Clinical Diagnostic Tools of Osteoporosis: Vertebral Fracture Assessment and Measurement of Bone Mineral Density (BMD)

2021 ◽  
pp. 163-176
Author(s):  
Masako Ito
Keyword(s):  
Bone Mineral Density ◽  
Vertebral Fracture ◽  
Bone Mineral ◽  
Vertebral Fracture Assessment ◽  
Diagnostic Tools ◽  
Mineral Density ◽  
Clinical Diagnostic ◽  
Fracture Assessment

scholarly journals AB0620 MODIFICATION OF THE DECISION OF THE ANTI-OSTEOPOROSIS TREATMENT AFTER PERFORMING THE VFA

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1344.2-1344
Author(s):  
H. Tantaoui ◽  
K. Nassar ◽  
S. Janani
Keyword(s):  
Bone Mineral Density ◽  
Vertebral Fracture ◽  
Bone Mineral ◽  
Clinical Data ◽  
Osteoporosis Treatment ◽  
Vertebral Fracture Assessment ◽  
Therapeutic Decision ◽  
Mineral Density ◽  
Osteoporosis Therapy ◽  
The Impact

Background:Spinal fractures are the most common of all osteoporotic fractures. Its diagnosis is essential, because the discovery of a vertebral fracture testifies the gravity of osteoporosis and modifies the therapeutic intervention threshold by justifying a specific anti-osteoporosis treatment. The evolution of densitometers now makes it possible to take a true X-ray image using software called “Vertebral Fracture Assessment” or VFA.Objectives:To assess the impact of VFA results on therapeutic decision-making after measuring bone mineral density.Methods:We conducted a retrospective and descriptive study in the rheumatology department.We included all patient followed at the consultation for bone pathologies, in whom a measurement of bone mineral density and a supplementation of VFA were performed. Clinical data, BMD, VFA and the therapeutic decision by anti-osteoporosis treatment before and after VFA were collected.Results:Sixty-one patients were included. The mean age was 62.8 years [38 - 85 years]. Sex ratio (female / male) was 19.3. At BMD level, patients with osteoporosis and osteopenia were 49% and 51% respectively. VFA objectified at least one spinal fracture in 64% of patients. Prior to VFA, anti-osteoporosis therapy was indicated to 49% of patients, based on clinical data and BMD. After performing VFA, the prescription of anti-osteoporosis therapy was indicated to 80% of patients.Conclusion:Patients who had no indication for osteoporosis treatment based on BMD data, VFA was able to modify their therapeutic treatment by detecting vertebral fractures in patients who had back pain.Disclosure of Interests:None declared.

scholarly journals POS1110 RELIABILITY OF VERTEBRAL FRACTURE ASSESSMENT ON DUAL-ENERGY X-RAY ABSORPTIOMETRY

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 835.2-835
Author(s):  
M. Yasmine ◽  
S. Mariem ◽  
S. Miladi ◽  
A. Fazaa ◽  
E. Fguiri ◽  
...  
Keyword(s):  
Vertebral Fracture ◽  
Bone Mineral ◽  
Vertebral Fracture Assessment ◽  
Mineral Density ◽  
Vertebral Height ◽  
Rater Reliability ◽  
X Ray ◽  
Normal Bone Mineral Density ◽  
Fracture Assessment ◽  
Grade 3

Background:Vertebral Fracture Assessment (VFA) is a new feature available on modern densitometers. Yet, the assessment of vertebral fracture (VF) status has not become standard practice.Objectives:Our study aimed to evaluate the reliability of VFA as assessed by a rheumatologist and a radiology technician.Methods:We conducted a cross-sectional study assessing the performance of low-radiation single energy x-ray absorptiometry VFA for the detection of VF. We selected patients who were assessed for osteoporosis according to screening protocols. Bone mineral densitometry was measured using standard methods over the lumbar spine L1-L4, the total proximal femur, and results were expressed as T-scores. All VFA were independently evaluated by 2 experienced readers: a rheumatologist and a radiology technician for the identification of VF (T4-L4). VF was classified according to the Genant grading system: grade 1 for an anterior, mid or posterior reduction of 20–25% in vertebral height; grade 2 for a reduction of 25– 40% and grade 3 for a reduction of more than 40% in vertebral height. A score for the inter-rater reliability between the readers was expressed using the kappa statistic.Results:One hundred patients were included with a mean age of 66.9 ± 9.5 years [46.7-83] years. There was a female predominance (91%). Nearly half of patients had osteopenia (48.9%), 27.7% had osteoporosis and 23.4% had a normal bone mineral density. On VFA scans, the non-visible vertebra was mostly located in the upper thoracic spine (60%). The mean number of VF was 1.2 [0-3] for both readers. According to the doctor’s evaluation, 25% of patients had at least one VF, of which 75.9% had a Genant grade 1, 17.2% had a Genant 2, and 6.9% had a VF grade 3. According to the technician evaluation, at least one VF was found in 36% of patients. A grade 1 was assessed in 91.7% of cases, a grade 2 in 8.3% of patients but no VF grade 3 was assessed. A kappa score for the inter-rater reliability between the readers for VFA was 0.545 (p=0.000). The overall agreement by grade between the readers was 0.785 (p=0,000). The exclusion of non-visible vertebra resulted in a better agreement (k=0.853). Further analysis excluding vertebra T4 to D10, revealed a very good agreement (k=0.9).Conclusion:Our study showed a low agreement between the readers on VFA and a better agreement when non-visible vertebrae were excluded. Thus, caution should be advocated when relying exclusively on this device.Disclosure of Interests:None declared.

scholarly journals Heterogeneity of Bone Mineral Density and Fatigue Failure of Human Vertebrae

2012 ◽  
Author(s):  
Yener N. Yeni ◽  
Laila M. Poisson ◽  
Michael J. Flynn
Keyword(s):  
Mechanical Properties ◽  
Bone Mineral Density ◽  
Vertebral Fracture ◽  
Bone Mineral ◽  
Vertebral Fractures ◽  
Important Determinant ◽  
Fatigue Properties ◽  
Static Properties ◽  
Mineral Density ◽  
Significant Interest

Bone qualities that are measurable via clinically available modalities and that can explain fracture risk beyond what is explainable by bone mineral density (BMD) are of significant interest. Evidence from literature suggests that the heterogeneity of BMD within a vertebra, in addition to the average BMD, may be an important determinant of the mechanical properties of a vertebra 1–3 and risk of a clinical vertebral fracture 4. Much of the experimental evidence comes from tests, in which vertebrae are monotonically loaded and relates BMD heterogeneity to the quasi-static properties of a vertebra 1, 3. The appearance of clinical vertebral fractures is in the form of progressive deformities indicating that fatigue processes are involved. However, the relationships between BMD heterogeneity and fatigue properties of a vertebra are not well-understood.

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