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Evaluation of vertebral fracture assessment by dual X-ray absorptiometry in a multicenter setting

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Abstract

Summary

The utility of vertebral fracture assessment (VFA) by DXA to detect prevalent vertebral fracture in a multicenter setting was investigated by comparison to conventional radiography. While limited by lower image quality, overall performance of VFA was good but had a tendency to miss mild prevalent fractures.

Introduction

In osteoporosis clinical trials standardized spine radiographs are used to detect vertebral fractures as a study endpoint. Lateral spine imaging with dual X-ray absorptiometry (DXA) scanners, known as vertebral fracture assessment (VFA) by DXA, presents a potential alternative to conventional radiography with lower radiation dose and greater patient convenience.

Methods

We investigated in a multicenter setting the ability of VFA to detect fractures in comparison with conventional radiography. The study examined 203 postmenopausal women who had imaging of the spine by DXA and radiography. Three radiologists experienced in vertebral fracture assessment independently read the VFA scans and radiographs using the Genant semiquantitative method on two occasions.

Conclusions

Analyzing the data from all readable vertebrae, the kappa statistic, sensitivity, and specificity ranged from 0.64–0.77, 0.65–0.84, and 0.97–0.98, respectively. Considering only moderate and severe fractures improved the kappa statistic (0.80–0.91) and sensitivity (0.70–0.86). While image quality of VFA is inferior to radiography, the detection of vertebral fractures using visual scoring is feasible. However, VFA underperformed due to unreadable vertebrae and reduced sensitivity for mild fractures. Nevertheless, VFA correctly identified most moderate and severe vertebral fractures. Despite this limitation, VFA by DXA provides an important tool for clinical research.

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References

  1. Rea JA, Chen MB, Li J et al (2000) Morphometric X-ray absorptiometry and morphometric radiography of the spine: a comparison of prevalent vertebral deformity identification. J Bone Miner Res 15:564–574

    Article  PubMed  CAS  Google Scholar 

  2. Steiger P, Cummings SR, Genant HK et al (1994) Morphometric X-ray absorptiometry of the spine: correlation in vivo with morphometric radiography. Study of Osteoporotic Fractures Research Group. Osteoporos Int 4:238–244

    Article  PubMed  CAS  Google Scholar 

  3. Chappard C, Kolta S, Fechtenbaum J et al (1998) Clinical evaluation of spine morphometric X-ray absorptiometry. Br J Rheumatol 37:496–501

    Article  PubMed  CAS  Google Scholar 

  4. Rea JA, Li J, Blake GM et al (2000) Visual assessment of vertebral deformity by X-ray absorptiometry: a highly predictive method to exclude vertebral deformity. Osteoporos Int 11:660–668

    Article  PubMed  CAS  Google Scholar 

  5. Ferrar L, Jiang G, Eastell R et al (2003) Visual identification of vertebral fractures in osteoporosis using morphometric X-ray absorptiometry. J Bone Miner Res 18:933–938

    Article  PubMed  CAS  Google Scholar 

  6. Ferrar L, Jiang G, Barrington NA et al (2000) Identification of vertebral deformities in women: comparison of radiological assessment and quantitative morphometry using morphometric radiography and morphometric X-ray absorptiometry. J Bone Miner Res 15:575–585

    Article  PubMed  CAS  Google Scholar 

  7. Pavlov L, Gamble GD, Reid IR (2005) Comparison of dual-energy X-ray absorptiometry and conventional radiography for the detection of vertebral fractures. J Clin Densitom 8:379–385

    Article  PubMed  Google Scholar 

  8. Rea JA, Chen MB, Li J et al (1999) Morphometric X-ray absorptiometry and morphometric radiography of the spine: a comparison of analysis precision in normal and osteoporotic subjects. Osteoporos Int 9:536–544

    PubMed  CAS  Google Scholar 

  9. Crabtree N, Wright J, Walgrove A et al (2000) Vertebral morphometry: repeat scan precision using the Lunar Expert-XL and the Hologic 4500A. A study for the ‘WISDOM’ RCT of hormone replacement therapy. Osteoporos Int 11:537–543

    Article  PubMed  CAS  Google Scholar 

  10. Ferrar L, Jiang G, Eastell R (2001) Short-term precision for morphometric X-ray absorptiometry. Osteoporos Int 12:710–715

    Article  PubMed  CAS  Google Scholar 

  11. Vokes TJ, Dixon LB, Favus MJ (2003) Clinical utility of dual-energy vertebral assessment (DVA). Osteoporos Int 14:871–878

    Article  PubMed  Google Scholar 

  12. Binkley N, Krueger D, Gangnon R et al (2005) Lateral vertebral assessment: a valuable technique to detect clinically significant vertebral fractures. Osteoporos Int 16:1513–1518

    Article  PubMed  Google Scholar 

  13. Chapurlat RD, Duboeuf F, Marion-Audibert HO et al (2006) Effectiveness of instant vertebral assessment to detect prevalent vertebral fracture. Osteoporos Int 17:1189–1195

    Article  PubMed  CAS  Google Scholar 

  14. Damiano J, Kolta S, Porcher R et al (2006) Diagnosis of vertebral fractures by vertebral fracture assessment. J Clin Densitom 9:66–71

    Article  PubMed  Google Scholar 

  15. Schousboe JT, Debold CR (2006) Reliability and accuracy of vertebral fracture assessment with densitometry compared to radiography in clinical practice. Osteoporos Int 17:281–289

    Article  PubMed  Google Scholar 

  16. Genant HK, Wu CY, van Kuijk C et al (1993) Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 8:1137–1148

    Article  PubMed  CAS  Google Scholar 

  17. Lang T, Takada M, Gee R et al (1997) A preliminary evaluation of the lunar expert-XL for bone densitometry and vertebral morphometry. J Bone Miner Res 12:136–143

    Article  PubMed  CAS  Google Scholar 

  18. Rea JA, Steiger P, Blake GM et al (1998) Optimizing data acquisition and analysis of morphometric X-ray absorptiometry. Osteoporos Int 8:177–183

    Article  PubMed  CAS  Google Scholar 

  19. Vallarta-Ast N, Krueger D, Binkley N (2006) Addition of right lateral decubitus positioning improves vertebral visualization with VFA in selected patients. J Clin Densitom 9:375–379

    Article  PubMed  Google Scholar 

  20. Delmas PD, Genant HK, Crans GG et al (2003) Severity of prevalent vertebral fractures and the risk of subsequent vertebral and nonvertebral fractures: results from the MORE trial. Bone 33:522–532

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

The authors wish to acknowledge Diane Krueger (University of Wisconsin–Madison) and the study nurses and technologists for assistance in data acquisition and preparation as well as the study participants who volunteered to participate in this research.

Funding

The collection and central review of radiographs and VFA scans was supported by Eli Lilly and Co.

Conflicts of interest

Doctors Fuerst, Wu, Genant, von Ingersleben, and Chen are employees and shareholders of Synarc, Inc. Dr. Mitlak is an employee and shareholder of Eli Lilly and Company. No other disclosures.

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Author notes

  1. G. Crans

    Present address: Elan Pharmaceuticals, Inc., South San Francisco, CA, USA

Authors and Affiliations

  1. Synarc, Inc., 575 Market Street, 17th Floor, San Francisco, CA, 94105, USA

    T. Fuerst, C. Wu, H. K. Genant, G. von Ingersleben & Y. Chen

  2. University of California, San Francisco, CA, USA

    H. K. Genant

  3. Indiana University School of Medicine, Indianapolis, IN, USA

    C. Johnston & M. J. Econs

  4. Osteoporosis Research, University of Wisconsin, Madison, WI, USA

    N. Binkley

  5. University of Chicago, Chicago, IL, USA

    T. J. Vokes

  6. Lilly Research Laboratories, Indianapolis, IN, USA

    G. Crans & B. H. Mitlak

Authors
  1. T. Fuerst
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  2. C. Wu
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  3. H. K. Genant
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  4. G. von Ingersleben
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  5. Y. Chen
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  6. C. Johnston
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  7. M. J. Econs
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  8. N. Binkley
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  9. T. J. Vokes
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  10. G. Crans
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  11. B. H. Mitlak
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Corresponding author

Correspondence to T. Fuerst.

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Fuerst, T., Wu, C., Genant, H.K. et al. Evaluation of vertebral fracture assessment by dual X-ray absorptiometry in a multicenter setting. Osteoporos Int 20, 1199–1205 (2009). https://doi.org/10.1007/s00198-008-0806-9

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  • DOI: https://doi.org/10.1007/s00198-008-0806-9

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