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging
keywords: EOS®; Osteoporosis; Vertebral fracture; X-rays