Vertebral Fracture Assessment in Postmenopausal Women with Low Bone Mass: Prevalence and Risk Factors
Keywords:
vertebral fracture assessment, low bone mass, postmenopausal womenAbstract
Objective The study aimed to use VFA to determine the prevalence of and risk factors associated with unnoticed VFs in postmenopausal women with low bone mass.
Methods A total of 330 consecutive postmenopausal patients with a mean age of 62.7 years (range 43 to 85 years) who had been diagnosed with low bone mass by bone mineral densitometry (BMD) with a T-score between -1.0 and -2.5 and who had undergone VFA study were retrospectively reviewed. No prior vertebral or non-vertebral fragility fractures had been observed in any of the patients. The VFAs were performed in a supine position using Hologic Discovery A. VFA interpretation was done independently by two experienced nuclear medicine physicians using a combination of the Genant visual semi-quantitative method and morphometric measurement. Demographic data from the medical records and questionnaires were reviewed.
Results The prevalence of VFs was 25.8%. Of those, 9.1% had Grade 1 and 16.7% had Grade 2 and/or 3 fractures. VFs were identified in 165 vertebrae of 85 patients who had VFs. Of which 49.7% were wedge and 50.3% were biconcave fractures but without crush fracture. The thoracolumbar junction (T11-L2) was the most common site of VFs. The interobserver agreement between the two nuclear medicine physicians was very good (Cohen’s kappa=0.89). Age, years since menopause, and steroid use were identified as independent risk factors.
Conclusion As VFA detected unnoticed VFs in one fourth of postmenopausal women with low bone mass, an additional VFA at the time of BMD study should be considered for this group of patients
References
Warriner AH, Patkar NM, Curtis JR, Delzell E, Gary L, Kilgore M, et al. Which fractures are most attributable to osteoporosis? J Clin Epidemiol. 2011;64:46-53.
Jager PL, Jonkman S, Koolhaas W, Stiekema A, Wolffenbuttel BH, Slart RH. Combined vertebral fracture assessment and bone mineral density measurement: a new standard in the diagnosis of osteoporosis in academic populations. Osteoporos Int. 2011;22:1059-68.
Cranney A, Jamal SA, Tsang JF, Josse RG, Leslie WD. Low bone mineral density and fracture burden in postmenopausal women. CMAJ. 2007; 177:575-80.
Arboleya L, Diaz-Curiel M, Del Rio L, Blanch J, Diez-Perez A, Guanabens N, et al. Prevalence of vertebral fracture in postmenopausal women with lumbar osteopenia using MorphoXpress(R) (OSTEOXPRESS Study). Aging Clin Exp Res. 2010; 22:419-26.
Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group. World Health Organ Tech Rep Ser. 1994;843:1-129.
Karlsson MK, Kherad M, Hasserius R, Nilsson JA, Redlund-Johnell I, Ohlsson C, et al. Characteristics of Prevalent Vertebral Fractures Predict New Fractures in Elderly Men. J Bone Joint Surg Am. 2016;98:379-85.
Ferrar L, Roux C, Felsenberg D, Gluer CC, Eastell R. Association between incident and baseline vertebral fractures in European women: vertebral fracture assessment in the Osteoporosis and Ultrasound Study (OPUS). Osteoporos Int. 2012; 23:59-65.
Kado DM, Duong T, Stone KL, Ensrud KE, Nevitt MC, Greendale GA, et al. Incident vertebral fractures and mortality in older women: a prospective study. Osteoporos Int. 2003;14:589-94.
Nuti R, Caffarelli C, Guglielmi G, Gennari L, Gonnelli S. Undiagnosed vertebral fractures influence quality of life in postmenopausal women with reduced ultrasound parameters. Clin Orthop Relat Res. 2014;472:2254-61.
MacLean C, Newberry S, Maglione M, McMahon M, Ranganath V, Suttorp M, et al. Systematic review: comparative effectiveness of treatments to prevent fractures in men and women with low bone density or osteoporosis. Ann Intern Med. 2008;148:197-213.
El Maghraoui A, Rezqi A, Mounach A, Achemlal L, Bezza A, Ghozlani I. Systematic vertebral fracture assessment in asymptomatic postmenopausal women. Bone. 2013;52:176-80.
Binkley N, Krueger D, Gangnon R, Genant HK, Drezner MK. Lateral vertebral assessment: a valuable technique to detect clinically significant vertebral fractures. Osteoporos Int. 2005;16:1513-8.
Fuerst T, Wu C, Genant HK, von Ingersleben G, Chen Y, Johnston C, et al. Evaluation of vertebral fracture assessment by dual X-ray absorptiometry in a multicenter setting. Osteoporos Int. 2009;20: 1199-205.
Vokes T, Bachman D, Baim S, Binkley N, Broy S, Ferrar L, et al. Vertebral fracture assessment: the 2005 ISCD Official Positions. J Clin Densitom. 2006;9:37-46.
Genant HK, Wu CY, van Kuijk C, Nevitt MC. Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res. 1993;8(9):1137-48.
Black DM, Cummings SR, Stone K, Hudes E, Palermo L, Steiger P. A new approach to defining normal vertebral dimensions. J Bone Miner Res. 1991;6:883-92.
Muschitz C, Patsch J, Buchinger E, Edlmayr E, Nirnberger G, Evdokimidis V, et al. Prevalence of vertebral fracture in elderly men and women with osteopenia. Wien Klin Wochenschr. 2009;121(15-16):528-36.
Negreiros CC, Berigo MG, Dominoni RL, Vargas DM. Asymptomatic vertebral fractures in patients with low bone mineral density. Rev Assoc Med Bras (1992). 2016;62:145-50.
Schousboe JT, DeBold CR, Bowles C, Glickstein S, Rubino RK. Prevalence of vertebral compression fracture deformity by X-ray absorptiometry of lateral thoracic and lumbar spines in a population referred for bone densitometry. J Clin Densitom. 2002;5:239-46.
Ballane G, Cauley JA, Luckey MM, El-Hajj Fuleihan G. Worldwide prevalence and incidence of osteoporotic vertebral fractures. Osteoporos Int. 2017;28:1531-42.
Kwok AW, Leung JC, Chan AY, Au BS, Lau EM, Yurianto H, et al. Prevalence of vertebral fracture in Asian men and women: comparison between Hong Kong, Thailand, Indonesia and Japan. Public Health. 2012; 126:523-31.
Utamakul C, Sritara C, Bhumiwat M, Bua-ngam C, Sriudomporn K, Promma S, et al. Unsuspected vertebral fracture in older women undergoing screening bone mineral density assessment: Prevalence, impact, and agreement with lateral spine radiography. Eur Geriatr Med. 2016;7:551-5.
Ho-Pham LT, Nguyen ND, Vu BQ, Pham HN, Nguyen TV. Prevalence and risk factors of radiographic vertebral fracture in postmenopausal Vietnamese women. Bone. 2009;45:213-7.
Jiang G, Eastell R, Barrington NA, Ferrar L. Comparison of methods for the visual identification of prevalent vertebral fracture in osteoporosis. Osteoporos Int. 2004;15:887-96.
Ferrar L, Jiang G, Adams J, Eastell R. Identification of vertebral fractures: an update. Osteoporos Int. 2005;16: 717-28.
Schousboe JT, Debold CR. Reliability and accuracy of vertebral fracture assessment with densitometry compared to radiography in clinical practice. Osteoporos Int. 2006;17:281-9.
Delmas PD, Genant HK, Crans GG, Stock JL, Wong M, Siris E, et al. Severity of prevalent vertebral fractures and the risk of subsequent vertebral and nonvertebral fractures: results from the MORE trial. Bone. 2003;33:522-32.
Kendler DL, Bauer DC, Davison KS, Dian L, Hanley DA, Harris ST, et al. Vertebral Fractures: Clinical Importance and Management. Am J Med. 2016;129:221.e1-10.
El Maghraoui A, Morjane F, Nouijai A, Achemlal L, Bezza A, Ghozlani I. Vertebral fracture assessment in Moroccan women: prevalence and risk factors. Maturitas. 2009;62:171-5.
El Maghraoui A, Mounach A, Rezqi A, Achemlal
L, Bezza A, Ghozlani I. Vertebral fracture assessment in asymptomatic men and its impact on management. Bone. 2012;50:853-7.
Schousboe JT, Vokes T, Broy SB, Ferrar L, McKiernan F, Roux C, et al. Vertebral Fracture Assessment: the 2007 ISCD Official Positions. J Clin Densitom. 2008;11:92-108.
Jitapunkul S, Thamarpirat J, Chaiwanichsiri D, Boonhong J. Incidence of vertebral fractures in Thai women and men: a prospective population-based study. Geriatr Gerontol Int. 2008;8:251-8.
O’Neill TW, Felsenberg D, Varlow J, Cooper C, Kanis JA, Silman AJ. The prevalence of vertebral deformity in european men and women: the European Vertebral Osteoporosis Study. J Bone Miner Res. 1996;11:1010-8.
Riggs BL, Wahner HW, Dunn WL, Mazess RB, Offord KP, Melton LJ, 3rd. Differential changes in bone mineral density of the appendicular and axial skeleton with aging: relationship to spinal osteoporosis. J Clin Invest. 1981;67:328-35.
Riggs BL, Wahner HW, Seeman E, Offord KP, Dunn WL, Mazess RB, et al. Changes in bone mineral density of the proximal femur and spine with aging. Differences between the postmenopausal and senile osteoporosis syndromes. J Clin Invest. 1982;70:716-23.
Angeli A, Guglielmi G, Dovio A, Capelli G, de Feo D, Giannini S, et al. High prevalence of asymptomatic vertebral fractures in post-menopausal women receiving chronic glucocorticoid therapy: a cross-sectional outpatient study. Bone. 2006;39: 253-9.
Mazzantini M, Di Munno O. Glucocorticoid-induced osteoporosis: 2013 update. Reumatismo. 2014;66:144-52.
Van Staa TP, Laan RF, Barton IP, Cohen S, Reid DM, Cooper C. Bone density threshold and other predictors of vertebral fracture in patients receiving oral glucocorticoid therapy. Arthritis Rheum. 2003;48:3224-9.
Nevitt MC, Cummings SR, Stone KL, Palermo L, Black DM, Bauer DC, et al. Risk factors for a first-incident radiographic vertebral fracture in women >or = 65 years of age: the study of osteoporotic fractures. J Bone Miner Res. 2005;20:131-40.
Curtis JR, Safford MM. Management of osteoporosis among the elderly with other chronic medical conditions. Drugs Aging. 2012;29:549-64.
