Instant vertebral assessment (IVA) in combination with bone densitometry (BDM): A new standard in the diagnosis of osteoporosis?

Abstract

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Objectives: Prevalent vertebral fractures constitute a significant risk factor for future fractures, which is independent of the bone density. New developments in DEXA machines allow visual and software-based detection of vertebral fractures. We aimed to determine the added value of IVA performed immediately after BDM. Methods: All patients referred to our university medical center department for BDM also underwent IVA om a Hologic Discovery A bone densitometer. Studies were analyzed by 3 experienced operators and physicians. The frequency of vertebral fractures was determined in the the entire cohort and in various subgroups. Referring physicians were asked for their opinion on the added value of IVA using a short questionaire. Results: 958 patients were included (64% females, 52% postmenopausal), 29% were assessed because of primary osteoporosis, 71% for secondary osteoporosis. 30% used corticosteroids. In 2% IVA was not possible due to extreme adipositas or deformities. In 71% T4 and in 86% T5 was the upper vertebral level that could be assessed. The main finding in this cohort was a prevalence of vertebral fractures of 26%. In 68% of these patients this fracture was unknown. We found a mean of 1.8 vertebral fractures per patient. Even after excluding mild fractures (=20-25% heightloss) still 17% of the patients had moderate (>25%) or severe (>40% heightloss) vertebral fractures. In the 27% with normal bone density the vertebral fracture prevalence was still 18%, in the 43% with ostopenia 23%, and in the 29% with osteoporisis 36%. In primary osteoporosis the vertebral fracture prevalence was 45%, in secondary osteoporosis 33%. Referring physicians reported that in 58% IVA results increased their understanding, and in 27% had an impact on treatment. Conclusions: IVA added to BMD is a very convenient and patient friendly diagnostic tool with a high diagnostic yield as the method detected vertebral fractures in 1 out of 4 patients. In 2/3 of these cases these fractures were unknown. In 18% of patients with normal bone density vertebral fractures were detected.