Vertebral fracture assessment in asymptomatic men and its impact on management

IntroductionRecognition of vertebral fractures (VFs) change the patient's diagnostic classification, estimation of fracture risk, and threshold for pharmacological intervention. Vertebral fracture assessment (VFA) enables the detection of VFs in the same session as bone mineral density (BMD) testing.ObjectiveTo study prevalence and risk factors of VFs using VFA in asymptomatic men and measure its impact on patients' management.MethodsWe enrolled791 men aged between 45 and 89 (mean age, weight and BMI of 62.4 ± 8.6) (45 to 89) years, 74.9 ± 12.7 (40 to 163) and 26.3 ± 4.0 (16.6 to 43.8) kg/m2, respectively. Lateral VFA images and scans of the lumbar spine and proximal femur were obtained using a GE Healthcare Lunar Prodigy densitometer. VFs were defined using a combination of Genant semiquantitative (SQ) approach and morphometry.ResultsVFs were identified in 318 (40.3%): 206 (26.0%) had grade 1 and 112 (14.2%) had grade 2 or 3. As would be expected, the prevalence of VFA-detected fractures globally increased significantly with age and as BMI and BMD declined. A fracture was identified on VFA in 85 (32.4%) of men with normal BMD (6.9% had grade 2/3 VFs) and in 144 (35.8%) with osteopenia (11.7% had grade 2/3 VFs). Stepwise regression analysis showed that presence of VFs was independently related to the osteoporotic status (OR = 4.761, 95%CI [2.956–7.668]; p < 0.0001) and current smoking (OR = 1.717, 95%CI [1.268–2.323]; p = 0.002).ConclusionOur results support the recommendation to enlarge the indications of VFA to all the men referred for DXA measurement.

► VFs recognition change the fracture risk estimation and threshold for treatment.
► Using VFA in 791 men, we found VFs in 40% (13% had moderate/severe VFs).
► VFA should be indicated to all the men needing DXA measurement.