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Vertebral fracture: epidemiology, impact and use of DXA vertebral fracture assessment in fracture liaison services

Vertebral fracture: epidemiology, impact and use of DXA vertebral fracture assessment in fracture liaison services
Vertebral fracture: epidemiology, impact and use of DXA vertebral fracture assessment in fracture liaison services
Vertebral fractures are independent risk factors for vertebral and nonvertebral fractures. Since vertebral fractures are often missed, the relatively new introduction of vertebral fracture assessment (VFA) for imaging of the lateral spine during DXA-measurement of the spine and hips may contribute to detect vertebral fractures. We advocate performing a VFA in all patients with a recent fracture visiting a fracture liaison service (FLS). Fracture liaison services (FLS) are important service models for delivering secondary fracture prevention for older adults presenting with a fragility fracture. While commonly age, clinical risk factors (including fracture site and number of prior fracture) and BMD play a crucial role in determining fracture risk and indications for treatment with antiosteoporosis medications, prevalent vertebral fractures usually remain undetected. However, vertebral fractures are important independent risk factors for future vertebral and nonvertebral fractures. A development of the DXA technology, vertebral fracture assessment (VFA), allows for assessment of the lateral spine during the regular DXA bone mineral density measurement of the lumbar spine and hips. Recent approaches to the stratification of antiosteoporosis medication type according to baseline fracture risk, and differences by age in the indication for treatment by prior fracture mean that additional information from VFA may influence initiation and type of treatment. Furthermore, knowledge of baseline vertebral fractures allows reliable definition of incident vertebral fracture events during treatment, which may modify the approach to therapy. In this manuscript, we will discuss the epidemiology and clinical significance of vertebral fractures, the different methods of detecting vertebral fractures, and the rationale for, and implications of, use of VFA routinely in FLS.
Bone mineral density (BMD), Fracture liaison service (FLS), Osteoporosis, Vertebral fracture, Vertebral fracture assessment (VFA), epidemiology
/10.1007/s00198-020-05804-3
0937-941X
Lems, W.F.
53426263-c1f1-45d1-b1a0-6bcc8b2677a0
Paccou, J.
f1116333-b90a-4e81-9b23-389d7a4d6d96
Zhang, Jean
437abe90-46ac-46de-8183-042c36ed3398
Fuggle, Nicholas
9ab0c81a-ac67-41c4-8860-23e0fdb1a900
Manju Chandran, Manju
0906289a-b6cb-47ea-836e-5bb8ec4bd7db
Harvey, Nicholas
ce487fb4-d360-4aac-9d17-9466d6cba145
Cooper, Cyrus
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Kassim Javaid, M.
12781b29-34fa-4158-837b-daf452b8d4ed
Ferrari, S.
6746194f-54f1-4c75-bcec-a7fcf2bc0c8b
Akesson, Kristina E.
467438a5-e6ef-4046-8c1b-8fc102a50579
International Osteoporosis Foundation Fracture Working Group
Lems, W.F.
53426263-c1f1-45d1-b1a0-6bcc8b2677a0
Paccou, J.
f1116333-b90a-4e81-9b23-389d7a4d6d96
Zhang, Jean
437abe90-46ac-46de-8183-042c36ed3398
Fuggle, Nicholas
9ab0c81a-ac67-41c4-8860-23e0fdb1a900
Manju Chandran, Manju
0906289a-b6cb-47ea-836e-5bb8ec4bd7db
Harvey, Nicholas
ce487fb4-d360-4aac-9d17-9466d6cba145
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
Kassim Javaid, M.
12781b29-34fa-4158-837b-daf452b8d4ed
Ferrari, S.
6746194f-54f1-4c75-bcec-a7fcf2bc0c8b
Akesson, Kristina E.
467438a5-e6ef-4046-8c1b-8fc102a50579

International Osteoporosis Foundation Fracture Working Group (2021) Vertebral fracture: epidemiology, impact and use of DXA vertebral fracture assessment in fracture liaison services. Osteoporosis International. (/10.1007/s00198-020-05804-3).

Record type: Article

Abstract

Vertebral fractures are independent risk factors for vertebral and nonvertebral fractures. Since vertebral fractures are often missed, the relatively new introduction of vertebral fracture assessment (VFA) for imaging of the lateral spine during DXA-measurement of the spine and hips may contribute to detect vertebral fractures. We advocate performing a VFA in all patients with a recent fracture visiting a fracture liaison service (FLS). Fracture liaison services (FLS) are important service models for delivering secondary fracture prevention for older adults presenting with a fragility fracture. While commonly age, clinical risk factors (including fracture site and number of prior fracture) and BMD play a crucial role in determining fracture risk and indications for treatment with antiosteoporosis medications, prevalent vertebral fractures usually remain undetected. However, vertebral fractures are important independent risk factors for future vertebral and nonvertebral fractures. A development of the DXA technology, vertebral fracture assessment (VFA), allows for assessment of the lateral spine during the regular DXA bone mineral density measurement of the lumbar spine and hips. Recent approaches to the stratification of antiosteoporosis medication type according to baseline fracture risk, and differences by age in the indication for treatment by prior fracture mean that additional information from VFA may influence initiation and type of treatment. Furthermore, knowledge of baseline vertebral fractures allows reliable definition of incident vertebral fracture events during treatment, which may modify the approach to therapy. In this manuscript, we will discuss the epidemiology and clinical significance of vertebral fractures, the different methods of detecting vertebral fractures, and the rationale for, and implications of, use of VFA routinely in FLS.

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Accepted/In Press date: 16 December 2020
e-pub ahead of print date: 21 January 2021
Keywords: Bone mineral density (BMD), Fracture liaison service (FLS), Osteoporosis, Vertebral fracture, Vertebral fracture assessment (VFA), epidemiology

Identifiers

Local EPrints ID: 446486
URI: http://eprints.soton.ac.uk/id/eprint/446486
DOI: /10.1007/s00198-020-05804-3
ISSN: 0937-941X
PURE UUID: aa594874-1330-4595-a69e-e0ce0602cf15
ORCID for Nicholas Harvey: ORCID iD orcid.org/0000-0002-8194-2512
ORCID for Cyrus Cooper: ORCID iD orcid.org/0000-0003-3510-0709

Catalogue record

Date deposited: 11 Feb 2021 17:33
Last modified: 18 Feb 2021 17:02

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Contributors

Author: W.F. Lems
Author: J. Paccou
Author: Jean Zhang
Author: Nicholas Fuggle
Author: Manju Manju Chandran
Author: Nicholas Harvey ORCID iD
Author: Cyrus Cooper ORCID iD
Author: M. Kassim Javaid
Author: S. Ferrari
Author: Kristina E. Akesson
Corporate Author: International Osteoporosis Foundation Fracture Working Group

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