title: Vertebral fracture assessment in patients presenting with a non-hip non-vertebral fragility fracture: experience of a UK Fracture Liaison Service.
abstract: Twenty-five percent of patients with a non-hip non-vertebral fragility fracture have an undiagnosed vertebral fracture detected by vertebral fracture assessment during bone densitometric assessment. The prevalence of an undiagnosed vertebral fracture is higher in older people, and they are more likely to have multiple vertebral fractures.
  
  
  OBJECTIVE
  Most vertebral fragility fractures (VFF) have no history of trauma. Vertebral fracture assessment (VFA) during dual energy x-ray absorptiometry (DXA) can be used to detect these VFFs. This study aims to identify the prevalence of undiagnosed VFF in patients presenting with a non-hip non-vertebral fragility fracture.
  
  
  METHODS
  Patients identified by the fracture liaison service (FLS) of a large UK university hospital presenting with a non-hip non-vertebral fragility fracture were evaluated from 1 January 2012 to 30 September 2015. Local protocol identified those that would proceed for VFA. Data was collected on patient characteristics, fracture details, bone mineral density (BMD) measurements and VFA results.
  
  
  RESULTS
  Five hundred sixty-seven patients (mean (SD) age, 72 (9.4) years) of mostly women (88.3%) had a VFA performed as part of their DXA assessment. One hundred forty-three patients (25.2%) were identified to have a vertebral fracture, of whom 57.3% of them had one fracture. 49.5% of those with vertebral fractures had BMD measurements diagnostic of osteoporosis. Mean (SD) age was higher in those with vertebral fractures compared to those without; 74.9 (8.3) years vs 70.4 (9.5) years, p < 0.00. Those aged 75 years and over were more likely to have multiple fractures than those younger than 75 years (16.3 vs 4%, p = 0.01).
  
  
  CONCLUSIONS
  A quarter of patients presenting with a non-hip non-vertebral fragility fracture have an undiagnosed vertebral fracture. Older people are more likely to have vertebral fractures and more likely to have multiple fractures. VFA during bone densitometric assessment can further aid stratifying future fracture risk.
authors.affiliation: Department of Internal Medicine, Hospital Clínic of Barcelona, University of Barcelona, 170 Villarroel, 08036, Barcelona, Spain.|Department of Healthcare for Older People, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, NG7 2UH, UK.
authors.forename: Aina Capdevila
authors.initials: AC
authors.lastname: Reniu
authors.affiliation: Department of Healthcare for Older People, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, NG7 2UH, UK. terenceong@doctors.org.uk.|Division of Rehabilitation and Ageing, Medical School, University of Nottingham, Nottingham, NG7 2UH, UK. terenceong@doctors.org.uk.
authors.forename: Terence
authors.initials: T
authors.lastname: Ong
authors.affiliation: Department of Healthcare for Older People, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, NG7 2UH, UK.
authors.forename: Syed
authors.initials: S
authors.lastname: Ajmal
authors.affiliation: Department of Healthcare for Older People, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, NG7 2UH, UK.
authors.forename: Opinder
authors.initials: O
authors.lastname: Sahota
mesh_terms: D015502:Absorptiometry, Photon / Q000379:methods; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density; D005260:Female; D050723:Fractures, Bone / Q000150:complications* / Q000000981:diagnostic imaging; D005598:Fractures, Spontaneous / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D033162:Incidental Findings; D008297:Male; D010024:Osteoporosis / Q000150:complications / Q000000981:diagnostic imaging; D015995:Prevalence; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D016103:Spinal Fractures / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000209:etiology; D006113:United Kingdom / Q000453:epidemiology
keywords: Aged; Fragility fracture; Osteoporosis; Vertebral fracture; Vertebral fracture assessment