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J Bone Miner Res. 2018 Nov 5. doi: 10.1002/jbmr.3595. [Epub ahead of print]

Adding Lateral Spine Imaging for Vertebral Fractures to Densitometric Screening: Improving Ascertainment of Patients at High Risk of Incident Osteoporotic Fractures.

Author information

1
Medical School, University of Western Australia, Perth, Australia.
2
Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, Australia.
3
Centre for Kidney Research, Children's Hospital at Westmead, School of Public Health, Sydney Medical School, The University of Sydney, Sydney, Australia.
4
School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia.
5
Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia.
6
Skeletal Health, Hologic, Inc., Marlborough, MA, USA.
7
Medical Technology and Physics, Sir Charles Gairdner Hospital, Perth, Australia.
8
Institute for Aging Research, Hebrew Senior Life, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
9
Park Nicollet Osteoporosis Center and HealthPartners Institute, and Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA.

Abstract

The current diagnosis of osteoporosis is limited to a T-score ≤-2.5. However, asymptomatic vertebral fractures (VF) are known to predict a high risk of subsequent fractures and pharmaceutical intervention is known to reduce future fracture risk in these individuals. In a prospective, population-based cohort of ambulant older women, we sought to evaluate the role of VF detection by screening densitometric lateral spine imaging (LSI) for VF at time of bone density testing to the effect on the magnitude of fracture risk. A total of 1084 women (mean age 75 years ± SD 3 years) had baseline LSI that identified 100 (9%) women with VFs and 89 (8%) with femoral neck (FN) T-score osteoporosis ≤-2.5. Follow-up identified incident clinical spine fracture in 73 (7%), 305 (28%) with any fracture-related hospitalization, and 121 (11%) with a hip fracture-related hospitalization. Compared with those without baseline VF, in those with baseline VF, relative risk (RR) for incident clinical spine, hip, and any fracture were 3.46 (95% confidence interval [CI] 2.14-5.60, p < 0.001); 1.72 (95% CI 1.09-2.71, p = 0.02), and 1.4 (95% CI 1.07-1.84, p = 0.02), respectively. In 675 (62%) of women with femoral neck osteopenia (T-score <-1 to >-2.5), 61 (9%) also had a VF. Compared with those without baseline VF, RR for any incident fragility fractures and fractures at spine and hip in those with baseline VF were 1.6 (95% CI 1.2-2.1, p < 0.01), 3.9 (95% CI 2.2-6.9, p < 0.01), and 1.6 (95% CI 0.9-2.8, p = 0.10), respectively. On basis of the prognosis, older women with LSI VF with osteopenia should be diagnosed with osteoporosis and should be considered for pharmaceutical intervention.

KEYWORDS:

DXA; FRACTURE IDENTIFICATION; LATERAL SPINE IMAGING; VERTEBRAL FRACTURE ASSESSMENT; aBMD

PMID:
30395687
DOI:
10.1002/jbmr.3595

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