title: A systematic review of diagnostic accuracy of vertebral fracture assessment (VFA) in postmenopausal women and elderly men.
abstract: This systematic review was performed to compare the diagnostic accuracy of vertebral fracture assessment (VFA) with that of spinal radiography for identification of vertebral fractures (VFs). VFA appeared to have moderate sensitivity and high specificity for detecting VFs when compared with spinal radiography.
  
  
  BACKGROUND
  VFs are recognized as the hallmark of osteoporosis, and a previous VF increases the risk of a future fracture. Therefore, the timely detection of VFs is important for prevention of further fractures. This systematic review examined the diagnostic accuracy of VFA using dual X-ray absorptiometry (DXA) to identify VFs.
  
  
  METHODS
  We searched for potentially relevant studies using electronic databases, including Ovid-Medline, Ovid-EMBASE, Cochrane library, and four Korean databases, from their inception to May 2013. We compared the diagnostic accuracy of VFA with that of spinal radiography for detection of VFs by analyzing the sensitivity and specificity using a 2 × 2 contingency table. Subgroup analyses were also performed on studies with a low risk of bias and applicability.
  
  
  RESULTS
  Twelve studies were analyzed for the diagnostic accuracy of VFA. The sensitivity and specificity were 0.70-0.93 and 0.95-1.00, respectively, analyzed on a per-vertebra basis, and 0.65-1.00 and 0.74-1.00 on a per-patient basis. The sensitivity and specificity of five studies in subgroups with a low risk of bias in the intervention test were 0.70-0.84 and 0.96-0.99, respectively. In studies with a low risk of bias in the patient selection, those based on a per-vertebra basis in three studies were 0.70-0.93 and 0.96-1.00, respectively.
  
  
  CONCLUSIONS
  VFA had moderate sensitivity and high specificity for detecting VF when compared with spinal radiography. However, the present findings are insufficient to assess whether spinal radiography should be replaced by VFA.
authors.affiliation: Department of Rheumatology, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea.
authors.forename: J-H
authors.initials: JH
authors.lastname: Lee
authors.affiliation: National Evidence-based Healthcare Collaborating Agency, Seoul, Republic of Korea.
authors.forename: Y K
authors.initials: YK
authors.lastname: Lee
authors.affiliation: National Evidence-based Healthcare Collaborating Agency, Seoul, Republic of Korea.
authors.forename: S-H
authors.initials: SH
authors.lastname: Oh
authors.affiliation: National Evidence-based Healthcare Collaborating Agency, Seoul, Republic of Korea.
authors.forename: J
authors.initials: J
authors.lastname: Ahn
authors.affiliation: Department of Biostatistics and Epidemiology, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea.
authors.forename: Y E
authors.initials: YE
authors.lastname: Lee
authors.affiliation: WHO Collaborating Centre for Pharmaceutical Science and Regulation, Department of Pharmaceutical Science, Utrecht University, Utrecht, Netherlands.
authors.forename: J H
authors.initials: JH
authors.lastname: Pyo
authors.affiliation: Department of Nuclear Medicine, Hanyang University Hospital, Seoul, Republic of Korea.
authors.forename: Y Y
authors.initials: YY
authors.lastname: Choi
authors.affiliation: Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea.
authors.forename: D
authors.initials: D
authors.lastname: Kim
authors.affiliation: Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea.
authors.forename: S-C
authors.initials: SC
authors.lastname: Bae
authors.affiliation: Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea.
authors.forename: Y-K
authors.initials: YK
authors.lastname: Sung
authors.affiliation: Department of Nuclear Medicine, School of Medicine, Kyung Hee University Hospital, Seoul, 130-872, Republic of Korea. deogyoon@daum.net.
authors.forename: D-Y
authors.initials: DY
authors.lastname: Kim
mesh_terms: D015502:Absorptiometry, Photon / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D015663:Osteoporosis, Postmenopausal / Q000150:complications; D058866:Osteoporotic Fractures / Q000000981:diagnostic imaging* / Q000209:etiology; D011859:Radiography; D012680:Sensitivity and Specificity; D016103:Spinal Fractures / Q000000981:diagnostic imaging* / Q000209:etiology
keywords: Osteoporosis; Systematic review; Vertebral fracture (VF); Vertebral fracture assessment (VFA)