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Zanardo M, Mennini C, Glielmo P, Fusco S, Albano D, Messina C. Dual Energy X-ray Absorptiometry: Radiographer'S Role in Assessing Fracture Risk Assessment Tool (FRAX) Questionnaire Variables. J Clin Densitom 2024; 27:101458. [PMID: 38141277 DOI: 10.1016/j.jocd.2023.101458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/29/2023] [Accepted: 11/29/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND The FRAX® algorithm is a tool used to calculate the 10-year probability of fracture in patients with osteoporosis and is based the assessment of several risk factors. We assessed the performance and accuracy of the completion of the FRAX® anamnestic questionnaire by the radiographer without impact on the clinical workflow. METHODOLOGY We evaluated the accuracy of fracture risk calculation by the radiographer using the FRAX® algorithm before and after specific training. A total of 100 women were enrolled in the study. The radiographer preliminarily administered the FRAX® questionnaire to all subjects before the execution of the DXA examination. After the end of the examination, a radiologist administered the questionnaire to the patient. Women were divided into two groups: group A (pre-training) and group B (post-training). The radiographer in group A completed the FRAX® questionnaire for the patients before training. For group B, the same radiographer completed the FRAX® questionnaire after training. The results of the FRAX® questionnaire completed by radiographer were compared with that completed by the referring physician. RESULTS Before training, radiographer's accuracy ranged from 92% (question 7, alcohol consumption) to 36% (question 6, secondary osteoporosis). After training, accuracy values improved substantially, ranging from 100% to 92%. Analysis of the absolute values of FRAX® showed that in the pre-training group data tended to be overestimated by the radiographer, with both major and fractures probabilities being significantly higher when assessed by the radiographer (12% and 5.8%, respectively). After the training, there was a marked decrease in the variation between the FRAX® data calculated by the radiographer and the radiologist. CONCLUSIONS The accuracy of fracture risk calculation by the radiographer using the FRAX® algorithm is significantly improved after a specific training period. This study demonstrates the importance of dedicated training radiographers on the FRAX® algorithm.
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Affiliation(s)
- Moreno Zanardo
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Cinzia Mennini
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, Milan, Italy
| | - Pierluigi Glielmo
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, Milan, Italy
| | - Stefano Fusco
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
| | - Domenico Albano
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, Milan, Italy; Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Università degli Studi di Milano, Milan, Italy
| | - Carmelo Messina
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, Milan, Italy; Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy.
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Sawicki P, Tałałaj M, Życińska K, Zgliczyński WS, Wierzba W. Current Applications and Selected Technical Details of Dual-Energy X-Ray Absorptiometry. Med Sci Monit 2021; 27:e930839. [PMID: 34131097 PMCID: PMC8216008 DOI: 10.12659/msm.930839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The application of dual-energy X-ray absorptiometry (DXA) examinations in the assessment of bone mineral density (BMD) in the lumbar spine, hip, and forearm is the basic diagnostic method for recognition of osteoporosis. The constant development of DXA technique is due to the aging of societies and the increasing importance of osteoporosis as a public health problem. In order to assess the degree of bone demineralization in patients with hyperparathyroidism, forearm DXA examination is recommended. The vertebral fracture assessment (VFA) of the thoracic and lumbar spine, performed by a highly-skilled technician, is an interesting alternative to the X-ray examination. The DXA total body examination can be useful in the evaluation of fat redistribution among patients after bariatric surgery, in patients infected with HIV and receiving antiretroviral therapy, and in patients with metabolic diseases and suspected to have sarcopenia. The assessment of visceral adipose tissue (VAT) and detection of abdominal aortic calcifications may be useful in the prediction of cardiovascular events. The positive effect of anti-resorptive therapy may affect some parameters of DXA hip structure analysis (HSA). Long-term anti-resorptive therapy, especially with the use of bisphosphonates, may result in changes in the DXA image, which may herald atypical femur fractures (AFF). Reduction of the periprosthetic BMD in the DXA measurements can be used to estimate the likelihood of loosening the prosthesis and periprosthetic fractures. The present review aims to present current applications and selected technical details of DXA.
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Affiliation(s)
- Piotr Sawicki
- Department of Rheumatology, Systemic Connective Tissue Diseases and Rare Diseases, Central Clinical Hospital MSWiA in Warsaw, Warsaw, Poland
| | - Marek Tałałaj
- Department of Geriatrics, Internal Medicine and Metabolic Bone Diseases, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Katarzyna Życińska
- Department of Rheumatology, Systemic Connective Tissue Diseases and Rare Diseases, Central Clinical Hospital MSWiA in Warsaw, Warsaw, Poland.,Department of Family Medicine, Medical University of Warsaw, Warsaw, Poland
| | | | - Waldemar Wierzba
- Central Clinical Hospital MSWiA in Warsaw, Warsaw, Poland.,UHE Satellite Campus in Warsaw, University of Humanities and Economics in Łódź, Warsaw, Poland
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Musa Aguiar P, Zarantonello P, Aparisi Gómez MP. Differentiation Between Osteoporotic And Neoplastic Vertebral Fractures: State Of The Art And Future Perspectives. Curr Med Imaging 2021; 18:187-207. [PMID: 33845727 DOI: 10.2174/1573405617666210412142758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 11/22/2022]
Abstract
Vertebral fractures are a common condition, occurring in the context of osteoporosis and malignancy. These entities affect a group of patients in the same age range; clinical features may be indistinct and symptoms non-existing, and thus present challenges to diagnosis. In this article, we review the use and accuracy of different imaging modalities available to characterize vertebral fracture etiology, from well-established classical techniques, to the role of new and advanced imaging techniques, and the prospective use of artificial intelligence. We also address the role of imaging on treatment. In the context of osteoporosis, the importance of opportunistic diagnosis is highlighted. In the near future, the use of automated computer-aided diagnostic algorithms applied to different imaging techniques may be really useful to aid on diagnosis.
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Affiliation(s)
- Paula Musa Aguiar
- Serdil, Clinica de Radiologia e Diagnóstico por Imagem; R. São Luís, 96 - Santana, Porto Alegre - RS, 90620-170. Brazil
| | - Paola Zarantonello
- Department of paediatric orthopedics and traumatology, IRCCS Istituto Ortopedico Rizzoli; Via G. C. Pupilli 1, 40136 Bologna. Italy
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Schousboe JT. Vertebral Fracture Identification as Part of a Comprehensive Risk Assessment in Patients with Osteoporosis. Curr Osteoporos Rep 2018; 16:573-583. [PMID: 30116975 DOI: 10.1007/s11914-018-0472-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE OF REVIEW To review current evidence regarding the vertebral fracture prevalence, the accuracy of vertebral fracture identification on current imaging technologies, and the potential impact of vertebral fracture identification on fracture risk. RECENT FINDINGS Important new studies have clarified the features of prevalent vertebral fracture that most strongly predict incident fractures. Age- and sex-stratified estimates of vertebral fracture prevalence on densitometric lateral spine images in the US population are now available. The accuracy of densitometric vertebral fracture assessment, how computed tomography scans and other spinal images obtained for indications other than vertebral fracture assessment can be leveraged to detect prevalent vertebral fractures, and the potential impact of vertebral fracture assessment on patient and provider fracture risk management behavior have been clarified. Substantial progress has been made regarding screening strategies using lateral spine imaging to detect prevalent vertebral fracture in the older population. Further research regarding implementation of these strategies in clinical practice and their impact on clinical outcomes is needed.
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Affiliation(s)
- John T Schousboe
- Park Nicollet Osteoporosis Center, HealthPartners Inc., Bloomington, MN, USA.
- HealthPartners Institute, Minneapolis, MN, USA.
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA.
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Malgo F, Hamdy NAT, Ticheler CHJM, Smit F, Kroon HM, Rabelink TJ, Dekkers OM, Appelman-Dijkstra NM. Value and potential limitations of vertebral fracture assessment (VFA) compared to conventional spine radiography: experience from a fracture liaison service (FLS) and a meta-analysis. Osteoporos Int 2017; 28:2955-2965. [PMID: 28842721 PMCID: PMC5624976 DOI: 10.1007/s00198-017-4137-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Accepted: 06/21/2017] [Indexed: 01/07/2023]
Abstract
UNLABELLED We evaluated the value of VFA in the identification of vertebral fractures using a retrospective study and a meta-analysis. Performance of VFA was adequate in the meta-analysis although this was not demonstrated in our centre. We recommend checking the performance of VFA tools before exclusively relying on this tool. INTRODUCTION Vertebral fractures are traditionally diagnosed using conventional radiographs of the spine. Vertebral fracture assessment (VFA) has been advocated as an alternative tool in the diagnosis of these fractures. METHODS We conducted a retrospective study as well as a systematic review and a meta-analysis to evaluate the performance of VFA compared to conventional spinal radiography in patients who had sustained a fracture and thus at risk for osteoporosis. A risk of bias analysis was also performed. RESULTS The diagnostic study included 542 patients (25% male) with fractures. The sensitivity of low-radiation VFA to detect a patient with a vertebral fracture ≥ Genant grade 2 was 0.77 and its specificity 0.80. Two hundred ninety-seven (55%) patients had ≥1 and 135(25%) ≥3 unevaluable vertebrae. The systematic review identified 16 studies including a total of 3238 subjects (19% male) with a mean age range of 45 to 74 years. Seven studies had a low risk of bias and 9 had an intermediate risk, mainly due to not consecutively including patients. The pooled sensitivity of VFA to detect a patient with a vertebral fracture ≥Genant grade 2 was 0.84 (95% CI, 0.72-0.92) and specificity 0.90 (95% CI, 0.84-0.94). CONCLUSIONS Our findings from the meta-analysis suggest an adequate performance of VFA for the detection of vertebral fractures. However, we could not demonstrate these findings in our center, especially the specificity. Our data advocate caution with exclusively relying on VFA in the assessment of vertebral fractures without identifying performance and potential limitations of the technique.
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Affiliation(s)
- F Malgo
- Department of Medicine, Division Endocrinology and Center for Bone Quality, C7-Q, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - N A T Hamdy
- Department of Medicine, Division Endocrinology and Center for Bone Quality, C7-Q, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - C H J M Ticheler
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - F Smit
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - H M Kroon
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - T J Rabelink
- Department of Medicine, Division Endocrinology and Center for Bone Quality, C7-Q, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - O M Dekkers
- Department of Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - N M Appelman-Dijkstra
- Department of Medicine, Division Endocrinology and Center for Bone Quality, C7-Q, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
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Hind K, Pearce M, Birrell F. Total and Visceral Adiposity Are Associated With Prevalent Vertebral Fracture in Women but Not Men at Age 62 Years: The Newcastle Thousand Families Study. J Bone Miner Res 2017; 32:1109-1115. [PMID: 28261864 DOI: 10.1002/jbmr.3085] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 01/17/2017] [Accepted: 01/19/2017] [Indexed: 12/11/2022]
Abstract
Low body weight is an established risk factor for osteoporosis and fracture, but the skeletal risks of higher adiposity are unclear and appear sex-specific and site-dependent. The aim of this study was to investigate associations of total fat mass (TFM), visceral adipose tissue (VAT), and C-reactive protein (CRP) with bone mineral density (BMD) and prevalent vertebral fracture (VF) in men and women aged 62 years. A total of 352 men and women aged 62.5 ± 0.5 years from the Newcastle Thousand Families Study cohort received dual-energy X-ray absorptiometry (DXA) evaluations of femoral neck and lumbar spine BMD, of the lateral spine for vertebral fracture assessment, and of the whole body for TFM and VAT (GE Lunar CoreScan, Madison, WI, USA). Plasma CRP, FRAX scores, falls in the last 12 months, and occupation at age 50 years were also included in the analysis. Vertebral fractures were less prevalent in women than in men (odds ratio [OR] = 0.33, p < 0.001) and BMD or FRAX scores did not differ between participants with and without VF. Women with VF were heavier and had higher TFM, VAT, and CRP than women without (p < 0.001). In women, greater (+1 SD) TFM and VAT increased the odds of any grade VF (TFM: OR = 1.06, p = 0.001; VAT: OR = 2.50, p = 0.002), and greater VAT mass increased the odds of prevalent mild VF (OR = 2.60, p = 0.002). In contrast, there were no associations in men. In both sexes, after controlling for body weight, neither VAT nor CRP were associated with BMD. In conclusion, irrespective of BMD, total and visceral adiposity were associated with prevalent VF in women but not in men. High fat mass, particularly if visceral, should be considered when assessing VF risk in women. Risk factors for VF in men require further investigation, particularly given their high prevalence. © 2017 American Society for Bone and Mineral Research.
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Affiliation(s)
- Karen Hind
- Carnegie Research Institute, Leeds Beckett University, Leeds, UK.,Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Mark Pearce
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Fraser Birrell
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
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Fechtenbaum J, Kolta S, Briot K, Roux C. Vertebral fracture assessment by dual X-ray absorptiometry. Osteoporos Int 2017; 28:1153-1154. [PMID: 27957588 DOI: 10.1007/s00198-016-3854-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 11/22/2016] [Indexed: 10/20/2022]
Affiliation(s)
- J Fechtenbaum
- Department of rheumatology, Cochin hospital, Paris, France.
| | - S Kolta
- Department of rheumatology, Cochin hospital, Paris, France
- Epidemiology and Biostatistics Sorbonne Paris Cité Research Center, INSERM U1153, Paris, France
| | - K Briot
- Department of rheumatology, Cochin hospital, Paris, France
- Epidemiology and Biostatistics Sorbonne Paris Cité Research Center, INSERM U1153, Paris, France
| | - C Roux
- Department of rheumatology, Cochin hospital, Paris, France
- Epidemiology and Biostatistics Sorbonne Paris Cité Research Center, INSERM U1153, Paris, France
- Paris Descartes University, Paris, France
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Rud B, Hyldstrup L. Vertebral fracture assessment by dual X-ray absorptiometry: reply to comments by Fechtenbaum et al. Osteoporos Int 2017; 28:1155. [PMID: 27957587 DOI: 10.1007/s00198-016-3856-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 11/22/2016] [Indexed: 10/20/2022]
Affiliation(s)
- B Rud
- The Osteoporosis Unit, Department of Endocrinology, Hvidovre University Hospital, Copenhagen, Denmark.
| | - L Hyldstrup
- The Osteoporosis Unit, Department of Endocrinology, Hvidovre University Hospital, Copenhagen, Denmark
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Deleskog L, Laursen NØ, Nielsen BR, Schwarz P. Vertebral fracture assessment by DXA is inferior to X-ray in clinical severe osteoporosis. Osteoporos Int 2016; 27:2317-2326. [PMID: 26892040 DOI: 10.1007/s00198-016-3532-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 02/08/2016] [Indexed: 10/22/2022]
Abstract
UNLABELLED Spine fractures are diagnosed by X-ray or vertebral fracture assessment (VFA) by dual-energy X-ray absorptiometry (DXA) scanning. The use of VFA evaluation by DXA is still debated. We demonstrate that VFA is inferior relative to X-ray in visualizing vertebrae properly in the upper spine and therefore with a reduced diagnostic performance in detecting fractures. INTRODUCTION Vertebral fracture assessment (VFA) by DXA has been evaluated for many years, and its use in clinical practice is still debated. In a cross-sectional setting, we aimed to compare VFA with traditional radiography in vertebral fracture (VF) diagnosis in severe osteoporotic patient. METHODS A total of 207 patients referred to the outpatient clinic for teriparatide treatment were screened, out of whom 35 (16.9 %) severe osteoporotic patients were identified (mean age 67.5 ± 11.3 years and median T-score -3.2 interquartile range (IQR) (-1.9 to -3.7). VF diagnosis was performed independently using VFA and X-ray in accordance with the semiquantitative (SQ) approach. The same technician performed the primary interpretation on both sets of images, after which a radiologist and an endocrinologist reviewed the evaluation for a conclusive judgement. RESULTS In total, 180 radiographic fractures were detected, corresponding to 5.1 fractures per individual. Using VFA, 18.5 % of vertebrae were considered unreadable, compared to 2.0 % on X-ray. The accuracy of VFA in VF detection using X-ray as a reference resulted in sensitivity and specificity of 75.5 and 86.7 %, respectively. Sensitivity decreased from the lumbar to thoracic level. Nevertheless, VFA only identified fractures consistently between Th11 and L3. CONCLUSION Our data, based on a severe osteoporotic population, demonstrate that VFA is inferior relative to X-ray in visualizing vertebrae properly in the upper spine, resulting in vertebrae not being assessable for analysis and a reduced diagnostic performance in detecting fractures. Improvements in DXA techniques are needed for it to be comparable with X-ray in VF diagnosis.
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Affiliation(s)
- L Deleskog
- Research Centre of Ageing and Osteoporosis, Department of Endocrinology PE, Rigshospitalet, Copenhagen, Denmark
| | - N Ø Laursen
- Department of Radiology, Frederiksberg University Hospital, Copenhagen, Denmark
| | - B R Nielsen
- Research Centre of Ageing and Osteoporosis, Department of Endocrinology PE, Rigshospitalet, Copenhagen, Denmark
| | - P Schwarz
- Research Centre of Ageing and Osteoporosis, Department of Endocrinology PE, Rigshospitalet, Copenhagen, Denmark.
- Faculty of Health Sciences, Copenhagen University, Copenhagen, Denmark.
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