Vertebral morphometric X-ray absorptiometry in women with Colles' fracture

The Prevalence of Undetected Vertebral Fracture in Patients with Back Pain by Dual-Energy X-ray Absorptiometry (DXA) of the Lateral Thoracic and Lumbar Spine

STUDY DESIGN

This is a prospective study.

PURPOSE

This study is conducted to determine the prevalence of unrecognized vertebral fracture (VF) in patients who present with back pain.

OVERVIEW OF LITERATURE

VF is often unrecognized, and significantly increases the risk of further fractures. Unfortunately, the patients at a high risk for VF usually do not receive adequate therapy to reduce the fracture risk.

METHODS

This is a prospective study of 344 patients who presented with back pain from April 2008 to May 2009. The patients underwent dual-energy X-ray absorptiometry (DXA) evaluation and vertebral fracture assessment from T4 to L4 using a hologic densitometer.

RESULTS

Three hundred forty four of 386 patients who presented with back pain were included. Forty two patients were excluded because of a prior history of VF or the lack of written consent. Most of the patients were female (95.3%). The mean age of the patients was 58.21 ± 11.74 years. According to the World Health Organization definition (based on the T-score), 13.4% of the patients had normal lumbar spine bone mineral density (BMD). 27.9% of them were osteopenic and 58.7% were osteoporotic. The overall prevalence of VF, as established by lateral vertebral assessment, was 39% (n = 134). Moreover, 62.6% (n = 84) of the patients with VF had more than one fracture and 64.1% (n = 86) of them had Grade 2 or 3 fracture.

CONCLUSIONS

We recommend performing not only DXA scanning for BMD evaluation, but also VFA by DXA in old patients with back pain.

The prevalence of vertebral fracture amongst patients presenting with non-vertebral fractures

INTRODUCTION

Despite vertebral fracture being a significant risk factor for further fracture, vertebral fractures are often unrecognised. A study was therefore conducted to determine the proportion of patients presenting with a non-vertebral fracture who also have an unrecognised vertebral fracture.

METHODS

Prospective study of patients presenting with a non-vertebral fracture in South Glasgow who underwent DXA evaluation with vertebral morphometry (MXA) from DV5/6 to LV4/5. Vertebral deformities (consistent with fracture) were identified by direct visualisation using the Genant semi-quantitative grading scale.

RESULTS

Data were available for 337 patients presenting with low trauma non-vertebral fracture; 261 were female. Of all patients, 10.4% were aged 50-64 years, 53.2% were aged 65-74 years and 36.2% were aged 75 years or over. According to WHO definitions, 35.0% of patients had normal lumbar spine BMD (T-score -1 or above), 37.4% were osteopenic (T-score -1.1 to -2.4) and 27.6% osteoporotic (T-score -2.5 or lower). Humerus (n=103, 31%), radius-ulna (n=90, 27%) and hand/foot (n=53, 16%) were the most common fractures. For 72% of patients (n=241) the presenting fracture was the first low trauma fracture to come to clinical attention. The overall prevalence of vertebral deformity established by MXA was 25% (n=83); 45% (n=37) of patients with vertebral deformity had deformities of more than one vertebra. Of the patients with vertebral deformity and readable scans for grading, 72.5% (58/80) had deformities of grade 2 or 3. Patients presenting with hip fracture, or spine T-score

CONCLUSIONS

Our results support the recommendation to perform vertebral morphometry in patients who are referred for DXA after experiencing a non-vertebral fracture. Treatment decisions will then better reflect any given patient's future absolute fracture risk. The 'Number Needed to Screen' if vertebral morphometry is used in this way would be seven to identify one patient with vertebral deformity, and 14 to identify one patient with two or more vertebral deformities. Although carrying out MXA will increase radiation exposure for the patient, this increased exposure is significantly less than would be obtained if X-rays of the dorso-lumbar spine were obtained.

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Key Words

• low trauma fracture
• number needed to screen
• osteoporosis
• vertebral fracture
• vertebral morphometry

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MESH Headings

• Absorptiometry, Photon/methods
• Age Factors
• Aged
• Body Mass Index
• Female
• Fractures, Bone/diagnosis
• Fractures, Bone/epidemiology
• Humans
• Lumbar Vertebrae/abnormalities
• Lumbar Vertebrae/injuries
• Male
• Middle Aged
• Osteoporosis/diagnosis
• Osteoporosis/epidemiology
• Prevalence
• Prospective Studies
• Recurrence
• Risk Factors
• Scotland/epidemiology
• Spinal Fractures/diagnosis
• Spinal Fractures/epidemiology
• Thoracic Vertebrae/abnormalities
• Thoracic Vertebrae/injuries

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Affiliation(s)

S J Gallacher Medical Unit, Southern General Hospital, 1345 Govan Road, Glasgow, G51 4TF, UK.
A P Gallagher
C McQuillian
P J Mitchell
T Dixon

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